IPN 2021 September

September 2021 Volume 13  Issue 9 PHARMACYNEWSIRELAND.COM

THE INDEPENDENT VOICE OF PHARMACY

In this issue: FOR HEALTHCARE PROFESSIONAL USE ONLY

WHY MEDICATE? TRY NUTRITION FIRST 1

NEWS: Pharmacy Vaccination Issues Page 7

REPORT: Pharmaceutical Society on Operational Standards Page 12

AWARDS: The People’s Pharmacist 2021; Search Begins Page 18

FEATURE: Emergency Contraception Education Page 26

For more information, call freephone 1800 923 404 or visit www.nutricia.ie Available to order from United Drug and Uniphar Reference: 1. Rosen R et al. J. Pediatr. Gastroenterol. Nutr. 2018; 66(3): 516-554.

IMPORTANT NOTICE: Breastfeeding is best. Aptamil Anti-Reflux is a food for special medical purposes for the dietary management of frequent reflux and regurgitation and must only be used under medical supervision.

Date of preparation: February 2021 Nutricia Ireland, Deansgrange, Co. Dublin

This Publication is for Healthcare Professionals Only

CPD: Atopic Eczema Page 49

CORPORATE PROFILE: Family Heritage more than Skin Deep Page 54

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Contents

Foreword

Page 6: McCauley Pharmacy partners with JAM Card

In lead news this issue, we cover the announcement that McKesson Corp has agreed to sell its Irish business to the Phoenix Pharmacy Group, owned by Germany’s billionaire Merckle family.

The sale includes United Drug Wholesale and their chain of LloydsPharmacy stores.

Page 7: Recalls made at Pharmacy level Page 8: United Drug Wholesale and LloydsPharmacy announce Sale

As yet, terms haven’t been disclosed. The sale includes the businesses in France, Italy, Ireland, Portugal, Belgium and Slovenia. It also includes the company’s German headquarters and wound-care business, and a stake in a joint venture in the Netherlands.

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Page 11: O’Sullivan’s open Bandon’s only Late Night Pharmacy

McKesson will retain its remaining European divisions in the U.K., Norway, Austria and Denmark for now, but said it “is committed to exploring strategic alternatives for all remaining European businesses and focusing future investments on growth strategies outside of Europe.”

Turn to page 8 for the full story.

Page 14: Need for Action on Self-Care

In other news, on page 12 the Pharmaceutical Society of Ireland discusses its first overview report on the implementation of the Covid-19 Operational Standards for Pharmacies, which were introduced last year on a “use and learn” basis.

Page 16: Pharmacy vulnerable to crime during lockdown

“We are encouraged by the positive response of community pharmacies to the Standards. Their introduction has helped align pharmacy regulation in Ireland with how healthcare settings,” says Niall Byrne, Registrar and Chief Officer of the PSI.

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Page 44: The Global Battle against Hepatitis C Page 62: Corporate Profile with Karen McWilliam PUBLISHER: IPN Communications Ireland Ltd. Clifton House, Fitzwilliam Street Lower, Dublin 2 00353 (01) 6690562

The team at IPN are very excited to launch the search for the 2021 People’s Pharmacist in this issue (page 18). As has been heavily documented, not just in our publication but across the national press; whilst Ireland went into lockdown, with hospitals over-stretched and GP surgeries closing, community pharmacy kept their doors firmly open.

The People’s Pharmacist Award seeks to recognise and reward this dedication and allows the public to demonstrates to everyone just how much their local pharmacy means to them.

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The People’s Pharmacist is unique in that it allows members of the public to nominate, and vote for, their community pharmacy hero.

Previous winners of this Award have included Kilian McGreal, Audrey Kingston, Ger Browne and James O’Sullivan.

MANAGING DIRECTOR Natalie Maginnis n-maginnis@btconnect.com

The Award truly showcases how pharmacists connect with and build relationships within their local community through the treatment and experiences of patients.

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

One of our clinically contributed features this issue covers education on emergency contraception by Grace O’Shea of Sexual Health West. This is supported by the news, on page 30 that pharmacists are calling for women to be allowed access to contraception directly from pharmacies, without prescription and free of charge.

ADVERTISING EXECUTIVE Amy Evans: amy@ipn.ie EDITORIAL/ EVENTS & MARKETING EXECUTIVE Aoife Jackson: aoife@ipn.ie CONTINUED PROFESSIONAL LEAD Sibongile Swan Mude swan@ipn.ie CONTRIBUTORS

Dr John Ashworth | Grace O’Shea Hazel Breen | Dr Shandeep Momi Gillian Hogan | Kristy Hayes Katie Mulrooney | Fathimah Kara Colm Baker | Rachel Dungan Dr Sarah Brewer | Colm Moore

DESIGN DIRECTOR Ian Stoddart Design

PHARMACYNEWSIRELAND.COM @Irish_PharmNews IrishPharmacyNews

In its 2019 submission to the Department of Health on the subject, the IPU pointed to HSE research that almost half of women in Ireland would prefer to access contraception through their pharmacy.

62 Irish Pharmacy IRISH News is PHARMACY circulated to all NEWS independent, multiple Pharmacists and academics in Ireland.

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.

Improving access to regular birth control means that more women will avail of it and this in turn will reduce the incidence of unintended or crisis pregnancy. These acknowledged issues that the UK scheme has sought to address are also a concern in Ireland,” says IPU Pharmacist Kathy Maher.

I hope you enjoy the issue.

Regulars FEATURE: MIGRAINE MEDICATION FEATURE: HEALTHY HEART CPD: ATOPIC ECZEMA FEATURE: SORE THROAT VS STREP THROAT TEAM TRAINING: MAGNESIUM BUSINESS CPD:

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6

News

New Pharmacy Handbook “Make every contact count” is the key message from International Pharmaceutical Federation (FIP) as it launched a new vaccination handbook for pharmacists.

The handbook details the many ways in which pharmacists can contribute to improving vaccination coverage, such as supply chain and stock management, storage, record keeping, facilitation of appointments and administration of vaccines, but it also gives emphasis to their important educational and advisory role.

uptake,” said Gonçalo Sousa Pinto, editor of the handbook and FIP’s lead for practice development and transformation.

The handbook provides guidance on the implementation of a range of pharmacy vaccination services, guidelines on safety, and answers to frequently asked questions about vaccines.

“Advocating vaccination should be part of the daily practice of community pharmacists. At this time of increasing levels of vaccine hesitancy, pharmacists should be equipped with proper training and tools to effectively communicate and provide evidence-based recommendations to populations in order to support vaccine

“Not all of the roles described in the handbook are currently open to pharmacists in every country — for example, pharmacists’ access to vaccination records is still not mainstream practice worldwide — but with this handbook FIP aims to support the expansion and development of the roles of pharmacists in order to increase

vaccination coverage across the globe,” Mr Sousa Pinto said.

The handbook is the latest addition to a range of resources developed

by FIP to transform vaccination through pharmacy. Other recent resources in this programme of work by FIP to ensure pharmacy’s contribution to the World Health Organization Immunisation Agenda 2030 and the Global Vaccine Action Plan 2011–2020 include a collection of evidence and guidelines for the development of vaccination services, a report on the roles of pharmacy in vaccination, and a regulatory self-evaluation assessment tool for advancing pharmacy services in this area.

McCauley Pharmacy Partners with JAM Card McCauley Pharmacy are delighted to announce its partnership with Just A Minute (JAM) Card to support inclusion and accessibility within communities around Ireland as the first pharmacy group to affiliate with the programme and complete the JAM Card Train and Trainer across each of its 35 stores.

Ciaran Delaney, JAM Ambassador with Tony McEntee, Chief Executive, McCauley Pharmacy

The JAM Card was developed by NOW Group participants in 2012 and allows people to ask for a minute of patience, discreetly and easily, in any situation they need it, including in shops, restaurants, public transportation, and now McCauley Pharmacies. With over 75,000 JAM Card users and 1,800 organisation partners, NOW Group is the business partner of choice for neurodiversity and hidden disabilities. McCauley Pharmacy has always been committed to

supporting diversity and disability, and with this added service can now better support everyone in the community.

McCauley Pharmacy is committed to JAM Card and have taken steps to ensure the success of the partnership, including fully training all their colleagues in how to offer the best support to JAM Card users, providing identifiable JAM Card pins to all colleagues and kitting out all pharmacy locations with JAM Card displays.

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Speaking of the partnership, Tony McEntee, Chief Executive McCauley Pharmacy, said, “McCauley Pharmacy has always been committed to providing the best possible service to each and every customer. We are always looking for ways to improve our pharmacy experience and we are thrilled to have become the first pharmacy group in Ireland to carry out the detailed staff training that builds this incredible initiative into the heart of our business. Certain daily tasks, such as picking up something from a pharmacy, can be daunting to those with a communication barrier and never has this been more apparent than during the Covid pandemic.

However, thanks to our JAM Card partnership customers can feel at ease and welcome in all of our McCauley locations. Our colleagues are looking forward to displaying the JAM Card logo with pride and welcoming JAM Card users with open arms.”

Birth Testing Programme The Health Information and Quality Authority (HIQA) has published a Health Technology Assessment (HTA) recommending the introduction of once-off testing for the Hepatitis C virus (HCV) to people in Ireland born between 1965 and 1985.

HIQA has advised the Minister for Health that implementation of a birth cohort testing programme would be costeffective and help Ireland achieve its HCV elimination goals. Following a public consultation, the HTA of birth cohort testing for hepatitis C was approved by the Board of HIQA and has been submitted to the Minister for Health for his consideration.

In Ireland, the prevalence of HCV infection is highest amongst those born between 1965 and 1985. Of the 1.5 million people in this cohort, it is estimated that one in every 100 may have chronic HCV infection. HIQA concluded that offering testing to this group would represent good value for money, but that due to the number of individuals involved, testing would have significant upfront costs. HIQA noted that an initial pilot programme would be beneficial to confirm the prevalence estimates and to address issues concerning the feasibility of the programme before rolling it out nationally.

Dr Máirín Ryan, HIQA’s Deputy CEO and Director of Health Technology Assessment, said, “If left untreated, chronic HCV infection can cause severe damage to the liver and other organs. For example, 128 liver transplants completed in Ireland between 2005 and 2018 were due to HCV. “From reviewing the evidence, we found that the tests available to diagnose chronic HCV infection are highly accurate.

Furthermore, the treatments are safe and effective, with over 95% of people treated being cured of their infection.”

In Ireland, the Health Service Executive (HSE) aims to achieve the World Health Organization’s target of making Hepatitis C a rare disease before 2030.

News Recall to Pharmacy Level The HPRA wishes to advise that, as a precautionary measure, specific batches of blood pressure products are being recalled to pharmacy level in Ireland.

The reason for this recall is due to the presence of an impurity called 5-(4’-(azidomethyl)-[1,1’biphenyl]-2yl)-1H-tetrazole (termed an ‘azide’ impurity), which has mutagenic potential.

The guidance states, “At present, there is no evidence that this impurity has caused any harm to patients and therefore this pharmacy-level recall is being undertaken as a precautionary measure. Specific batches are being recalled in cases where the impurity is above regulatory acceptable levels.”

Please note that this is a different impurity to that which led to previous sartan recalls in 2018 and 2019.

Recall letters are being issued by the marketing authorisation holders to wholesalers and pharmacies.

Product name or type: • Specific batches of products containing irbesartan and valsartan from Sanofi-Aventis Ireland Ltd. and Clonmel Healthcare Ltd. • One batch of an irbesartancontaining product parallel distributed by PCO Manufacturing Ltd. Information for pharmacists 1. Immediately quarantine any units from the batches / products listed in Appendix I. For hospital pharmacies, this will include units at wards, clinics and any other relevant locations within the hospital.

2. Return the quarantined units to your wholesaler. The wholesaler will be in a position to advise on receiving credit for returned packs.

3. As this is a pharmacy level recall, there is no requirement to contact patients. Should patients taking these medicines contact you in respect of this recall, it is important that they are advised to continue taking their medicine. This recall is being undertaken as a precautionary measure and the health risk presented by abruptly discontinuing the medicine is higher than any potential risk presented by the impurity.

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Potential Impact to Pharmacy Vaccination All vaccinating pharmacies should be supplied with Pfizer vaccine as soon as possible to facilitate younger people who are waiting to be vaccinated, as current stocks of the Johnson and Johnson (Janssen) vaccine are diminishing nationwide and vaccination rates could be impacted, the Irish Pharmacy Union has advised.

As of end of July, pharmacies in the vaccination programme have vaccinated over 150,000 people in their local communities since the service was launched in June by Health Minister Stephen Donnelly.

Over 100,000 of these have been in the 18-29 age group.

Of the almost 1,000 participating pharmacies, all were receiving the Janssen vaccine, but stocks are now diminishing rapidly, and only about 320 pharmacies are currently administering Pfizer vaccines.

These were selected by the HSE on the basis that their communities are at a distance from HSE vaccination centres. Early replenishment of Janssen vaccine supplies looks unlikely on the scale required, which will significantly affect the continuing rollout of vaccines in local communities.

IPU Secretary General Darragh O’Loughlin said, “We are seeing very strong community support for local vaccination, with thousands of applicants still coming forward and 150,000 already vaccinated.

Pharmacists can continue to make further strong progress if all participating pharmacies are supplied with the Pfizer vaccine and this is particularly the case as younger people are being invited to receive a vaccine.

“The strong demand and positive feedback to date has highlighted the benefits of providing vaccination in local community

pharmacies. The vaccination centres have performed admirably but they have their limitations.

Travel to vaccine centres, the potential for long queues and the overall time required could be a disincentive to some people.”

“As the eligibility for vaccines now expands to younger age groups the challenges of reaching vaccination centres will become amplified for many. Younger people are less likely to have access to a car and may have less flexible employment. Pharmacies eliminate these concerns by providing a fast and convenient service within local communities. Accessibility

and convenience will be key to completing the vaccination campaign and that is what pharmacies offer.

“Over half of the Irish population lives within one kilometre of a pharmacy and 85% live within 5km. Expanding pharmacy vaccine supplies would sustain almost 1,000 vaccination locations in practically every town and village in the country.”

He concluded “The full reopening of our society depends on the pace of the vaccine roll-out.

By maximising the capacity of pharmacies that pace can significantly increase.”

Date for your Diary The Annual Medicines for Europe and IGBA Conference will be held in Athens to shape the 2030 agenda for the off-patent industry. Held from 6-8 October, 2021, the agenda will draw lessons from the pandemic and look towards the future of the industry.  Building the access gaps affecting patients around the world  Rebuilding for a resilient future  Strengthening global manufacturing and supply chains The Conference in the Divani Apollon Palace Hotel Athens will reflect on the industry achievements in improving patients’ lives and will be pivotal to rolling out the off-patent industry proposals for the next decade.

Visit www.medicinesforeurope.com for further details.

PHARMACYNEWSIRELAND.COM

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News

LloydsPharmacy and UD Wholesale - Sold McKesson Corp has recently agreed to sell their Irish business, including United Drug Wholesale and its chain of LloydsPharmacy stores to the Phoenix Group.

McKesson’s commitment to streamline the business and prioritize investments in the areas where we have deep expertise and are central to our long-term growth strategy,” said Brian Tyler, chief executive officer, McKesson. “We are confident that under the Phoenix group’s strong leadership, the businesses included in this agreement will be well-positioned for the future to compete more effectively and better serve customers.

The transaction is expected to close in 2022, subject to customary closing conditions, including receipt of required regulatory approvals.

business spans across three business units; United Drug Wholesale, United Drug Consumer and United Drug Distribution – all leaders in their category.

United Drug is Ireland’s largest pharmaceutical distribution company and was originally founded as a family business in Ballina, Mayo in 1948. United Drug has been a force for innovation in Ireland’s pharmaceutical industry and employs more than 650 staff across operations in Dublin, Limerick and Mayo. Partnering with more than 1,800 pharmacies, hospitals, clinics and primary care centres across Ireland, their

LloydsPharmacy incorporates approximately 90 pharmacies located in the heart of local communities throughout the country. Being part of the local community is very important to LloydsPharmacy, and their friendly, approachable, highly trained colleagues are what set them apart from their competitors.

“Today’s transaction marks an important step in advancing

“We will continue to operate our remaining businesses in the UK, Norway, Austria, and Denmark while also exploring a strategic path forward to fully exit the European region. Our goal is to accelerate our growth strategies, becoming a more focused organization and enabling our mission to improve care in every setting.”

The Phoenix Group is a leading integrated healthcare provider and a leader in the European healthcare sector, with over 25 years’ experience serving customers, patients, and partners across Europe. The Phoenix Group shares McKesson’s deep commitment to these groups, which is one of the many reasons that the Phoenix Group is the ideal leader to take these European businesses into the future.

Pharmacy Doubles Down The number of community pharmacies administering the Pfizer/BioNTech vaccine doubled as Irish Pharmacy News was going to press, to over 700 nationwide as the HSE extended vaccination to 12-15 year olds, in addition to people aged 16 years and upwards, the Irish Pharmacy Union has confirmed.

As the national vaccination programme enters a new phase, community pharmacists continue to play a major role in the fight against Covid-19, administering close to 200,000 vaccines to date, since June when Minister Donnelly announced the expansion of the programme to pharmacies.

vaccine will now continue as the mainstay of the pharmacy-based campaign against the virus.

However, any remaining stocks of the successfully administered Janssen vaccine can be administered to adults (over 18) in participating pharmacies until they are used up.

Some 320 pharmacies had already been administering Pfizer vaccines, among almost 1,000 pharmacies who have also been offering the Janssen vaccine. Over 700 pharmacies had originally indicated their availability to administer the Pfizer vaccine and these will now receive stock to begin vaccinations.

The HSE will be providing detailed information to parents and the public in relation to this programme. Vaccination centres will continue to be a primary location for the administration of the vaccines to 12-15 year olds and pharmacies will strongly augment this, ensuring appropriate geographical access taking account of distance from vaccination centres.

It is anticipated that the Pfizer

PHARMACYNEWSIRELAND.COM

IPU Secretary General Darragh O'Loughlin said, “It makes a lot of sense for parents to be able to bring their children to a local participating pharmacy for vaccination, bringing children to a familiar environment which provides reassurance and convenience for families and young people and reducing the pressure to travel to a vaccination centre.

“Over half of the Irish population lives within one kilometre of a pharmacy and 85% live within 5km. This enhanced local availability of the Pfizer vaccine will provide a further major incentive for people to be vaccinated and this in turn will help Ireland turn the corner in the fight against Covid-19.”

Obese Cancer Research The most obese cancer patients have the lowest number of cancer-killing Natural Killer (NK) cells in their tumours. That is according to new research, which also identifies a biological pathway that can be targeted with drugs to mitigate the unhelpful migration of NK cells away from the tumours where they can fight the cancer.

In combination, the findings offer significant hope that a new therapeutic approach may one day make a difference by redirecting and reinvigorating the anti-cancer immune response.

A team of scientists led by Dr Melissa Conroy and Dr Joanne Lysaght from Trinity College Dublin’s School of Medicine, worked with blood, fat, and tumour tissue samples collected from oesophagogastric adenocarcinoma (OAC) patients, who were being treated at the National Oesophageal and Gastric Centre at St. James’s Hospital.

OACs are a group of obesityassociated and inflammationdriven cancers. Sadly, survival rates are very low: five-year survival rates for oesophageal adenocarcinoma and gastric adenocarcinoma are 20 and 32% respectively and this is largely due to poor treatment response rates of <30%, highlighting the need for new and additional treatment options.

The team of scientists discovered an inverse correlation between visceral obesity and NK cells in tumours, such that the most obese patients have the lowest number of NK cells in their tumours.

Crucially, the scientists identified that a protein called Fractalkine plays a key role in both pulling the NK cells into the visceral fat and altering their activity.

They showed experimentally that this pathway can be targeted with drugs to reduce the extent to which the NK cells are erroneously diverted from the tumours.

This research was supported by funding from Breakthrough Cancer Research and the Irish Research Council.

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News

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Lucky for Some - O’Sullivan’s Open 13th Store O’Sullivan’s Pharmacy recently celebrated the opening of their Late Night Pharmacy located in the Primary Care Centre in Bandon. It is the only late night pharmacy in the town.

Aoife O’Keeffe, Pharmacy Assistant, Wiktoria Palka, Pharmacy Assistant, Michelle Nyhan, Supervising Pharmacist, Vadim Smetanin, Support Pharmacist, Helen Harrington, Manager and Tracy Payne, Pharmacy Assistant

O’Sullivans Late Night Pharmacy recently opened in Bandon The Bandon Late Night Pharmacy is the 13th pharmacy store for O’Sullivan’s Pharmacy group.

O’Sullivan’s Pharmacy is family owned and run with roots going back many years with their

pharmacy on O’Connell Avenue, Limerick serving customers since 1926. The pharmacy team strive to ensure that their services stay in tune with the needs of their customers. With the tagline that ‘At

O’Sullivans, you are the centre of our attention’ - their highly skilled team works towards the same goal: To offer a reliable, confidential and personalised service as standard, throughout their stores.

Pharmacy Manager Helen Harrington speaking at the opening stated, “I would like to thank everyone for calling into us on our first day of business. To our friends, family and all who helped us on our journey to make this dream come through we are very grateful.

“And to my amazing team, the long hours and dedication they put in the past few weeks, they have all being amazing. We look forward to meeting everyone in Bandon and the surrounding areas in West Cork in time to come.”

Pharmacy Manager Helen Harrington with Cork County Mayor Gillian Coughlan

Webinar for recently established Responsible Persons in Ireland • Are you a company in Ireland responsible for making cosmetic products available on the EU market?

• Are you located in Ireland and have recently taken on the role of Responsible Person for a cosmetic product?

• Has your company recently relocated its Responsible Person office to Ireland?

• Are you importing cosmetic products from Great Britain for supply to the Irish market?

The Health Products Regulatory Authority (HPRA) is the competent authority in Ireland for the regulation of cosmetic products. We are hosting a webinar exclusively for the attention of new or recently established Responsible Persons (RPs) in Ireland, including RPs who may have relocated to be established in Ireland. The webinar will outline and discuss the relevant EU and Irish legislation, along with HPRA guidelines, to assist RPs in achieving compliance with the relevant legislative requirements.

The webinar will consist of presentations outlining the regulatory framework of cosmetic products with particular emphasis on the obligations of the RP and HPRA expectations in relation to RPs established in Ireland. You will also have the opportunity to submit questions to the HPRA. The webinar will be held on 15 September 2021. Registration for the event will open on 12 August 2021. The registration link will be available on this webpage, in addition to details regarding the timing and the agenda for the event. Visit www.hpra.ie for the details

PHARMACYNEWSIRELAND.COM

12

Report

Positive Reaction to Pharmacy Standards The Pharmaceutical Society of Ireland (PSI) has published its first overview report on the implementation of the Covid-19 Operational Standards for Pharmacies, which were introduced last year on a “use and learn” basis.

Niall Byrne, Registrar and Chief Officer of the PSI

the ‘use and learn’ period has concluded at the end of 2021.”

Mr Byrne added, “The PSI is keen to see the Operational Standards adopted across the community pharmacy sector as they support good practice, allow innovation and help to assure the public that pharmacies are championing safety and quality.

in place to protect their patients, communities and staff, while continuing to deliver essential healthcare services, despite the ongoing risks and challenges presented by Covid-19. These good practices reflect very well on the commitment and professionalism of community pharmacists and of their pharmacy teams.

“Our monitoring visits allowed us see the many good practices and innovative measures that pharmacy teams have put in place to protect their patients, communities and staff, while continuing to deliver essential healthcare services, despite the ongoing risks and challenges presented by Covid-19” The Standards provide guidance to those in leadership and governance positions in pharmacies on how best to ensure safe services and environments for patients, public and staff during the pandemic. The report highlights a range of good practices found in pharmacies as well as noting some areas requiring improvement.

“We are encouraged by the positive response of community pharmacies to the Standards.

Their introduction has helped align pharmacy regulation in Ireland with how healthcare settings, more generally, are regulated. Internationally, regulatory standards, and the monitoring of performance against standards, are recognised for their effectiveness in driving improvements in quality and safety in healthcare, and in supporting good governance and strong leadership across

healthcare settings,” said Niall Byrne, Registrar and Chief Officer of the PSI. The PSI’s Operational Standards cover a range of areas including infection prevention and control, patient and staff safety, as well as continuity planning to help ensure the ongoing provision of pharmacy and medicine services.

“As regulator, we believe it is very important to highlight good practices as part of how we assure the public that they can trust the quality of healthcare services and advice available through their local pharmacy.”

According to the PSI’s overview report, these initial visits also highlighted areas that require further improvement.

For example, there was some evidence that not all pharmacists are benefiting from appropriate rest breaks during their working day. PSI is also concerned that, due to the necessary measures implemented to reduce the spread of Covid-19 in pharmacies (social distancing measures, PPE and virtual consultations), patients may not always be receiving the appropriate level of counselling on their medicines.

As part of its initial monitoring of the Standards, the regulator conducted over 40 visits to pharmacists.

In addition, PSI also noted a lack of structures and processes to capture patient feedback on the quality of care they receive. “These are three important areas of patient safety and wellbeing which both pharmacies and the regulator need to focus on into the future” said Mr. Byrne.

Mr Byrne said “While this is a small number of community pharmacies, we learned a lot from our engagement with pharmacists and their wider pharmacy teams, gaining valuable insights into how the Standards are working in practice. Our monitoring visits allowed us see the many good practices and innovative measures that pharmacy teams have put

“We will be doing further monitoring over the coming months to learn more about good practices in use and to encourage wider adoption of the Standards.

Our learnings will inform the further development of our monitoring and judgement framework. This will assist us in carrying out ongoing assessments of performance against the standards once

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“Fundamentally, our ongoing work with stakeholders is directed towards building awareness among the public of the standard of healthcare services and advice that should be expected by all who visit a community pharmacy.”

The pharmacy profession has also been supportive in relation to the Standards. Liam Butler, pharmacist and owner of an independent pharmacy in Birr, Co Offaly, said “When applying the standards in my pharmacy I found that they were easy to use and quite practical in their approach. The standards allow a more flexible approach to regulation while also driving quality improvement in healthcare, which will ultimately benefit patients.” Emily Kelly, former superintendent pharmacist of a chain of pharmacies, said “The standards provide a really useful resource to help you reflect on your practice and identify any gaps. In my experience, the standards had a positive impact on driving improvements within our pharmacies and I welcome the introduction of the new standardsbased approach by the PSI.” “Overall, our experience with the development and implementation of standards, to date, is that these can play an important role in how the PSI regulates community pharmacies into the future. We consider that providing a statutory basis for standards is, among other matters, an important legislative reform issue, which we are keen to progress under our current Corporate Strategy 2021 – 2023. Our strategic goal is to work with the Department of Health and other stakeholders, to see the Covid-19 Operational Standards, and other relevant standards, placed on a statutory basis within the not-too-distant future,” Mr Byrne stated.”

The overview report is available to download at www.psi.ie. Details of the Covid-19 Operational Standards can also be found on the PSI website.

News

13

Retail Excellence for Pharmacy Community pharmacy across Ireland are showcasing their dedication to excellence with the announcement of the Retail Excellence Top125 Stores in Ireland shortlisting.

Just under 30 pharmacies have made the list including several from the McCabes Pharmacy Group and the Adrian Dunne Pharmacy Group alongside: Brennan’s Life Pharmacy, Donabate Conaty’s CarePlus Pharmacy, Meath Cunningham’s Pharmacy, Athlone Holly’s Haven Pharmacy, Galway Liberty Pharmacy, Thurles Loughrea CarePlus Pharmacy, Loughrea Lynch’s totalhealth Pharmacy, Meath McGorisks’ Pharmacy, Athlone, and Morrison’s Pharmacy, Cahir The Top125 stores are part of the AIB Merchant Services Retail Excellence Awards, which were established in 1997 to promote best practice and encourage high standards in the Irish retail industry

and are now the largest and most prestigious of its kind in Ireland.

The Awards will take place virtually in November 2021.

Former Store of the Year winners include Willow (Ennis), Garvey’s SuperValu (Tralee), TileStyle (Dublin), Applegreen (Dublin), O’Briens Wines (Limerick and Dublin) and Greenacres (Wexford).

Duncan Graham, Managing Director of Retail Excellence, said, “The entire Irish retail industry has suffered an unprecedented blow over the past 18 months due to Covid-19, which makes these awards all the more important for businesses throughout the country who have put an emphasis on customer service and safety in the most trying of circumstances.

These Top125 stores are flying the flag for the retail industry but in truth countless other retailers deserve credit for the way in which they met the challenge of the pandemic head-on and came out strongly on the other side.”

Scope of Community Pharmacy Report Scope of community pharmacy practice and the sector’s regulation, distribution of medicines and remuneration are among the aspects explored in a new report published by the International Pharmaceutical Federation (FIP) recently.

The report presents data from 79 countries, including Ireland, that took part in a detailed survey between November 2020 and January 2021, giving the most up-to-date snapshot of the state of community pharmacy around the world.

“Community pharmacy global report 2021” builds on FIP’s previous (2016) report. Findings include a 12.1% increase in the average density of community pharmacists per 10,000 population (since 2016), currently at 5.19 (n=42), and an 11.2% increase in the number of community

pharmacies per 10,000 population, currently at 2.78 (n=50).

“The global community pharmacy landscape is in constant evolution, with influencing factors including changing needs, emerging technologies and trends in regulation and self-care, as well as the Covid-19 pandemic.

“This continued research and sharing of knowledge by FIP is important in order for us to ensure that community pharmacy is wellprepared to serve our populations in the future, to indicate what and where the shortfalls are, and to set

directions for work. This new FIP report is most valuable — together with the FIP Development Goals it provides inspiration for the transformation of pharmacy in a changing healthcare and consumer context,” said Lars-Åke Söderlund, president, FIP Community Pharmacy Section.

The 2021 report raises concerns over access to community pharmacies and pharmacists, and patient safety in some regions. For example, in general, low-income countries were found to have less than one pharmacy per 10,000 population.

“Low access to pharmacies can translate to difficulties in having timely access to medicines and the professional services of pharmacists, and ensuring responsible use of medicines,” Mr Söderlund explained.

Africa, the Eastern Mediterranean and South-East Asia reported a higher frequency of nonprescription medicines being sold outside community pharmacies, with a likely lack of professional advice and no guarantee of quality assurance.

PHARMACYNEWSIRELAND.COM

14

News

Vitamin D Retesting Expenditure Trinity researchers have found significant expenditure on vitamin D retesting, yet those who are deficient or most at risk of deficiency (young adults aged 18-39 years) are the least likely to have their vitamin D levels monitored or rechecked in by general practitioners in Dublin.

Helena Scully, Mercers Glanbia Bone Research Fellow & Lead Author, MISA Institute, School of Medicine, Trinity College

the COVID-19 virus and other medical conditions. This has led to a surge in the number of vitamin D tests in Ireland and globally placing increased pressure on healthcare systems.

The study, published in the Journal of Clinical Chemistry and Laboratory Medicine, has for the first time, gathered and analysed data on vitamin D retesting. It establishes the need for a better understanding of the role of vitamin D testing in the population and for greater focus to be placed on the monitoring of vitamin D status in particular groups.

The research has identified what proportion of patients are retested, whether this was appropriate, and if vitamin D levels improved after retesting. The team also identified the cost of inappropriate or unnecessary retests.

In recent years, there is greater public awareness of vitamin D, its importance in bone health and potential effects on immunity,

While there are Irish guidelines for vitamin D testing, there are no clear recommendations as to who should be retested (that is, have repeat tests). This study aimed to identify what proportion of patients are retested, whether this was appropriate, and if vitamin D levels improved after retesting. The cost of inappropriate or unnecessary retests was also identified.

Key findings • One in four patients had their vitamin D retested.

• One in ten tests were requested earlier than recommended, a third were done too frequently and more than half were in patients with adequate vitamin D levels, incurring significant costs.

• While young adults were most likely to have low vitamin D, they were the least likely to have it rechecked.

• Women were also more likely to have repeat tests, however they were less likely to be deficient.

• Discovered that levels of vitamin D deficiency fell considerably between initial and repeat tests, however nearly one in four (23%) still remained deplete after two or more retests.

The study also suggests that a user-friendly general practitioner (GP) ordering system for vitamin D requests that restricts it to pre-defined criteria, such as limiting retests within 3 months or more than 2 per year, should be considered. By implementing these measures, the number of inappropriate tests and the costs, could be be hugely reduced and the efficiency of the system improved.

Helena Scully, Mercers Glanbia Bone Research Fellow & Lead Author, MISA Institute, School of Medicine, Trinity College, said, “We have found that one in four patients have their vitamin D frequently checked by their GP, and yet some remain deficient after several tests.

Young adults and males were most likely to have low vitamin D but were retested the least. This shows those who are at most risk of vitamin D deficiency are not being assessed, leading to misdirection of resources from those who need it most. Clear guidelines on who should have their vitamin D retested and when are needed to better identify deficiency in the population.”

Need to Take Action on Self-Care On the occasion of International Self-Care Day 2021 and WHO Self-Care month, The Global Self-Care Federation (GSCF) underscores the importance of acting on self-care by engaging in positive and consistent self-care practices.

Self-care produces overwhelming long-term benefits for your personal health, while alleviating resources for the most vulnerable.

Adopting good self-care habits beyond the pandemic is one of the best ways we can continue to protect ourselves, our communities and our healthcare professionals.

GSCF’s 2021 International Self-Care Day campaign focuses on the #SelfCarePromise theme, encouraging people to actively take control of their own health by making a personal

commitment to embrace a specific self-care action.

help us to build more resilient health systems.”

“We’re delighted to see so many people make self-care promises to for example, better monitor their own health, increase their daily activity or improve their own health literacy,” said Judy Stenmark, Director General, GSCF. “We are seeing that people truly want to manage their own health, particularly during the pandemic.

It is essential that we provide them with the adequate knowledge and resources to do so, which will

Part of this will involve strengthening policy frameworks to ensure they are coherent and fully support self-care. GSCF’s forthcoming ‘Self-Care Readiness Index’ due to be published in September, will serve as a practical tool for self-care advocates to better understand and recognize the critical enablers of self-care, and help countries to integrate self-care into their national health policies.

PHARMACYNEWSIRELAND.COM

Turning Back the Clock Research from APC Microbiome Ireland (APC) SFI Research Centre at University College Cork (UCC) introduces a novel approach to reverse aspects of aging-related deterioration in the brain and cognitive function via the microbes in the gut.

As our population ages one of the key global challenges is to develop strategies to maintain healthy brain function. This ground-breaking research opens up a potentially new therapeutic avenues in the form of microbial-based interventions to slow down brain aging and associated cognitive problems.

The work was carried out by researchers in the BrainGut-Microbiota lab in APC led by Prof John F. Cryan, Vice President for Research & Innovation, University College Cork as well as a Principal Investigator at APC Microbiome Ireland an SFI Research Centre, based in in University College Cork and Teagasc Moorepark.

There is a growing appreciation of the importance of the microbes in the gut on all aspects of physiology and medicine. In this latest mouse study the authors show that by transplanting microbes from young into old animals they could rejuvenate aspects of brain and immune function.

Professor John F. Cryan, says, “This new research is a potential game changer , as we have established that the microbiome can be harnessed to reverse age-related brain deterioration.

We also see evidence of improved learning ability and cognitive function.”

Although very exciting Cryan cautions that “it is still early days and much more work is needed to see how these findings could be translated in humans.”

APC Director Prof Paul Ross stated that, “This research of Professor Cryan and colleagues further demonstrates the importance of the gut microbiome in many aspects of health, and particularly across the brain/gut axis where brain functioning can be positively influenced.”

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Adults: One tablet to be taken 20 minutes before going to bed, or as directed by a physician. Do not exceed the maximum dose of one tablet in 24 hours.

Elderly patients or patients with liver or kidney problems should consult their doctor before taking this medicine. Children under 18 years: Not recommended. The product should not be taken for more than 7 days without consulting a doctor. Contraindications: hypersensitivity to the active substance or to any of the excipients, stenosing peptic ulcer, pyloroduodenal obstruction, phaeochromocytoma, known acquired or congenital QT interval prolongation, known risk factors for QT interval prolongation. Special warnings and precautions: pregnancy/lactation, renal and hepatic impairment, myasthenia gravis, epilepsy or seizure disorders, narrow-angle glaucoma, prostatic hypertrophy, urinary retention, asthma, bronchitis, COPD. Patients should be advised to promptly report any cardiac symptoms. Tolerance and / or dependence may develop with continuous use. Do not take for more than 7 consecutive nights without consulting a doctor. Should not be used in patients currently receiving MAO inhibitors (MAOI) or patients who have received treatment with MAOIs within the last two weeks Use in the elderly should be avoided. Avoid concomitant use of alcohol or other antihistamine-containing preparations. Do not drive or operate machines. Cases of abuse and dependence were reported in adolescents or young adults for recreational use and/or in patients with psychiatric disorders and/or history of abuse disorders. Contains lactose. May suppress the cutaneous histamine response to allergen extracts and should be stopped several days before skin testing. Interactions: Alcohol, CNS depressants, MAO inhibitors, anticholinergic drugs (e.g. atropine, tricyclic antidepressants), metoprolol and venlafaxine, CYP2D6 inhibitors, Class Ia and Class III anti-arrhythmics. Side effects: sedation, drowsiness, disturbance in attention, unsteadiness, dizziness, thrombocytopenia, hypersensitivity reactions, confusion, paradoxical excitation, convulsions, headache, paraesthesia, dyskinesias, blurred vision, tachycardia, palpitations, thickening of bronchial secretions, dry mouth, gastrointestinal disturbance, muscle twitching, urinary difficulty, urinary retention, fatigue. Legal classification: P: PA1186/016/001 MAH: Chefaro Ireland DAC. The Sharp Building. Hogan Place. Dublin 2. Ireland. SPC: https://www.medicines.ie/medicines/nytol-one-a-night-50-mg-tablets-34889/smpc IRE NYT 2021 09

16

News

Pharmacies Left Vulnerable to Crime Pharmacies across the country were left more vulnerable to crime as the result of lockdowns, a new study by the Irish Pharmacy Union (IPU) has revealed.

• 64% of pharmacists believed that remaining open during the lockdown made their business more vulnerable Commenting on the findings Dermot Twomey, President of the IPU said, “It is deeply concerning that pharmacies, which provide an essential healthcare service to their communities, are being targeted in this way. At a time when crime rates nationally fell significantly, burglaries alone have fallen by 35%, it is concerning that pharmacies only saw a very slight drop in overall crime rates.”

The 2021 Pharmacy Crime Survey, has shown that while overall crime against pharmacies fell slightly there was a concerning increase in the levels of violence being encountered by pharmacy staff.

Key findings of the IPU Pharmacy Crime Survey reveal: • 65% of all pharmacies were victims of crime over the past 12 months • This is down slightly from 72% in the previous year • 14% of pharmacies were also the victim of a raid and 15% have had controlled drugs taken

Shoplifting remains the most common offence, impacting 87% of pharmacies which reported experiencing crime.

However, according to Dermot, the increase in violence is deeply concerning. “The number of pharmacists experiencing violence increased dramatically over the past year. 40% of crime victims suffered at least one violent incident, up over a third in just one year. The use of weapons is very common and too many pharmacy workers have encountered knives and even guns.

“The theft of cosmetics (84%), fake tan (48%) and supplements (33%) is all too common” according to Dermot.

“While this is upsetting and costly there is a more sinister problem emerging with the theft of medicines. Of pharmacies who have experienced crime, 8% suffered the theft of prescription medicines and 15% had controlled drugs stolen. These medications are controlled for a reason and, if taken without appropriate clinical guidance, they are potentially extremely dangerous.”

Citing the impact of the Covid-19 pandemic on crime in pharmacies Dermot said, “There is a definite feeling that pharmacies suffered as a result of their dedication in staying open through each lockdown. 64% felt this made pharmacies more vulnerable as a result of being one of the few businesses remaining open, combined with there being fewer people on the streets, and a lack of Garda presence.”

Concluding, he added, “In the vast majority of cases pharmacies welcome the support they receive from the Gardaí. It is clear that providing the Gardaí with the resources to increase visibility within our communities would have a beneficial effect, reducing crime rates not just in pharmacies but throughout the community.”

Consider a Career Move to LloydsPharmacy Being part of Lloydspharmacy is more than just being part of a team, it’s about being a part of a community. LloydsPharmacy employees care about the patients and communities they serve and follow the principles of Integrity, Customer-First, Accountability, Respect and Excellence (ICARE). These principles are the foundation for how LloydsPharmacy interact with their customers, business partners and with each other.

Opportunities Nationwide: We are currently looking to recruit Pharmacists & Pharmacy Technicians for various positions across Ireland. This is an exciting opportunity for you to progress your career with one of Ireland’s most well-established community pharmacy chains with 89 pharmacies nationwide.

We have some amazing opportunities for Supervising and Support pharmacist roles, specifically Blanchardstown, Dublin 22, Hollyhill Cork as well as Limerick and Tralee.

Attractive packages, training, career progression and support structure: Please get in touch

Hay Fever Sales Soar As pollen counts remained high around Ireland as a result of the recent hot weather, LloydsPharmacy confirms sales of allergy treatment products, since April this year, have increased by 38.7% in comparison to 2020.

The jump in sales has steadily increased over the past number of weeks as the weather has become warmer with more recent data confirming that sales increased by 59.9% in one week in July.

Oral tablets are the most popular treatments in stores and according to recent research conducted by Empathy Research on behalf of LloydsPharmacy, 54% of Irish consumers choose to combat hay fever via tablets while 29% opt for nasal products, followed by 17% who choose eye drops as a means to ward off the symptoms caused by higher pollen count in the air.

Due to the pandemic, it is more important than ever to manage hay fever symptoms correctly, especially during warmer days when pollen counts are at their highest.

This can help avoid misdiagnosing symptoms that can be attributed to both hay fever and Covid-19.

With the country currently in the midst of pollen season (which typically runs from April to September), many people across Ireland will experience hay fever due to high levels of pollen in the air.

if you would be interested in discussing these opportunities in more detail, we are confident we can accommodate your preferred location and working hours and we have a competitive package on offer.

• Clinical support team

Need more information?

LloydsPharmacy research shows some of the most common hay fever symptoms range from sneezing (76%), runny or blocked nose (72%) and itchy, red and/or watery eyes (71%). Untreated symptoms can impact peoples’ lives significantly. Of those experiencing symptoms, 39% said that their sleep has been impacted and 56% are spending less time outside as a result of their symptoms.

• Flexible contracts

Visit our careers page https://lloydspharmacy.ie/pages/ careers. The Talent Acquisition team are always on hand to help guide you through the process or answer any queries you might have at jobs@lloydspharmacy.ie

The LloydsPharmacy team is on hand to help keep symptoms under control and Pharmacists can recommend the correct products to protect, treat or relieve hay fever symptoms.

• Bespoke Pharmacist Induction programme and peer support • Monthly Performance Bonus • Sick pay

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• Regular CPD • Opportunity for progression and development

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FIND OUT MORE AT GSKHEALTHPARTNER.COM *compared to standard paracetamol. **when used as directed/always read the label before use 1. Laska EM et al. JAMA 1984; 251(13): 1711-1718 Product Information: Please consult the summary of product characteristics for full product information. Panadol Extra 500mg/65mg Soluble Effervescent Tablets, paracetamol 500mg, caffeine 65mg. Indications: Relief of mild to moderate pain including rheumatism, neuralgia, musculoskeletal disorders, headache, symptoms of colds and flu, fever, toothache and menstrual pain. Dosage: Adults and children 16 years and over: 2 tablets up to 4 times a day. Do not exceed 8 tablets in 24 hours. You may need a lower dose if you are underweight (<50kg), malnourished, dehydrated or if you have alcohol problems. Children aged 12-15 years: 1 tablet up to 4 times a day.

Do not exceed 4 tablets in 24 hours. Do not give to children under 12 years. Minimum dosing interval: 4 hours. Contraindications: Hypersensitivity to paracetamol, caffeine or any ingredients. Precautions: Avoid concurrent use with other paracetamol-containing products. Diagnosed liver of kidney impairment. Patients on concomitant treatment with drugs that induce hepatic enzymes. Patients with depleted glutathione levels or chronic alcoholism or sepsis. Avoid excessive caffeine intake. Caution in those with hereditary sugar intolerance or on a low sodium diet. Should not be used in pregnancy or lactation without medical advice. Do not exceed the stated dose.

Prolonged use except under medical supervision may be harmful. If high fever, or signs of secondary infection occur or if symptoms persist for longer than 3 days, consult your doctor. Side effects: See SPC for full details. All very rare: Thrombocytopenia, hypersensitivity reactions including anaphylaxis and skin rash, angioedema, StevensJohnson syndrome, Toxic Epidermal Necrolysis, bronchospasm, hepatic dysfunction. Frequency unknown: Nervousness, dizziness. When combined with dietary caffeine intake, higher doses of caffeine may increase potential for caffeine related adverse events such as insomnia, restlessness, anxiety, irritability, headaches, GI disturbances and palpitations. Overdose: Immediate medical advice should be sought in the event of an overdose, even if symptoms of overdose are not present. Legal Category: Supply through pharmacy only. MA Number: PA 678/39/10. MA Holder: GlaxoSmithKline Consumer Healthcare (Ireland) Limited, 12 Riverwalk, Citywest Business Campus, Dublin 24. Additional information is available upon request. Text prepared: June 2020. Contains paracetamol. Always read the label/leaflet.

PM-IE-PAN-21-00017.

Supported by Panadol

Community pharmacists are the front door to the health service.

In very corner of Ireland, whilst the Covid-19 pandemic closed GP surgeries and hospital capacity overflowed, pharmacists stepped up.

Pharmacy doors remained firmly open during an unprecedented challenging time. Indeed many patients turned to their community pharmacist for consultations for more serious conditions which are usually dealt with by GPs. It was, with unparalleled gratitude to Irish pharmacists, that members of the public received vital medicines, health and wellbeing advice and that the vulnerable and those in need were protected and kept safe.

Now more than ever before, it has become clear to everyone that pharmacists are the most critical member of Ireland’s health service family, embedded in the heart of every community.

Irish Pharmacy News is delighted to announce the search is on to find The People’s Pharmacist for 2021, in association with Panadol; giving the Irish public the opportunity to nominate and vote for, their local pharmacist who has gone above and beyond.

The People’s Pharmacist Award seeks nominations from across the country, giving patients the opportunity to recognise

and salute their local pharmacist. Through this Award, we are enabling the public to have a voice in recognising the unwavering support and spirit that makes pharmacists the backbone of our health service in every community across Ireland.

We will hear stories of compassion and dedication which go above and beyond – resulting in a shortlisting of six of the most deserving finalists.

A nation-wide voting process takes place after we announce the finalists, with an anticipated reach of over 1 million - further bringing awareness into every home across Ireland as to the bravery, hard work and sacrifice pharmacists have made since Covid-19 hit our shores in March 2020.

For further details contact Kelly Jo Eastwood at (87) 737 6308 or vial email: Kelly-jo@ipn.ie *Note: This Award is open to public nomination and voting processes only. Pharmacists may not enter themselves or a colleague/family member.

20

News

Report Uncovers Costs of Antimicrobial Resistance The Health Information and Quality Authority (HIQA) has recently published its report on the economic burden of antimicrobial resistant infections on Irish public acute hospitals in 2019. an enhanced focus should be placed on measures to address the AMR threat among vulnerable groups in this new plan, such as those in residential care. The plan should also prioritise advancing eHealth and clinical pharmacy services.”

Seeking to build on progress achieved nationally through implementation of the first iNAP plan, HIQA’s recommendations are to:

Sean Egan, Head of Healthcare, HIQA

Antimicrobial resistance (AMR) is a global public health concern; it is defined as the ability of a micro-organism (for example, a bacterium) to stop an antimicrobial from working against it. AMR is driven largely by excessive and inappropriate use of antimicrobials in human and animal populations.

As a result of AMR, treatment options become limited and common infections become more difficult and expensive to treat.

At the request of the Department of Health, HIQA undertook an analysis of the hospital costs associated with AMR. This work, part funded by the Health Research Board, supports Ireland’s First National Action Plan (iNAP) on Antimicrobial Resistance.

HIQA’s work included a literature review to inform an economic

assessment of AMR. The subsequent analysis estimated the costs associated with eight selected antimicrobial-resistant bacteria of public health concern.

HIQA found that over 4,700 of these resistant bacterial infections occurred across 50 public acute hospitals in Ireland in 2019.

The study estimated that AMR associated with these bacteria cost the health service an additional ¤12 million in extra hospital bed days in 2019. HIQA also found that these resistant infections resulted in about 215 deaths and almost 5,000 DALYs, or years of full health lost.

in HIQA’s submission to the Department of Health to inform its second National Action Plan on Antimicrobial Resistance (AMR) 2021-2025 (iNAP).

Earlier this year, HIQA made recommendations to address gaps and tackle antimicrobial resistance in Ireland’s health system. The recommendations are outlined

“HIQA strongly supports the view that the next national AMR action plan continues to promote a one-health approach, in line with Sláintecare. We also believe that

Sean Egan, HIQA’s Head of Healthcare, said, “Antimicrobial resistance will remain a continued critical challenge for health and social care services, as the ongoing discovery of new antibiotics has failed to keep pace with the emergence of antibiotic resistance. National efforts are critically important to tackle antimicrobial resistance (AMR) — the ‘quiet’ pandemic impacting health and social care.

• Place a targeted focus on the prevention and control of infection and antimicrobial resistance among our more vulnerable patient populations, including older people and people with a disability in residential care settings, as they have particular needs and present specific added challenges for those responsible for infection prevention and control and antimicrobial stewardship.

• Enhance clinical pharmacy services in those hospitals that continue to fall behind benchmarked provision nationally.

• Further enhance the role of eHealth in accelerating national AMR efforts.

• Continue to advance efforts to improve the quality of the physical infrastructure in many of Ireland’s congregated health and social care settings, to mitigate the risk of potential infection spread.

Medical Cannabis Access Programme Developments The Minister for Health, Stephen Donnelly TD, has announced that the Medical Cannabis Access Programme (MCAP) is now open for medical consultants to make an application for themselves and their patients to be registered for the programme.

Registration by consultants and their patients on the Cannabis for Medical Use Register, to be operated by the HSE, is required for the prescribing of cannabisbased products under the MCAP. This is a further important step in the ongoing roll out of the MCAP in Ireland.

The Minister said: “Today is a significant step forward in the ongoing delivery of the MCAP. This step forward will greatly assist patients who, under the

supervision of their consultant, need to avail of medicinal cannabis products to alleviate the effects of their severe medical conditions.

I now hope the programme continues to go on and grow and expand further, to best meet the needs of patients and families around Ireland.”

The MCAP will require a dispensing fee to be agreed with community pharmacists and this process is ongoing.

PHARMACYNEWSIRELAND.COM

Ministerial Licence Programme – courier collections to continue.

In addition to the MCAP, the Minister for Health will continue to operate the Ministerial Licence programme, enabling some 63 patients to avail of medicinal cannabis products, sourced from a pharmacy in the Hague in the Netherlands.

Since April of last year, owing to the COVID-19 travel restrictions and quarantine requirements the

Department has organised courier collections of patients’ cannabis products in the Netherlands and had these products delivered to them at their homes. This initiative will continue.

It is hoped that over time as more acceptable products are made available on the MCAP, the Ministerial Licence Programme patients may be treated under the programme. However, this is a clinical choice to be made by the patients and their clinicians.

INDICATED FOR THE PREVENTION OF PNEUMOCOCCAL PNEUMONIA IN ADULTS

1

IN ADULTS AGED ≥ 65 YEARS

With each additional comorbid condition, the risk for pneumococcal pneumonia multiplies compared to healthy adults of the same age2 These underlying conditions included2: Alcoholism Asthma

1 underlying condition

2 underlying conditions

>3 underlying conditions

Chronic cardivascular disease Chronic liver disease

2.1x increased risk

4.2x increased risk

9.2x

Chronic pulmonary disease

increased risk

Current smokers Diabetes

1,3

Help prevent pneumococcal pneumonia with the proven protection of Prevenar 13

Proven to reduce the risk of community-acquired pneumonia: Results from the Community-Acquired Pneumonia Immunisation Trial in Adults (CAPiTA) – one of the largest vaccine efficacy trials ever conducted in older adults.3,4

ABBREVIATED PRESCRIBING INFORMATION Prevenar 13* Suspension for Injection Pneumococcal polysaccharide conjugate vaccine (13-valent, adsorbed) Presentation: Each 0.5ml dose of Prevenar 13 contains 2.2 micrograms of each of the following pneumococcal polysaccharide serotypes: 1, 3, 4, 5, 6A, 7F, 9V, 14, 18C, 19A, 19F, 23F and 4.4 micrograms of pneumococcal polysaccharide serotype 6B. Each pneumococcal polysaccharide is conjugated to CRM197 carrier protein and adsorbed on aluminium phosphate. 1 dose (0.5 ml) contains approximately 32 µg CRM197carrier protein and 0.125 mg aluminium. Indications: Active immunisation for the prevention of invasive disease, pneumonia and acute otitis media caused by Streptococcus pneumoniae in infants, children and adolescents from 6 weeks to 17 years of age. Active immunisation for the prevention of invasive disease and pneumonia caused by Streptococcus pneumoniae in adults ≥18 years of age and the elderly. Dosage and Administration: The immunisation schedules for Prevenar 13 should be based on official recommendations. It is recommended that infants who receive a first dose of Prevenar 13 complete the vaccination course with Prevenar 13. For intramuscular injection. Infants aged 6 weeks-6 months: Three dose primary series: The recommended immunisation series consists of four doses, each of 0.5ml. The primary infant series consists of three doses, with the first dose usually given at 2 months of age and with an interval of at least 1 month between doses. The first dose may be given as early as six weeks of age. The fourth (booster) dose is recommended between 11 and 15 months of age.

Two dose primary series: Alternatively, when Prevenar 13 is given as part of a routine infant immunisation programme, a series consisting of three doses, each of 0.5ml, may be given.

The first dose may be administered from the age of 2 months, with a second dose 2 months later. The third (booster) dose is recommended between 11 and 15 months of age. Preterm infants (< 37 weeks gestation): In preterm infants, the recommended immunisation series consists of four doses, each of 0.5 ml. The primary infant series consists of three doses, with the first dose given at 2 months of age and with an interval of at least 1 month between doses. The first dose may be given as early as six weeks of age. The fourth (booster) dose is recommended between 11 and 15 months of age. Unvaccinated infants and children ≥ 7 months of age: Infants 7-11 months: Two doses, each of 0.5 ml, with at least a 1 month interval between doses. A third dose is recommended in the second year of life. Children aged 12-23 months: Two doses, each of 0.5 ml, with at least a 2 month interval between doses. Children and adolescents aged 2-17 years: one single dose of 0.5 ml. Prevenar 13 vaccine schedule for infants and children previously vaccinated with Prevenar (7-valent) (Streptococcus pneumoniae serotypes 4, 6B, 9V, 14, 18C, 19F, and 23F): Infants and children who have begun immunisation with Prevenar may switch to Prevenar 13 at any point in the schedule. Children aged 12-59 months: Children who are considered completely immunised with Prevenar (7-valent) should receive one dose of 0.5 ml of Prevenar 13 to elicit immune responses to the 6 additional serotypes. This dose of Prevenar 13 should be administered at least 8 weeks after the final dose of Prevenar (7-valent). Children and adolescents aged 5-17 years: One single dose of Prevenar 13 if they have been previously vaccinated with one or more doses of Prevenar. This dose of Prevenar 13 should be administered at least 8 weeks after the final dose of Prevenar (7-valent). Adults ≥18 years of age and the elderly: One single dose. The need for revaccination with a subsequent dose of Prevenar 13 has not been established. Regardless of prior pneumococcal vaccination status, if the use of 23 valent polysaccharide vaccine is considered appropriate, Prevenar 13 should be given first. Special Populations: Individuals who have underlying conditions predisposing them to invasive pneumococcal disease (such as sickle cell disease or HIV infection) including those previously vaccinated with one or more doses of 23-valent pneumococcal polysaccharide vaccine may receive at least one dose of Prevenar 13. In individuals with an haematopoietic stem cell transplant (HSCT), the recommended immunisation series consists of four doses of Prevenar 13, each of 0.5 ml. The primary series consists of three doses, with the first dose given at 3 to 6 months after HSCT and with an interval of at least 1 month

between doses. A fourth (booster) dose is recommended 6 months after the third dose.

Contra-indications: Hypersensitivity to any component of the vaccine or to diphtheria toxoid. As with other vaccines, the administration of Prevenar 13 should be postponed in subjects suffering from acute, severe febrile illness. However, the presence of a minor infection, such as a cold, should not result in the deferral of vaccination. Warnings and Precautions: Do not administer intravascularly. Appropriate medical treatment and supervision must be readily available in case of a rare anaphylactic event. This vaccine should not be given as an intramuscular injection to individuals with thrombocytopenia or any coagulation disorder that would contraindicate intramuscular injection, but may be given subcutaneously if the potential benefit clearly outweighs the risks of administration.

Prevenar 13 will only protect against Streptococcus pneumoniae serotypes included in the vaccine, and will not protect against other microorganisms that cause invasive disease, pneumonia, or otitis media. As with any vaccine, Prevenar 13 may not protect all individuals receiving the vaccine from pneumococcal disease. Individuals with impaired immune responsiveness, whether due to the use of immuno-suppressive therapy, a genetic defect, human immunodeficiency virus (HIV) infection, or other causes, may have reduced antibody response to active immunization. Safety and immunogenicity data are available for a limited number of individuals with sickle cell disease, HIV infection, or with an HSCT. Safety and immunogenicity data for Prevenar 13 are not available for individuals in other specific immuno-compromised groups (e.g., malignancy or nephrotic syndrome) and vaccination should be considered on an individual basis. Infants and children aged 6 weeks to 5 years: Prevenar 13 does not replace the use of 23-valent pneumococcal polysaccharide vaccine in at risk children ≥ 24 months of age. Children ≥ 24 months of age at high risk, previously immunised with Prevenar 13 should receive 23-valent pneumococcal polysaccharide vaccine whenever recommended. The potential risk of apnoea and the need for respiratory monitoring for 48-72 hours should be considered when administering the primary immunisation series to very premature infants (born ≥ 28 weeks of gestation) and particularly for those with a previous history of respiratory immaturity. When Prevenar 13 is administered concomitantly with Infanrix hexa (DTPa-HBV-IPV/Hib), the rates of febrile reactions are similar to those seen with concomitant administration of Prevenar (7-valent) and Infanrix hexa. Increased reporting rates of convulsions (with or without fever) and hypotonic hyporesponsive episode (HHE) were observed with concomitant administration of Prevenar 13 and Infanrixhexa. Antipyretic treatment should be initiated according to local guidelines for children with seizure disorders or with a history of febrile seizures and for all children receiving Prevenar 13 simultaneously with vaccines containing whole cell pertussis.

Adults aged 50 years and older: When Prevenar 13 was given concomitantly with trivalent inactivated influenza vaccine (TIV), the immune responses to Prevenar 13 were lower compared to when Prevenar 13 was given alone, however, there was no long-term impact on circulating antibody levels. The immune responses to Prevenar 13 were noninferior when Prevenar 13 was given concomitantly with quadrivalent inactivated influenza vaccine (QIV) compared to when Prevenar 13 was given alone. As with concomitant administration with trivalent vaccines, immune responses to some pneumococcal serotypes were lower when both vaccines were given concomitantly. Fertility, Pregnancy & Lactation: There are no data from the use of pneumococcal 13-valent conjugate in pregnant women. It is unknown whether pneumococcal 13-valent conjugate is excreted in human milk. Animal studies do not indicate direct or indirect harmful effects with respect to reproductive toxicity. Side Effects: Analysis of postmarketing reporting rates suggests a potential increased risk ofconvulsions, with or without fever, and HHE when comparing groups which reported use of Prevenar 13 with Infanrix hexa to those which reported use of Prevenar 13 alone. Adverse reactions reported in clinical studies or from the post-marketing experience for all age groups are listed in this section per system organ class,in decreasing order of frequency and seriousness. The frequency is defined as follows: very common (≥ 1/10), common (≥ 1/100 to < 1/10), uncommon (≥ 1/1,000 to < 1/100), rare (≥ 1/10,000 to < 1/1,000), very rare (≤ 1/10,000), not

known (cannot be estimated from available data). Infants and children aged 6 weeks to 5 years: Very common (≥ 1/10): Decreased appetite, fever, pyrexia, irritability, any vaccination-site erythema, induration/swelling or pain/tenderness, somnolence, poor quality sleep. Vaccination-site erythema or induration/swelling 2.5cm – 7.0 cm (after the booster dose and in older children [age 2-5 years]. Common (≥ 1/100 to < 1/10): Vomiting, diarrhoea, rash, pyrexia >39 °C, vaccination-site movement impairment (due to pain), vaccination-site erythema or induration/swelling 2.5cm – 7.0cm (after infant series). Uncommon (≥ 1/1,000 to < 1/100): Convulsions (including febrile convulsions), urticaria or urticaria-like rash, vaccination-site erythema, induration/swelling >7.0cm, crying. Rare: Hypersensitivity reaction including face oedema, dyspnoea, bronchospasm, hypotonic-hyporesponsive episode. Not known: Lymphadenopathy (localised to the region of the vaccination site), anaphylactic/anaphylactoid reaction including shock, angioedema, erythema multiforme, vaccination site urticaria, vaccination-site dermatitis, vaccination-site pruritus, flushing. In clinical studies infants vaccinated at 2, 3 and 4 months of age, fever ≥ 38°C was reported at higher rates among infants who received Prevenar (7-valent) concomitantly with Infanrix hexa than in infants receiving Infanrix hexa alone. After a booster dose at 12 and 15 months of age, the rate of fever ≥ 38°C was greater in infants who received Prevenar (7 valent) and Infanrix hexa at the same time compared to infants receiving Infanrix hexa alone. These reactions were mostly moderate (less than or equal to 39°C) and transient. Additional information in special populations: Apnoea in very premature infants (≤ 28 weeks of gestation). Children and adolescents aged 6 to 17 years of age: Very common (≥ 1/10): Decreased appetite, irritability, any vaccination-site erythema, induration/swelling or pain/ tenderness, somnolence, poor quality sleep, vaccination-site tenderness (including impaired movement). Common (≥ 1/100 to < 1/10): Headaches, vomiting, diarrhoea, rash, urticaria or urticaria-like rash, pyrexia. Additional information in special populations: Children and adolescents with sickle cell disease, HIV infection or an HSCT transplant have similar frequencies of adverse reactions, except that headaches, vomiting, diarrhoea, pyrexia, fatigue, arthralgia, and myalgia were very common. Adults ≥18 years of age, and the elderly: Very common (≥ 1/10): Decreased appetite, headaches, diarrhoea, vomiting,(in adults aged 18 to 49 years), rash, chills; fatigue; vaccination-site erythema; vaccination-site induration/swelling; vaccination-site pain/tenderness (severe vaccination-site pain/ tenderness very common in adults aged 18 to 39 years); limitation of arm movement (severe limitation of arm movements very common in adults aged 18 to 39 years), arthralgia; myalgia.

Common (≥ 1/100 to < 1/10): Vomiting (in adults aged 50 years and over), pyrexia(very common in adults aged 18 to 29 years). Uncommon (≥ 1/1,000 to < 1/100): Nausea, hypersensitivity reaction including face oedema, dyspnoea, bronchospasm, lymphadenopathy localized to the region of the vaccination site. Additional information in special populations: Adults with HIV infection have similar frequencies of adverse reactions, except that pyrexia and vomiting were very common and nausea common. Adults with an HSCT have similar frequencies of adverse reactions, except that pyrexia and vomiting were very common. For full prescribing information see the Summary of Product Characteristics. Legal Category: S1A. Package Quantities: Pack of 1 single-dose prefilled syringe (with separate needle) or pack of 10 single- dose pre-filled syringes. Marketing Authorisation Numbers: Single-dose pre-filled syringe (with separate needle) pack of 1: EU/1/09/590/002, single-dose pre-filled syringe pack of 10: EU/1/09/590/003. Marketing Authorisation Holder: Pfizer Europe MA EEIG, Boulevard de la Plaine 17, 1050 Bruxelles, Belgium. For further information on this medicine please contact: Pfizer Medical Information on 1800 633 363 or at EUMEDINFO@pfizer.com. For queries regarding product availability please contact: Pfizer Healthcare Ireland, Pfizer Building 9, Riverwalk, National Digital Park, Citywest Business Campus, Dublin 24 + 353 1 4676500.

Date of preparation: 11/2018. *Trade mark.

Ref: PN 11_0 IE.

References: 1. Prevenar 13 Suspension for Injection. Summary of Product Characteristics. 2. Shea K, Edelsberg J, Weycker D, et al. Rates of Pneumococcal Disease in Adults with Chronic Medical Conditions. Open Forum Infectious Disease. 2014;1-9.

3. Bonten M.J.M., Huijts S.M, Bolkenbaas M, et al. Polysaccharide Conjugate Vaccine Against Pneumococcal Pneumonia in Adults. The New England Journal of Medicine. 2015;372:1114-25. 4. Pfizer Inc. Press Release Mar 18, 2015.

Date of Preparation: February 2021 | PP-PNA-IRL-0006

The vital role of the VMS category in

81 €

+16.6% IN VALUE

MILLION

(+€11.5 million)

Vitamin C SALES

Vitamin D SALES

+64%

+48%

As we head towards cold & flu season, people are

increasingly thinking about how they can best support their immune systems. This has become even more evident since the arrival of coronavirus and is reflected in the rising sales of VMS products with immune supporting nutrients.

So, how can pharmacies ensure their VMS category is meeting the immunity needs of their customers this winter?

STOCK THE RIGHT RANGE Start by ensuring you stock the right range of immunity focused products. The key nutrients to look out for include vitamin C, vitamin D and zinc. Whilst sales of vitamin D showed strong growth across 2020, it particularly soared during the winter months +99% as consumers looked to support their immune systems2.

VITAMIN C Helps to protect cells and keep them healthy, maintaining healthy skin, blood vessels, bones and cartilage and helping with wound healing. Vitamin C cannot be stored by the body so is needed in the diet every day.

VITAMIN D Benefits are numerous but particularly regarding immune and bone health. The body creates vitamin D from direct sunlight on the skin, however we do not make enough all year round. Whilst it is found in a small number of foods, a good quality supplement (particularly between October and March when sunlight is limited) is often recommended to ensure requirements are met.

ZINC An essential trace mineral vital for many functions in the body including the normal development and function of immune cells and supporting the skin barrier, which protects against foreign invaders entering the body.

Whilst diet and lifestyle should always be the first choice to obtain nutrients in today’s world this is not always easy to achieve and supplements can bridge the gap to optimal nutrition.

USE EMPLOYEE EXPERTISE Data shows many people enter the VMS category buying vitamin C and vitamin D products before expanding their repertoire. The willingness of VMS consumers to engage with new products offers an excellent opportunity for pharmacies to provide education and support. Having staff trained on specific products can increase their sales by up to 26%2 and will help consumers find the right product for their needs and in turn drive customer satisfaction and repeat purchase.

What’s more, 58% of VMS buyers prioritise quality3.

Pharmacies should therefore offer a range of more premium quality products, thus providing the opportunity for shoppers to trade up.

CREATE EFFECTIVE DISPLAYS Clear category merchandising, signposting and pointof-sale materials will ensure customers can find the products they want.

Making the fixture easy to navigate is a fundamental way to safeguard against missed sales. Group similar products together and double-face key sellers to help them to standout on-shelf. An excellent way to capture attention and encourage engagement is to create theatre with a secondary display.

immune support this winter V I TA M I N S A N D S U P P LEM ENTS

Introducing the Solgar® Immunity range: Vitamin D3 (Cholecalciferol) 2200 IU • Keeps bones and teeth healthy

This premium formula delivers vitamin D in the form that is easiest to use by the body - D3.

• Helps muscle function • Supports immunity

Vitamin D3 is the more potent form of vitamin D compared to vitamin D2 and Solgar®’s vitamin D3 is one of the highest strength vitamin Ds available.

• Vegetarian, Kosher • Free from sugar, salt and starch

Ester-C® Plus 1000 mg Vitamin C • Retained in the body’s immune cells for up to 24hrs

Maintain immune system function throughout the year with scientifically studied ingredient Ester-C®.

• Gentle, highly absorbable patented form of vitamin C

Exclusively formulated for Solgar®, Ester-C® is retained in white blood cells for up to twenty-four hours. Twice as long as standard ascorbic acid.

• Excellent antioxidant • Non-acidic form for sensitive stomach

Ultibio Immune • Unique formula to balance and maintain the immune system • Immune supporting vitamin A, B12 and D3 • Two clinically studied live bacterial strains Lactobacillus plantarumHEAL9 and Lactobacillus paracasei8700:2 • Easy to swallow one-a-day capsule formula

A careful balance of gut microbes is critical for immune defences. To achieve a healthy gut we need a well-balanced and varied diet.

Bacterial strains also play an important role and multiple clinical studies indicate the efficacy of the two strains in Ultibio Immune to balance and maintain the immune system.

• Suitable for vegetarians

Flavo-Zinc Lozenges • Potent antioxidant that is recommended by specialists • Supports healthy brain function • For healthy skin, hair and nails • Provides Zinc as Citrate and Gluconate

• Easy to take lozenge form Flavo-Zinc Lozenges provides premium quality zinc in a highly absorbable and easy to take lozenge form.

ABOUT SOLGAR® An award-winning range of over 350 nutritional supplements. Solgar® has over 70 years of commitment to quality, health & wellness and remains at the forefront of nutritional science.

We are proud to say that 98% of Solgar® consumers would recommend our brand.* For more details on opening an account or to place an order email enquiries4@solgar.com 1 Kantar 52wks to Feb 21. 2 Kantar 12wks to Feb 21. 3 The Nature’s Bounty Co. research. 4 Survey of 1000 VMS users in the UK in Dec 2020.

Food supplements should not be used instead of a varied balanced diet and a healthy lifestyle. Solgar® is a registered trademark. For business use only.

24

Eczema

Top Tips in Eczema Management First, a point of clarification – many think the word “eczema” implies a genetic condition and “dermatitis” implies an external allergic problem – in fact, both terms to a dermatologist are interchangeable / mean precisely the same thing.

Written by Dr John Ashworth, Consultant Dermatologist M.B. Ch.B. (1979) M.R.C.P. (1983) M.D. (1988) www.dermatologist.ie

and often they have very little idea about the relative strengths.

DAKTACORT is a good +1 product for most facial eruptions and covers both SEBORRHOEIC and also ATOPIC disease.

All forms of eczema have a common abnormality, OIL DEFICIENCY in the skin (not water deficiency) - therefore the term “dry skin” is very misleading. Oily greasy products like VASELINE work well but you cannot go out wearing them, more cosmetically acceptable moisturisers are often preferred.

The preference is purely personal – there is no “best” product.

CLINGFILM: If you apply a treatment to the skin and then wrap the kitchen clingfilm temporarily over the area this enhances the penetration and effectiveness of the cream or moisturiser. This is a particularly useful technique to use overnight in bed – and can make a very dramatic difference to a number of patients.

Dermatologists would hardly ever use those terms without an explanatory prefix for example SEBORRHOEIC ECZEMA or ALLERGIC CONTACT DERMATITIS thus designating a subcategory which is important in terms of management / advice.

The classic genetic variation is called ATOPIC DERMATITIS and is often linked to asthma, hayfever and these patients are generally “sensitive” - have irritations with simple products like moisturisers / sun screens / soap powders etc.

Many patients have overlaps of 2 types of eczema – so don’t get hung up on the “name” – more important, why are they in front of you with a problem? Do they understand the potential causes of eczema (genetic, allergic, infected) and the relative strengths of their skin treatments? What if any circumstances have changed?

TOP TIP 1: Most flaring eczema is NOT due to environmental changes – flaring eczema is usually due to normal skin bacteria being scratched into the skin surface and multiplying – thus, INFECTION is

the commonest cause of flaring eczema. So adding an antiseptic topically or an antibiotic orally (FLUCLOXACILLIN 500 mg x4 per day for 14 days) will often make a dramatic difference.

but also to airborne pollen landing on the skin – FINGER TO FACE transfer of allergens (eg in the garden; cookery products; nail varnish) is another very important cause of face and neck eczema.

NEWLY DEVELOPED ECZEMA: If the problem is recent – then consider circumstances – external allergy may be of relevance – starting work as a hairdresser, nurse, food industry – any wet work / regular hand washing is a potential problem – these considerations are important.

In colder months eczema can also flare for different reasons – the skin tends to be less oily in winter and needs more emollient and protection from prolonged exposure to cold and wind.

Wet work – both domestic and occupational, can obliterate the adhesion between the top of the fingernail and the nailfold skin thus allowing contaminants underneath the skin and this can precipitate nasty finger and hand eczema – hand protection by using cotton gloves inside rubber gloves when doing any dirty or wet work can be a tremendously helpful piece of professional advice to give to patient.

In sunnier months eczema can flare and many patients can be sensitive both to direct sunshine

PHARMACYNEWSIRELAND.COM

TOP TIP 2: Empower your patient with further information eg www.dermatologist.ie; www.dermnetnz.org; www.BAD.org.uk Give your patients a star rating with your dispensed steroids so they can understand the different strengths of steroid creams eg BETNOVATE ++++ ; EUMOVATE ++; HYDROCORTISONE + ; EMOLLIENTS zero pluses – and appropriate / inappropriate body locations for the different strengths.

When I see patients on multiple steroid creams I often ask them to put the creams on my desk in strength order from top to bottom

So diagnosing and offering advice hinges on a relatively simple history.

KEY QUESTIONS:  Past personal and family history of eczema / asthma / hay fever – indicates a genetic disease  Recent sudden onset with no past history indicates the possibility of external factors  A scaly dandruff like appearance on the face, scalp or upper body indicate a likely SEBORRHOEIC DERMATITIS type problem  Sudden deterioration of a previously lower level problem indicates likely infection OVERALL STRATEGY: Try to establish a likely diagnosis by appropriate history taking Advise about avoiding causation when possible Tackle infection Encourage oil replacement Make sure patients have a grip of steroid potency in the products you provide – and guidance to online information resources as appropriate.

News

25

New Appointment for Pharmacist Ronan The Minister for Health, Stephen Donnelly TD, has appointed Ronan Quirke to the board of the Medical Council.

Ronan is a practicing Community Pharmacist and an Adjunct Senior Clinical Lecturer at the School of Pharmacy in UCC, as well as holding a teaching appointment at the School of Pharmacy, TCD. He is a former President of the Pharmaceutical Society of Ireland and is a current member of the Fitness to Practice Committee of the Medical Council of Ireland.

Ronan is appointed following a Public Appointments Service campaign and his appointment is from 14th June 2021 to 31st May 2026.

¤300,000 Research Bursaries The Charitable Infirmary Charitable Trust (CICT), Ireland’s oldest charity, has awarded two medical research bursaries to teams at Beaumont Hospital to fund scientific and medical research and simultaneously support education and development through pursuit of MD or PhD qualifications. Each award is for two years and has an annual value of up to ¤75,000.

Following an open competition, the Medical Group of CICT awarded the bursaries to: Dr Christina Campbell, Respiratory Department, Beaumont Hospital and Dr Olufemi Olumide Aoko, Hepatology Unit, Beaumont Hospital.

Commenting on the awards, Michael Patten, Chairman of the CICT said, “These new bursaries are designed to promote talent development and scientific/medical research and discovery at Beaumont and are open to all the caring professions based on the hospital campus. We were delighted with the sheer quality of applications for these inaugural bursaries which bodes well for medical discovery at Beaumont. We wish the recipients well in the coming years and will track their progress with great interest.”

Ministers for Health publish the Tobacco Free Ireland 2020 Annual Report Minister for Health, Stephen Donnelly, T.D. and Minister of State for Public Health, Wellbeing and the National Drugs Strategy, Frank Feighan T. D. have welcomed the publication of the Tobacco Free Ireland 2020 Annual Report.

Tobacco Free Ireland is Ireland’s national tobacco control policy and sets a target for Ireland to be tobacco free by the year 2025.

A high-level action plan for Tobacco Free Ireland was published in March 2015 and each year the Department of Health reports on the ongoing implementation of the plan. The Annual Report outlines several key achievements in 2020, despite the disruption caused by the COVID 19 pandemic during the year.

These include: • The inclusion of information on the dangers of tobacco use in Healthy Choices 1, the first substance misuse module of Junior Cycle Social, Personal and Health Education, aimed at first year students.

• The launch of a new QUIT marketing campaign by HSE National Communications and the HSE Tobacco Free Ireland Programme, called The Last Stop.

• The completion by the Health Research Board of three comprehensive evidence

reviews on electronic cigarettes and heated tobacco products commissioned by the Minister.

Minister of State for Public Health, Wellbeing and the National Drugs Strategy, Frank Feighan T. D.

• A further increase of 50 cent on a packet of cigarettes with prorata increases on other tobacco products in Budget 2021.

Minister Donnelly said, ‘’Despite the obvious challenges from the COVID-19 pandemic, work has continued in the last year towards our goal of a Tobacco Free Ireland. By working to remove smoking from daily life in Ireland and educating young people on the dangers of tobacco, while making cessation assistance as widely available as possible, we can continue to build on the promising results we have seen in recent years.

“I urge anyone that is thinking of quitting to act now. Stopping smoking remains one of the best decisions a person can make for their health. The last 18 months has further highlighted the importance of being proactive about our own health and the health of those around us. The HSE QUIT service remains available to anyone that needs it.’’

Minister Feighan said; ‘’We continue to make progress towards a tobacco – free future for all of Ireland but especially for our young people. The inclusion of a section on the dangers of smoking in the Junior Cycle SPHE curriculum is both welcome and needed. The growing popularity of community – led campaigns for tobacco free environments in cities and towns across the country means that smoking can become increasingly removed from the lives of our children. With increased education on this topic, it is possible that we can have our first smoke – free generation.

“Our Public Health (Tobacco and Nicotine Inhaling Products) Bill will ban the sale of tobacco products at places or events that are intended for children and we are also banning the sale of e-cigarettes to persons under 18 years of age. I am determined to do what I can to ensure that our children do not start smoking and can live their lives free of this addictive and lethal product.’’

PHARMACYNEWSIRELAND.COM

Emergency Education s Relationships and Sexuality Educators, we come across countless concerns from young people around many different topics. One particular worry that pops up time and time again is accessing emergency contraception. Many myths still encircle this little pill and the age of misinformation is far from over. Let’s take a look at some points that we feel are very important to consider when facilitating a kind and safe space for folks to access this very important form of healthcare.

1. What’s In a Name?!

Emergency contraception is more commonly known among young people as the ‘morning after pill’, and this often leads to the belief that the pill can and should only be taken the morning after having unprotected sex. It is important that this little myth is squashed and that young people understand that emergency contraception should be taken as soon as is possible (at any time of night or day, not just the morning!), and that its effectiveness can decrease if left too long.

The MAP can in fact be taken up to 120 hours after unprotected sex but the sooner it is taken the more effective it is.

2. Third Time’s a Charm The good ol’ “you can only take it three times in your life” myth is still doing the rounds.

It is a great idea to reassure people that they can take it many times in their life and it will still work effectively, while

highlighting that it is not intended to be used as regular contraception or more than once per menstrual cycle.

3. Avoiding Alcohol Many young people believe that emergency contraception will not work if they go on to drink alcohol that day/night, which is untrue and yet another myth that could deter people from going to the bother of accessing it. However, it is good to explain why emergency contraception might fail, which brings us to our next point...

4. T’s and C’s Many young folks are unaware of how hormonal contraception – including emergency contraception – actually works inside the body. It can be very useful to explain this simply, so that it is clear that it passes through the digestive system (as opposed to straight into the blood

26 | PHARMACYNEWSIRELAND.COM

Written by Grace O’Shea, Sexual Health West

stream like many other forms). Therefore vomiting and diarrhoea can interfere with its effectiveness, which can accompany excess alcohol intake (rather than the alcohol itself stopping the pill from doing its job). It is really important that young people know that they may need to come and get another pill if they experience any of these digestive issues. We also receive questions about how emergency contraception may interact with other medications, so this always needs to be discussed too.

5. To Be Sure To Be Sure While it’s always good to reassure young folks that emergency contraception can be 99% effective if taken correctly, there is always some risk that it will not work, e.g. if the person has already ovulated and conception has already happened. It is important for them to keep an eye on their cycle and take at least one pregnancy

ellaonepharmacists.ie

r e h It‘s g n i n r o m r e t f a

Be her support and ensure she’s making an informed choice.

No other emergency hormonal contraception (EHC) is more effective than ellaOne®.1 REFERENCES: 1. Glasier A et al. Lancet 2010; 375 (9714): 555-62 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. Nonhormonal 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, 200 avenue de Paris, 92329 Châtillon, 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: May 2019 Unique ID: IE/ELLA/0112 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 IE/ELLA/0200 Date of preparation: November 2020

“It is good practice to try and be as inclusive as possible when discussing emergency contraception.

Sex can be difficult to navigate as a young person as it is” test in the coming weeks. On the note of pregnancy tests – several young people have asked us whether the emergency contraception pill can be found hidden inside pregnancy tests! Another myth, this time born from a viral video showing a pregnancy test being broken open to reveal this ‘pill’ – which in reality was a tablet used to absorb the urine and obviously should not be eaten. The joys of the internet.

6. Other Options It is always good to offer accurate information to young people wherever possible as there is so much information floating around out there. It may be useful to have a leaflet or poster or a section on the pharmacy website detailing different types of contraception available (including cost – many young people do not realise that they can access it for free using a medical card) and also information on crisis pregnancy services and abortion.

Our website provides information on all the STI clinics in Ireland and HSE Crisis Pregnancy contact details on https://www. sexualhealthwest.ie/useful-contacts

7. Sex – Small Word, Many Meanings Sex means different things to different people, and there can be a lot of confusion regarding what ‘counts’ as sex – and what kind of sex can result in pregnancy. I have spoken to young people who went and bought emergency contraception after engaging in oral sex because they were convinced there was a risk of pregnancy!

I have also heard stories from others stating that they did not go and get the pill because their partner wore a condom ‘most of the time’.

It is good to be as clear and to-the-point as possible when determining if there is a risk of pregnancy. Many young people (and probably some older people too!) do not realise that pregnancy can happen if pre-ejaculate enters the vaginal passage.

It may be very helpful to point people towards some sound information around proper condom use and sex myths (“yes, a pregnancy can result from having sex standing up, underwater, during your period, before your first period and from first-time sex” – just some of the myths we spend a lot of time busting!).We strive to

use language that is as factual as possible rather than more veiled references – e.g. using the terms ‘penile-vaginal penetration’ or ‘penis-in-vagina sex’ rather than ‘heterosexual sex’ or ‘full sex’ is far more inclusive and accurate.

Unfortunately, it is very possible that a young person looking for emergency contraception could have been sexually assaulted or raped. They may be in shock after this trauma and at a loss as to how to cope with what has happened. In this case, it is often inappropriate to use the word ‘sex’, as what has happened is not sex. The Rape Crisis Network Ireland offers disclosure training which equips participants with the skills and knowledge to handle such a situation efficiently and sensitively. It is a brilliant idea for anyone, especially people who are likely to meet victims and survivors of sexual assault in a healthcare setting, to have this training and refresh it regularly. The national helpline for anyone who has been raped or sexually assaulted is 1800 77 8888 (https://www.drcc.ie/services/helpline/).

8. The Importance of Inclusivity It is good practice to try and be as inclusive as possible when discussing emergency contraception. Sex can be difficult to navigate as a young person as it is, but it can be even trickier if a person experiences gender dysphoria.

It is always a good idea to move away from assumptions when asking questions related to health or sexual activity, for example, using the term ‘sexual partner’ instead of ‘boyfriend’ or asking someone what their pronouns are. These are small changes which feel a lot easier and automatic with a little practice, but can make the world of difference in making people of all genders and sexualities feel safe and respected.

9. Step by Step We often get asked about what actually happens when one goes into the pharmacy and asks for emergency contraception – will they be taken into a private room? What questions will they have to answer? Do they have to go in themselves for it? What if the pharmacist tells everyone? To minimise these worries and encourage young people to come in, it could be a good idea to have a step-bystep description of what happens in your pharmacy on your website, making sure to mention if your pharmacy offers a click and collect service. This way, folks know what to expect and may hopefully realise that it is not that scary, really!

10. Sussing Out Side Effects We have certainly heard a horror story here and there among young people regarding supposedly dreadful side effects of taking emergency contraception. It is often not known that some people may get no side effects, while some may experience significant side effects. It is good to inform young people of what to look out for, and remind them that if

28 | PHARMACYNEWSIRELAND.COM

they do experience vomiting or diarrhoea as a side effect, the pill may not work.

We are always encouraging young people to track their menstrual cycles, so it is also important to highlight that emergency contraception can affect this.

Menstrual cycles can be so irregular and unpredictable during adolescence even without any interference from emergency contraception, and pregnancy can often go unnoticed for this reason.

11. Touching on Testing It is very important that anyone accessing emergency contraception knows that unprotected sex can lead to STI’s as well as pregnancy. Although we work actively to break down stigma around STI’s by reminding people that anyone can get an STI and that they are all treatable and most are curable, it is still important that regular STI testing is encouraged. Having details of local STI testing facilities is useful, as well as information on PrEP and PEP.

12. The Pill Police Young people are very often stressed about admitting that they have had sex under the age of 17 (sexual consent), and may also be worried about trying to access the pill if they are under the age of 16 (medical consent). Some believe that a pharmacist may inform their parents, or that they may even get in trouble with the Gardaí.

Overall, the young people we meet often find the thought of going into a pharmacy and asking for emergency contraception daunting and scary. They worry that they will get in trouble, that their confidentiality will be broken or that they will not be given the pill. We always advise young people not to give up, and to go to another pharmacy if they can or ask the first pharmacy to point them in the right direction. We remind them that they have nothing to be ashamed of, that they deserve to have control over their health and body, and that they should be supported and given the care they need in order to prevent pregnancy.

We assure young people that it is up to the pharmacist to consider the age and circumstances of the young person and decide if they need to be referred on to a medical practitioner, other healthcare professional or another agency or authority, in order to help or protect the young person.

We also inform young people that they should be referred to another healthcare professional, service, or organisation if a pharmacist decides not to provide emergency contraception. The worst thing that can happen is that a young person is refused emergency contraception and they walk out the door with no intention of looking for further care or support. It is essential that we facilitate compassionate, shame-free, non-judgemental discussions and provide relevant information whenever the opportunity arises.

FOR HEALTHCARE PROFESSIONAL USE ONLY

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1. Billeaud C et al. Gastric emptying in infants with or without gastro-oesophageal reflux according to the type of milk. Eur J Clin Nutr 1990; 44: 577–583. 2. Chao et al. Therapeutic effect of Novalac-IT in infants with constipation. Nutrition 2007;23:469–473. 3. Infante et al. Modification of stool’s water content in constipated infants: management with an adapted infant formula. Nutrition Journal 2011; 10:55-8. 4. Benninga MA; MENA Infant Constipation Study Group, Vandenplas Y. The Magnesium-Rich Formula for Functional Constipation in Infants: a Randomized Comparator-Controlled Study. Pediatric Gastroenterology Hepatology and Nutrition 2019 May;22(3):270-281. 5. Kanabar D et al. Improvement of symptoms in infant colic following reduction of lactose load with lactase. J Hum Nutr Dietet 2001; 14: 359-363. 6. Moro G, et al. Dosage-related bifidogenic effects of galacto- and fructooligosaccharides in formula-fed term infants. J Pediatr Gastroenterol Nutr. 2002 Mar;34(3):291-5.

IMPORTANT NOTICE:

The World Health Organisation (WHO) has recommended that pregnant women and new mothers be informed on the benefits and superiority of breastfeeding – in particular the fact that it provides the best nutrition and protection from illness for babies. Mothers should be given guidance on the preparation for, and maintenance of, lactation, with special emphasis on the importance of a well-balanced diet both during pregnancy and after delivery. Unnecessary introduction of partial bottle-feeding or other foods and drinks should be discouraged since it will have a negative effect on breastfeeding. Similarly, mothers should be warned of the difficulty of reversing a decision not to breastfeed. Before advising a mother to use an infant formula, she should be advised of the social and financial implications of her decision: for example, if a baby is exclusively bottle-fed, more than one can (400 g) per week will be needed, so the family circumstances and costs should be kept in mind. Mothers should be reminded that breast milk is not only the best, but also the most economical food for babies. If a decision to use a formula is taken, it is important to give instructions on correct preparation methods, emphasising that unboiled water, unsterilised bottles or incorrect dilution can all lead to illness. This product must be used under medical supervision. SMA® Comfort is a special formula intended for the dietary management of bottle-fed babies with colic and constipation. It is suitable as the sole source of nutrition up to 6 months of age, and in conjunction with solid food up to 12 months of age.

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30

Contraception

Ireland should follow UK on Contraceptives - say Pharmacists The Irish Pharmacy Union has reiterated its call for women to be allowed access to contraception directly from pharmacies, without prescription and free of charge. a working group in 2019 to consider the policy, regulatory and legislative issues relating to enhanced access to contraception, following the recommendations of the Joint Committee on the Eighth Amendment.

“As of this week, two specific progesterone-based oral contraceptives are available over the counter in UK pharmacies without prescription. Women in Ireland should also be allowed similarly convenient access to oral contraceptives through their pharmacist ,” said Kathy Maher, a community pharmacist and pastPresident of the IPU. “The 2020 Programme for Government commits to the establishment of free contraceptive care, starting with women and girls aged between 17 and 25. Prior to this, the former Minister for Health, Simon Harris TD established

“While stating that contraceptive usage is generally high and stable, the working group cited lack of local access, cost, inconvenience, lack of knowledge, and embarrassment among younger women, as the main obstacles to accessing contraception in Ireland, among other factors. We look forward to the work of the Contraception Implementation Group being progressed as rapidly as possible.

“Improving access to regular birth control means that more women will avail of it and this in turn will reduce the incidence of unintended or crisis pregnancy. These acknowledged issues that the UK scheme has sought to address are also a concern in Ireland.”

In its 2019 submission to the Department of Health on the subject, the IPU pointed to

HSE research that almost half of women in Ireland would prefer to access contraception through their pharmacy.

“Irish pharmacists have been trusted to supply free emergency contraception without prescription since 2011, and this service has been funded for medical card holders since 2017. Pharmacists would undergo appropriate training and would provide information in respect of the contraceptive being dispensed.

“Oral contraceptives are among the safest and most studied medicines available and there is no clinical reason why they should universally require a prescription. In the UK, two types of progesterone contraceptives have been approved for pharmacy dispensing, to include a brief consultation with the pharmacist, and these are known to have high levels of efficacy and a strong safety profile.

“There is no clinical reason why oral contraceptives should still require a prescription. The oral contraceptive is one of the

safest and most well studied medicines available. The supply of hormonal contraception directly from a pharmacy, under protocol without prescription, is becoming increasingly accepted worldwide.

In Ireland, we have a de facto version of this service when a woman uses an online doctor to get a prescription, as the clinical blood pressure and BMI checks are carried out by the pharmacy.

Public opinion research carried out by Behaviour & Attitudes consistently shows that the public overwhelmingly wants a greater range of medicines made available without prescription.

“Both the American Academy of Family Physicians and the American College of Obstetricians and Gynecologists support access to contraception without prescription, and it has become widely available across the USA and Canada. The World Health Organisation also recommends this in its guidelines on contraception, so we need to move forward positively with this very meaningful development which will be of most benefit to women,” Ms Maher concluded.

ellaOne looks to #ShareTheFacts This year, emergency contraception brand ellaOne has been exploring young Irish women’s attitudes towards sex, relationships and managing their sexual health. A survey of 2000 Irish women aged 1834 was conducted as part of the brand’s Share the Facts campaign, designed to help encourage factual conversation around the morning after pill.

The research showed that some confusion exists around how the morning after pill works with 28% of those surveyed correctly answering that it delays ovulation, meaning the educational role of the pharmacist as a first port of call for women remains as important as ever. Unfortunately, there is still some stigma around the topic.

When asked why they had not taken the morning after pill, despite a potential need, 24% of younger women surveyed aged 18-24 said they were too embarrassed to go to a pharmacy while 11% of this age group said they didn’t want to admit to having unprotected sex during a pandemic to a pharmacist.

As accessible health care professionals, pharmacists are uniquely positioned to provide non-judgemental advice and

PHARMACYNEWSIRELAND.COM

support to women seeking information about emergency contraceptives. Understanding that for some women, this sense of embarrassment exists, is a great start. ellaOne is an emergency contraceptive pill that is available from pharmacies without a prescription. No other morning after pill is more effective at preventing pregnancy after unprotected sex. ellaOne consists of one filmcoated tablet which should be taken as soon as possible, but no later than 5 days (120 hours) after unprotected sex or contraceptive failure. Each film-coated tablet of ellaOne contains 30 mg ulipristal acetate. Always read the label.

For more information see www.ellaOne.ie

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MAI Advocating for Better Access to Care and Medication in Ireland

O

ne of The Migraine Association of Ireland’s goals at the start of 2021 was to open the discussion for better ‘Access to Care’ in Ireland for those living with migraine in conjunction with the European Migraine and Headache Association (EMHA).

Unfortunately, Ireland lags way behind in the medication approval process as well as the market availability compared to our neighbouring countries in the UK and Europe. We strongly believe migraine patients in Ireland should have the same medications available to them as other countries across the pond do, and that the standard wait time for medications to be approved should be reduced significantly.

MAI’s Board Member, Jeff Smith M.D. delved into this in detail at the EMHA 2021 #TogetherTalks on the 16th of June where he showed the staggering difference compared to other countries and what we could do as a nation to

improve wait times. This event came off the back of the EMHA ‘Access to Care’ global survey which ran over a 6-week period asking participants to take part to tell them ‘How they felt the access to care and cost of care was in their country’.

Following on from this The Migraine Association of Ireland created a survey to ask migraine patients multiple questions on ‘How they viewed the access to care and medication in Ireland’.

A total of 83 participants took part in the MAI survey. We asked 7 questions in total around access to care, treatments and medications available in Ireland compared to other countries. Questions were targeted at those suffering from episodic and chronic migraine. We also wanted to gain feedback from migraine sufferers, therefore, we left some questions open to comment, while also having scored questions to gain a consensus to how those living with migraine feel about

32 | PHARMACYNEWSIRELAND.COM

Written by Hazel Breen, Communications and Information Officer, Migraine Association of Ireland

access to care in Ireland overall. The results are as follows…

- 44% stated they have episodic migraine, 56% suffer with chronic migraine.

- When asked how you would rate treatment options available in Ireland (1 being the lowest, 10 being the highest), most participants scored 5.

The second highest score was 1, the remaining high scores all fell under 5 showing a lack of satisfaction overall.

- When asked how you would rate medication options available in Ireland, most participants scored 5. The second

score was 1, the remaining high scores were all feel under 5 showing a lack of satisfaction overall.

highest scores were 3 and 4. Again, most of the high scores were on the lower side of the scale.

QUESTION 2 Results

12

- When asked how you would rate treatment options for migraine in Ireland compared to other countries, most participants scored 5. Second to that high score was 2.

10 8

- When asked do you think Ireland is far behind other countries in relation to treatment/medication for migraine, 82% said yes.

- When asked what needs to happen to improve treatment options in Ireland, we had an array of responses suggesting better access to care, treatments, and medication options.

Multiple participants stated they had to travel the UK for treatment, more access to Anti-CGRP drugs, more regular clinic times, more access to medications overall as it can be trial and error for those living with migraine to see what works for them and more access to devices to name a few.

- Lastly, we asked if there were any further comments our participants may like to add. Most said there needs to more awareness around how debilitating migraine is, GPs should be further educated in this area, chronic migraine should be put on the disability list and to quote one participant, “I honestly feel Ireland is way behind the rest of the western world in the acknowledgement and treatments available for migraine sufferers.

The conclusion from this survey is most participants view Ireland’s access to care for migraine as lacking in much needed resources, medical professionals specialising in migraine, GPs with a full

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When asked how you would rate medication options available in Ireland, most

understanding migraine, facilities #TogetherTalks online webinar participantsofscored 5. The second highest the scores were 3 and 4.

Again, most ofonthe ‘Better Access to Care’. As mentioned nationwide andwere options as side well of the scale. high scores on for thekids lower previously, Jeff Smith M.D. spoke at this as addition, most feel waiting - adults.

When In asked how you would rate treatment options for migraine in Ireland event after his in-depth research into lists are too long, and this has a huge compared to other countries, most participants scored 5. Second to that high Irelands access to medications process. Jeff impact on their life overall. The word score was 2. is a physician by training and has worked ‘MORE’ was used in nearly every answer - When asked do you think Ireland is far behind countries incompanies relation tofor the last for other pharmaceutical which further proves that migraineurs treatment/medication for migraine, 82% said yes. thirty years, most recently with Alder in Ireland feel they do not have enough Biopharmaceuticals whoin have developed - When asked what needs happen to improve treatment options Ireland, we options when it comes to caretoand oneaccess of theto anti-CGRP medications. had an array of the responses care, treatments, and The medication to have quality suggesting of life they better company was recently taken by deserve.

The consensus that Ireland is medication options.isMultiple participants stated they had to travel the over UK for Lundbeck which led to Jeff’s retirement significantly behind other countries in treatment, more access to Anti-CGRP drugs, more regular clinic times, more from the company, and he is now a Board relation to to treatment options and access to be trial access medications overall as it can and error for those living with member of MAI. The talk was moderated medication for Migraine. migraine to see what works for them and by more access to devicesMAI to name a few.

Sadhbh Armstrong, Regional - isLastly, wenote asked there comments ourOfficer. participants may like to It vital to thatif we hadwere a lotany of further Development add. Most saidfrom thereparticipants needs to more awareness around how debilitating migraine positive feedback about Jeff wasted nomigraine time in stating migraine and in this area, is, GPsclinics, shouldspecialists, be further GPs, educated chronic shouldthe be facts put on and gave a highly engaging presentation pharmacists in Ireland stating thatone they the disability list and to quote participant, “I honestly feel Ireland is way covering all areas taking Ireland v-s felt behind supported learned so world much in the theand resthave of the western acknowledgement treatments Belgium for example.and In Ireland, the actual fromavailable them onfor how to try to manage migraine sufferers. medication approval process takes just their migraine. under 550 days, whereas Belgium’s actual TheAfter conclusion fromwere this in survey is most participants view Ireland’s access to care the results for both surveys medication approval process takesfor just the EMHA in conjunction with MAI held over 200 days from start to finish. in migraine as lacking in much needed resources, medical professionals specialising

migraine, GPs with a full understanding of migraine, facilities nationwide and options for kids as well as adults. In addition, most feel waiting lists are too long, and this has a huge impact on their life overall. The word ‘MORE’ was used in nearly every answer

IQVIA - Median Time to Availability 2015-2018

Germany Switzerland Denmark Netherlands Sweden Finland Austria England Turkey Belgium Spain Scotland Italy Iceland Greece Croatia Slovenia Norway Albania Hungary Latvia Ireland France Estonia Slovakia Bulgaria Czech Macedonia Bosnia Portugal Serbia Poland Romania Lithuania

1000 900 800 700 600 500 400 300 200 100 0

The current drugs available for migraine in Ireland are:

PHARMACYNEWSIRELAND.COM | 33

Irelands medication approval process timeframe is broken down as follows: NCPE Rapid Review and NCPE HTA takes 242 days HSE price discussions and drugs review and approval takes 307 days Totalling 549 days Belgium’s medication approval process timeframe is broken down as follows: INAMI-RIZIV Assessment, CRM/CTG Assessment, Minister Recommendation and Post-minister Recommendation takes 210 days in total.

Granted, this is an example of a highly efficient approval process in Belgium’s case, but Ireland falls way behind most EU countries in the approval process. In an IQVIA study on the ‘Median time to availability 2015-2018’ which included the UK at the time, Ireland is as low as 13 on the list of the number of days for medication approval. See the graph on previous page.

The current drugs available for migraine in Ireland are: Acute Treatment – Triptans, Analgesics (e.g., Aspirin, Paracetamol, Non-steroid anti-inflammatory drugs (e.g., ibuprofen) Prevention of migraine – Beta blockers (e.g., Propranolol), Anti-depressants (e.g., Amitriptyline), Anti-epileptics (e.g., topiramate), Calcium channel blockers (e.g., nicardipine), Serotonin reuptake inhibitors (e.g., fluoxetine), Botulinum toxin.

Anti-CGRPs and other drugs waiting for approval and to be made available in Ireland are: Erenumab – By Novartis Fremanezumab (Ajovy) – By Teva Galcanezumab – By Eli Lilly Eptinezumab – By Lundbeck Gepants and Ditans What is CGRP and what does it do?

(CGRP-R), or binding to the substance (CGRP) and not allowing it to reach the nerve. For more information see Prof. Peter Goadsbys Interview from the European Academy of Neurology Congress 2016 on our website www.migraine.ie

NCPE Verdict:

Several pharmaceutical companies are involved in the manufacture of anti-CGRP and other drugs. The main ones are Amgen/Novartis Inc, Teva, Eli Lilly, Lundbeck, Allergan and Biohaven Pharmaceuticals.

Eptinezumab (Yvepti) by Lundbeck has yet to be submitted to the NCPE for evaluation and authorisation.

Erenumab – By Novartis The Marketing Authorisation was granted in Ireland in the Summer 2018 and Novartis is currently awaiting the results of the Health Technology Assessment for the Irish licensing application.

The Migraine Association wrote the supporting patient organisation document as part of this process.

Current Access: Erenumab was available on a managed access programme, but this was closed to new patients in June 2019.

NCPE Verdict:

Gepants are ‘cousins’ of Erenumab, Fremanezumab, etc., they are small molecule drugs which block the CGRP receptor and are effective at relieving migraine. They are currently only available in the US and as acute treatments. Gepants rapidly penetrate the brain so work quickly. Studies on the preventative properties of Gepants are ongoing.

The FDA in the US has authorised two Gepants, but they have not arrived in Ireland yet. These are: • Utopgepant (Ubrelvy) • Rimegepant (Nurtec ODT)

Teva is also awaiting the results of the Health Technology Assessment for the Irish licensing application. The Migraine Association wrote the supporting patient organisation document as part of this process also.

For further information and updates on the latest information on the availability of the new Anti-CGRP medications in Ireland keep an eye on our website.

For general updates you can go to https://www.cgrpforum.org/.

Current Access:

While we understand that many other factors come into play when it comes to medication approvals and better access to care, it is simply not acceptable for Ireland to be so far behind neighbouring countries and to not have the same options available to those suffering with migraine.

Currently there is no law for medication approval in Ireland, whereas in the UK if a medication is not approved by the said deadline, the parties are held accountable and fined. This type of process helps push approval along faster for obvious reasons.

• CGRP dilates blood vessels.

NCPE Verdict:

• Degrades mast cells (cells which control inflammation during allergic reactions)

The NCPE has recommended Fremanezumab for both Episodic and Chronic Migraine – we are still awaiting the HSE verdict.

There are 2 main approaches for targeting CGRP in migraine: large molecule monoclonal antibodies given by injection to prevent attacks and small molecule absorbable tablets for acute and possibly preventative treatment. Medications act by either blocking a receptor called the calcitonin gene-related peptide receptor

Gepants and Ditans

Teva’s version of anti-CGRP medication, Fremanezumab (Ajovy) became available on a ‘Free of Charge’ or ‘Compassionate Grounds’ programme, which is like the managed access programme, from July 2019. New patients can only access Fremanezumab through their Neurologists.

Fremanezumab (Ajovy) – By Teva

• It spikes during migraine.

• Creates an inflammatory fluid in the blood vessels.

Eptinezumab – By Lundbeck

Lasmiditan (Reyvow) by Eli Lilly, is not an anti-CGRP medication but the first of a new group of headache medicines that are called a “Ditan”. It is an Antagonist at the 5-HT 1F serotonin receptor, whereas Triptans work on the 5-HT 1B and 5-HT 1D receptors. Like a Triptan, Lasmiditan can stop a migraine when taken at the appropriate time, but unlike a Triptan, it is thought to decrease stimulation of the trigeminal system and treat migraine pain without causing vasoconstriction so may be helpful for people for whom Triptans are contraindicated due to cardiovascular problems. Lasmiditan is not available in Ireland yet.

The National Centre for Pharmacoeconomics (NCPE) has recommended Erenumab for chronic migraine only – we are still awaiting the HSE verdict.

Patients can only access Fremanezumab through their Neurologist as explained above, after having failed three or more preventative medications. Other criteria may also apply.

• It is a substance that is released in the trigeminal nerve.

They are currently awaiting submissions of HTAs which will be looking at the efficacy of the medication and cost effectiveness against current treatments.

Galcanezumab – By Eli Lilly Eli Lilly’s Galcanezumab is next, but we have no news as to its availability yet.

Galcanezumab has been granted FDA approval in the US to treat episodic Cluster Headache in adults. So far it is the only one of the new treatments to be approved for Cluster Headache.

34 | PHARMACYNEWSIRELAND.COM

The Migraine Association of Ireland would like to see a positive change in the process overall that will reduce the timeframe for medication approval and availability in Ireland significantly and in turn help those living with migraine have a better quality of life.

For more information, visit migraine.ie

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BUCCOLAM is indicated the treatment ofacute, prolonged, acute, inconvulsive seizures infants, toddlers, adolescents (from 3 months to <18 years).

BUCCOLAM® must only be used by parents/carers where the patient has been diagnosed to have epilepsy. For infants between 3–6 months of age, treatment should be in a hospital setting where BUCCOLAM (R) must only be used by parents/carers where the patient has been diagnosed to have epilepsy. For infants between 3-6 months of age, treatment should be in a hospital setting where monitoring is monitoring is possible and resuscitation equipment is available. 1 Please consult the Buccolam® Summary of Product Characteristics (SmPC) before prescribing. ® possible and resuscitation equipment is available. . Summary of Product Characteristics.

References: 1. Buccolam Further prescribing information is available on request from Neuraxpharm or the Summary of Product Characteristics - eMail: medinfo@neuraxpharm.com or Tel.: +353 (1) 4688 202 Marketing Authorisation Holder: Laboratories Lesvi S.L. Avinguda Joan Despi, 08970 Barcelona, Spain. Marketing Authorisation Number: EU/1/11/709/001-004 Legal Classification: POM CD. Pricing Information: POA Adverse events should be reported to: medinfo@Neuraxpharm.com - Tel: +353 (1) 4688202 or the Health Products Regulatory Authority - www.hpra.ie – e: medsafety@hpra.ie Tel +353 (1) 676 4971 Fax: +353 1 6767836 ®

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Neuraxpharm is delighted to commence operations in Ireland Many of us will suffer mental or neurological disorders at some point in our lives.

The wellbeing of those suffering from these disorders is at the heart of what we do. This is why we investigate and develop new solutions.

Our commitment has led us to become a European leader in developing medicines for Central Nervous System disorders. We strive to support our • ONE-A-DAY doctors, pharmacists, nurses and the families affected.

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News

Sunlight and Diet Key Factors for Eye Health A new study reports on sunlight and nutrition as being key contributors to eye health.

This research was published by a team led by Dr Marina Green from The Nutrition Research Centre Ireland in Waterford Institute of Technology.

It is the first study of its kind to describe macular pigment and its determinants for the Mexican population. Additionally, this research investigated the impact of environmental and nutritional factors on macular pigment.

The level of macular pigment present in the human eye enhances visual function in a variety of ways. Low levels of macular pigment have been proposed to be a risk factor for Age-related Macular Degeneration,

Professor John Nolan and Dr Marina Green, The Nutrition Research Centre Ireland, Waterford Institute of Technology

A review by RCSI University of Medicine and Health Sciences in collaboration with the HSE National Quality Improvement Team has found that quality improvement (QI) studies in Ireland over a five-year period conformed to high reporting standards and enhanced multiple elements of healthcare quality.

the leading cause of significant vision loss usually found in those over the age of 55. Macular pigment also absorbs harmful blue light, protecting the retina from damage.

The review showed an increasing trend in the frequency of publication of QI studies in Ireland, with 43 studies published during the period 2015–2020.

Dr Green’s study has discovered that those with high sunlight exposure during the day have significantly higher Macular Pigment. Interestingly, macular pigment and serum concentrations of the carotenoids lutein and zeaxanthin were significantly higher in the Mexican study sample compared with an Irish sample, but this difference was not reflected when the dietary analysis was carried out. This finding sheds light on the importance of nutrition and dietary patterns on macular pigment, and consequently, on eye health.

Key findings from the review showed that most QI studies were conducted in hospitals and aimed to improve the effectiveness (65%), efficiency (53%), timeliness (47%) and safety (44%) of care. Fewer aimed to improve patientcentredness (30%), value for money (23%) or staff well-being (9%).

Pharmed Present Macu-Save® As we grow older our eye health comes under increasing pressure and in particular the macula.

Macular health is an increasing concern as AMD is the No.1 cause of sight loss in Ireland over 50’s.

The macula pigment comprises of three carotenoids: Lutein, MesoZeaxanthin and Zeaxanthin. The body does not produce Lutein and Zeaxanthin. The macular pigment can therefore become severely depleted in those with a poor diet lacking in the right foods. Hence, why it could be advantageous to use supplementations such as MACU-SAVE®.

• MACU-SAVE® offers the highest quality grade ingredients in its products for its customers.

• It is suitable for diabetics, gluten free, yeast free, lactose free and contains no artificial preservatives or sweeteners.

• All of the three macular carotenoids in MACU-SAVE® are of the highest quality grade and

The review found that costs and healthcare outcomes were understudied and require increased attention to support better decision-making about resource allocation in healthcare. No study aimed to increase equity.

Dr Siobhán McCarthy, the study's first author and lecturer at the RCSI Graduate School of Healthcare Management, commented, "The review has, for the first time, profiled the characteristics of QI studies published in Ireland. It is encouraging to see that the studies meet high reporting standards with a focus on internationally recognised elements of healthcare quality.

“It is also pertinent that the review findings align with current international discussion about the need to promote equity-focused quality improvement work.

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"It is becoming increasingly acceptable to discuss costs in healthcare and the review points to an existing awareness of costs among QI practitioners in Ireland. Approximately half of studies discussed costs but did not quantify these sufficiently, highlighting the need to provide greater guidance to QI practitioners on performing cost analysis in healthcare. With appropriate educational guidance and resources, this awareness can be fine-tuned to support informative QI cost analyses."

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Hypothyroidism: What it looks like and Treatment Options

H

ypothyroidism in the general population is suspected to range anywhere from 10-15%.

For this reason it is vital that we understand and utilise every strategy at our disposal to ensure proper medical management of this condition. The most common form of hypothyroidism is Hashimoto’s thyroiditis, making up over 90% of all hypothyroid cases not just in Ireland but worldwide. Being so prevalent in society means you’ll be dispensing medication or fielding questions about the medications the person is taking.

Those who suffer from hypothyroidism have exceedingly varied degrees of symptoms. This in of itself, isn’t a particular problem for clinicians to identify and treat as we have long known the collective symptoms that make up the hypothyroid condition. Classic symptoms are usually hair loss, fatigue, constipation, ‘brain fog’, and weight gain, among many more less common symptoms.

established as the gold standard in medical management.

Even with the introduction and extensive use of levothyroxine there still remain a sizeable population that do not seem to respond to the conventional therapy.

As anecdotal evidence, in my practice I have been witnessing a very high rate of poor symptom response to just levothyroxine treatment only. These patient’s usually exhibit the worst of the hypothyroid symptoms: - Excessive, almost crushing, fatigue - Crippling brain fog - Severe constipation - Systemic joint or muscle pains that incapacitate them - Unrelenting weight gain - Debilitating anxiety/panic attacks

The tricky thing about hypothyroidism is the treatment itself, which is not always a straight line to improvement.

- Infertility or recurrent miscarriages

At present the accepted and only mainstream management for hypothyroidism, regardless of its origins, is the use of levothyroxine. This monotherapy has been the mainstay approach of the modern medical world since its commercial release of levothyroxine in the 1950s.

In my search for an answer I came upon the earliest treatment method of the hypothyroidism which was NDT. Nowadays NDTs are better regulated and much more consistent, compared to its earlier counterparts however there are still issues with production that make it less than ideal for a lot of patients.

Anecdotally, only a very small portion of my patients respond favourably to this form of monotherapy.

At the time of its introduction, it made treatment of hypothyroid symptoms much more reliable and safe compared to the previous method of using natural desiccated thyroid (NDT) medication. NDTs contain a large dose of T4, some T3, and a small amount of T2, T1, and calcitonin. As technology and standards improved so did the reliability of NDT medications but by that time, levothyroxine had been firmly

Written by Dr. Shandeep Momi, MRCGP Founder of Functional Thyroid Care www.functionalthyroidcare.com Facebook: @functionalthyroidcare Instagram: @functionalthyroidcare

- Among other symptoms

For those patients that do not respond well to just levothyroxine or NDT alone, the addition of liothyronine is a game changer. When given with levothyroxine, my patients almost universally reported an improvement in all observable metrics.

The degree of improvement is dose dependent and also relies heavily on

38 | PHARMACYNEWSIRELAND.COM

improving the supporting systems of the thyroid. Once those supporting systems are improved, the patient usually notices a subtle, yet sustained, improvement in their symptoms.

One of the most effective ways of getting good relief from patients taking both levothyroxine and liothyronine is multidosing. While levothyroxine is designed to be taken once daily, due to longer half-life, liothyronine should ideally be given in multiple doses, specifically because of its much shorter half life. Most patients need to start with three times a day dosing and as their symptoms stabilise, are able to take it twice a day.

With the dissemination of medical knowledge through the internet, more and more patients are taking their health into their own hands and are looking for answers. As a result many patients are self medicating and self treating with over the counter thyroid preparations from foreign countries. To keep thyroid management safe and effective for our patients, GPs, Endocrinologists, and pharmacists should be looking at all these treatment options and tailoring them to the patient’s needs.

I hope that this provides some insight into where and how the alternative treatments for hypothyroidism can be utilised and when.

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Supporting a Healthy Heart in Pharmacy

Written by Gillian Hogan, Irish Heart Foundation

What is an AED? An AED is an Automated External Defibrillator. It is a portable, simple to use, computerised device. When someone suffers a sudden cardiac arrest, it checks the heart’s rhythm and automatically recognises if there is a life-threatening rhythm. Once detected the AED then delivers a shock to stun the heart and help it return to its normal rhythm.

“As the public often run to them in times of emergencies, pharmacies are optimal locations to keep AEDs”

T

he sudden collapse of Danish footballer Christian Eriksen due to a cardiac arrest during the first half of Denmark’s opening Euro 2020 match against Finland shocked viewers around the world.

The quick action of Eriksen’s team mates and officials to save his life has highlighted the need for bystanders to react with speed to a cardiac arrest.

When somebody suffers a cardiac arrest, without CPR or a defibrillator (AED) their chances of survival decrease by 10% every minute.

Because of the quick actions by those around him, Christian Eriksen thankfully survived.

Eriksen was also fortunate that the event happened in such a public place with people on hand to immediately begin CPR and use an AED. However, we know that 70% of cardiac arrests happen in the home, so it is vital that people understand what to do in that situation.

As the public often run to them in times of emergencies, pharmacies are optimal locations to keep AEDs. There are a number of things to keep in mind before buying an AED including accessibility, durability, how easy it is to use, the cost, shelf life and whether or not warranty or backup is provided by the manufacturer.

It is important that the AED is located in a central location, that bystanders are aware of its location, that it is accessible at all times and easy to access. AEDs should be regularly checked to ensure they work and the battery and pads are within date.

After being treated on the pitch with CPR and a defibrillator, Eriksen regained consciousness and was hospitalised. He has since been fitted with an ICD. What is an ICD? An ICD or Implantable Cardioverter Defibrillator is a battery-powered device that is placed inside your chest cavity under your skin near your shoulder. It continuously monitors your heart rhythm.

It can either act as a pacemaker detecting when the heartbeat is too slow and sends tiny electrical signals to your heart, or if your heart beat it too fast or chaotic, it emits shocks to bring the heart back into normal rhythm. People generally have ICDs implanted because their heart has been damaged by a heart attack or because they have a heart condition, often inherited, that puts them at risk of developing arrhythmias.

Prevention Heart disease and stroke is still one of the leading causes of death in Ireland. A total of 8,744 lives were lost to heart disease and stroke last year, according to the latest figures from the Central Statistics Office.

40 | PHARMACYNEWSIRELAND.COM

The good news is that 80 per cent of death and disability from heart disease and stroke is preventable.

One of the best ways to prevent the risk of developing cardiovascular disease is to maintain a healthy lifestyle.

There are a number of modifiable risk factors that can influence and increase this risk and these include high cholesterol, high blood pressure, overweight, physical activity and smoking.

Cholesterol Cholesterol is a type of fat in our blood which is produced by the liver. Everyone has cholesterol and some of it comes from the food that we eat. Our bodies need a certain amount of cholesterol for normal cell function, to help digestion and produce certain hormones.

Not all cholesterol is bad. If your total cholesterol is high, it can mean that you have a lot of LDL (bad) cholesterol in your blood. Too much LDL cholesterol can be harmful because it sticks to the inside walls of your arteries. This can lead to fatty material building up – in a process called atherosclerosis. It makes it harder for blood to flow through, which can lead to a stroke or heart attack.

High cholesterol affects people of all ages. High cholesterol can be inherited but is also caused by lifestyle. People with high cholesterol often have no noticeable symptoms. The only way to know if you have high cholesterol is to go to your doctor and have a blood test.

Your cholesterol can become raised for a number of reasons, including a strong family history, low physical activity, a diet high in saturated fat, smoking and having overweight or obesity.

There are treatments available to patients with high cholesterol if needed. For example, medication may be prescribed to keep levels of LDL cholesterol under control.

Making small changes now can make a big difference to patients’ lives now and in the future.

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Physical activity and smoking cessation Getting regular physical activity is one of the best things you can do to improve your overall health. It is recommended that adults should be active at a moderate intensity, for at least 30 minutes a day, five days a week.

Smoking is a major risk factor for cardiovascular disease, including heart attack and stroke. One in every two smokers will die of a tobacco-related disease.

Blood Pressure Over half of all adults in Ireland over 45 years of age have high blood pressure (or hypertension). The risk factors associated with high blood pressure can be avoided if your blood pressure is controlled.

However, about four in every five men and two-thirds of women with high blood pressure are not being treated.

High blood pressure usually has no symptoms. The only way to find out if you have high blood pressure is to have it measured. The normal level of blood pressure is usually about 120 (systolic) over 80 (diastolic). If your blood pressure is 140 over 90 or higher (or 140 over 80 if you have diabetes) you should discuss this reading with your doctor.

The only way to look after and to know if you have high blood pressure is to have it measured. It is recommended that people aged over 30 have their blood pressure checked every year. If your blood pressure is borderline high (around 140 over 90), you’ll need to get it checked more often by a doctor or nurse.

Pharmacists are very well placed to detect high blood pressure and many pharmacies offer blood pressure checks with some doing 24-hour blood pressure monitoring.

A 2018 study by the Irish Pharmacy Union revealed that one in four people who had their blood pressure checked at their local pharmacy as part of a new study were identified as having high blood pressure.

According to the findings of the pilot study which aimed to detect people at risk of hypertension and atrial fibrillation in the community, 5.5% were found to have an irregular pulse and two per cent showed signs of both.

Furthermore 26% were referred to their GP because of their check and four per cent of those were started on medication.

Once you stop smoking, your mental and physical health improves immediately.

After one year, your risk of having a heart attack is cut to half that of a smoker.

Pharmacists around the country are also very well placed to support people to stop smoking by offer smoking cessation services and supports.

Supports and Services At the Irish Heart Foundation, we have supported people living with cardiovascular disease for more than 50 years and we have developed a range of new services to support people living with cardiovascular disease through the Covid-19 pandemic and beyond.

We run 31 support groups around the country which prior to the outbreak of Covid-19 met regularly in person.

Since the pandemic, this network has transitioned to online and telephone support, making them even more accessible.

The Heart Support Network, Life After Stroke and The Irish Heart Foundation’s Carers’ group are all private Facebook groups we run by to give patients access to expert information and allow them to share thoughts and concerns with similarly affected people. All groups include home-based exercise videos, advice from nurses, tips on diet and peerto-peer support which is vital at this time.

New members are always welcome in all groups and are easy to join. Please email Tracy on tegan@irishheart.ie or call 01 6685001.

Heart Failure supports Approximately 90,000 people in Ireland are living with heart failure, many of whom were cocooning during the pandemic. We established a suite of new support services for people with heart failure to help keep them well and alleviate their sense of isolation and loneliness.

The supports, which include a podcast series, nurse support line, private

42 | PHARMACYNEWSIRELAND.COM

Facebook support page, online meetings, daily online exercise classes and peerto-peer support are all designed to help patients and their families to keep both physically and mentally well while staying at home.

People can sign up to receive the supports on irishheart.ie or for queries please phone 01 668 5001 or email heartfailure@irishheart.ie.

Stroke Support It’s estimated that around 7,500 people are hospitalised after a stroke in Ireland each year – the equivalent of 21 strokes a day nationwide – and the majority of people will be discharged home after spending an average of around two weeks in hospital.

Returning home after stroke is difficult at any time, but never more so than during the Covid-19 pandemic. So, stroke patients being discharged from hospital needed extensive extra support.

To meet this need, in conjunction with the HSE National Stroke Programme, we launched a new telephone support service for stroke patients post-discharge.

There are also a number of stroke patients who may need ongoing support in their recovery irrespective of whether they are newly discharged or not. Therefore, the service is open to anyone post-stroke regardless of where they are in their recovery journey.

The phone service involves trained and experienced Irish Heart Foundation staff and volunteers making regular calls to stroke survivors who have been referred by acute hospital stroke teams to check on their health and wellbeing.

The service provides any information or advice patients require, answers their questions about recovery from stroke, and helps ensure they have everything they need to keep safe.

For more information on the stroke support service please call 01 6685001 or email support@irishheart.ie Monday to Friday 9 am to 1 pm.

The Irish Heart Foundation also offers a free nurse support line with trained nurses available on phone and email support Monday to Friday 9 am to 1 pm.

Anyone living with heart disease and stroke who has concerns or questions can contact the nurse support line on 01 668 5001 or support@irishheart.ie.

For more information on heart health or ways to get support please see www.irishheart.ie

BE PREPARED WHEN SEIZURES STRIKE BUCCOLAM (R) is indicated for the for treatment of prolonged, convulsive seizures infants, toddlers, childreninand adolescents (from 3 children months to and <18 years).

BUCCOLAM is indicated the treatment ofacute, prolonged, acute, inconvulsive seizures infants, toddlers, adolescents (from 3 months to <18 years).

BUCCOLAM® must only be used by parents/carers where the patient has been diagnosed to have epilepsy. For infants between 3–6 months of age, treatment should be in a hospital setting where BUCCOLAM (R) must only be used by parents/carers where the patient has been diagnosed to have epilepsy. For infants between 3-6 months of age, treatment should be in a hospital setting where monitoring is monitoring is possible and resuscitation equipment is available. 1 Please consult the Buccolam® Summary of Product Characteristics (SmPC) before prescribing. ® possible and resuscitation equipment is available.

References: 1. Buccolam . Summary of Product Characteristics.

Further prescribing information is available on request from Neuraxpharm or the Summary of Product Characteristics - eMail: medinfo@neuraxpharm.com or Tel.: +353 (1) 4688 202 Marketing Authorisation Holder: Laboratories Lesvi S.L. Avinguda Joan Despi, 08970 Barcelona, Spain. Marketing Authorisation Number: EU/1/11/709/001-004 Legal Classification: POM CD. Pricing Information: POA Adverse events should be reported to: medinfo@Neuraxpharm.com - Tel: +353 (1) 4688202 or the Health Products Regulatory Authority - www.hpra.ie – e: medsafety@hpra.ie Tel +353 (1) 676 4971 Fax: +353 1 6767836 ®

1

Neuraxpharm is delighted to commence operations in Ireland Many of us will suffer mental or neurological disorders at some point in our lives.

The wellbeing of those suffering from these disorders is at the heart of what we do. This is why we investigate and develop new solutions.

Our commitment has led us to become a European leader in developing medicines for Central Nervous System disorders. We strive to support our doctors, pharmacists, nurses and the families affected.

Now that we have located in Ireland, we look forward to working as part of the Irish Healthcare System, supporting patients and healthcare professionals in reducing the impact of Central Nervous System disorders in the lives of patients.

44

Hepatitis C

HCV: The Global Battle Against Viral Disease In 2020 the year that witnessed the most significant medical and scientific collaboration on a scale unprecedented in history, three scientists who made a pivotal contribution to the global fight against bloodborne hepatitis, Harvey J. Alter, Michael Houghton, and Charles M. Rice were jointly awarded the Nobel Prize in Physiology or Medicine 2020. Their efforts along with countless others have saved millions of lives as we continue the battle against viral diseases.

Written by Kristy Hayes, Head of Advocacy, The Hepatitis C Partnership

fallout of COVID-19 will demand greater collaboration amongst healthcare professionals and with an estimated 85M visits a year, who are better placed than Irish Pharmacists to meet these demands. The hugely successful COVID-19 vaccine programme is a testament to the potential success of this approach.

Decentralised Models of Care

This battle permeated all of our lives in 2020, in an imposing, devastating, and unpredictable manner, the fallout of which, in terms of screening and treatment across many health domains, has yet to be determined. Early indicators suggest data concerning communicable diseases, such as HIV and Syphilis, show increased prevalence.

Screening for blood-borne viruses has been greatly reduced and access to drop-in facilities remains a challenge as a result of infection control procedures.

In Ireland, an estimated 2030,000 people are infected with HCV and 60% of those may be undiagnosed. That's roughly the size of the population of Mullingar, many of whom are unaware they have the disease, which is a major cause of cirrhosis and liver cancer.

Hepatitis C is one of the leading sources of end-stage liver disease, HCC, and liver-related deaths in the western world. It is also one of the main indications for liver transplantation worldwide.

Drop-In HCV Treatments The Number of people completing treatment for Hep C in Ireland fell to 110 in the first quarter of 2021, a sizable decline from the 354 in the same period in 2019 and the 193 in 2020 (*). Just 532 people commenced treatment in 2020 compared to 1,196 in 2019. According to Professor Jack Lambert, Consultant

in Infectious Diseases and Genitourinary Medicine at Dublin’s Mater Hospital and UCD, “At the moment, we have probably had as many, if not more, new infections in the past five years as we have successfully treated,”.

The untreated spread of HCV poses a significant challenge, particularly given the impact this virus has on socio-economically disadvantaged persons including PWIDs, prisoners, migrants, and the homeless. Taking into account that the model of care in Ireland is still centralised towards hospital clinics or specialist addiction services, linkages to care for those on the periphery including some of these marginalised groups is greatly reduced.

Scale Up Screening Wider screening for at-risk groups particularly amongst certain age cohorts namely the baby boomer generation (those born between 1946 to 1964) as recommended by the CDC recommendation report in 2012, may provide an opportunity to identify hidden infections.

According to the WHO, countries that are delivering successful elimination strategies are screening widely amongst at-risk groups.

“Everyone should have a Hep C test once in their lifetime, probably during their forties, as is the case in the US, we must target other cohorts for screening,” said Professor Jack Lambert.

PHARMACYNEWSIRELAND.COM

In 2019 The National Hepatitis C Treatment Programme (NHCTP) led

by Professor Aiden McCormick, published Community Treatment Guidelines which outlined details of the programme for trained level 1 and level 2 GP’s and community pharmacists. All participating GPs must be registered to prescribe methadone, and training is coordinated by the ICGP, PCRS, and hospital pharmacists. In 2020 11 patients started treatment in a pharmacy dispensing site (National Hepatitis C Treatment Registry Monthly Report). However, burgeoning evidence about micro elimination in at-risk groups has led to discussions between the NHCTP and various pharmacists in Ireland about initiating a pilot pharmacy-led programme.

Growing evidence from Scotland, Australia, and the US suggest that pharmacists are in a unique position to increase access to care and improve health outcomes for patients with an HCV diagnosis.

Capacity building through shared care We see this working successfully for many disease areas where this sharing of strengths, skills, and resources increases equality of access to care and reduces the heavy burden on primary care services. Pharmacists have a multitude of touchpoints to support national public health agendas in an age of growing demand for healthcare. The

Initiation of this multidisciplinary approach must embrace a decentralized model of care as outlined by the WHO and The American Association for the Study of Liver Diseases (AASLAD), in terms of tackling the burden of HCV in our communities. Creating the necessary infrastructure for elimination requires crossdisciplinary approaches to increase screening, testing, and diagnosis.

Recent evidence seems to suggest a more central role of pharmacists who benefit from existing relationships with patients.

Andrew Radley, consultant in public health pharmacy at NHS Tayside in Scotland, and his team, have examined the efficacy of this pathway across 55 pharmacies involving 2718 patients who attended for OST. Staff from all sites received training on Good Clinical Practice, testing for BBVs as well as Information on Hepatitis C and its treatment. Pharmacists completed a pretreatment checklist of medical comorbidities, medical history, and concomitant medication to look for drug-drug interactions (DDIs), phlebotomy in the pharmacy determining suitability for treatment.

Simplifying and expanding access enhanced HCV testing and increased treatment uptake in this pathway and treatment success mirrored that of the conventional pathway. Treatment success more than doubled across the board and significant capacity was added to secondary care settings which were also estimated to be more cost-effective.

In discussions with Andrew Radley earlier in the year, he stressed the importance of linking pharmacists with the care network and ensuring the buy-in of all pharmacy staff as key factors in achieving micro elimination. Approaches such as these provide a great

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initiative set to launch in November this year, called Roadmap to Zero.

opportunity to deliver clinical services in line with public health, with Remuneration increasingly being based on clinic services as opposed to dispensing alone.

Web-based applications will see prescriptions dispensed online and a paradigm shift for pharmacists as key providers in the primary care network look set to prevail in the landscape. In Tayside, community pharmacists are set to join OST teams later in the year to help integrate this model of care.

The key take-home message here is related to the significance of relationships. The acknowledgment of the trusted relationship between pharmacists and their patients but also within their wider peer group.

Pharmacists taking this leap of faith were supported, mentored and teams worked with them to establish this pathway. This relational empathy was applied to health promotion and harm reduction discussions during screening and treatment.

Relationships make a difference It’s widely said that the quality of a patient's experience dictates concordance with healthcare advice. Peers, many of whom have lived experience of HCV are a key component of any successful community programme. Many of those with an HCV diagnosis are screened by peers and the trust ensuing from positive and often trauma-informed engagement leads to greater treatment success. “ I only found it I had Hep C in

2020 when I attend a Hep C session, I had a swab and I went to the hospital to give blood and they said yeah you have Hepatitis C, I reckon I had it for 30 years without knowing", said Michelle, HCV Peer with the Hepatitis C Partnership.

Michelle, like many others, was engaged in a recovery programme and had never been tested for HCV until a peer worker from the Mater Hospital delivered an HCV awareness session. Linking peers into any future HCV pharmacyled initiative across various engagement points would seem essential for success.

Making HCV a rare disease Models of care and indeed the success of our neighbours in Scotland should be considered in light of their elimination achievements. In 2020, the Tayside region encompassing about 416,090 people, became one of the first regions in the world to eliminate HCV. With a comparable population and great enthusiasm for knowledge sharing this model could see many of our barriers to engagement reduced if not eliminated.

The recently published WHO Interim Guidance for Country Validation of Viral Hepatitis Elimination, provides a global framework for the validation of elimination and overall proposes the use of absolute impact targets to validate elimination at the national level for each country.

The NHCTP is set to publish a revised and updated National Hepatitis C strategy, which is currently being reviewed by the department of health. The Hep C partnership, a national collaborative network of stakeholders working towards ensuring the elimination of Hepatitis C in Ireland, hopes to support these efforts through an

The purpose of the project is to identify the current operational Cascade of Care for Hepatitis C and to identify and progress following lines of inquiry towards the development of a Roadmap to Cure. We aim to align our objectives with those of the Pr National Treatment Program to focus on filling gaps and ensuring the implementation of the national treatment guidelines. In doing so we will deliver a document that e communicates this process as dle Abb well as highlighting best practiceMid initiatives for elimination. It is our responsibility to ensure that people who experience being marginalised are not excluded from the process otts L and have access to information,North support, and services that meet their needs. Our vision is to see a world free from liver-related diseases associated with Hepatitis C infection.

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We have received some fantastic feedback already from this initiative and we look forward to continued support from the pharmaceutical community. For more information please contact kristy@hepcpartnership.ie or visit www.hepcpartnership.ie.

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Ireland is not among the 11 countries worldwide on track meet to meet Hepatitis C elimination targets by 2030, warns Kristy Maclean Hayes, Head of Advocacy with the Hepatitis C Partnership.

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MAVIRET ® is contraindicated in patients with severe hepatic impairment (Child-Pugh C) and not recommended in patients with moderate hepatic impairment (Child-Pugh B).1 * Refers to GT 1–6, excluding decompensated cirrhotic patients and liver or kidney transplant recipients. MAVIRET® is not indicated in decompensated cirrhosis. The recommended duration of MAVIRET® is 12 weeks in liver or kidney transplant recipients, with or without cirrhosis.1 ‡ Tablets should be swallowed whole, taken at the same time with food and not chewed, crushed, or broken.1 ITT = intent-to-treat Fleet Street

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mg pibrentasvir. Please refer to the Summary of Product Characteristics (SmPC) before prescribing. INDICATION: For treatment of Chronic Hepatitis C Virus (HCV) in adults and in adolescents aged 12 to <18 years. DOSAGE AND ADMINISTRATION: Oral. Treatment to be initiated and monitored by physician experienced in the management of patients with HCV infection. See SmPC for full posology. Dosage: Adults and adolescents aged 12 to <18 years: The recommended dose of Maviret is 300 mg/120 mg (three 100 mg/40 mg tablets), taken orally, once daily at the same time with food. Treatment Duration: Patients without prior HCV therapy (GT 1, 2, 3, 4, 5, 6): No cirrhosis: 8 weeks. Cirrhosis: 8 weeks. Patients who failed prior therapy with peg-IFN + ribavirin +/- sofosbuvir, or sofosbuvir + ribavirin: GT 1, 2, 4-6: No cirrhosis: 8 weeks. Cirrhosis: 12 weeks. GT 3: No cirrhosis: 16 weeks. Cirrhosis: 16 weeks. Special Populations: HIV-1 Co-infection: Follow the dosing recommendations as above. For dosing recommendations with HIV antiviral agents, refer to SmPC for additional information. Elderly: No dose adjustment required. Renal impairment: No dose adjustment required. Hepatic impairment: No dose adjustment recommended in patients with mild hepatic impairment (Child-Pugh A). Maviret is not recommended in patients with moderate hepatic impairment (Child-Pugh B) and is contraindicated in patients with severe hepatic impairment (Child-Pugh C). Liver or kidney transplant patients: 12 weeks in liver or kidney transplant recipients with or without cirrhosis, with 16 week treatment duration to be considered for GT 3-infected patients who are treatment experienced with peg-IFN + ribavirin +/- sofosbuvir, or sofosbuvir + ribavirin. Paediatric S f adjustment required in adolescents aged 12 to <18 years.

Population: Noudose folk The safety and efficacy Soft Maviret in children aged less than 12 years have not yet been established. DiabeticrePatients: et Diabetics may experience improved glucose control, potentially resulting in symptomatic hypoglycaemia, after initiating HCV

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direct acting antiviral treatment. Glucose levels of diabetic patients initiating direct acting antiviral therapy should be closely monitored, particularly within the first 3 months, and their diabetic medication modified when necessary.

CONTRAINDICATIONS: Hypersensitivity to the active substances or to any of the excipients. Patients with severe hepatic impairment (Child-Pugh C). Concomitant use with atazanavir containing products, atorvastatin, simvastatin, dabigatran etexilate, ethinyl oestradiol-containing products, strong P-gp and CYP3A inducers (e.g., rifampicin, carbamazepine, St. John’s wort (Hypericum perforatum), phenobarbital, phenytoin, and primidone). SPECIAL WARNINGS AND PRECAUTIONS: Hepatitis B Virus reactivation: HBV screening should be performed in all patients before initiation of treatment. HBV/HCV co-infected patients are at risk of HBV reactivation, and should, therefore, be monitored and managed according to current clinical guidelines. Hepatic impairment: Maviret is not recommended in patients with moderate hepatic impairment (Child-Pugh B) and is contraindicated in patients with severe hepatic impairment (Child-Pugh C). Patients who failed a prior regimen containing an NS5A- and/or an NS3/4A-inhibitor: GT 1-infected (and a very limited number of GT 4-infected) patients with prior failure on regimens that may confer resistance to glecaprevir/pibrentasvir were studied in the MAGELLAN-1 study. The risk of failure was, as expected, highest for those exposed to both classes. A resistance algorithm predictive of the risk for failure by baseline resistance has not been established. Accumulating double class resistance was a general finding for patients who failed re-treatment with glecaprevir/pibrentasvir in MAGELLAN-1. No re-treatment data is available for patients infected with GT 2, 3, 5 or 6. Maviret is not recommended for the re-treatment of patients with prior exposure to NS3/4A- and/or NS5A-inhibitors. Lactose: Maviret contains lactose. Patients with rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption should not take this medicinal product. INTERACTIONS: See SmPC for full details. Contraindicated:

References: 1. Maviret Summary of Product Characteristics. AbbVie Ltd. Available at www.medicines.ie. 2. HSE 2020, National Hepatitis C Treatment Programme Clinical Advisory

W ic k lo w S t Group Community Treatment Guidelines. Accessed January 2021. Available at: https://www.icgp.ie/go/library/catalogue/item?spId=FE497472-496A-4229-99A1783EA2C8095B. re3.eZuckerman E, Gutierrez JA, Dylla DE, et al. 8-Week Glecaprevir/Pibrentasvir Is Safe and Efficacious in Treatment-Naïve Hepatitis C Patients: An Integrated Analysis. Clinical t Gastroenterology and Hepatology 2020.

IE-MAVI-210002 | Date of Preparation: February 2021

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Dabigatran etexilate, carbamazepine, phenytoin, phenobarbital, primidone, rifampicin, ethinyloestradiolcontaining products, St. John’s wort, atazanavir, atorvastatin, simvastatin. Not Recommended: darunavir, efavirenz, lopinavir/ ritonavir, lovastatin, ciclosporin doses > 100 mg per day. Use Caution: digoxin, pravastatin, rosuvastatin, fluvastatin, pitavastatin, tacrolimus. Monitor Levels: Digoxin, Monitor INR with all vitamin K antagonists. No dose adjustment: Losartan, valsartan, sofosbuvir, raltegravir, elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide, levonorgestrel, norethidrone or norgestimate as contraceptive progestogen. FERTILITY, PREGNANCY AND LACTATION: Maviret is not recommended in pregnancy. It is not known whether Maviret and its metabolites are excreted in breast milk. No human data on the effect of glecaprevir and/or pibrentasvir on fertility are available. SIDE EFFECTS: See SmPC for full details. Very common side effects (≥1/10): headache, fatigue. Common side effects (≥1/100 to <1/10): diarrhoea, nausea, asthenia. Frequency not known (cannot be estimated from the available data): pruritus.

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▼ This medicinal product is subject to additional monitoring. This will allow quick identification of new safety information. Healthcare professionals are asked to report any suspected adverse reactions via HPRA Pharmacovigilance; website: www.hpra.ie. Suspected adverse events should also be reported to AbbVie Limited on 01-4287900.

LEGAL CATEGORY: POM(S1A) MARKETING AUTHORISATION NUMBER/ PRESENTATIONS: EU/1/17/1213/001 – blister packs containing 84 (4 x 21) filmcoated tablets. MARKETING AUTHORISATION HOLDER: AbbVie Deutschland GmbH & Co. KG, Knollstrasse, 67061 Ludwigshafen, Germany. Further information is available from AbbVie Limited, 14 Riverwalk, Citywest Business Campus, Dublin 24, Ireland. DATE OF REVISION: January 2020. PI/1213/008.

City Qu ay

Life isis aa health health journey Life with its ups and downs, and its challenges. These can be big or small, with its ups and downs, and its challenges. These can be big or small, lifelong or temporary. Everyone, from childhood to old age, faces health lifelong or temporary. Everyone, from childhood to old age, faces health challenges and needs, wherever they are. challenges and needs, wherever they are.

We, at Sanofi, are dedicated to supporting people through their health We, at Sanofi, are dedicated to supporting people through their health challenges. challenges.

As a global biopharmaceutical company, our passion is to prevent illness As a global biopharmaceutical company, our passion is to prevent illness with vaccines, provide treatments to fight pain, and we stand by the few with vaccines, provide treatments to fight pain, and we stand by the few who suffer from rare disease as well as the millions with long-term chronic who suffer from rare disease as well as the millions with long-term chronic conditions. conditions.

With more than 100,000 people in 100 countries, we transform scientific With more than 100,000 people in 100 countries, we transform scientific innovation into healthcare solutions around the globe. innovation into healthcare solutions around the globe.

Ourpatients patientsinspire inspireus usto topioneer. pioneer.

Our MAT-IE-2001756(v1.0) MAT-IE-2001756(v1.0) Date of Preparation February 2021 Date of Preparation February 2021

sanofi.ie sanofi.ie

CPD: Atopic Eczema Continuing Professional Development

CPD

49

AUTHOR: Katie Mulrooney Support Pharmacist, O’Sheas Pharmacy Kilkenny

60 Second Summary Eczema often occurs concurrently in patients with other atopic diseases such as asthma, allergic rhinitis and food allergy. Each of these conditions share a common pathogenesis, often presenting together in the same individual and family.

The most important and basic requirement of eczema therapy is emollient use as a moisturiser or soap substitute. They come as lotions, ointments and creams that need to be used several times a day in order to ease dry, itchy skin and to repair the skin barrier.

Patients and even healthcare professionals sometimes can be hesitant to use a topical corticosteroid cream due to the side effects associated with them. The phrases “topical steroid phobia” or “corticophobia” have been used to describe this scenario.

The most common side effect of topical corticosteroid use is skin atrophy, the skin becomes thinner and easily bruised. It is more likely to occur when topical corticosteroids are applied to the face or the flexures.

The risk of experiencing systemic side effects of topical steroids is higher when patients use higher potency products or a long duration of treatment with topical glucocorticosteroids of any potency.

The NICE guidelines recommend that topical steroids for use in atopic eczema should be prescribed for once or twice daily application only. With that being said, it is important to signpost that the recommended dosing pattern and duration of treatment in the product licence of a topical corticosteroid formulation may vary to a number of published clinical guidelines for this disease.

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

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

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

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

3. PLAN - If I have identified a

5. WHAT NEXT - At this time you may like to record your learning for future use or assessment. Follow the

4 previous steps, log and record your findings.

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.

Atopic Eczema: Topical Corticosteroid Therapy and Patient Counselling The term “Eczema” originates from the Greek word “ekzein” which means “to boil out or to boil over.” Eczema (also called 'atopic dermatitis' or 'atopic eczema') is a chronic inflammatory skin condition, characterised by dry itchy skin with eczematous lesions that typically fluctuates between periods of relative quiescence and flares, although some patients may have a chronically active disease.

Eczema often occurs concurrently in patients with other atopic diseases such as asthma, allergic rhinitis and food allergy.

Each of these conditions share a common pathogenesis, often presenting together in the same individual and family. 'Atopy' refers to the genetic tendency to produce immunoglobulin E (IgE) antibodies in response to common environmental proteins such as pollen, house dust mite, and food allergens.

The Irish Skin foundation reports that 15-20% of all GP consultations a year are dedicated to investigating skin related concerns. In Ireland, eczema approximately affects 1 in 5 children and 1 in 10 adults.

Children can outgrow this condition when branching into adulthood, however they are likely to present with life-long sensitive skin and may experience an exacerbation of symptoms of eczema following lengthy intervals.

The most important and basic requirement of eczema therapy

is emollient use as a moisturiser or soap substitute. They come as lotions, ointments and creams that need to be used several times a day in order to ease dry, itchy skin and to repair the skin barrier.

When emollient use alone cannot control an eczema flare, a topical steroid may be prescribed for short-term use.

Topical corticosteroids have been a part of the mainstay treatment of atopic eczema for over 40 years.

Hydrocortisone was the original topical steroid used to treat eczema and other dermatoses.

Now, over 30 additional corticosteroids have been licensed for the treatment of atopic eczema.

These formulations are typically used for the treatment of an eczema flare-up when emollient therapy alone has proven to be insufficient. Their anti-inflammatory and anti-proliferative effects deliver a dramatic improvement to an exacerbated patch of skin within a short period of time. They exert their immunosuppressive activity through in a number of different ways including; inhibiting the late phase allergic reaction process by decreasing the density of mast cells, decreasing chemotaxis, lessening the activation of eosinophils, reducing cytokine production and preventing the metabolism of arachidonic acid.

Patients and even healthcare professionals sometimes can be hesitant to use a topical corticosteroid cream due to the

side effects associated with them.

The phrases “topical steroid phobia” or “corticophobia” have been used to describe this scenario. One of the important roles of pharmacists and pharmacy staff is to counsel patients how to use medication safely. Patient counselling can provide an excellent opportunity to stimulate a positive perception towards the use of topical steroids and advise patients how to use the dispensed preparation safely in order to avoid unwanted side effects.

The side effects of topical steroids • The side effects of topical corticosteroid use include: • Thinning of the skin (skin atrophy) • Stretch marks (striae) • Easy bruising or tearing of the skin (Senile/solar purpura) • Enlarged blood vessels (Telangiectasia) • Localised increased hair thickness and length (Hypertrichosis) • Pigmentation changes to the skin • Perioral dermatitis • Steroid rosacea or acne • Pustular psoriasis • Contact dermatitis

50

CPD: Atopic Eczema

• Masking and exacerbation of fungal infections

Potency

Medicine

• Hypercortisolisim (Cushing’s syndrome)

Very Potent

Clobetasol propionate

0.05%

Potent

Betamethasone valerate

0.1%

Hydrocortisone butyrate Mometasone fumoate

0.1%

Betamethasone dipropionate Betamethasone Valerate Clobetasone butyrate

0.05%

Hydrocortisone Acetate

1%

Hydrocortisone

1%

• Hypothalamic-pituitary-adrenal axis suppression • Growth retardation in young children • Topical steroid withdrawal syndrome The most common side effect of topical corticosteroid use is skin atrophy, the skin becomes thinner and easily bruised. It is more likely to occur when topical corticosteroids are applied to the face or the flexures. The thin skin on the face and the flexures, allows for a high delivery of product absorption which may progress to cause skin atrophy. When it is possible, patients should be counselled to avoid application of topical steroids to these areas. When it is unavoidable, the SPC of the chosen product can be an excellent source of information for the recommended dose and duration of treatment to avoid unwanted side effects.

Cessation of topical therapy to the affected area may lead to a gradual recovery, however this is not guaranteed. The resulting loss of elasticity of the dermis following the prolonged or excessive use of potent steroids could potentially create permanent stretch marks. Pharmacists should counsel patients using topical corticosteroids to avoid their use in the periocular region as they can contribute to the development of cataracts and glaucoma.

Topical corticosteroid preparations vary greatly in potency. There are four different classes of potency: mild, moderately potent, potent and very potent. The potency of a compound is determined by the degree of vasoconstriction a topical corticosteroid can produce and the subsequent inhibition of inflammation that results. The more potent a product is, the greater its’ ability to suppress the inflammatory pathway.

The risk of experiencing systemic side effects of topical steroids is greater when patients use higher potency products or a long duration of treatment with topical glucocorticosteroids of any potency. The extended use of high-potency steroids may place the patient at risk of a “rebound” flare-up of eczema after stopping the use of a topical steroid preparation. In some cases, where a higher potency product has been used for an extended period of time, it may be necessary to

Moderate

Mild

reduce treatment gradually or switch to a lower potency product to complete the course.

The systemic absorption of topical corticosteroids involves the passage of the drug through epidermis, dermis into the blood stream. The extent of percutaneous absorption of these compounds is determined by many different factors that will be discussed throughout this article.

Strength

0.1%

0.025% 0.05%

Licensed product examples Dermovate 0.05% w/w Ointment® Dermovate 0.05% w/w Cream® Dermovate Scalp Application 0.05% w/v Cutaneous solution® Etrivex 500mcg/g shampoo® Betnovate 0.1% w/w Cream® Betacap Scalp Application 0.1% w/w cutaneous solution® Betnovate 0.1% w/w Ointment® Betnovate Scalp Application 0.1% w/v cutaneous solution® Betnovate-C 0.1%/3% w/w Cream® Bettamousse 1mg/g (0.1%) cutaneous foam Eczibet 20mg/g and 1mg/g Cream® (with fusidic acid) Fucibet 20mg/g and 1mg/g Cream® (with fusidic acid) Fucibet Lipid 20mg/g and 1mg/g Cream ® (with fusidic acid) Locoid Cream 0.1% w/w® Locoid Lipocream 0.1%w/w Cream® Elocon 0.1% w/w Cream® Elocon 0.1% w/w Ointment® Elocon 0.1% w/w Scalp Lotion® Monovo 1mg/g Cutaneous Emulsion® Monovo 1mg/g Cream® Diprosalic 0.05% and 2% w/w Scalp Application® (with salicylic acid) Betnovate RD 0.025% w/w Cream® Betnovate RD 0.025% w/w Ointment® Eumovate 0.05% Cream® Eumovate 0.05% Ointment® Fucidin H 20mg/g and 10mg/g Cream® (With fusidic acid) HC45 Hydrocortisone Acetate Cream 1%w/w® Calmurid HC 10%/5%/1% w/w Cream® (with urea and lactic acid) Canesten HC 1%w/w and 1%w/w Cream® (with clotrimazole) Cortopin 1% w/w cream® Daktacort 2% w/w and 1% w/w Cream® (with miconazole nitrate) Hydrocortisone 1% w/w cream® Hydrocortisyl 1% w/w skin cream®

Topical medicinal formulations typically have a slow and poor extent of absorption, topical steroids are no exception to this.

Absorption is directly proportional to the mass or concentration of topical steroid applied to the skin up to a critical point. The rubbing motion increases the surface area of the skin being treated and augments the local blood supply in the area to facilitate

systemic absorption. The more frequency the application of a topical corticosteroid treatment is the greater the contact period and overall absorption.

A study was conducted to determine to determine the absorption of a once daily application of hydrocortisone 1% cream. Following a 24 hour period, less than 2% of the steroid was found to be systemically

51 absorbed. When the absorption of topical corticosteroids is higher, the patient is at a higher risk of experiencing unwanted systemic side effects. The systemic side effects of topical glucocorticosteroids include: hypercortisolism, hypothalamicpituitary-adrenal axis suppression or growth retardation in young children.

The risk factors for experiencing systemic effects include: • Higher potency products • Duration of exposure • Application to a large surface area of the skin • The use of the occlusive dressings prior to administration • The use of the product on intertriginous areas of the skin • Increased hydration of the stratum corneum • Use on the face and flexures • Use on broken or an impaired skin barrier • Age: Children and infants have a higher rate of absorption than adults When topical corticosteroids are absorbed into the bloodstream, the steroid is metabolised primarily in the liver by the enzyme CYP 3A4, followed by excretion through the kidneys or as their metabolites in bile. Patients with decreased hepatic or renal function or those who concomitantly use medication that are potent inhibitors of CYP 3A4 are placed at an increased the risk of experiencing the unwanted effects of these products.

The most vulnerable cohort of patients to experience these side effects are children and infants, as they have a higher surface area to body mass ratio than adults.

Special care should be taken to avoid the use of potent topical steroids or the prolonged use of topical steroids in these groups.

For breastfeeding mothers, the use of topical corticosteroids is not recommended unless the benefits to the mother outweigh the potential risk to the infant.

It is not known whether the topical administration of topical corticosteroids in breastfeeding mothers could result in sufficient systemic absorption to produce detectable amounts in breast milk.

What is the correct dose, frequency of application and duration of treatment?

The guidelines recommend that topical steroids for use in atopic eczema should be prescribed for

once or twice daily application only. With that being said, it is important to signpost that the recommended dosing pattern and duration of treatment in the product licence of a topical corticosteroid formulation may vary to a number of published clinical guidelines for this disease. For example, The British Association of Dermatologists suggest that topical corticosteroids should be used twice daily for 10-14 days, followed by a “holiday period” of emollients only. In contrast, the product licence of Dermovate 0.05% w/w ointment directs once or twice daily application of the product for up to 4 weeks until an improvement in the condition is noted, followed by a reduction in the frequency of application or switching to a less potent preparation for continuing drug therapy. The license also states that as an alternative Dermovate 0.05% w/w ointment could be used to treat exacerbations of the disease in multiple short bursts of treatment.

Considering the economic impact of eczema Eczema has the potential to have a detrimental impact on the quality of life of a patient, especially for those with moderate to severe eczema. The cost of topical treatments such as emollients, steroids or immunomodulators can be expensive and repetitive.

In the effort of optimising accessibility for to healthcare for patients, pharmacist should consider the economic burden of this disease by taking the relative cost of different preparations of equal potency into account upon dispensing in combination with the amount of product that will be required based upon the product pack size, treatment area, frequency of application and prescribed treatment length.

The fingertip unit system: How much do I need?

A fingertip unit (FTU) is the amount of topical steroid that is squeezed from a tube of topical corticosteroid with a standard 5mm nozzle onto an adult’s fingertip (from the end of the finger to the first crease of the finger).

One FTU provides a sufficient amount of the preparation to treat an area of the skin twice the size of the flat of an adult’s hand with the fingers closed beside one another. The body is divided into five distinct areas and each area, depending on the age of the patient, has a recommended amount of steroid to cover that entire area. Two fingertip units are approximately the equivalent of 1g of the topical steroid. The FTU system can be used to estimate the amount of product required for a course of topical steroid treatment and subsequently, the appropriate product size for the patient.

Face and neck An entire arm and hand An entire leg and foot

• Cracks and sores – treatment with topical corticosteroids on broken skin can increase the risk of systemic side effects.

Their use should be avoided where possible and should be completely avoided if there is an underlying skin infection which has not been treated. The use of a moisturiser free from alcohol or acid is more suitable.

What site of skin is to be treated • Palms and soles: ointment or cream • Skin fold: Cream or lotion

Choosing the appropriate formulation

• Hairy areas: lotion, shampoo, solution, gel or foam

The “five rights” of medication use include: the right patient, the right drug, the right time, the right dose, and the right route. There is often more than one formulation available for topical corticosteroid products of equal strength. When dispensing a topical corticosteroid formulation, the nature of the skin or site of the eczema on the skin to be treated can be taken into consideration in order to choose the most appropriate product.

Patient counselling for topical corticosteroid use

What is the nature of the skin to be treated • For wet skin (presence of blisters or pus): cream and lotion formulations are most suitable.

• For dry, scaly skin: ointment formulations are most suitable.

Area of skin to be treated (adults) A hand and fingers (front and back) Front of chest and abdomen Back and buttocks

• For inflamed skin: cream or ointment formulations, occlusion of the skin several hours before the application of topical corticosteroid formulations may be of benefit.

These two treatments should be spaced apart appropriately as occlusion can enhance the systemic absorption of topical corticosteroids by up to 10 times.

Size 2 adult hands 14 adult hands 14 adult hands 5 adult hands 8 adult hands 16 adult hands

Patients should be educated about the side effects of topical steroid formulations to highlight the importance of using these products correctly. As the saying goes, knowledge is power, it can help patients and healthcare professionals alike to overcome the barriers of topical steroid phobia. A counselling session should include the steps patients can take to overcome or avoid the risks of experiencing the side effects of topical corticosteroid preparations. These counselling points may include: 1. Wash your hands before the handling or application of a topical product to the skin.

FTUs each dose (adults) 1 FTU 7 FTUs 7 FTUs 2.5 FTUs 4 FTUs 8 FTUs

Face and neck An entire arm and hand An entire leg and foot

5 adult hands 8 adult hands 16 adult hands

2.5 FTUs 4 FTUs 8 FTUs

52 CPD: Atopic Eczema Area of skin to be treated (adults) A hand and fingers (front and back) Front of chest and abdomen

Back and buttocks

Size

FTUs each dose (adults) bedding regularly should be and the Children’s Dermatology Life Quality Index (CDLQI) score recommended butFTU washing 2 adult hands 1 or Dermatology Life Quality Index may not totally remove the (DLQI) score.

absorbed product.

9. Wash your hands the 14 adult 7 after FTUs handling or application of a hands topical product to the skin.

New treatments 7 on FTUs the market 14 adult for atopic dermatitis: Dupixent hands (dupilumab) human 5 adultDupilumab handsis a fully 2.5 FTUs monoclonal antibody that acts 8 adultagainst hands FTUs interleukin4(IL)-4 receptor alpha to inhibit IL-4/IL-13 16 adult 8 FTUs signalling, produced in Chinese Hamster Ovary (CHO) cells by hands recombinant DNA technology. ®

Face and neck An entire arm and hand An entire leg and foot

This product has a number of therapeutic indications including; 2. A patch test should be 6. Avoid the use of this product on Patient Population Initial dose Subsequent atopic dermatitis, asthma and recommended to all patients areas of the body where thedoses skin othermore week) chronic rhinosinusitis with before using any new topical is thinner and(every may absorb Adults product on their skin. 600mg 300mgresulting in nasal polyposis (CRSwNP). It A pea product, potentially Adolescents (age 12-17 may be of interest for patients sized amount of the new unwanted side-effects. This may who have tried and tested the years) ointment, lotion or cream should include the face, the genitals, be applied to the pulse of a wrist topical corticosteroids and the skin folds,300mg broke, raw or >60 years 600mg or the crook of an elbow for 24immunosuppressants for their thick skin, areas of the skin that <60 years 400mg 200mg 48 hours without washing. After atopic dermatitis, receiving rub together i.e. beneath the this time period has lapsed, poor results. breasts or between the buttocks ensure there are no signs of an or thighs.

On the 2nd of March 2021, allergic reaction in the specified The Medication Management 7. Once the inflammation of the area. Typical signs of an allergic Programme (MMP) released skin has come under control reaction include; redness, a Managed Access Protocol following the use of a topical itchiness, pain, flaking and/or a (MAP) to provide conditional corticosteroid, stop using rash. If any traces of an allergic reimbursement for the confined this product, in line with the reaction have developed on use of Dupixent® in patients instructions given to you by your the skin, the patient should be aged 12 years and over for doctor. If the inflammation of the counselled to avoid using this systemic treatment of moderateskin has not resolved by the end new product. to severe atopic dermatitis. of a treatment course, consult 3. Only apply a topical Eligible applicants include your doctor for the next step. corticosteroid preparation to the patients who have previously 8. Some topical products may affected area of the skin at the tried immunosuppressant contain flammable ingredients frequency prescribed by your therapies which have failed, doctor for a specified length such as paraffin. Patient’s were poorly tolerated or of time. using products that contain otherwise contraindicated. The flammable ingredients should reimbursement for this new 4. Explain the FTU system and be directed to avoid smoke or product can be applied for by the how this can be used by the naked flames due to the risk of prescriber on an individual patient patient to apply the appropriate severe burns. Fabric such as basis. As part of the application amount of steroid on the clothing, bedding, dressings process, the prescriber must affected area of the skin. that have been in contact with confirm the patient is receiving this product can burn more best supportive care for atopic 5. Apply your regular emollient easily, making them a serious dermatitis, the patient’s current or moisturiser 30 minutes fire hazard. When using these after the application of the Eczema Area and Severity Index topical corticosteroid. products, washing clothing and (EASI) score (equal to 16 or more)

The product is available as a prefilled pen in two different strengths: Dupixent® 200 mg solution for injection in pre-filled pen and Dupixent® 300 mg solution for injection in pre-filled pen. The recommended dosing schedule as outlined by the product’s SPC is listed in the table below.

Following a 16 week treatment period, the patient should notice a dramatic improvement in their skin condition. An adequate response may be measured as; a minimum of 50% reduction in the EASI score or an at least a 4-point reduction in the DLQI score recorded at the beginning of treatment. The NICE guidelines and the MAP recommend that dupilumab should be stopped at 16 weeks if a patient’s atopic dermatitis has not responded adequately to treatment.

References https://www.ncbi.nlm.nih.gov/pmc/ articles/PMC4171913/ https://www.ncbi.nlm.nih.gov/pmc/ articles/PMC2957754/ https://www.ncbi.nlm.nih.gov/pmc/ articles/PMC4171913/ https://www.ncbi.nlm.nih.gov/pmc/ articles/PMC8018988/ https://irishskin.ie/eczema/ https://www.ncbi.nlm.nih.gov/pm c/?term=finger+tip+unit+topical+ steroid https://www.imt.ie/news/ healthcare-news/irish-skinfoundation-calls-hse-reimburseeczema-drug-20-08-2020/ https://nationaleczema.org/ eczema/treatment/topicals/

Patient Population

Initial dose

Adults Adolescents (age 12-17 years) >60 years <60 years

600mg

Subsequent doses (every other week) 300mg

600mg 400mg

300mg 200mg

WHOLE OAT EXTRACT

OAT FLOUR

OAT OIL

CERAMIDES

NATURE. NURTURED

BY SCIENCE. Our triple oat complex harnesses the goodness from the oat and combines it with protective ceramides.

Creating a formula that helps to improve the skin’s natural microbiome balance, leaving skin more resilient and healthy looking from day 1. That’s why 90% of customers like yours say they felt immediate comfort after using Aveeno® Dermexa Daily Emollient Cream.1 So when you’re next faced with the question – how can I treat my dry and irritated skin?

Recommend Aveeno® Dermexa.

1. HTC Survey of 144 participants, January 2021 IE-AV-2100044

54

Corporate Profile

A Heritage More Than Skin Deep Since 1934, the Gardiner Family have been producing the purest, gentlest formulations for dry and sensitive skin in Ireland. Here Joanna Gardiner, CEO, reveals how a proud tradition of purity, heritage and family values has seen the business thrive.

Joseph Gardiner was a practical man with a hard work ethic. He was also a man with a good idea back in the days when moisturising bases for dry skin, eczema and rashes were made at the back of the chemist shop with a pestle and mortar.

Joseph saw an opportunity to make up products like Silcock’s Base, Emulsifying Ointment and Calamine Cream to save chemist shops the bother, and to hand deliver them across the nation under the brand Ovelle.

In 1934, he established the family skincare apothecary in Dundalk and Newry and, together with his sons Gerald and Sean, steered the family business through the 1930s, World War 2 and the Troubles in the border area.

Traditional Formulations “It sounds strange now, but there really weren’t any dermatologists on the island when the business

was founded,” explains Joanna Gardiner, who is Joseph’s granddaughter and the current CEO of the business.

“For example, Dr Silcock, originator of the eponymous Base, was a Liverpool dermatologist who visited Temple Street and the Mater Hospital Dublin on a monthly basis to treat patients with eczema. Today, his formula is still widely recommended as an alternative to soap to wash and moisturise dry skin.

“Joseph made Ovelle traditional formulations to soothe and repair dry skin. Later on, we created Elave sensitive skincare, to provide a daily regime of shampoos, lotions and creams that work to prevent flare-ups of eczema and other sensitive skin conditions.”

Joanna’s late father Sean and his wife Rosemarie, both pharmacists, led the way in investing heavily in research and development, literally creating a war chest of

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“It sounds strange now, but there really weren’t any dermatologists on the island when the business was founded...Dr Silcock, originator of the eponymous Base, was a Liverpool dermatologist who visited Temple Street and the Mater Hospital Dublin on a monthly basis to treat patients with eczema” traditional and pharma grade formulations, as well as forging incredible business relationships with aid agencies worldwide.

Patrick Gardiner, the Research and Quality Director and Joseph’s grandson, has been hugely successful in combining the achievement of manufacturing excellence which complies with multiple global quality standards with innovation in high performing skincare formulation.

Global Reach Today, the business is a global concern exporting over 55% of

their skincare solutions across the world. But, insists Joanna, it is still a family values business at heart.

Everything is manufactured in Ireland - they are Guaranteed Irish - and they are proud to support local suppliers.

“It is a philosophy that has served us well,” she says. “We have evolved as a company over the decades, of course, but we remain loyal to our staff and customers and always endeavour to put them first.

“We are very grateful for the support of healthcare professionals and remain very hands-on,

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Joseph Gardiner, Founder delivering skincare directly to pharmacies. We believe that pharmacists and pharmacy assistants recommend us because we are a trusted solution for dry, sensitive skin with decades of experience.

“Over the past 86 years we have employed three generations in Dundalk, many of them brothers and sisters, husbands and wives, fathers and sons, mothers and daughters. The people who have worked with us have been a great asset and remain so.”

The business is now proudly flying under the flag of ‘Gardiner Family Apothecary’ as a way of connecting their two brands, Ovelle and Elave, as well as saluting the values, tradition and heritage that have seen the business thrive.

Significant Investments That has included significant investment in quality systems to enable operating to the highest Pharma standards. They are stringently audited to GMP by the HPRA for licensed medicines, and to globally recognised standards for medical device skincare, Ecocert organic and cosmetic GMP formulations.

“Sustainability is a massive commitment and will remain a priority going forward,” says Joanna. “We operate to ISO 14001 environmental standard and strive at all times to reduce our carbon footprint.

“We were the first manufacturer in the North-East of Ireland to use lithium-free solar panels to generate our own energy on site, and over the past year have upgraded our packaging to meet the highest recycling standards.”

Recently, they were accredited with PETA Vegan for 92% of their formulations and Gluten-Free to support their long-standing

“We are so grateful to Irish medical professionals, particularly Pharmacists, who have put their trust in us and our formulations to soothe and repair sensitive skin. We intend always to stay close to our roots and community across the island” Peta Cruelty-Free standards in everything they manufacture.

In 2020, Gardiner Family Apothecary was awarded 4 Green Parent Awards and are hugely pleased with their most recent accolade of the Global Health & Pharma Best Cruelty Free Skincare Brand Award.

But, at the end of the day, Joanna insists it’s what’s in the bottle that matters.

“In short, Gardiner Family Apothecary is where you can find all your skincare needs for even the most sensitive, eczema or rosacea prone skin,” she says. “Your skin is your largest organ and the skin barrier has to be cared for properly.

“Medical experts confirm that it is ingredients like foaming sulfates and harsh preservatives such as parabens and MI, that trigger flareups and have led to the dramatic rise in sensitive skin.

Joanna Gardiner, CEO The past 18 months have been challenging for most businesses.

Unlike other sectors, Pharma was protected through the pandemic - not least because pharmacies remained open, even if footfall was down – so Gardiner Family Apothecary was fortunate in being able to continue trading.

As they have been manufacturing disinfectants and sanitisers for years for aid agencies, they could adapt quickly to produce Ovelle Hand Sanitiser Gel, which is as gentle as an alcohol hand sanitiser can be, as well as very gentle hand washes and moisturisers to create a protective hand hygiene category.

The business currently partners with TinyLife, an incredible premature baby charity in Northern Ireland, are proud skincare

partners of Dundalk Football Club, and sponsor Dundalk Rugby Football Club.

Indeed, the future for Gardiner Family Apothecary looks green.

Joanna says: “We are so grateful to Irish medical professionals, particularly Pharmacists, who have put their trust in us and our formulations to soothe and repair sensitive skin. We intend always to stay close to our roots and community across the island.” www.gardinerfamilyapothecary.com

Twitter: @GF_Apothecary FaceBook: gardinerfamilyapothecary Instagram: @gardinerfamilyapothecary

Facing Challenges “Did you know, for example, that some of the perfumes used in other moisturisers contain at least 100 chemicals - how could that be good for your skin? And that is just scratching the surface!

“Our longevity as a business underlines our success in creating safe and effective formulations which reduce flare-ups and promote a clear, healthy hydrated skin barrier. To us, ‘clean skincare’ means avoiding any unnecessary reactive ingredients that could upset the skin.”

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News

New Irish Relaunch for Patients Monday, 12th July 2021: Lloyds Online Doctor is relaunching its service in Ireland. To mark the launch, Lloyds Online Doctor offered new and existing patients the opportunity to use the service at a reduced rate; with consultations at half price (€12.50) until 6th August 2021.

Lloyds Online Doctor offers patients confidential and convenient online consultations with Irish-based doctors. To use the service, patients complete a short medical questionnaire which is assessed by an Irishbased doctor who may provide a prescription for in-pharmacy collection, or the paper prescription can be sent to the patient by post. If the consulting doctor requires any additional information from the patient they will be contacted by

the doctor. All of Lloyds Online Doctor’s GPs are registered with the Irish Medical Council.

Services covered by Lloyds Online Doctor include: • Contraception • Erectile dysfunction treatment • Weight loss treatment Discussing the updated service, Dr Kieran Seyan, Chief Medical Officer, Lloyds Online Doctor said, “Lloyds Online Doctor launched in July 2013 and was one of the

first online doctor services in Ireland. We've treated over two million patients and issued over three million prescriptions in the UK and Ireland. We have a simple goal: to make Irish healthcare more accessible and more affordable.”

In January 2021 Lloyds Online Doctor’s service in Ireland was paused due to a change in the law linked to the end of the Brexit transition period.

To use the service, visit: https:// www.lloydsonlinedoctor.ie/

New Innovations in Meeting Demand Gain Control of Resources with Time and Attendance Tracking Pre-Covid-19, no one could have envisaged how rapidly businesses would need to change the way they operated. Organisations all over the world have had to pivot to meet increasing demands for more flexible, effective and tailored IT solutions for their businesses.

Ciaran Rowsome, CEO, Flextime

wipes out any errors which could lead to staff being overpaid for submitting inaccurate timesheets.

Supporting your Employees

One of the biggest benefits of time tracking is the insight it gives you into your company’s health and profitability. Time tracking helps you to see exactly where resources are being spent. But perhaps the timeliest benefit is that this software will move your business into the new era of flexible and remote working that was thrust upon the world due to the outbreak of Covid-19.

It’s important for all employees to feel fully supported and not feel they are being monitored when it comes to time and attendance recording. FlexTime solutions acts as an ‘honest broker’ between both the employer and the employee because the welfare of both groups is considered.

While countries are slowly reopening and people are returning to the workplace, many businesses have been forced to adapt their time and attendance procedures to make them fit changing work environments. These changes are likely to lead to a more permanent shift in the way work is completed and time is recorded.

With FlexTime’s innovative VisionTime system, employees can easily record time spent in different workplaces, visits to worksites and the all-important task monitoring.

Due to FlexTime’s experience in

flexible IT solutions pre-Covid 19, it is uniquely positioned to understand and cater to the changing nature of the workplace.

Its systems are already ahead of the curve. Its Time and Attendance system is more flexible than most. Unique features include innovative shift arrangements, the ability for the employee and supervisor to interact intuitively digitally, easy shift swapping and solutions on querying a particular shift or shift change. All of these save businesses time and therefore money.

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Far from being a ‘one size fits all solution’, FlexTime helps solve the needs of the employer and employee by offering a two-way solution that allows everyone to be at their best in the working environment. FlexTime systems can be tailored to suit the needs of every business and its employees.

There are also many ‘off the shelf’ service offerings, which are also highly effective.

At first glance it may seem that manual methods of time and attendance tracking are cheaper but over time research shows that using software gives a return on investment in more ways than one.

Companies that use software are freeing up staff resources that were allocated to manually processing and transcribing the payroll for other tasks. HR staff will no longer be subject to enquiries about annual leave entitlement and annual leave requests. Another money-saver is that the software

The benefits of this flexibility is that employees have an increased feeling of personal control over their schedule and work environment. It increases productivity and satisfaction and has a knock on effect on retention.

It reduces burnout as employees can take breaks when they need them. It leads to increased morale, engagement and commitment to the organisation. It is a win-win situation for all concerned.

• Improve efficiency • Grow your business • Create a central database • Shift scheduling/Scheduling solutions To find out more about how FlexTimes VisionTime system can help your business read the full article at www.pharmacynewsireland.com

News

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FMD Use and Learn Period Due to End The Irish Medicines Verification Organisation Safety Features Oversight Group1 continues to oversee progress with Falsified Medicines Directive implementation in Ireland. FMD has been in a ‘use and learn’ phase for pharmacies, hospitals and wholesalers in this country since February 2019 due, in part, to the impact of Covid-19 and Brexit.

The Safety Features Oversight Group, following consultation with all relevant stakeholders, has now agreed a plan for ending use and learn on a phased basis concluding at the end of Q1 2022.

The following prerequisites have been defined by the Safety Features Oversight Group to ensure that end-users and marketing authorisation holders (MAHs) are ready for the end of use and learn, minimising disruption for them and for patients: • Alert rate at 0.05% or lower, i.e., alerts generated by pharmacies, hospitals and wholesalers (‘end-users’), as a % of the total number of end-user scans2; • All end-users scanning packs in accordance with their obligations under the Commission Delegated Regulation on Safety Features (EU) 2016/161 as amended; • Avoidable alerts minimised by addressing issues with scanners, software, MAH data and procedural errors; • Clear instructions available for all parties on what to do if there is an alert, including clear responsibilities for deciding if packs may be supplied or not, i.e., alert handling guidance in place;

• Fast efficient process for communication between parties; • Clarity on impact of Brexit on supply chain/alerts; • Capacity of end-users to deal with alerts in face of challenges of Covid-19; • European Medicines Verification System has the capacity to cope with Covid-19 vaccines and treatments.

Pharmacies, hospitals and wholesalers are expected to comply with their obligations under the Commission Delegated Regulation (EU) 2016/161 to scan packs and verify safety features during use and learn. o If an alert or any other unexpected message is flagged when a pack is scanned, the pack should still be supplied to the patient in line with your existing procedures, unless you have overriding concerns that a falsified medicine is involved. o If you have grounds for believing that a pack has been interfered with or could be falsified, please report this to the HPRA, by email to qualitydefects@hpra. ie or using the HPRA’s online reporting system https://www. hpra.ie/homepage/about-us/ report-an-issue (select the online form ‘Medicine Quality Issue / Defect’).

If you have any queries about your FMD obligations, please contact the PSI (Retail Pharmacy Businesses), HSE FMD project team (public hospitals), HPRA (wholesalers, MAHs, manufacturers, parallel importers, parallel distributors) or IMVO.

1. Comprising Irish Medicines Verification Organisation (IMVO), Department of Health, Health Products Regulatory Authority (HPRA), Pharmaceutical Society of Ireland (PSI), Health Service Executive (HSE) and Private Hospitals Association (PHA).

Parallel importers and parallel distributors should continue to comply with the guidance issued to them by the HPRA on 7th February 2020.

2. The following are excluded when calculating the % alert rate as they have no impact on Irish end-users – alerts generated by MAH transactions and alerts from intermarket transactions (IMTs), i.e. alerts on Irish packs generated by end-users in other markets.

Please contact IMVO if you have any other queries or need support on any matter. Queries specifically related to FMD software should be sent to your FMD software provider.

Boots Ireland 5km Night Walk Boots Ireland has partnered with Muireann O’Connell, Virgin Media TV presenter, to launch its Boots Night Walk in aid of the Irish Cancer Society Night Nursing service which provides end-of-life care for people living with cancer in Ireland. The Irish Cancer Society Night Nursing service is free to people who avail of it, and it is funded almost entirely by donations. Boots Ireland has been a proud supporter of the Irish Cancer Society since 2012 and through the support of their colleagues and customers have raised over €2 million for the service so far, equating to over 6,300 nights of care.

This year, due to Covid-19 social distancing guidelines and to ensure everyone’s safety, Boots Ireland is continuing to do things a little differently. The Boots Night Walk will take place on Monday 6th September - you choose the location and time of your 5km walk and we will all walk together from afar! You can visit www. bootsnightwalk.com to donate now or set up your own fundraising page and start raising money for this great cause ahead of the walk on September 6th.

Alongside the walk, Honour Tags are now on sale in Boots stores

nationwide for ¤2. All funds raised from the Boots Night Walk will go towards the Irish Cancer Society Night Nursing service.

Managing Director at Boots Ireland, Stephen Watkins, said, “Our entire Boots Ireland team is extremely proud of the work that we have done over ten years to support the Irish Cancer Society and its Night Nurse service, and we would also like to thank the public for continuing to join us on the Boots Night Walk again this year as we continue to raise funds for this invaluable service.”

Boots Night Walks Campaign ambassador Muireann O’Connell, Virgin Media TV Presenter

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Sore Throat

Sore Throat VS Strep Throat?

The throat is a muscular tube that begins behind the nose and ends in the neck. The term 'sore throat' describes the symptom of pain at the back of the mouth. Four regions are principally involved: the pharynx, the larynx, the tonsils and (rear) the epiglottis.

Written by Fathimah Kara, Pharmacist, Reidy’s Pharmacy Rathcoole

Drugs which can cause blood disorders such as neutropenia, agranulocytosis and thrombocytopenia can lead to infection and sore throat.

These include cytotoxic drugs and carbimazole.

Refer patients with an accompanying fever to their GP to rule out more serious systemic causes including COVID-19.

Acute sore throat is commonly caused by a viral or bacterial infection. It is often associated with the common cold. The highest incidence is in children and young adults, with 50% of cases occurring in people aged 5–24 years. Symptoms are self-limiting and can last for around 1 week.

The majority of sore throats do not require referral to the GP and antibiotics do not significantly improve the outcomes. Therefore, pharmacists have an important role in managing sore throat.

Explanation, reassurance, and symptomatic treatment is frequently all that is necessary when a person presents with a sore throat. However, there is still an important role in checking the need for referral when certain warning signs or symptoms are present.

Corticosteroid inhalers can cause hoarseness and candidal infections of the throat and mouth. If suspected, check that the patient is rinsing their mouth after using their inhaler and check their inhaler technique.

Referral to their GP may be required. Agranulocytosis (a marked decrease in the numbers of circulating granulocytes) is a rare complication associated with some medications.

Agranulocytosis can present as a sore throat. Medicines known to cause this adverse event include carbimazole and cytotoxic

The degree of throat discomfort can range from itch to severe pain. Sore throats are often associated with other symptoms such as fever and headache.

Cough, rhinorrhoea and hoarseness are uncommon with bacterial infection and may be suggestive of a viral cause.

Conditions associated with sore throat that are not normally lifethreatening include: common cold and influenza. Less common causes of sore throat include HIV. Physical irritation of the throat may occur due to gastrooesophageal reflux disease or cigarette smoke.

PHARMACYNEWSIRELAND.COM

agents. Any patient taking these agents and presenting with a sore throat should be referred to their GP immediately.

Glandular fever is one viral cause of sore throat that often produces marked discomfort and may cause dysphagia. It is caused by the Epstein-Barr virus and its peak incidence is among adolescents and young adults.

The signs and symptoms often mimic those of streptococcal sore throat. It is characterised by pharyngitis, fever and fatigue.

Referral to the GP is necessary for an accurate diagnosis.

Complications Complications include otitis media and parapharyngeal abscess.

• it becomes difficult to swallow saliva or liquids, if any difficulty in breathing develops, or if there is any one-sided neck or throat swelling • if the person is taking a disease-modifying antirheumatic drug (DMARD), carbimazole, is on chemotherapy, has known or suspected leukaemia, asplenia, aplastic anaemia or HIV/AIDS or is taking an immunosuppressive drug following a transplant.

Management Patients should be advised to: • take regular paracetamol or ibuprofen to relieve the pain and fever

The patient should be admitted immediately to hospital if they have stridor, breathing difficulty, or dehydration.

• avoid hot drinks and food to avoid exacerbating the pain

The person should be advised to seek follow up if:

• use simple mouthwashes, e.g. warm salty water at frequent intervals until the discomfort and swelling subside.

• symptoms have not improved after 3 or 4 days of antibiotic therapy • pain does not improve after 3 days, and/or there is fever over 38.3°C

• take adequate fluids to avoid dehydration

Treatment • Ibuprofen and paracetamol can be used as an antipyretic and/or analgesic.

COLD & FLU?

MA holder: Rowa Pharmaceuticals Ltd., Newtown, Bantry, Co. Cork, Ireland.

PA0074/067/006 Date of preparation: 6/21 CCF: 23764

NEW

Marketed by

ABBREVIATED PRESCRIBING INFORMATION Product Name: Brupro Cold & Flu 200 mg/30 mg film-coated tablets. Composition: Each film-coated tablet contains 200 mg ibuprofen and 30 mg pseudoephedrine hydrochloride. Description: Yellow, round, film-coated tablets. Diameter: approx.

11 mm, height: approx. 5 mm. Indication(s): Adults and adolescents aged 12 years and older: For the symptomatic relief of nasal/sinus congestion with headache, fever and pain associated with the common cold and flu. Dosage: 1 tablet every 6 hours if necessary. For more intense symptoms, 2 tablets every 6 hours if necessary, to a maximum total daily dose of 6 tablets (equivalent to 1200 mg ibuprofen and 180 mg pseudoephedrine hydrochloride). The maximum total daily dose of 6 tablets must not be exceeded. For short-term use. The patient should consult a doctor if symptoms worsen. The maximum duration of treatment is 4 days for adults and 3 days for adolescents aged 12 years and older. In situations where the symptoms predominantly consist of either pain/fever or nasal congestion, administration of single entity products is to be preferred. Undesirable effects may be minimised by using the lowest effective dose for the shortest duration necessary to control symptoms. The tablets should be swallowed whole without chewing with a large glass of water, preferably during meals. Contraindications: Hypersensitivity to ibuprofen, pseudoephedrine hydrochloride or to any of the excipients; Patients aged under 12 years; Pregnant women during the third trimester of pregnancy; Breast-feeding mothers; History of gastrointestinal bleeding or perforation, related to previous NSAIDs therapy; Active, or history of recurrent peptic ulcer/haemorrhage (two or more distinct episodes of proven ulceration or bleeding); Severe heart, liver or renal (glomerular filtration below 30ml/min) failure; Conditions involving an increased tendency to bleeding; Patients with known hypersensitivity or who have experienced asthma, urticaria, or allergic-type reactions after taking ibuprofen, aspirin or other NSAIDs; Severe cardiovascular disorders, coronary heart disease (heart disease, hypertension, angina pectoris), tachycardia; Hyperthyroidism; Diabetes; Pheochromocytoma; History of stroke or presence of risk factors for stroke; History of myocardial infarction; Closed-angle glaucoma; Urinary retention; History of seizures; SLE; Use of MAOIs. Warnings and Precautions for Use: Concomitant use with other NSAIDs including cyclo-oxygenase (COX)-2 selective inhibitors should be avoided. If symptoms persist beyond the recommended maximum duration of treatment with this medicinal product (4 days for adults and 3 days for adolescents), measures to be taken should be re-evaluated, in particular the possible usefulness of an antibiotic treatment. Acute rhinosinusitis, suspected to be of viral origin, is defined by moderate intensity, bilateral rhinological symptoms dominated by nasal congestion with serious or puriform rhinorrhea, occurring in an epidemic context. The puriform appearance of rhinorrhea is common and does not systematically correspond to bacterial superinfection. Sinus pains, during the first days of the illness, are associated with congestion of the sinus mucosa (acute congestive rhinosinusitis) and most often are resolved spontaneously. In the event of acute bacterial sinusitis, antibiotic therapy is justified. Special warnings related to pseudoephedrine hydrochloride: Discontinue in development of hypertension, tachycardia, palpitations, cardiac arrhythmias, nausea or any neurological signs such as onset or worsening of headache. Refer to the SPC for other warnings on use and discontinuation requirements. Precautions for use related to pseudoephedrine hydrochloride: Discontinue treatment several days before surgery if volatile halogenated anaesthetics are to be used due to risk of acute hypertension. Athletes: Possibility of positive results in doping tests. Interference with serological testing: Pseudoephedrine has the potential to reduce iobenguane i-131 uptake in neuroendocrine tumors, thus interfering with scintigraphy. Special warnings related to ibuprofen: Bronchospasm may be precipitated in patients suffering from, or with a history of bronchial asthma or allergic disease. Do not take in cases of asthma without prior consultation with a doctor, as an acute asthma attack can be precipitated, particularly when allergic to acetylsalicylic acid or an NSAID. Patients who have asthma associated with chronic rhinitis, chronic sinusitis and/or nasal polyposis have a higher risk of allergic reactions when taking acetylsalicylic acid and/or NSAIDs. Refer to the SPC for more information on medication overuse headache (MOH), blood clotting disorders, gastro-intestinal bleeding, ulceration or perforation

If you need effective relief take it. If you don’t don’t. (discontinue immediately in these cases), history of gastro-intestinal disease (ulcerative colitis, Crohn's disease), alcohol, risk of arterial thrombotic events (particularly at a high ibuprofen dose of 2400 mg/day), serious skin reactions. Discontinue at the first appearance of skin rash, mucosal lesions, or any other sign of hypersensitivity. Consider carefully in uncontrolled hypertension, congestive heart failure (NYHA II-III), established ischaemic heart disease, peripheral arterial disease, and/or cerebrovascular disease and high doses (2400 mg/day) should be avoided. Precautions for use related to ibuprofen: Monitor the elderly carefully, due to increased frequency of NSAID-related undesirable effects, particularly gastro-intestinal bleeding and perforation, which can be fatal. Monitor in history of gastro-intestinal disease (such as peptic ulcer, hiatus hernia or gastrointestinal bleeding). Monitor urine output and renal function initially in heart failure, chronically impaired renal or hepatic function, patients taking diuretics, hypovolaemia as a result of major surgery. If visual disturbances occur during the course of treatment, a full ophthalmological examination should be carried out. Interactions: Refer to the SPC for detailed information on interactions. Combination of pseudoephedrine with: Non-selective MAOIs (iproniazid); Other indirectly-acting, orally or nasally administered sympathomimetics or vasoconstrictor agents, α-sympathomimetic drugs, phenylpropanolamine, phenylephrine, ephedrine, methylphenidate; Reversible inhibitors of monoamine oxidase A (RIMAs), linezolid, dopaminergic ergot alkaloids, vasoconstrictor ergot alkaloids: Volatile halogenated anaesthetics: Guanethidine, reserpine and methyldopa: Tricyclic antidepressants; Digitalis, chinidine or tricyclic antidepressants.

Concomitant use of ibuprofen with: Other NSAIDs, including salicylates and COX-2 selective inhibitors; Digoxin; Corticosteroids; Anti-platelet agents; Acetylsalicylic acid; Anticoagulants: (e.g.: warfarin, ticlopidine, clopidogrel, tirofiban, eptifibatide, abciximab, iloprost); Phenytoin; Selective serotonin reuptake inhibitors (SSRIs); Lithium; Probenecid and sulfinpyrazone Diuretics, ACE inhibitors, beta-receptor blockers and angiotensin-II antagonists; Potassium sparing diuretics; Methotrexate; Ciclosporin; Tacrolimus; Zidovudine; Sulphonylureas; Quinolone antibiotics; Heparins; Gingko biloba. Pregnancy and Lactation: Contra-indicated during breastfeeding and the third trimester of pregnancy and should only be given if clearly necessary during the first and second trimester. Ability to Drive and Use Machinery: Minor or moderate influence on the ability to drive and use machines. Patients who experience dizziness, hallucinations, unusual headaches and visual or hearing disturbances should avoid driving or using machinery. Single administration or short-term use of this medicine does not usually warrant the adoption of any special precautions. Undesirable Effects: Common: Gastrointestinal discomfort, dyspepsia, abdominal pain, nausea, vomiting, flatulence, diarrhoea, constipation, minor gastrointestinal blood loss in rare cases leading to anaemia. Refer to the SPC for other undesirable effects. Marketing Authorisation Holder: Rowa Pharmaceuticals Ltd., Bantry, Co. Cork. Marketing Authorisation Number: PA0074/067/006.

Further information and SPC are available from: Rowex Ltd., Bantry, Co. Cork. Freephone: 1800 304 400 Fax: 027 50417 .

E-mail: rowex@rowa-pharma.ie Legal Category: Not Subject to medical prescription. Date of Preparation: May 2021.

Adverse events should be reported. Reporting forms and information can be found on the HPRA website (www.hpra.ie) or by emailing Rowex pv@rowa-pharma.ie

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Sore Throat • Some patients may wish to try medicated lozenges containing either a local anaesthetic, a non-steroidal anti-inflammatory drug (NSAID) or an antiseptic for symptomatic relief.

People with a sore throat caused by streptococcal bacteria are more likely to benefit from antibiotics.

FeverPAIN criteria is a clinical scoring tool that can help identify people in whom this is more likely.

People who are most likely to benefit from an antibiotic have a FeverPAIN score of 4 or 5.

FeverPAIN criteria: Fever (during previous 24 hours) 1 point Purulence (pus on tonsils) 1 point Attend rapidly (within 3 days after onset of symptoms) 1 point Severely Inflamed tonsils 1 point No cough or coryza (inflammation of mucus membranes in the nose) 1 point Score 0-1 = do not offer an antibiotic.

Score 2-3 = no antibiotic or consider a back-up antibiotic prescription.

Score ≥4 = consider a back-up antibiotic prescription or an immediate antibiotic.

Higher scores suggest more severe symptoms and likely bacterial (streptococcal) cause.

Sources: NICPLD eLEarning hse.ie (https://www.hse.ie/eng/ services/list/2/gp/antibioticprescribing/conditions-andtreatments/upper-respiratory/ pharyngitis-sore-throattonsillitis/)

Vaccine Appetite High – says IPHA New research, carried out by Ipsos MRBI for the Irish Pharmaceutical Healthcare Association (IPHA), showed that 76% of people aged between 18 and 34 said they would take a vaccine for the disease. That figure excludes those who have already been vaccinated for Covid-19. Last month, the same figure was 78% and, in April and May, it was 77%.

Overall, 89% of people either intend to get vaccinated for Covid-19 or have already received a vaccine for the disease, according to the research. That figure has remained steady in recent months.

The results show that 19% of people generally will take a Covid-19 vaccine. But when combined with the cohort that has received at least one Covid-19 vaccine dose, or 70% of the sample*, that number rises to 89%.

Just 6% overall say they will refuse a Covid-19 vaccine and 4% are unsure.

The results come as over 80% of adults have received at least one dose of a Covid-19 vaccine. Ireland is among the fastest countries in Europe to vaccinate its population.

People aged between 18 and 24 are the latest group that can register online to get a Covid-19 vaccine. People aged between 18 and 34, or those over 50, can

PHARMACYNEWSIRELAND.COM

get vaccinated for Covid-19 in most pharmacies.

vaccinated for the disease. We urge them to get vaccinated.

The industry urged continued uptake of Covid-19 vaccines, including among younger people.

“Vaccines-makers are continuing to surge global production of Covid-19 vaccines, investing in their own sites and forming hundreds of partnerships and collaborations with other suitable manufacturing sites. At the same time, our industry is working hard to generate responses for variants of concern as the fight against Covid-19 continues.”

Bernard Mallee, Director of Communications and Advocacy at IPHA, said, “Our data shows very significant public appetite to get vaccinated for Covid-19. People aged between 18 and 34 are slightly more hesitant about getting

S E O R E H D Y COVI A D O T E T A N I NOM

IPN are looking for your nominations for Ireland’s Pharmacy industry’s most inspiring and enthusiastic people.  Do you know someone who has

went above and beyond in Pharmacy?

 Who deserved recognition

for a special project they have executed?

 Who has shown an ability to

get things done during a period of change?

 Who has developed something

new and innovative within their organisation?

Pharmacists have continued to provide a first-class service in the face of adversity, with each pharmacy team displaying the highest levels of resilience, determination, and courage.

And now the time has come to reward that resilience.

That determination. That courage…

Nominations are sought from across the pharmacy profession in Ireland.

Email nomination(s) to aoife@ipn.ie or Kelly-jo@ipn.ie DEADLINE MONDAY 4th OCTOBER

62

Corporate Profile

Offering Bespoke Pharmacy Solutions Irish Pharmacy News recently spoke with Karen McWilliam, BD Rowa™ Territory Manager for Ireland, Northern Ireland and Scotland, who shared her automation journey, encompassing the delivery of innovative solutions whilst delivering best practice and efficiency.

“For me, delivering automated solutions that deliver real financial and operational benefits is a source of great personal pride and satisfaction. Nonmore so than when I see first-hand, customers witnessing the value that automation has added to their business” “The smiles that greet me after only a few weeks from investing in automation, is an unmistakable sign that they have made the right decision.”

As a company, BD Rowa™ daily drives towards improving their products, developing new solutions and entering new markets for the benefits of consumers, their customers and their needs.

Karen has been with BD Rowa™ since 2013; with both parents working within the pharmacy industry, pursing a career on this path was always in her blood. She told us, “I began in the summer holidays of my teenage years filling bottles, sweeping up and emptying bins. During the 90s I worked my way up in a variety of roles for some of the UK’s biggest pharmacy chains, while training and studying to become a pharmacy technician.”

This culminated in Karen working as a dispensing technician for the Scottish Prison Service. “Here, I experienced for the first time a newly established hub and spoke environment, where I dispensed all the drugs for Scottish Prisons.

From this role I decided to take my career in a new direction and

moved into sales with PMR systems. Being able to combine my knowledge and passion for pharmacy, with the variety and challenges of sales was a perfect environment for me to continue my personal and professional development.

Delivering Innovation “For me, delivering automated solutions that deliver real financial and operational benefits is a source of great personal pride and satisfaction. Non-more so than when I see first-hand, customers witnessing the value that automation has added to their business. The transformation from a chaotic and busy workplace to the calmness that comes with changing any workflow to become more efficient is evident.

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Describing what this means for her on a day-to-day basis Karen explains, “Although my role has operations and responsibilities that I cover on a daily basis, the main reason I love what I do is that no two days are the same.

“This is simply because the range of customers and prospective customers are unique and have their own individual business needs and requirements. At BD Rowa™ we offer bespoke solutions which I tailor to each customer and this will have an impact on what my day could look like.

A typical day could include: • Visiting a customer for the first time to consult with them what they want to achieve and how/if BD Rowa™ can assist in that journey

Karen McWilliam, BD Rowa™ Territory Manager for Ireland

• Site visits for future customers to talk and discuss with current customers what the BD Rowa™ solution has done for them and why they invested in the technologies • Measuring pharmacies to create bespoke designs which incorporate all the solutions the customer is looking for • Watching the latest BD Rowa™ system go live in a very excited pharmacy environment • Visiting a customer to consult on their use and efficiencies of the system “I am with our customers every step of the journey to make sure that not only do I understand what they are trying to achieve as an end result, but that they are supported every step of the way offering many years of experience and advice.”

Automation Leaders BD Rowa™ has firmly established itself as a leader in the field of pharmacy automation and helped to transform the future of this market. Karen highlights, “The key thing about BD Rowa™ is that it has not just found a technology that works and is reliable but continues to invest and develop in new and improved technologies every step of the way. To ensure we stay up to date and have a solution that is versatile to suit a whole host of business needs and requirements, we look at several different areas. We gather

My because my pharmacy offers everything from anti-allergy treatment to cedar oil

Your BD Rowa™ Plus: Our state-of-the-art order picking systems not only improve your goods management. They also give you the freedom to offer your customers a wider range of products.

Find out more at: bd.com/rowa

#innovationforpeople

64

Corporate Profile “Around the world we have experienced an increase in the number of enquiries from pharmacists. They want to learn more about how automation and digitalisation can help them and we believe this increase has been driven by the pandemic.

Pharmacies have seen the importance of being able to maintain their operations with minimal staff.

“Many pharmacies have experienced staff who have fallen ill with Covid-19 or had those who have needed to self-isolate.

We have several customers who have told us stories of how their robots have been invaluable to them during this difficult time. They have explained how robots have enabled them to continue serving their community and not let their patients down, even when they have experienced a staff shortage.

feedback from our customers and the market, which in turn goes into develop new products or make software enhancements.

“It is not only the technology that BD Rowa™ invests in but also their support structure. They grow and continuously educate the service team to offer a high level of support. In addition, they have a team of consultants who train and consult with the customers to use their systems effectively, to improve their workflows and to become more efficient in time and stock control. We understand that although this is common and everyday life for us, it can be a huge and daunting change for a customer. Therefore, we establish a good relationship and offer advice when needed or asked for.

We take the customer through each step of the journey from the initial introduction or sales visit through to install, training and dayto-day operation.

“BD Rowa™ will never stop developing and has developed their portfolio to include collection service products, store interior and window facing digital screens, self-checkout and temperature control software. This ensures that not only the dispensing side of the business is covered but all aspects of the pharmacy. It is an innovative company that is a market leader globally with over 10,000 installations worldwide.”

Future of Digitalisation Some might say that the Covid-19 pandemic has accelerated the use of automation, in Ireland and further afield. As pharmacy automation is a market within which BD Rowa™ has long been associated, Karen agrees.

“Our support package offers a 24/7 hotline. Most of the enquiries received are resolved over the phone, however if an on-site visit is needed, we can send our local engineers to the site.”

There may be a number of key challenges on the horizon for community pharmacists across Ireland, and indeed globally.

However Karen is confident that with the right support in place, automation and being ‘fit for the future’ shouldn’t be one of them.

“Community pharmacists will probably be facing a few different challenges going forward. One such challenge could be managing stock. Pharmacies want to be prepared for stock issues and then on the other hand do not want to over order and have money tied up in assets.

“A solution for this is to be able to analyse stock; the ability to look at which products are being used, which products are nearest to expiry so that they get used first and knowing when stock is low by receiving an alert, pharmacies can even have the knowledge it is being re-ordered automatically.

“Pharmacies are under pressure to offer additional services to their patients, which is also an opportunity to generate another source of income. The challenge is how to offer additional services without increasing the number of staff. When processes become automated it can free up staff time to focus on other areas of the business such as consulting with patients.

“Another challenge connected to this, is how to promote these additional services on offer. Digital screens provide an opportunity here, not just to show the supplementary services provided

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by the pharmacy but also to advertise the NHS services, OTC and OTS products. The digital screens can be scheduled to display dynamic relevant content at specific times/days for example, hay fever products in summer or cold relief products in winter.

medications or OTC items 24/7.

Patients can collect their order at quieter times or even just at a time that is convenient to them. The process is easy, all they need is their pickup code, which can be emailed or sent via text, which is then read by the terminal.”

“The ability to schedule content ahead of time means that the information is being displayed with very little intervention, which is one less thing for the pharmacist to worry about.

Speaking directly to pharmacy teams, she concludes, “If you are a pharmacy owner or manager and are facing any of the above challenges, we would be happy to discuss what opportunities are available to you to make the most of your business.

“Our communities are still uncertain as to how this pandemic will impact our lives in the future.

There will be those who will remain cautious in busy high streets and enclosed spaces.

Community pharmacists may wish to find a solution for this segment of the public.

“There is an opportunity to have a Pickup station outside pharmacies enabling patients to collect their

“We understand not every situation is the same and we can tailor make a solution to suit your space and purpose.”

Contact Karen for further information on Email: karen.mcwilliam@bd.com Mobile: +44(0)7876861754 Website: www.bd.com/rowa

INDICATED FOR THE PREVENTION OF PNEUMOCOCCAL PNEUMONIA IN ADULTS

1

PNEUMOCOCCAL

PNEUMOCOCCAL

VACCINATION VS PNEUMONIA

The persons depicted are models used for illustrative purposes only.

1,2

Help prevent pneumococcal pneumonia with the proven protection of Prevenar 13

Proven to reduce the risk of community-acquired pneumonia: Results from the Community-Acquired Pneumonia Immunisation Trial in Adults (CAPiTA) – one of the largest vaccine efficacy trials ever conducted in older adults.2,3 ABBREVIATED PRESCRIBING INFORMATION Prevenar 13* Suspension for Injection Pneumococcal polysaccharide conjugate vaccine (13-valent, adsorbed) Presentation: Each 0.5ml dose of Prevenar 13 contains 2.2 micrograms of each of the following pneumococcal polysaccharide serotypes: 1, 3, 4, 5, 6A, 7F, 9V, 14, 18C, 19A, 19F, 23F and 4.4 micrograms of pneumococcal polysaccharide serotype 6B. Each pneumococcal polysaccharide is conjugated to CRM197 carrier protein and adsorbed on aluminium phosphate. 1 dose (0.5 ml) contains approximately 32 µg CRM197carrier protein and 0.125 mg aluminium. Indications: Active immunisation for the prevention of invasive disease, pneumonia and acute otitis media caused by Streptococcus pneumoniae in infants, children and adolescents from 6 weeks to 17 years of age. Active immunisation for the prevention of invasive disease and pneumonia caused by Streptococcus pneumoniae in adults ≥18 years of age and the elderly. Dosage and Administration: The immunisation schedules for Prevenar 13 should be based on official recommendations. It is recommended that infants who receive a first dose of Prevenar 13 complete the vaccination course with Prevenar 13. For intramuscular injection. Infants aged 6 weeks-6 months: Three dose primary series: The recommended immunisation series consists of four doses, each of 0.5ml. The primary infant series consists of three doses, with the first dose usually given at 2 months of age and with an interval of at least 1 month between doses. The first dose may be given as early as six weeks of age. The fourth (booster) dose is recommended between 11 and 15 months of age.

Two dose primary series: Alternatively, when Prevenar 13 is given as part of a routine infant immunisation programme, a series consisting of three doses, each of 0.5ml, may be given.

The first dose may be administered from the age of 2 months, with a second dose 2 months later. The third (booster) dose is recommended between 11 and 15 months of age. Preterm infants (< 37 weeks gestation): In preterm infants, the recommended immunisation series consists of four doses, each of 0.5 ml. The primary infant series consists of three doses, with the first dose given at 2 months of age and with an interval of at least 1 month between doses. The first dose may be given as early as six weeks of age. The fourth (booster) dose is recommended between 11 and 15 months of age. Unvaccinated infants and children ≥ 7 months of age: Infants 7-11 months: Two doses, each of 0.5 ml, with at least a 1 month interval between doses. A third dose is recommended in the second year of life. Children aged 12-23 months: Two doses, each of 0.5 ml, with at least a 2 month interval between doses. Children and adolescents aged 2-17 years: one single dose of 0.5 ml. Prevenar 13 vaccine schedule for infants and children previously vaccinated with Prevenar (7-valent) (Streptococcus pneumoniae serotypes 4, 6B, 9V, 14, 18C, 19F, and 23F): Infants and children who have begun immunisation with Prevenar may switch to Prevenar 13 at any point in the schedule. Children aged 12-59 months: Children who are considered completely immunised with Prevenar (7-valent) should receive one dose of 0.5 ml of Prevenar 13 to elicit immune responses to the 6 additional serotypes. This dose of Prevenar 13 should be administered at least 8 weeks after the final dose of Prevenar (7-valent). Children and adolescents aged 5-17 years: One single dose of Prevenar 13 if they have been previously vaccinated with one or more doses of Prevenar. This dose of Prevenar 13 should be administered at least 8 weeks after the final dose of Prevenar (7-valent). Adults ≥18 years of age and the elderly: One single dose. The need for revaccination with a subsequent dose of Prevenar 13 has not been established. Regardless of prior pneumococcal vaccination status, if the use of 23 valent polysaccharide vaccine is considered appropriate, Prevenar 13 should be given first. Special Populations: Individuals who have underlying conditions predisposing them to invasive pneumococcal disease (such as sickle cell disease or HIV infection) including those previously vaccinated with one or more doses of 23-valent pneumococcal polysaccharide vaccine may receive at least one dose of Prevenar 13. In individuals with an haematopoietic stem cell transplant (HSCT), the recommended immunisation series consists of four doses of Prevenar 13, each of 0.5 ml. The primary series consists of three doses, with the first dose given at 3 to 6 months after HSCT and with an interval of at least 1 month

between doses. A fourth (booster) dose is recommended 6 months after the third dose.

Contra-indications: Hypersensitivity to any component of the vaccine or to diphtheria toxoid. As with other vaccines, the administration of Prevenar 13 should be postponed in subjects suffering from acute, severe febrile illness. However, the presence of a minor infection, such as a cold, should not result in the deferral of vaccination. Warnings and Precautions: Do not administer intravascularly. Appropriate medical treatment and supervision must be readily available in case of a rare anaphylactic event. This vaccine should not be given as an intramuscular injection to individuals with thrombocytopenia or any coagulation disorder that would contraindicate intramuscular injection, but may be given subcutaneously if the potential benefit clearly outweighs the risks of administration.

Prevenar 13 will only protect against Streptococcus pneumoniae serotypes included in the vaccine, and will not protect against other microorganisms that cause invasive disease, pneumonia, or otitis media. As with any vaccine, Prevenar 13 may not protect all individuals receiving the vaccine from pneumococcal disease. Individuals with impaired immune responsiveness, whether due to the use of immuno-suppressive therapy, a genetic defect, human immunodeficiency virus (HIV) infection, or other causes, may have reduced antibody response to active immunization. Safety and immunogenicity data are available for a limited number of individuals with sickle cell disease, HIV infection, or with an HSCT. Safety and immunogenicity data for Prevenar 13 are not available for individuals in other specific immuno-compromised groups (e.g., malignancy or nephrotic syndrome) and vaccination should be considered on an individual basis. Infants and children aged 6 weeks to 5 years: Prevenar 13 does not replace the use of 23-valent pneumococcal polysaccharide vaccine in at risk children ≥ 24 months of age. Children ≥ 24 months of age at high risk, previously immunised with Prevenar 13 should receive 23-valent pneumococcal polysaccharide vaccine whenever recommended. The potential risk of apnoea and the need for respiratory monitoring for 48-72 hours should be considered when administering the primary immunisation series to very premature infants (born ≥ 28 weeks of gestation) and particularly for those with a previous history of respiratory immaturity. When Prevenar 13 is administered concomitantly with Infanrix hexa (DTPa-HBV-IPV/Hib), the rates of febrile reactions are similar to those seen with concomitant administration of Prevenar (7-valent) and Infanrix hexa. Increased reporting rates of convulsions (with or without fever) and hypotonic hyporesponsive episode (HHE) were observed with concomitant administration of Prevenar 13 and Infanrixhexa. Antipyretic treatment should be initiated according to local guidelines for children with seizure disorders or with a history of febrile seizures and for all children receiving Prevenar 13 simultaneously with vaccines containing whole cell pertussis.

Adults aged 50 years and older: When Prevenar 13 was given concomitantly with trivalent inactivated influenza vaccine (TIV), the immune responses to Prevenar 13 were lower compared to when Prevenar 13 was given alone, however, there was no long-term impact on circulating antibody levels. The immune responses to Prevenar 13 were noninferior when Prevenar 13 was given concomitantly with quadrivalent inactivated influenza vaccine (QIV) compared to when Prevenar 13 was given alone. As with concomitant administration with trivalent vaccines, immune responses to some pneumococcal serotypes were lower when both vaccines were given concomitantly. Fertility, Pregnancy & Lactation: There are no data from the use of pneumococcal 13-valent conjugate in pregnant women. It is unknown whether pneumococcal 13-valent conjugate is excreted in human milk. Animal studies do not indicate direct or indirect harmful effects with respect to reproductive toxicity. Side Effects: Analysis of postmarketing reporting rates suggests a potential increased risk ofconvulsions, with or without fever, and HHE when comparing groups which reported use of Prevenar 13 with Infanrix hexa to those which reported use of Prevenar 13 alone. Adverse reactions reported in clinical studies or from the post-marketing experience for all age groups are listed in this section per system organ class,in decreasing order of frequency and seriousness. The frequency is defined as follows: very common (≥ 1/10), common (≥ 1/100 to < 1/10), uncommon (≥ 1/1,000 to < 1/100), rare (≥ 1/10,000 to < 1/1,000), very rare (≤ 1/10,000), not

References: 1. Prevenar 13 Suspension for Injection Summary of Products Characteristics.

2. Bonten M.J.M., Huijts S.M, Bolkenbaas M, et al. Polysaccharide Conjugate Vaccine Against Pneumococcal Pneumonia in Adults.

The New England Journal of Medicine. 2015;372:1114-25.

3. Pfizer Inc. Press Release Mar 18, 2015.

known (cannot be estimated from available data). Infants and children aged 6 weeks to 5 years: Very common (≥ 1/10): Decreased appetite, fever, pyrexia, irritability, any vaccination-site erythema, induration/swelling or pain/tenderness, somnolence, poor quality sleep. Vaccination-site erythema or induration/swelling 2.5cm – 7.0 cm (after the booster dose and in older children [age 2-5 years]. Common (≥ 1/100 to < 1/10): Vomiting, diarrhoea, rash, pyrexia >39 °C, vaccination-site movement impairment (due to pain), vaccination-site erythema or induration/swelling 2.5cm – 7.0cm (after infant series). Uncommon (≥ 1/1,000 to < 1/100): Convulsions (including febrile convulsions), urticaria or urticaria-like rash, vaccination-site erythema, induration/swelling >7.0cm, crying. Rare: Hypersensitivity reaction including face oedema, dyspnoea, bronchospasm, hypotonic-hyporesponsive episode. Not known: Lymphadenopathy (localised to the region of the vaccination site), anaphylactic/anaphylactoid reaction including shock, angioedema, erythema multiforme, vaccination site urticaria, vaccination-site dermatitis, vaccination-site pruritus, flushing. In clinical studies infants vaccinated at 2, 3 and 4 months of age, fever ≥ 38°C was reported at higher rates among infants who received Prevenar (7-valent) concomitantly with Infanrix hexa than in infants receiving Infanrix hexa alone. After a booster dose at 12 and 15 months of age, the rate of fever ≥ 38°C was greater in infants who received Prevenar (7 valent) and Infanrix hexa at the same time compared to infants receiving Infanrix hexa alone. These reactions were mostly moderate (less than or equal to 39°C) and transient. Additional information in special populations: Apnoea in very premature infants (≤ 28 weeks of gestation). Children and adolescents aged 6 to 17 years of age: Very common (≥ 1/10): Decreased appetite, irritability, any vaccination-site erythema, induration/swelling or pain/ tenderness, somnolence, poor quality sleep, vaccination-site tenderness (including impaired movement). Common (≥ 1/100 to < 1/10): Headaches, vomiting, diarrhoea, rash, urticaria or urticaria-like rash, pyrexia. Additional information in special populations: Children and adolescents with sickle cell disease, HIV infection or an HSCT transplant have similar frequencies of adverse reactions, except that headaches, vomiting, diarrhoea, pyrexia, fatigue, arthralgia, and myalgia were very common. Adults ≥18 years of age, and the elderly: Very common (≥ 1/10): Decreased appetite, headaches, diarrhoea, vomiting,(in adults aged 18 to 49 years), rash, chills; fatigue; vaccination-site erythema; vaccination-site induration/swelling; vaccination-site pain/tenderness (severe vaccination-site pain/ tenderness very common in adults aged 18 to 39 years); limitation of arm movement (severe limitation of arm movements very common in adults aged 18 to 39 years), arthralgia; myalgia.

Common (≥ 1/100 to < 1/10): Vomiting (in adults aged 50 years and over), pyrexia(very common in adults aged 18 to 29 years). Uncommon (≥ 1/1,000 to < 1/100): Nausea, hypersensitivity reaction including face oedema, dyspnoea, bronchospasm, lymphadenopathy localized to the region of the vaccination site. Additional information in special populations: Adults with HIV infection have similar frequencies of adverse reactions, except that pyrexia and vomiting were very common and nausea common. Adults with an HSCT have similar frequencies of adverse reactions, except that pyrexia and vomiting were very common. For full prescribing information see the Summary of Product Characteristics. Legal Category: S1A. Package Quantities: Pack of 1 single-dose prefilled syringe (with separate needle) or pack of 10 single- dose pre-filled syringes. Marketing Authorisation Numbers: Single-dose pre-filled syringe (with separate needle) pack of 1: EU/1/09/590/002, single-dose pre-filled syringe pack of 10: EU/1/09/590/003. Marketing Authorisation Holder: Pfizer Europe MA EEIG, Boulevard de la Plaine 17, 1050 Bruxelles, Belgium. For further information on this medicine please contact: Pfizer Medical Information on 1800 633 363 or at EUMEDINFO@pfizer.com. For queries regarding product availability please contact: Pfizer Healthcare Ireland, Pfizer Building 9, Riverwalk, National Digital Park, Citywest Business Campus, Dublin 24 + 353 1 4676500.

Date of preparation: 11/2018. *Trade mark.

Ref: PN 11_0 IE.

Date of Preparation: February 2021 | PP-PNA-IRL-0005

66

Finance

20% Tax Relief 40% Ta Contribution €1,000 Tax Relief -€200 Net CostintoFinance you You may remember the excitement around the SSIA savings accounts introduced Act 2001€800

Additional Voluntary Contributions – The Forgotten Tax Break

and the subsequent interest in these plans with people clearly seeing the benefits of the government contributing an extra 25% on top of your contribution. Many of you readingBased this will have availedabove, of if you decided to on the example these savings contracts for this reason. Yet an AVC to your pension which of comes tax thewith nett the costgovernment is €600. Any growth on you contributing up to 40% and giving you tax free growth on investment returns are typically ignored. The purpose of this article is to explain how they work and to make the case forNow whylook AVC’s should rolehas in turned in at this again,have your a€600 your overall financial planning.

66% and this is before your money is expo overlooked concepts in pension investing.

Written by Kieran Moore, Moore Wealth Management

The Revenue Commissioners have established limits which apply to the contributions for which you can claim tax relief. The table The Revenue Commissioners havebelow established displays the percentage of your income that cancan claim tax tax relief. tablecontributing below displays th you receive reliefThe on when to a retirement fund. relief on when contributing to a retirement fun

Additional voluntary contributions (AVCs)

In any tax year employee contributions are In anyaccording tax year to employee are lim limited age and a contributions percentage of earnings thatincludes year. Thisany includes any that year.for This contributions to yo contributions to your main scheme. The relief on earnings pensionlimit contributions for 2021 is €115 maximum for tax relief on pension contributions for 2021 is ¤115,000.

AVCs are a defined contribution pension arrangement provided for your scheme usually by an insurance company or specialist pension provider. The fund available at retirement is determined by the combination of your contributions and any investment returns on these contributions.

What is a last minute AVC?

AVCs are a simple and tax efficient way of saving for your retirement. They are extra contributions made to increase your pension made by you personally supplementing the contributions made by your company or employer. They can be made easily into your existing company pension plan, so you do not even need to set up a new contract. The main advantage of AVC’s is that you as the employee get personal income tax relief on your contributions into the AVC. This year before you finalise your personal tax return you should look at all the options available to you to before parting with your hard-earned cash.

Here are the 5 top reasons to make an AVC this year before the tax deadline 1. Any contribution will come with full tax relief against your 2020 tax return.

2. If you reduce your final bill for 2020 then your preliminary tax bill for 2021 will also be reduced 3. Personal cash is losing money in real terms when left on deposit. AVC’s are an excellent way of utilising surplus personal cash.

4. Personal cash when invested is subject to tax on the growth at 41%, AVCs have tax free growth.

5. Paying yourself a bonus and then putting this bonus into an AVC will offset any personal tax and help extract cash from your business.

PHARMACYNEWSIRELAND.COM

You can make a last minute AVC payment into your pension scheme before you retire.

This can be particularly attractive for you if you can get tax relief on the contribution you make before you retire and if you can then get back your AVC fund as a tax-free lump sum on retirement. Please note that all last minute AVCs must be paid into your pension scheme before you actually retire so it is important to start the process well in time before your retirement date.

There are of course some revenue rules and regulations around AVCs and these are explained below.

What are the limits to the AVCs I can pay?

AVC pension contributions that you make while working are treated the same as normal pension contributions for tax purposes, so you may qualify for tax relief at your highest rate of tax as shown in the table below.

Age Under 30 30-39 40-49 50-54 55-59 60 and over

Percentage Allowed 15% 20% 25% 30% 35% 40%

What can I use AVCs for at retirement?

There are several benefit options at retirement, What canon I use AVCs forcircumstances at retirement? depending the individual of each member and Revenue restrictions:

There are several benefit options at retirement • Immediate tax free cash lump sum member and Revenue restrictions: • Purchase an annuity to provide guaranteed income for life

•

Immediate tax free cash lump sum

• Transfer the fund to an Approved Retirement • (ARF) Purchase an annuity to provide guaran Fund for drawdown in retirement as you • need Transfer the fund to an Approved Retir • Increase the tax-free lump sum on retirement need

• Increase the tax-free lump sum on reti • Provide for/or increase dependant's pension.

Based on the example above, if you decided to make an AVC of ¤1,000 and you are on the 40% rate of tax the nett cost is ¤600. Any growth on your AVC pension fund investment is tax free.

• option Provide for/or increase dependant's pe Which or combination of options is best for you will depend on your circumstances when you retire and should be determined in Which option combination of options conjunction with or a full cash flow model run by is bes a Certified Firm. Anything retire andFinancial shouldPlanning™ be determined in conjunction else is not full and proper advise.

Now look at this again, your ¤600 has turned into ¤1,000. This is the same as an investment return of 66% and this is before your money is exposed to investment returns.

This is one of the most overlooked concepts in pension investing.

To discuss if this is an option for you please contact Kieran Moore of Moore Wealth Management via To discuss this is an option forwebsite you please con 086380 1868,ifkieran@mwm.ie or visit our www.mwm.ie They have been advising the pharmacy 086- 380 1868 , kieran@mwm.ie or visit our community for over 15 years and are well versed in pharmacy community for over 15 years and are your needs.

Contribution Tax Relief Net Cost to you

Planning ™ Firm. Anything else is not full and p

20% Tax Relief 40% Tax Relief €1,000 €1,000 -€200 -€400 €800 €600

Based on the example above, if you decided to make an AVC of tax the nett cost is €600. Any growth on your AVC pension

Expert Second Opinion Service Confidential free Pension review We give you the peace of mind that comes with knowing the advice you received was in your best interest As a Certified Financial Planning Firm™ operating at the highest level of accreditation worldwide we will provide you with that reassurance and clarity. www.mwm.ie What are we looking for ?

1

Fees – Why pay more than you need to? You don’t do it for stock in your business so why do it for your pension

2

Performance – How does your pension compare to best in class

3

Risk – Are you over exposed to risk.

4

Was there actually financial advice? - Did you just get sold products or do you have a comprehensive personalized financial plan with full cashflow modelling?

colm@mwm.ie

086 860 39 53

|

kieran@mwm.ie

086 380 18 68

Moore Wealth Management Limited trading as Moore Wealth Management is Regulated by the Central Bank of Ireland Reg number 55195

Topic Team Training – Magnesium Deficiency 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. deficiencies in adults today, and this is associated with an increased risk of conditions such as diabetes, poor absorption, chronic diarrhoea, coeliac disease and 'hungry bone syndrome'.

According to the College of Naturopathic Medicine, 10 signs someone may be lacking in magnesium are: 1. Tiredness 2. Twitching eyes, muscle spasms, restless feet and leg cramps (including at night) 3. Sugar or chocolate cravings (cacao beans are high in magnesium) 4. Constipation

We are going to focus on Magnesium and highlight the benefits as - May reduce blood pressure - May improve mood - May help control blood sugar - May reduce heart disease risk 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.

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 Magnesium Deficiency.

Magnesium is an essential mineral needed for over 300 chemical reactions in the body, including regulating blood sugar levels and pumping the heart. It’s also a vital co-factor nutrient for other minerals (helping them to do their job) including chromium and calcium. Without magnesium, these other minerals do not work efficiently.

The average healthy adult requires around 270-400mg of magnesium per day, but research has shown that on average 50% of Irish people do not get enough Magnesium in their diets. In fact, magnesium deficiency is one of the most common nutritional

Consider:  The benefits of efficient magnesium consumption on the immune system and overall health  How to spot magnesium deficiency in customers to get them the help they need  OTC medicines that may cause magnesium deficiency  The importance of good magnesium intake for everyone and the recommended allowances  Lifestyle issues that may be impacting on the immune system  When to refer customers to the pharmacist.

68 | PHARMACYNEWSIRELAND.COM

diabetes, and certain cancers.

Also, low magnesium appears to be a risk factor for osteoporosis.

There's some evidence that eating foods high in magnesium and other minerals can help prevent high blood pressure in people with prehypertension.

Intravenous or injected magnesium is used to treat other conditions, such as eclampsia during pregnancy and severe asthma attacks. Magnesium is also the main ingredient in many antacids and laxatives.

The recommended dietary allowances (RDA) for magnesium, as suggested by the Food Safety Authority of Ireland are:

5. Pre-Menstrual Tension (PMT) and spasmodic period pain

Ages 19–30

6. Recurring headaches or migraines

Women: 310 mg

7. Depression or low mood 8. Feeling edgy, tense or anxious 9. Sleep issues especially falling asleep 10. Cardiovascular issues such as high blood pressure or irregular heartbeat Adults who get less than the recommended amount of magnesium are more likely to have elevated inflammation markers.

Inflammation, in turn, has been associated with major health conditions such as heart disease,

Key Points: Check your pharmacy team are aware and understand the following key points:  The pharmacy team knows to be sensitive in dealing with customers who may feel vulnerable  The team knows which groups of customers are likely to be at risk of magnesium deficiency  The health conditions associated with poor magnesium intake  My pharmacy assistants can meet the points in this training checklist.

Men: 400 milligrams (mg) Ages 31 and Older Men: 420 mg Women: 320 mg Pregnant and lactating women should consume more magnesium. Depending on age, the recommended dietary allowance (RDA), or the amount needed to reach sufficient levels, for these women ranges from 310 to 400 mg.

Actions:  Ensure efficient sign posting to discreet consultation areas within the pharmacy for further help and advice  Ensure that I know the recommendations for magnesium intake and supplements for each customer depending on sex and age  The recommended allowances for pregnant women  Are we confident about raising issues of vitamin deficiency with customers?  Can we provide good advice on dealing with magnesium deficiency?  Train the team to meet all the above considerations

50% of Irish people do not get enough Magnesium Magnesium is involved in more than 600 reactions in the human body and is essential for health.

BLOOD PRESSURE

MOOD

BLOOD SUGAR

HEART DISEASE

Unfortunately, studies suggest that about 50% of people in Europe get less than the recommended daily amount of Magnesium in their diet.

Sona, the best selling Magnesium supplements in Irish pharmacies.

SONA provides Magnesium tablets of 250mg, 300mg Time Release and 500mg elemental Magnesium.

SONA SUPPORTING Order direct from Sona on PH: 01 451 5087.

Also available from wholesalers, United Drug and Uniphar.

IrIsh vItamIns

70

Pharmacy Business

To DIY or Not to DIY? Moving your Independent Pharmacy Online Consumers have flocked online during the pandemic but many smaller independent pharmacies are still lagging behind. less willing to invest in a business that hasn't an e-Commerce website in 5, 10 or 15 years?

 Will you be able to win customers from pharmacies who have been online for 5-10 years?

Futureproof Your Retail Pharmacy With An Online Customer Service Experience

Which is the Best Option for Moving Your Independent Pharmacy Online?

Doing It Yourself: Is your life not hard enough?

While the occasional cosmetics sale may not worry your bottom line too much now, these small transactions will allow your online competitors to build trust with your customers.

It can be difficult to know what is the best route to move your specific independent pharmacy business online. While there are plenty of website platforms and services I will breakdown the main options as:

Written by Colm Baker

As telemedicine grows, online services like Healthwave, Phlo and Lloyds Direct that offer nationwide prescription deliveries will increasingly be trying to attract your dispensary customers online.

Reports from McKinsey & PWC both indicate that online pharmacy sales & telemedicine were two of the biggest growth areas online.

McKinsey reports of a “decade in days” when it comes to consumers’ digital adoption. Boots online sales had grown by 155% and many other pharmacies have reported similar growth.

This dramatic shift in consumer behaviour has seen a response from Irish pharmacies. The PSI’s Internet Supply List increased from 51 pharmacy websites at the end of 2019 to 128 at the end of 2020 to currently exceed 170 pharmacy websites. When you consider that the big pharmacy chains & groups are listed as a single pharmacy website it means that there are many hundreds of Irish retail pharmacies who are now selling products online.

It’s great to see that many independent pharmacies have realized that their current and future customers want an online customer service experience. With the movement of Amazon into the pharmacy market and disruptive online nationwide delivery services like Healthwave in Ireland, and Phlo & Lloyds Direct in the UK, independent pharmacies need to start building their online brands.

It’s true that many people would still rather support a local independent pharmacy. But what if you’re the only local pharmacy that doesn’t allow people to order prescriptions, book services and shop online?

While it may seem like a massive undertaking for independent pharmacies to enter the world of e-Commerce, you don’t necessarily have to go “all-in” and compete with the big pharmacy chains for total domination of the online market.

Most independent pharmacies, particularly owner-operated single independents, have no intention or ambition to “move online” in such a big way. And that’s perfectly okay.

You will have a lot less headaches.

But for the reasons discussed above you do need to provide an online customer service experience that at a minimum, allows your local customers to order prescriptions, book services and shop online. This could be viewed as a defensive, long-term strategy rather than one focused on growth.

For most independent pharmacy owners, the exit strategy is to sell your business at some point in the future. Put yourself in the shoes of prospective buyers. Would you be

However, many independent pharmacies are still lagging behind with outdated brochure websites and others have not yet entered the online space at all.

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1. Do It Yourself 2. Low-Cost Agency Development 3. High-Cost Agency Development Any of these options could work for your pharmacy but you need to consider each option in relation to your specific business. Consider the following questions first:  How much time do you & your team have available?  What marketing skills & experience does your team have?  What are your ambitions for your pharmacy website?  Are you focused on futureproofing your existing retail business or growing new revenue streams?  Will you need to recruit new staff to manage your website, marketing and order fulfillment if you intend on scaling a large e-Commerce business?  What level of investment are you willing to put into website development?  What ongoing level of investment are you willing to put into digital marketing, website management and license fees for software?  Do you have a unique selling proposition to other pharmacies who are far more experienced selling online?

Regardless of which website platform you choose, it will never be as easy to launch a website as the platforms make it out to be.

With that said, I know there will still be some pharmacy owners who will want to explore this route. There are only two website builders you should consider if you are going the DIY route: Shopify & WooCommerce (WordPress).

Shopify is a comprehensive, all-inone e-commerce software solution.

It streamlines the process and makes it easier for you to create an online store, accept payments, and manage your products. It also has dedicated customer support based in Ireland. You don't have to worry about as many of the technical aspects of managing a website, such as hosting, updates, and security.

However, to provide such an easy-to-use platform, there are limitations with pricing, design, features, content management, and integrations.

Yes, you may be able to build a simple website using Shopify. But to build a high-performing website that will compete with other pharmacies who spend in excess of €20,000 on their websites is a different kettle of fish altogether.

You will still need a development team to get near that level.

The more apps and features you want, the more monthly fees you will incur. There are also restrictions around payments, products and business models to be aware of. Don’t forget you are only renting a space on Shopify’s software and as a result, you have to play by their rules.

WooCommerce is an open-source e-commerce plugin built for WordPress websites. It

71 allows you to create an online store and leverage the most powerful content management system available, WordPress.

Since it is open source, this offers much more flexibility than Shopify, and you can customize every aspect of your website. You will have enough functionality & freedom to sell any type of product with awesome design features.

WooCommerce definitely requires more technical skill to get your website launched and running well.

While there are endless videos & support articles online, getting direct customer support about your specific problems is not as simple as with Shopify.

Although there are limitations with Shopify when it comes to pricing, design and functionality, I would recommend it as the best choice if you are going the DIY route unless you have some technical website experience with WordPress.

However, I do not recommend going the DIY route. You will create endless headaches and waste so much of your own time to produce a website that won’t look or perform as well as your competitors. This route should only be considered by those pharmacies who are really watching the bank balances or have website development experience in their teams.

Low-Cost Development WordPress Agencies eg. The Social Pharmacist A recent KPMG report found that 99% of Irish consumers say that a good website is important when they are shopping online. Having a team of professional designers, developers, graphic designers and marketers will provide a much safer route to launching a highquality website with a great design and customer experience.

your services, your products or the features that you need. You will end up micro-managing and spending so much time providing content to these agencies. It’s one of the big advantages of working with our pharmacist-led team at The Social Pharmacist.

We also implement a simple “Drag & Drop'' page builder on all of our pharmacy clients websites. This means you will be able to make simple edits to text and images yourself without any knowledge of coding. We also provide a range of video tutorials so you can learn how to manage the minor edits needed on your website yourself.

Depending on the size of your pharmacy, you could also be eligible to get 50% of the development costs covered by your Local Enterprise Office.

You should consider this route if you don’t want to make a major investment but want a modern, high-quality website that futureproofs your retail pharmacy.

You will be able to enter new markets and create new revenue streams while developing your teams e-Commerce skills.

High Cost Development Magento, ABCommerce, Absolute etc.

For those independent pharmacies who have major ambitions and are ready to make a significant investment, there are a number of enterprise-level solutions that offer additional benefits.

The most popular of these solutions for the Irish pharmacy market has been AB-Commerce.

AB-Commerce offers a turnkey solution for medium-sized retailers, encompassing best-in-class e-Commerce functionality, web hosting, high-end graphic design,

over 100 martech plugins and ePOS/ERP systems integrations.

There are also other enterpriselevel examples such as McCabes Pharmacy (Absolute), Meaghers Pharmacy (Milk Bottle Labs), Cara Pharmacy (IRP Commerce) and Life Pharmacy (Magento).

These websites are all really well equipped to take your e-Commerce functionality to the next level. This route should only be considered by those independent pharmacies who are ready to invest serious time, finances and personnel into e-Commerce. Remember that paying for an e-Commerce website to be launched is only your initial cost. An even greater investment is needed in personnel, marketing and advertising budgets to turn it into a standalone, profitable, selfsufficient business. Before making the investment, be certain of how you’re going to stand out and provide a clear difference to the other pharmacies who have been doing this for years.

My Personal Recommendation Customers want to reduce their time in retail stores and want the convenience of ordering prescriptions, services and products online to save time.

You need to start developing your online brand now. You need to provide an online customer service experience that futureproofs your retail pharmacy business. You don’t want to be the only local pharmacy that doesn’t provide an online experience for customers.

But you are no longer only competing with local pharmacies in your area. The growth of e-Commerce means that you are now competing with big pharmacy chains across the country for

retail sales. And the growth of nationwide prescription delivery services also create a growing threat to your dispensary turnover too.

Creating an online customer service experience for your local customers minimizes the risk of losing customers to online alternatives. Moving your pharmacy online can also create new revenue streams and growth opportunities.

But what route should you take?

Don’t be fooled by the lure of “easy money”. You will be competing with at least 30 Irish pharmacy brands who have invested in high-end e-Commerce websites. Not to mention others who are doing a great job building online businesses using lowercost websites. Many of your competitors will have a 5-10 years headstart on you too. They probably have greater brand awareness through a bigger retail footprint too.

On writing this article, there are over 170 pharmacy websites on the PSI Internet supply list. To put that into perspective, there are only 10 spaces on the first page of Google. How do you differentiate from them? If you are going to try to compete with them, it will take time, money and a lot of hard work.

Reflect realistically on your business, your ambitions, the skill sets within your team and how much investment you are ready to make in eCommerce at this current moment.

If you are still uncertain about which route to take, feel free to get in touch with me through The Social Pharmacist website.

A WordPress website will give your pharmacy a range of additional benefits and freedom to develop your online brand as your online business evolves. This route allows you to enter the e-Commerce space in a serious way and learn what it’s all about before making serious investments in time, finances and personnel.

There are many reputable website development agencies who can build a modern, effective e-Commerce website for your pharmacy. But also be aware of many unscrupulous people in this industry too.

One of the biggest problems you will encounter is that most website development companies won’t have a clue about your business,

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72

Advertorial

Love Your Heart With Medical Director of Healthspan Dr Sarah Brewer Your heart is an amazing organ that contracts and relaxes around 100,000 times every day to keep blood circulating around your body. Because your heart muscle contracts continuously, it needs more oxygen, glucose and other vital nutrients than any other muscle. In fact, nutrition is so important for heart health that a worldwide study, carried out across 52 countries, concluded that almost a third of heart attacks are linked to a poor diet.i Medical Director of Healthspan, Dr Sarah Brewer

to 16.6/8.2 mmHg compared with placebo in people with hypertension.v N.B. Statin drugs switch off the production of both cholesterol and coenzyme Q10 in the liver, and can halve circulating levels of coenzyme Q10 within 4 weeks. This reduction may contribute to muscle-related side effects experienced by some people taking a statin.

Omega 3

The DASH (Dietary Approach to Stopping Hypertension) diet is widely recommended, as it's based on the Mediterranean way of eating. This has been shown to improve many risk factors for heart disease, from blood pressure and type 2 diabetes to cholesterol levels and being overweight.

Although diet should always come first, some supplements may also offer heart health benefits, particularly for those who follow a diet that restricts certain foods.i Coenzyme Q10

The long-chain omega-3 fatty acids DHA and EPA are found in algae extracts and the oils of the marine fish that eat them. DHA and EPA reduce inflammation and blood stickiness, have beneficial effects on blood pressure and lower blood levels of triglyceride (a type of circulating fat). They also have a protective effect against abnormal heart rhythms, especially in the heart muscle receiving a poor blood supply.vi Current health guidelines recommend eating two servings of fish per week, one of which is oily (e.g. salmon, mackerel, herring, sardines). If you don’t eat fish, consider taking a daily omega-3 supplement.

Coenzyme Q10 is involved in energy production and is especially concentrated in heart muscle cells.

The amount of coenzyme Q10 that you make in the body peaks at around the age of 20 years, then declines, so that by the age of 40 the amount present in some cells is up to 32% lower than when you were in your 20s, and by the age of 80 has halved again.

Black garlic

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Coenzyme Q10 supplements can improve heart muscle strength and the amount of blood pumped with each heartbeat.iv The results from 12 clinical trials also show that coenzyme Q10 has the potential to lower blood pressure by up

L-Arginine

Black garlic is produced by a natural fermentation process that converts unstable ‘smelly’ sulphur-containing compounds into stable, odourless antioxidants.

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L-arginine is an amino acid that is used to make nitric oxide: a substance that increases blood vessel elasticity and dilation. In people with borderline high blood

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pressure, taking l-arginine can lower blood pressure by as much as 11/4.9 mmHg, alongside a 23% improvement in arterial elasticity.viii What’s more, L-arginine normalises blood pressure without causing it to go too low. When healthy people with normal blood pressure took L-arginine (at doses of 6g to 12g per day for 4 weeks) their blood pressure did not significantly reduce, and most reductions occurred at night.ix Magnesium Magnesium is involved in just about every metabolic reaction in the body, from muscle contraction and electrolyte balance to energy production and overcoming tiredness and fatigue. Magnesium is particularly beneficial in the circulation, lowering blood pressure, reducing abnormal blood clotting, promoting blood vessel dilation and protecting against abnormal heart rhythms and heart failure.

All these beneficial effects may explain why research involving almost 533,000 people found that the risk of cardiovascular events (heart attack, stroke) was 15% lower in those with the highest dietary magnesium intake and 33% lower in those with the highest blood levels of magnesium.x Magnesium is often combined with B vitamins, which are involved in energy metabolism, the maintenance of red blood cells and healthy heart function.

Vitamin K2 Vitamin K comes in several forms, of which vitamin K2 is important for heart health. Vitamin K2 activates a protein (MGP) which helps to prevent a build-up of calcium in artery walls. Among over 16,000 women who were studied for around 8 years, every 10mcg increase in dietary vitamin K2 intake was found to reduce the risk of coronary heart disease by 9%.xii N.B. Seek medical advice before taking supplements containing vitamin K if you are taking warfarin or have a blood clotting disorder.

Vitamin D3 Over the age of 50, your ability to synthesise vitamin D reduces, so

that you may synthesise four times less natural vitamin D in later life than you did in your 20s and 30s.

This may account for the increased prevalence of some age-related diseases such as hypertension.

A study involving 15,000 adults found that people with the lowest vitamin D levels were 30% more likely to have high blood pressure than those with optimal levels.

There is now mounting evidence that, in people over the age of 50 who are vitamin D deficient and who have hypertension, taking vitamin D3 supplements can significantly reduce both systolic and diastolic blood pressure. Good vitamin D levels may also help to protect against stroke.

You can also reduce your risk of heart disease by: - Not smoking – smokers are five times more likely to have a heart attack in their 30s and 40s than non-smokers, and three times more likely to have one overall - Losing any excess weight, especially the ‘menopot’ around your waist - Exercising regularly for at least 30 minutes, on most days - Keeping your alcohol intake within recommended safe limits - Cutting back on salt intake – don’t add salt during cooking or at the table, and compare labels to select products with the lowest content of salt/ sodium chloride - Avoiding excess stress, which increases your blood pressure by an amount equivalent to carrying an extra 20kg in weight, or an additional 20 years in age - Knowing your blood pressure and cholesterol levels - Maintaining tight control of heart disease risk factors such as high blood pressure, diabetes and raised cholesterol (through diet, lifestyle and any necessary prescribed medication)

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74

Business CPD

The Future of Pharmacy - Part 3

Navigating the Synergies and Potential Conflicts of Interest between Professional Practice and Business Excellence LEARNING OUTCOMES At the end of article, you will be able to…

• Explore how 4Front’s 6Ps of Pharmacy Excellence model can support pharmacists to navigate the synergies and potential conflicts of interest between professional practice and business excellence • Discuss ‘Professionalism’ in a Pharmacy context • Identify drivers that increase the likelihood of exemplary Professional Performance

In Part 1 (July 2021) of ‘The Future of Pharmacy,’ Business CPD Series, we identified 4Front’s Personal Leadership pillar as the foundation of Pharmacy Excellence. In Part 2 (August 2021), we discussed how mastery of 4Front’s Promotion pillar amplifies your ability to promote the value of health, the value of pharmacy, the value of your products and services, and the value of your professional expertise.

with the patients’ best interest at heart, create physically and psychologically safe working environments and be accountable for upholding, reviewing and upgrading your standards and actions, individually and collectively.

 P – To honour the first principle of the PSI’s Code of Conduct for Pharmacists (Put the • Identify drivers that increase the risk of poor Professional Performance Patient First), you must create • Recognise ONE key factor that underpins Professional Excellence opportunities for YOUR needs • Describe ways to grow your capacity to navigate professional to be recognised, assessed and dilemmas with confidence and care responded to. Furthermore, In Part 3 we focus on 4Front’s this process must ensure that Professional pillar.

• Prioritise your highest value activities your dignity is preserved and What does ‘Professional’ means in • Take action your values respected. Regular, in the context of 4Front’s 6Ps of scheduled, personal reflection Pharmacy Excellence? (with the support of a coach, INTRODUCTION: mentor or super-visor) provide What drives the quality of your a confidential space to increase IPN’s Pharmacy Business Excellence Series is for community professional performance? your awareness of the factors IPN 4Front Pharmacy Business Excellence Article JUNE 2021 pharmacists committed to growing their professional and How does mastery of 4Front’s that impact your decision making business knowledge and skills to overcome challenges and thrive Professional pillar lift process, shine a light on your as a community pharmacist. performance in the other 5Ps? assets and your blind-spots, and help you to recognise (and act IPN is proud to partner with 4Front Pharmacy to bring you the Where is the best place to focus upon) early warning signs which, if ‘IPN/4Front Pharmacy Business Excellence Series.’ to continually grow and develop unaddressed, could compromise your professional performance in a In this series, you will apply 4Front’s 6P’s of Pharmacy Excellence your professional performance. It way that to navigate the ‘Future of Pharmacy.’ also helps you to recognise and manage any conflicts of interest,  honours the PSI Code of 4Front’s 6P’s of Pharmacy Excellence are including commercial incentives, Conduct, which could compromise your 1. Personal Leadership  enhances patient care, professional judgement or patient care. Lack of regular, intentional 2. Professional Practice  increases your confidence, reflection, mentoring and/or integrity and reputation, and 3. Person-Centred Care (Patients/Customers/Staff/Other super-vision increases the risk In this article we take a deep dive into what ‘Personal Leadership’ means in in the context of Healthcare Professionals) of poor professional judgement,  future proofs your career, your 4Front’s 6Ps of Pharmacy Excellence and why Personal Leadership is THE critical foundation with decisions coloured by business and our profession? on which personal, professional and business life mastery is founded.

4. Products and Services unconscious bias, self-protective survival instincts, self-doubt and/or 5. Promotion insufficient self-care. (Personal)

6. Prosperity (Profit and Time)

 P – Several principles of the PSI’s Code of Conduct for Pharmacists relate to how we relate to others. This includes Principle 1: Put the Patient First, Principle 3: Communicate Effectively, Principle 4: Work with Others, Principle 5: Show Leadership. These Principles are Your mission, should you choose to accept it, is to use this enabled by Principle 6: Maintain framework as a guide to Competence and Principle 7: Be Open and Honest, when we focus • (re)activate your inner scientist, so you run the experiments our Professional Development on required to take your next bold move towards an ever more learning how to create a ‘Sage’ compelling future driven (Shirzad Chamine) growthWhile personal leadership develops fromisthe effects are felt not only by youculture and Professional Excellence ainside key out, its focused workplace that • develop mastery as you embrace your challenges and your family, but also by your employees, your customers, your colleagues and your pillar of Pharmacy Excellence, is open and honest, amplifies opportunities community. Furthermore, without a strong personal leadership foundation, the other 5Ps because thisabove) is the basis on which individual and collective strengths suffer. (see image • take PRIDE in what you do as you create an ever more public trust in pharmacy and and encourages synergy and • P - Making ethical decisions becomes increasingly difficult (Professional). prosperous future pharmacists is founded. Exemplary professional growth. Through • P - Demonstrating empathy in teamwork, customer care and conflict becomes professional PRIDE (Personal Responsibility increasinglyperformance limited (People). requires • equip, enable, engage and empower yourself, your team and an ever growing ability to trust In Delivering Excellence), and your patients to become more proactive about managing your collaborative teamwork, patient in Dungan the quality and integrity of 2021 Rachel – 4Front Pharmacy 31 May own health and wellbeing. care, commitment and results your professional judgement, act

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Each month, Rachel Dungan ‘The Pharmacist Coach,’ guides you to apply 4Front’s 6Ps of Pharmacy Excellence Framework to create your pharmacy future. While Rachel is the creator of this framework and the author of these articles, YOU are the author of your career, your future. The future of pharmacy is in your hands, in your heart, in your head.

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heart, it also increases the patient’s trust in the efficacy of your products and services, and high levels of trust makes it more likely that they will act upon your advice.

76

Business CPD

Seven Principles which govern pharmacists in the practice of their profession.

What drives Professional Performance?

In examining the creation of a framework to measure medical professionalism, Stern (2006) identified professional competence, communication skills and ethical understanding as the foundation stones of professionalism. However, the consistent application of these skills in alignment with four principles is what demonstrate professionalism.

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Firstly, Stern identifies that there is increased likelihood of pharmacists that are driven by Excellence - a commitment to competence and a desire to exceed ordinary standards – to demonstrate exemplary Professional Performance. This observation is aligned with other research indicating that an orientation selection, sourcing and sale having a short-term, hap-hazard, are multiplied. Tragically, many towards a Growth Mindset (Carol Saboteur driven approach, much of products and services from pharmacy workplaces promote a Dweck), the Sage Brain (Shirzad time is often wasted on reacting to pharmacies, you optimise your more fear-based culture in which Chamine) and Learned Optimism workplace drama and crises that Article SEP 2021 IPN 4Front Pharmacy Business Excellence ability to respond to patients ‘Saboteur’ Driven behaviours (Martin Seligman) motivates consume your time with negative needs, the changing nature of dominate (Shirzad Chamine). professionals to enjoy empowering energy and do not give you a healthcare and the evolution of the Such workplaces may present themselves and to The third principle identified by Stern to increase the likelihood of others pharmacists positive return on your time or highest value roles of pharmacists as uncaring or more interested continually develop mastery the demonstrating exemplary Professional Performance is Accountability: includesof selffinancial investment.

(Prosperity) and community pharmacies. in keeping up appearances changing knowledge and skills of regulation, standard setting, managing conflicts if interest and the acceptance The degree to which the staff than doing the right thing.

What is ‘Professionalism’? required of pharmacy professionals responsibility. demonstrate competence and the Other manifestations could be and their teams.

In the workplace, professionalism selected products and services workplaces that are more focused is key to building trust and respect, Conversely, a Fixed Mindset (Carol meet professional standards and on who is to blame than on leading high performing teams, Dweck), Saboteur-Driven Brain solve your patients’ problems learning from mistakes, workplaces as well as advancing within your (Shirzad Chamine) and Negativity that tolerate gossip or complaining, can be audited. An example of career. However, each of us has Bias create the tendency to do internal audit is the PSI Pharmacy without directly addressing the different perceptions of what the minimal required to avoid Assessment System Self-Audit concern with the person involved professionalism means and how to negative consequences. Given performed by a staff member. An and workplaces where microeffectively demonstrate it. the pace of change of technology, example of an external audit could management and perfectionism healthcare, education and be the Pharmacy Assessment dominate over creating a culture In modern day pharmacy, patient expectations, simply System Audit performed by an which enables pharmacists and there is no uniform definition upholding existing standards and external consultant). When the all their colleagues to do their of professionalism. In Ireland, requirements, without an ongoing highest level of innovation, probity highest value work. At an individual the PSI Core Competency drive to bring professional practice Framework outlines competencies and integrity are not applied to all level, saboteur driven workplaces to the next level, condemns you and behaviours that indicate promote self-protective behaviours, aspects of the pharmacy supply for self-delusion is a part One highly to acondition. life of mediocrity (at effective best) and competence in the domain of of the human chain, patient safety, professional Our capacity suspicion and workplace drama, strategy to provide a confidential space to navigate potential conflicts of interest is to avail our profession to the brink Professional Practice.

The PSI relevance and business raison which results in increased of mentoring, super-vision. provides the space to reflect, Code ofcoaching Conductoralso outlines Such support of irrelevance. d’etre are compromised. (Products stress, overwhelm and burnout, honestly explore the pros and cons of any decision, look at things from a number of and Services) stress induced absenteeism and different perspectives. recruitment challenges. Staffing  P – Promoting the value of shortages and workplace negativity Rachel Dungan – 4Front Pharmacy 2021of pharmacy health15 andAug the value impact patient safety, through are PSI core competencies. Those factors such as distraction, lack who hold conflicting beliefs about of effective communication, professionalism and promotion reduced pharmacist/patient may hold back from developing consultations, insufficient training mastery in this core competency and development. These increase and risk unintentionally fear of admitting to or learning from slipping into poor professional near misses, which increases the performance, blame or judgement. risk of an actual dispensing error (Promotion) occurring. Whatever it is, your  P – By consistently workplace culture has an energy demonstrating that you genuinely that is palpable to patients, locums have the patient’s best interest at and your community. (People) heart, and by proactively creating  P – By applying current, a Sage-based workplace culture, evidence based, legal and ethical you inspire trust, goodwill, loyalty decision making criteria to the and prosperity. By habitually The fourth and final principle identified by Stern to increase the likelihood of pharmacists demonstrating exemplary Professional Performance is Altruism: acting in the best interests of patients and not self-interest.

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77 heart, without compromising your needs and values.

According to IPSOS MRBI Veracity Index 2021, community pharmacists rank the highest as the most trustworthy profession

TRUST – At the Heart of Professional Excellence

Ipsos MRBI

Veracity Index 2021 - Who Do We Trust The Most?

Q. Now I will read you a list of different types of people. For each would you tell me if you generally trust them to tell the truth, or not?

Profession

Level of Trust

Change since May 2020

local pharmacists

96%

=

nurses

95%

-2

doctors

94%

-1

Earning this trust is something for which we can be proud and never take for granted. Earned trust, is a fundamental meta-skill, underlying all aspects of professional performance. Its absence or presence infiltrate every aspect of what you do, the impact and influence you have and how you perceive yourself and others. Trust in our profession is contributed by every representative of that profession. While others actions are not within your direct control, three pillars of trust ARE within your control and direct influence.

teachers

88%

-1

scientists

87%

=

NPHET *

87%

-4

1. Trust in yourself

weather forecasters

85%

+2

2. Trust in your team

gardaí judges

IPN 4Front Pharmacy Business Excellence Article SEP 2021 +1 83%

3. Trust in your patients

79%

-5

Why build trust in yourself?

Absence of self-trust can be 72% television news readers highly destructive where self-4 doubt, unhappiness and lack 70% civil servants of confidence can lead to +2 67% economists professional dissatisfaction, stress, overwhelm, anxiety, burnout or +4 58% ordinary person in the street wondering if you are good enough. +1 pollsters This absence of self-trust creates 57% a self-protective barrier between +2 56% clergy/priests you and others and creates a negativity bias with you. When you -9 eu leaders 49% are genuinely open, honest and -5 trade union officials 46% transparent with yourself, admit your own saboteurs, mistakes, +3 45%overcome journalists and team capacity to The second principle identified by Altruism: acting in the best weaknesses, fears, incompetence interests of patients and the Saboteur driven negativity and Stern to increase the likelihood -2 and behaviours to yourself, you local councillors 44% not self-interest. instead pay realistic attention to of pharmacists demonstrating can now shine a light on what the Sage driven positive thoughts exemplary Professional = 43% business leaders was previously in your blind-spot Pure altruism, is like unconditional and beliefs is vital so that you Performance is Humanism and consciously choose what love, in that it is given without -4 41% chief executives regularly recharge your batteries respect,charity compassion, empathy, you want to do about it. Each act any expectation of return. In and minimise34% the risk compassion honour and integrity.bankers These +1 of personal integrity gradually healthcare, over-giving and fatigue, overwhelm and burnout. qualities and behaviours are builds competence, discernment, under-receiving increases the risk -16 31% especiallygovernment important ministers in healthcare self-confidence, resilience and of compassion fatigue, apathy, The third principle identified by professions, as they enhance trust overwhelm and burnout.-1By putting certainty that you can deal with estate agents Stern to increase the likelihood 29% and influence on multiple levels. any uncertainty that life deals you your own oxygen mask on first, of pharmacists demonstrating -8 24% Professional and that you will take Sage action you professionally balance altruism exemplary In 4Front’s STEPS™politicians Consultation for the right reasons. As Professor with healthy self-care so =that you Performance is Accountability: Framework, Empathise is the 17% advertising executives Professionally applyingapproaches the principlesand of humanism is just as important among healthcare create win-win Brene Brown says, ‘Trust of others includes self-regulation, fulcrum on which the success of teams. hold Developing the individual and team capacity to overcome the Saboteur driven -2 the patient’s best interest at begins with self-trust.

If you can’t social media influencers 6% standard setting, managing negativity and instead pay realistic attention to the Sage driven positive thoughts and the other STEPS depend. conflicts if interest and the Public Health Emergency Team beliefs is vital so that you regularly recharge your batteries and minimise the risk Mutual respect (treating the patient * National acceptance of responsibility. compassion fatigue, overwhelm and burnout. as an expert in their own life and Powered by: Ipsos MRBI Omnipoll Our capacity for self-delusion is a owningOmnipoll your own expertise as a is a telephone omnibus survey which interviews a fresh sample of 1,000 adults aged 15+ every two weeks. For this survey we interviewed 1,002 adults aged 15+ between 24th February - 7th March 2021. part of the human condition. One medicine expert), compassion, For further information on Omnipoll please contact: For further information on Veracity Index please contact: highly effective strategy to provide empathy, honour and integrity all Tarik Laher Belinda Norton Hollie Power tarik.laher@ipsos.com a confidentialhollie.power@ipsos.com space to navigate build trust between you and your belinda.norton@ipsos.com Phone +353 (0)1 4389000 Phone +353 (0)1 4389000 Phone +353 (0)1 4389000 potential conflicts of interest is patient. When the patient trusts to avail of mentoring, coaching that you have their best interests or super-vision. Such support at heart, it also increases the provides the space to reflect, patient’s trust in the efficacy of honestly explore the pros and cons your products and services, and of any decision, look at things from high levels of trust makes it a number of different perspectives. more likely that they will act upon your advice.

The fourth and final principle identified by Stern to increase Professionally applying the the likelihood of pharmacists principles of humanism is just demonstrating exemplary as important among healthcare Professional Performance is teams. Developing the individual -5

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each other about their weaknesses, mistakes, fears and behaviours and know that each team member has the team’s best interests at heart. Based on this foundation, they create a CPD 78 Business culture that brings out the best in everyone and is consistently getting better, growing its capabilities and having a most positive impact on patient care.

expert in their own life. Patient Professional Self-Reflection Questions safety is greatly enhanced when honest, open conversations The tension between professional topics such as medication Rachel Dungan 4Front about Pharmacy 15 Aug 2021 A wonderful thing about– self-trust practice and business excellence adherence, vaccine hesitancy, is that it is 100% within your has always existed and continues concern about side effects or control to grow and develop it. to evolve. In order to be symptoms arise. Without a firm Conversely, you have the capacity trustworthy and skillfully navigate foundation of vulnerability based to influence (but not to control) the potential conflicts of interest, trust, both patient and healthcare speed and depth to which other each of us must fulfil our potential professional can end the people trust you. as we evolve in response to the conversation feeling frustrated, needs of our patients, our teams, As you deepen your trust in not having identified or solved the our communities, our profession, yourself and act with increasing real problem. our business and the healthcare integrity, you become more open service. As you think about and willing to trust in your team While it is easy to intellectually pharmacy of the future. Consider when you confide in them that understand how to apply this the following questions with your they will not use your confidences framework, mastery requires team, coach, mentor or other for personal gain, and you will Constant And Never Ending confidente to help you decide not leverage their confidences Feedback (CANI). It requires that on the most effective path to against them. According to you continually professional growth and creating Patrick Lencioni and Shirzad value in your pharmacy practice..  master your own Saboteurs, Chamine, members of great Judgements and Stress (an 1. What does ‘professionalism’ teams trust one another on a mean to you? What does essential pre-requisite for fundamental, emotional level. They ‘professionalism’ mean to each demonstrating real empathy) are comfortable being vulnerable member of your team? with each other about their  demonstrate empathy weaknesses, mistakes, fears and 2. What are examples of you (not sympathy), behaviours and know that each and your team acting in ways team member has the team’s best  stay curious long enough to that honour your professional interests at heart. Based on this understand your patient’s ideas, values? foundation, they create a culture concerns and expectations that brings out the best in everyone 3. What are examples of you (not assume), and is consistently getting better, and your team acting in growing its capabilities and a way that violates your  identify the cause the problem having a most positive impact on professional values? From (not just respond to symptoms), patient care. your perspective, what are  offer context specific advice the intended and unintended The third pillar is to Trust in your (not generic) and consequences/results?

Patients and to treat them as an  safety net with (not for) equal partner. You are an expert 4. What can you do to in healthcare. Your patient is the your patient. consistently demonstrate count on yourself you can’t ask other people to give you what you don’t have’.

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honouring your professional values?

5. What can you do to reduce behavours that violate your professional values?

6. What potential conflicts of interest are important to identify and proactively address?

7. What is one behaviour you could change immediately, that would contribute to creating a healthy workplace?

8. What are ways you can build ‘vulnerability based trust’ with your team, your patients and other healthcare professional colleagues?

9. What is work that ONLY you can do (as a pharmacist, as a supervisor, as a superintendent, as a business owner)? What activities do you need to stop doing in order to prioritise work that ONLY you can do? What could you delegate? What could you defer?

10. What conversations / training / upskilling is required to support you and each member of your team to step into your highest value work?

Next Steps  Answer the Professonal

79 Self-Reflection questions and record your thinking. Journaling, recording a CPD cycle, voice to text software

 Re-read Part 1 and Part 2 of this Future of Pharmacy series and reflect on how 4Front’s 6Ps of Pharmacy Excellence inter-relate for you

Further Reading 1. ‘Positive Intelligence’ by Shirzad Chamine 2. ‘The Speed of Trust’ by Stephen Covey

 Dedicate regular time in your diary to pause, reflect and debrief your reflections to ensure that you are not just busy, but intentionally moving in the right direction, for the right reasons.

 Engage in ongoing strategies to develop yourself as a the person who is the professional, so that you mitigate the risk of your professional judgement being clouded by unconscious bias.

RESOURCE ANNOUNCEMENTS

Professional Practice CPD Cycle - A Pharmacist Owner CPD Cycle

1. As an IPN reader, we invite you to register for FREE pharmacy team training www.4FrontPharmacy.ie. You can also browse our range of online programmes to support you and your team to develop your consultation skills, gain OTC product knowledge and deal with medical emergencies.

2. 4FrontPharmacy Solutions will be hosting two cohorts of the Positive Intelligence® flagship 8-week Mental Fitness Programme specifically for pharmacists and their teams over the coming months. To find out more about how this Programme and Coaching can help you improve morale, wellbeing and team performance, drive your sales and improve patient safety email rachel@racheldungan.com and use the subject line ‘IPN Sep 2021.’

AUTHOR: Rachel Dungan MPSI, ACC. Rachel Dungan MPSI, MICF, ACC. Community Pharmacist. Lifestyle Medicine Advisor.

Positive Intelligence Certified Coach. European Mentoring & Coaching Council Senior Practitioner. Award-Winning Wellbeing and Leadership Coach known as ‘The Pharmacist Coach.’ Rachel worked for 20 years as a supervising and superintendent pharmacist.

Now, more than ever, her vision is to empower, equip, enable and engage pharmacists and their teams with the knowledge and skills required to focus on what is most important, rediscover joy and happiness and help them build the habits to put their own oxygen mask on first.

She is co-founder of www.4FrontPharmacy.ie.

Its mission is to raise the global standard of pharmacy consultations by empowering pharmacists and their teams to expand their perspective, knowledge and skills to create sustainable health behaviour change.

3. ‘Conversational Intelligence’ by Judith Glaser 4. ‘BRAVING – The Seven Elements of Trust’ by Brene Brown

S

Self-Appraisal WHAT I intend to learn and why I have been called for ePortfolio Review in Jan 2022 for the first time. I want to ensure that I can tick all the boxes to meet the regulatory requirements to successfully complete my review.

P

Personal Plan HOW I intend to learn it I plan to • Log into the IIOP website and find out the ePortfolio Review standards for this year.

• Review the CPD cycles I have already created in my ePortfolio and see which ones I might select for review.

• Speak with other colleagues called for ePortfolio Review.

A

Action What I actually did • As above PLUS • I reviewed the IPN business CPD articles on ‘the Future of Pharmacy,’ because they have sample CPD cycles I can model.

• I contacted the article author Rachel Dungan MPSI • I expressed an interest in being involved in the IIOP Early Career Mentoring Pilot.

D

Document What I have learned specifically • I learned the minimum requirements to submit for ePortfolio Review 2021/2022. I need to submit 4 cycles from 2021 and 2 cycles started in 2017-2020.

• Previously, I had only considered clinical based cycles for my CPD cycles. However, having read the CPD cycles in the IPN Business Series, it has expanded my thinking in relation to the depth and breadth of CPD cycles I can record.

E

Evaluate ONE example of how I put my learning into practice • I had never considered Pharmacy Mentoring until I spoke to Rachel Dungan and she shared her experience as a mentor on the IIOP Early Career Mentoring Pilot. The opportunity to have a confidential space to explore my professional practice excites me, so I wrote to the IIOP to submit an expression of interest for any future mentoring programme they may run.

• Having spoken to Rachel Dungan, I have enrolled in the 8-Week Positive Intelligence Programme® as a way to enhancing my ability to trust in myself and my own professional judgement. I believe that patient safety will be a big winner.

• I started this journey believing that ePortfolio Review was a burdensome, tick box exercise, but now I have experienced the real value of intentional learning and growth, focused on developing me, (the person who is the professional), I find myself having a far more positive attitude towards CPD!

CCF Domains (and Competencies) The Pharmacist selected Competencies under the following domains for this CPD Professional Practice (Engages in appropriate CPD), 2. Personal Skills (Leadership Skills, Decision Making Skills, Team-Working Skills, Communication Skills) Contributed by Rachel Dungan MPSI of 4Front Pharmacy. To find out more about how 4Front Pharmacy’s Positive Intelligence® Programme and Coaching can help you improve morale, wellbeing and team performance, drive your sales and improve patient safety email rachel@racheldungan.com and use the subject line ‘IPN Sep 2021.

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Clinical Profiles

MOUTH KOTE - FOR MODERATE TO SEVERE XEROSTOMIA For long- lasting relief of dry mouth & throat For patients, especially those on cancer treatment, dry mouth can be a significant area of discomfort. As well as a side effect of cancer treatment, dry mouth, or xerostomia, can be caused by medications including: hypertensives, psychoactive drugs, decongestants, cardiovascular drugs and antihistamines.

By offering your patients a solution that not only helps relieve dry mouth, but actually does so without causing damage to their teeth, even helping to remineralise tooth enamel, you can help improve the quality of life for patients experiencing xerostomia.

On behalf of Parnell Pharmaceuticals, United Drug introduce you to their two leading dry mouth solutions:

• Mouth Kote Dry Mouth Spray • Mouth Kote Remint Remineralizing Spray.

These solutions not only help prevent cause tooth decay, but in the example of the Remint product, can actually help your patients to remineralise and restore their tooth enamel.

FREE sample sachets are available - contact Peter Whitty on 087 820 9008 to get your FREE sample.

IRELAND SECURES ALMOST 700,000 ADDITIONAL DOSES OF PFIZER/BIONTECH COVID-19 VACCINE The Minister for Health is pleased to announce that Ireland has signed an agreement to purchase almost 700,000 doses of Pfizer/ BioNTech COVID-19 vaccine.

The doses secured through the agreement will be used to support the continued acceleration of the vaccination programme to younger people. The additional doses, which are being secured directly from Pfizer, are a redistribution of supplies which had originally been ordered by Romania.

Welcoming the announcement, Minister for Health Stephen Donnelly TD expressed his thanks to Romania and said the deal underlined the benefits of the European approach to vaccine procurement.

“On behalf of the Government, I wish to sincerely thank our colleagues in Romania, including His Excellency President Iohannis and his officials. The agreement

underlines the benefits of European solidarity with regards to vaccine procurement.

“More than 500 million doses of COVID-19 vaccine have now been distributed across the European Union. The increased availability of vaccine supply has enabled Ireland to accelerate its vaccination programme over recent months and this week is expected to see the six millionth dose administered in Ireland since the vaccination programme began.”

Vaccine manufacturer Pfizer is now to confirm the precise dates for the delivery of this additional supply, which is expected to arrive in Ireland this month.

FDA APPROVES NEXVIAZYME® (AVALGLUCOSIDASE ALFA-NGPT), AN IMPORTANT NEW TREATMENT OPTION FOR LATE-ONSET POMPE DISEASE The U.S. Food and Drug Administration (FDA) has approved Nexviazyme® (avalglucosidase alfa-ngpt) for the treatment of patients one year of age and older with late-onset Pompe disease, a progressive and debilitating muscle disorder that impairs a person's ability to move and breathe. Nexviazyme is an enzyme replacement therapy (ERT) designed to specifically target the mannose-6-phosphate (M6P) receptor, the key pathway for cellular uptake of enzyme replacement therapy in Pompe disease. Nexviazyme has been shown in clinical trials to provide patients with improvements in respiratory function and walking distance.

Pompe disease affects an estimated 3,500 people in the United States and can present as infantile-onset Pompe disease (IOPD), the most severe form of Pompe disease with rapid onset in infancy, and late-onset Pompe disease (LOPD), which progressively damages muscles over time. LOPD symptoms may present at any age. However, due to the wide spectrum of clinical presentations and progressive nature of the disease, it can take seven to nine years before patients receive an accurate diagnosis. As the disease progresses, people with LOPD may require mechanical ventilation to help with breathing or a wheelchair to assist with mobility.

Pompe disease is caused by a genetic deficiency or dysfunction of the lysosomal enzyme acid alpha-glucosidase (GAA), which results in build-up of complex sugars (glycogen) in muscle cells throughout the body. The accumulation of glycogen leads to irreversible damage to the muscles, including the diaphragm that supports respiratory function and skeletal muscles that affect mobility, functional endurance and breathing.

The key pathway to transport GAA enzyme into the lysosomes in the cell is through the M6P receptor.

Nexviazyme is specifically designed to target M6P to improve cellular enzyme uptake and enhance glycogen clearance in target tissues with an approximate 15-fold increase in M6P content compared to alglucosidase alfa, the comparator arm in the pivotal study.

Clonmel Healthcare introduce Oyavas® Clonmel Healthcare are delighted to announce the introduction of Oyavas®, the new Bevacizumab biosimilar.

Oyavas® is an anti-VEGF monoclonal antibody, indicated for the treatment of the same 6 cancer types as the reference product*†1,2 • Breast cancer • Cervical cancer • Colorectal cancer • Lung cancer • Ovarian cancer • Renal cell cancer Oyavas® is confirmed to be biosimilar to the reference product*3, demonstrated

according to EMA recommendations and guidelines.

SIMPLY CONVINCING – with similar efficacy, safety and quality to the reference product*3 Simply AFFORDABLE – with improved cost effectiveness compared to the reference product*4 Simply RELIABLE – with dedicated European production and comprehensive logistical support

on 01-6204000 or e-mail oyavas@clonmel-health. ie if you require any additional information.

Marketing authorisation number: EU/1/20/1510/001002. Marketing authorisation holder: STADA Arzneimittel AG, Stadastrasse 2-18, 61118 Bad Vilbel, Germany.

Date prepared: July 2021.

2021/ADV/OYA/077H.

Full prescribing information is available on request or alternatively please go to www.clonmel-health. ie. Medicinal product subject to medical prescription.

*Avastin

Please contact Clonmel Healthcare

2. Avastin SmPC (Feb. 2021)

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† Not all treatment schedules within each cancer type are approved due to patent protection 1. Oyavas SmPC (Apr. 2021).

3. Oyavas EPAR Public Assessment Report. Available at: https://www.ema. europa.eu/en/documents/assessmentreport/oyavas-epar-public-assessmentreport_en.pdf. Last accessed May 2021.

4. Cost of Oyavas and reductions in price will vary depending on the market

Clinical Profiles CRCBIOSCREEN ANNOUNCES PUBLICATION OF CLINICAL VALIDATION DATA OF A MULTITARGET FECAL IMMUNOCHEMICAL TEST FOR COLORECTAL CANCER SCREENING CRCbioscreen, a Dutch diagnostics company, dedicated to developing a next generation stool test for population based ColoRectal Cancer or CRC screening, has announced the publication of promising results of a diagnostic accuracy study with a multitarget immunochemical test (mtFIT) for early detection of CRC. Data were published in the prestigious journal Annals of Internal Medicine. The researchers found that the combination of 3 biomarkers (hemoglobin, calprotectin and serpin F2) had significantly higher sensitivity compared with the standard FIT test, without compromising specificity. The mtFIT detects 35% more advanced adenomas, which could translate into 12% CRC incidence reduction and 8% CRC mortality reduction.

The paper was authored by a team of researchers and clinicians from the Netherlands Cancer Institute, Amsterdam, in collaboration with researchers from AmsterdamUMC and ErasmusMC in Rotterdam, The Netherlands.

The researchers used bio-banked residual FIT sample buffer from 1,284 patients to assess if the addition of protein biomarker quantification in stool could be used to improve the sensitivity of FIT, without sacrificing specificity.

The patients were classified by their most advanced lesion – CRC, advanced adenomas, advanced serrated polyps, nonadvanced adenomas, and nonadvanced serrated polyps— and then classification and regression tree (CART) analysis was applied to biomarker concentrations in order to identify the optimal combination for detecting advanced neoplasia.

Performance of this combination, the mtFIT, was cross-validated using a 'leave-one-out' approach and compared with FIT at equal specificity.

The researchers found that the combination of 3 biomarkers (hemoglobin, calprotectin and serpin F2) had significantly higher sensitivity than FIT for advanced neoplasia (i.e. CRC and advanced precursor lesions) with equal specificity to FIT. The

improvement was seen in the advanced adenomas, for which sensitivity was increased by 35%, while sensitivity for CRC and advanced serrated polyps did not change. The improved sensitivity for advanced adenomas may prove critical to improving FIT's performance as a cancer prevention test.

The authors estimate that when performed biennially and compared to traditional biennial FIT, mtFIT would reduce CRC incidence and mortality by 12% and 8%, respectively, assuming 73% adherence.

Finally, the mtFIT was also deemed cost-effective. Funding has been secured to conduct a prospective screening trial to further validate mtFIT within the context of the Dutch CRC screening program.

An independent editorial comment in the same issue of the journal commented on the study to be "important because the challenge of building a better screening test was approached from the perspective of an organized, population-based screening program, and it shows the potential of relatively inexpensive enhancements to the widely used FIT to improve sensitivity without sacrificing specificity" and "Ultimately, this study offers promise of incremental but important improvements in the effectiveness of population-based CRC screening through novel biomarker measurement using an existing screening platform."

HANSA BIOPHARMA ANNOUNCES REIMBURSEMENT IN THE NETHERLANDS OF IDEFIRIX® (IMLIFIDASE) Hansa Biopharma, “Hansa” (Nasdaq Stockholm: HNSA), the pioneer in enzyme technology for rare immunological conditions, has announced that its firstin-class treatment Idefirix® (imlifidase) is, as of August 1, reimbursable and available for use in the Netherlands. Idefirix® is the first and only treatment approved for use in the European Union for desensitization of highly sensitized patients prior to kidney transplantation, allowing them to be considered for a life-altering kidney transplantation from a deceased donor.

“Highly sensitized patients have high levels of immunoglobulin G against many human leukocyte antigens that can cause tissue damage and

potentially transplant rejection.” says Dr Annelies de Weerd, nephrologist at the Erasmus Medical Center in Rotterdam.

“Idefirix is the first medicine to desensitize immunized kidney transplant candidates. It works by inactivating immunoglobulin G, then reduces the risk of hyperacute rejection following transplantation.”

Hansa Biopharma’s commercial launch activities throughout Europe are underway as planned.

Pricing for Idefirix® has been published in the first markets[*] and the first commercial sales were reported in Q1 2021.

The first agreements around reimbursement and funding access with healthcare providers and payers have been completed, and more are expected in the early-launch countries over the course of 2021.

“At Hansa, our mission is to significantly improve the lives of rare disease patients with serious unmet medical needs, bringing highly innovative medicines from the laboratory to patients”, said Henk Doude van Troostwijk, Senior Vice President and Chief Commercial Officer, Hansa Biopharma. “We are excited to be able to partner with the healthcare community in the Netherlands to offer a new therapy option for highly sensitized patients waiting for a potentially life-saving kidney transplant. This reimbursement announcement shows how we are delivering on our commitment to improve the lives of patients with rare immunological conditions.”

LEO PHARMA ANNOUNCES MHRA AND EC APPROVAL OF ADTRALZA (TRALOKINUMAB) LEO Pharma UK and Ireland, a leader in medical dermatology, has announced that the Medicines and Healthcare products Regulatory Agency (MHRA) and the European Commission (EC) has approved tralokinumab for the treatment of moderate-tosevere atopic dermatitis in adult patients who are candidates for systemic therapy.

The MHRA and EC approvals make tralokinumab the first and only approved biologic that specifically targets the IL-13 cytokine alone, a key driver of atopic dermatitis signs and symptoms.3,4 Tralokinumab is the first high affinity, human monoclonal antibody developed to specifically bind to and inhibit the IL-13 cytokine in adult patients

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with uncontrolled moderate-tosevere atopic dermatitis. 1,3,4 Tralokinumab will be available in a 150 mg/mL prefilled syringe for subcutaneous injection with an initial dose of 600 mg followed by 300 mg every other week.

Tralokinumab can be used with or without topical corticosteroids (TCS).5 “Atopic dermatitis can be an intensely itchy, challenging and unpredictable skin condition for some. As clinicians, we always want more options for patients and the approval of tralokinumab means that clinicians across the UK and Ireland now have an important new treatment option for patients with moderate-tosevere atopic dermatitis in adult patients” said, Professor Anthony Bewley, Consultant Dermatologist at Barts Health NHS Trust.

The MHRA and EC approval of tralokinumab is a significant milestone for thousands of adults in Europe living with atopic dermatitis,” said Dr. Amit Aggarwal, Medical Director, LEO Pharma UK and Ireland.

“Tralokinumab was developed based on the advanced understanding of the immune processes underlying atopic dermatitis, which is fundamental to our mission of pioneering medical dermatology” he continued.

The approval is based primarily on safety and efficacy results from the ECZTRA 1, 2 and ECZTRA 3 pivotal Phase 3 trials, which included more than 1,900 adult patients with moderate-to-severe AD. Safety data was evaluated from a pool of five randomized, double-blind, placebo-controlled trials, including ECZTRA 1, 2 and ECZTRA 3, a dose ranging trial, and a vaccine response trial.

LEO Pharma is working closely with key stakeholders to support access to tralokinumab for eligible patients. The MHRA and EC decisions are valid in the UK and all European Union Member States, Iceland, Norway, and Liechtenstein. Additional regulatory filings are underway with [the U.S. Food and Drug Administration (FDA) and other] health authorities worldwide.

DUPIXENT® (DUPILUMAB) SIGNIFICANTLY IMPROVED ITCH AND HIVES IN PATIENTS WITH CHRONIC SPONTANEOUS URTICARIA A pivotal Phase 3 trial evaluating Dupixent® (dupilumab) in patients with moderate-to-severe chronic

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Clinical Profiles

spontaneous urticaria (CSU), an inflammatory skin disease, met its primary endpoints and all key secondary endpoints at 24 weeks. Adding Dupixent to standard-of-care antihistamines significantly reduced itch and hives for biologic-naïve patients, compared to those treated with antihistamines alone (placebo) in Study A (the first of two trials) of the LIBERTY CUPID clinical program.

CSU is a chronic inflammatory skin disease characterized by the sudden onset of hives on the skin and/or swelling deep under the skin. Despite standardof-care treatment, people with CSU often experience symptoms including a persistent itch or burning sensation, which can be debilitating and significantly impact quality of life. Swelling often occurs on the face, hands and feet, but can also affect the throat and upper airways.

CSU is typically treated with antihistamines but for up to 50% of people living with CSU their disease remains uncontrolled and available treatment options are few. CSU is the fifth inflammatory disease for which Dupixent has achieved positive Phase 3 data, including atopic dermatitis, asthma, chronic rhinosinusitis with nasal polyposis and eosinophilic esophagitis (EoE, investigational).

In the trial (n=138), adding Dupixent to standard-of-care antihistamines nearly doubled the reduction in itch and urticaria activity compared to standard-ofcare alone at 24 weeks: • 63% reduction in itch severity with Dupixent vs 35% with standard-of-care (antihistamines) as measured by a 0-21-point itch severity scale (10.24-point reduction with Dupixent vs 6.01-point reduction with standard-of-care) (p<0.001), the primary endpoint in the US (secondary endpoint in the EU) with continuous improvement out to week 24.

adverse events were generally similar between the Dupixent and placebo groups (50% of Dupixent patients and 59% of placebo patients). The most common adverse events were injection site reactions (11% Dupixent, 13% placebo).

The potential use of Dupixent in CSU and EoE is currently under clinical development, and the safety and efficacy have not been fully evaluated by any regulatory authority.

ABBOTT ANNOUNCES R&D INVESTMENT IN CLONMEL Global healthcare company Abbott has announced further investment in its cardiovascular Research and Development Centre based at its Vascular devices site in Clonmel, Co. Tipperary, Ireland.

Abbott is the world leader in drug-eluting stents. Both R&D and manufacturing of Abbott’s new vascular technologies to treat complex heart disease take place at its Clonmel site. The Irish R&D team spent three years developing the company’s market-leading stent, XIENCE Sierra, which is being used worldwide in patients who, because of the nature of their disease, might not previously have been suitable for minimally invasive surgery. Abbott’s manufacturing plant in Clonmel manufactures its XIENCE family of stents, including XIENCE Sierra, for global use.

The continued major investment programme in its R&D centre in Clonmel, supported by the Irish

• 65% reduction in urticaria activity (itch and hives) severity with Dupixent vs 37% with standard-of-care, as measured by a 0-42-point urticaria activity scale, (20.53-point reduction with Dupixent vs 12.00-point reduction with standard-of-care) (p<0.001), the primary endpoint in the EU (secondary endpoint in the US) with continuous improvement out to week 24.

The trial demonstrated safety results similar to the known safety profile of Dupixent in its approved indications. For the 24-week treatment period, the occurrence of treatment emergent

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government through IDA Ireland, comes as Abbott celebrates 75 years in Ireland this year. Over the next three years, Abbott will invest ¤37.8 million in an R&D programme focusing on the discovery, innovation and development of a number of projects, including next generation drug eluting stents, as well as coronary and endovascular balloon technologies.

Deirdre Mullins, site director, Abbott in Clonmel said, “Our market leading XIENCE stents were developed in Clonmel and today’s announcement places us at the vanguard of Abbott’s global research efforts in cardiovascular treatments. We are very proud that the life changing technologies we design and manufacture in Clonmel are saving lives in Ireland and across the world.”

CEO of IDA Ireland Martin Shanahan said, “Abbott has demonstrated real commitment to its Irish operations in its 75 years here, investing and expanding its operations and growing jobs across its manufacturing and shared services sites, employing over 4,000 people in Ireland.

The economic and jobs benefit of Abbott’s longevity here is substantial. I congratulate the Irish and global teams on this investment and wish Abbott continued success in its operations here.”

Over 90,000 Irish people have heart disease and it is one of the most common causes of hospitalisation in people aged over 65 in Ireland. Dr Colm

Hanratty, Consultant Cardiologist at Mater Private Network Dublin, is a pioneer in the treatment of patients with complex cardiovascular disease and broadcasts operations all over the world, sharing his knowledge and skills with consultants across the globe.

He said, “Drug eluting stents revolutionised the treatment of cardiovascular disease. But we are starting to see more complex cases. As people get older, the arteries narrow, they become twisted and there is a build-up of plaque. Abbott’s XIENCE Sierra stent is a feat of engineering that means we can treat previously untreatable patients.”

Dr Diarmuid Meagher, Director of Research and Development, Abbott, explains that the engineering team worked closely with Dr Hanratty and the global interventional cardiology community to understand the challenges that were impacting successful cardiovascular interventions. “We adapted the XIENCE design to develop a stent for older and more complex patients which was smaller, more flexible and physically stronger. Its sophisticated navigation makes it easier to manoeuvre through challenged arteries and obstacles and it’s now being used in 90 countries around the world.”

Abbott has announced further investment in its cardiovascular Research and Development Centre based at its Vascular devices site in Clonmel, Co. Tipperary, Ireland

Clinical Profiles MINISTER FOR HEALTH ANNOUNCES HSE APPROVAL TO REIMBURSE PATISIRAN (ONPATTRO) The Minister for Health, Stephen Donnelly TD is pleased to announce that the drug Patisiran (Onpattro) has been approved by the HSE for reimbursement in the treatment of hereditary transthyretin-mediated (hATTR) amyloidosis. hATTR amyloidosis is an inherited, rare, life-limiting, multi-systemic disease where there are limited treatment options currently available.

In order for the HSE to recommend in favour of reimbursement of Patisiran (Onpattro), the HSE has undertaken considerable engagement and negotiation with the manufacturer Alnylam over a protracted period.

Speaking today, Minister Donnelly said, “The reimbursement of Patisiran by the HSE is a welcome decision for hereditary transthyretin-mediated amyloidosis patients, their families and friends.

"Our country continues to make new and innovative treatment available to patients and the allocation of ¤50m in Budget 2021 for new medicines ensures that this continues. However, securing access to treatments for patients at an affordable price remains the key priority. I wish to take the opportunity to thank the HSE for the dedication it has put into the Patisiran negotiations over a long period, which required significant work and deserves recognition.”

The HSE now advise that they will develop and implement the required managed access programme, as required for reimbursement, in order for all eligible patients with hATTR amyloidosis with stage 1 or stage 2 polyneuropathy to access treatment with Patisiran in the near future.

ORPHAN-DRUG DESIGNATION FOR VO659, AN INVESTIGATIONAL THERAPY FOR HUNTINGTONS DISEASE VICO Therapeutics, a Leiden Bio Science Park, the Netherlands, based biotech company focusing on the development of RNA modulating therapies for rare neurological disorders, has announced that the Office of Orphan Products Development (OOPD) of the U.S. Food and Drug Administration (FDA) has granted orphan-drug designation for VO659, VICO's investigational antisense oligonucleotide (AON) therapy, for the treatment of Huntington's disease (HD). This news comes only one month after

VICO announced that VO659 had received orphan-drug designation for the treatment of spinocerebellar ataxia (SCA). This new designation completes the quartet of orphan designations for VO659 in HD and SCA in both the US and EU. Rupert Sandbrink, MD PhD, Chief Medical Officer at VICO, stated, "Huntington's disease, like many types of SCA, belongs to the group of polyglutamine disorders which are rare genetic and progressive brain diseases.

Patients affected by Huntington's disease experience motor disturbances, personality changes and dementia, leading to increasing disability, loss of independence and reduced survival. Only very limited, symptomatic treatment options are currently available for patients with this devastating disease. Our investigational RNA modulating therapy is aimed to be a disease modifying treatment for polyglutamine disorders, designed to lower the mutant polyglutamine protein levels that cause these neurodegenerative diseases.

"We are delighted that FDA has granted this orphan-drug designation, following the ODD for SCA one month ago. This is affirmation of the potential of our AON approach."

The FDA's Office of Orphan Products Development grants Orphan Drug Designation to drugs and biologics that are defined as those intended for the safe and effective treatment, diagnosis or prevention of rare diseases/ disorders that affect fewer than 200,000 people in the U.S. The designation allows VICO to qualify for a number of incentives, including seven years of market exclusivity upon regulatory approval; exemption from FDA application fees for Huntington's Disease; and tax credits for qualified clinical trials.

SANOFI TO ACQUIRE TRANSLATE BIO; ADVANCES DEPLOYMENT OF MRNA TECHNOLOGY ACROSS VACCINES AND THERAPEUTICS DEVELOPMENT As part of Sanofi's endeavor to accelerate the application of messenger RNA (mRNA) to develop therapeutics and vaccines, the company has entered into a definitive agreement with Translate Bio (NASDAQ: TBIO), a clinical-stage mRNA therapeutics company, under which Sanofi will acquire all outstanding shares of Translate Bio for $38.00 per share in cash, which represents a total equity value of approximately $3.2 billion (on a fully diluted basis). The Sanofi and Translate Bio Boards of Directors unanimously approved the transaction.

"Translate Bio adds an mRNA technology platform and strong capabilities to our research, further advancing our ability to explore the promise of this technology to develop both best-in-class vaccines and therapeutics," said Paul Hudson, Sanofi Chief Executive Officer. "A fully owned platform allows us to develop additional opportunities in the fast-evolving mRNA space. We will also be able to accelerate our existing partnered programs already under development. Our goal is to unlock the potential of mRNA in other strategic areas such as immunology, oncology, and rare diseases in addition to vaccines."

In June 2018, Sanofi and Translate Bio entered into a collaboration and exclusive license agreement to develop mRNA vaccines which was further expanded in 2020 to broadly address current and future infectious diseases. There are two ongoing mRNA vaccine clinical trials under the collaboration, the COVID-19 vaccine Phase 1/2 study with results expected in Q3 2021 and the mRNA seasonal influenza vaccine Phase 1 trial with results due in Q4 2021. The acquisition builds on Sanofi's establishment of a first-of-its kind vaccines mRNA Center of Excellence.

On the therapeutic side, Translate Bio has an early-stage pipeline in cystic fibrosis and other rare pulmonary diseases. In addition, discovery work is ongoing in diseases that affect the liver, and Translate Bio's MRTTM platform may be applied to various classes of treatments, such as therapeutic antibodies or vaccines in areas such as oncology. Sanofi's recent acquisition of Tidal Therapeutics expanded the company's mRNA research capabilities in both immuno-oncology and inflammatory diseases. The Translate Bio acquisition further accelerates Sanofi's efforts to develop transformative medicines using mRNA technology.

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Tonery, CEO of the Bon Secours Hospital Dublin said, “We are very proud to announce our support for this dynamic, progressive and successful four-successive All-Irelands champion team. As the official medical partner, we will be working closely with the DublinLGFA medical staff to assist them to keep the senior squad fit and healthy by providing players with access to our world-class healthcare facilities and wide team of specialists at our hospital in Glasnevin.“ The partnership has been agreed initially until 2024 and both the hospital and the team are keen to establish a longer term relationship.

Mike Tonery went on to say that, “Delivering healthcare excellence to patients from across Ireland requires team work and dedication and with so many of our staff and their families already firm supporters of the team, partnering with the DublinLGFA team is a fantastic way for the Bon Secours Hospital Dublin to be involved. Best of luck to the team on Saturday and for the season ahead. We look forward to seeing the ladies and Dublin bringing even more silverware to Glasnevin in 2021.”

Also commenting on the announcement, Mick Bohan, Manager of the Dublin Senior Ladies Football team said, “Quick access to diagnostics tests and scans plays a critical role in facilitating early diagnosis, rehabilitation and return to play. Having speedy access to these services and the range of specialists at the Bon Secours Hospital Dublin will ensure that our players receive the best possible care and are back on the pitch as soon as possible. This is of particular importance this year with the season being so condensed and competitive. We look forward to the partnership continuing over the coming years.”

BON SECOURS HOSPITAL MEDICAL PARTNER TO DUBLIN LADIES FOOTBALL TEAM The Bon Secours Hospital Dublin has been appointed as the official medical partner of the Dublin Senior Ladies Football team.

Under the agreement, the players will have rapid access to diagnostics including MRI, X-Ray and ultrasound and to relevant specialties amongst the hospital’s 140 medical and surgical consultants. Bon Secours Hospital Dublin will also contribute towards the funding of the team’s medical staff.

Commenting on the launch of the medical partnership, Mr Mike

Mike Tonery - CEO, Bon Secours Hospital Dublin, Carla Rowe and Nicola Owens - Dublin team players at the announcement of the partnership

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