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December 2017 Volume 9  Issue 12

Dynamic 100 Issue

THE INDEPENDENT VOICE OF PHARMACY

In this issue: NEWS: Retail Excellence announce Pharmacy Award Winner Page 4

NEWS: Pharmacy Chain to create 70 jobs Page 6

EVENT: IIOP All Ireland Conference Page 18

FEATURE: Eye Care Page 40

Relieves night time pain Reduces temperature Aids restful sleep Product Information: Please consult the summary of product characteristics for full product information. Panadol Night Film-coated Tablets, paracetamol 500mg, diphenhydramine hydrochloride 25mg. Indications: Short-term treatment of bedtime symptoms of cold and flu pain, rheumatic and muscle pain, backache, toothache, headache, menstrual pain. Dosage: Adults and children 12 years and over: 2 tablets 20 minutes before bed. Max 2 tablets in 24 hours. Minimum dosing interval between this and any other paracetamol containing product: 4 hours. Other products containing paracetamol may be taken during the day but the total daily dose of paracetamol must not exceed 4000mg. Do not give to children under 12 years except on medical advice. Not to be taken by the elderly with confusion. Max duration of continued use without medical advice: 10 days. Contraindications: Hypersensitivity to paracetamol or any of the other ingredients, closed angle glaucoma, porphyria. Precautions: Liver or kidney impairment, epilepsy or seizure disorders, myasthenia gravis, narrow-angle glaucoma, prostatic hypertrophy, urinary retention, pyloroduodenal obstruction, asthma, bronchitis, COPD, hereditary sugar intolerances, the elderly, pregnancy and lactation, concomitant use of sedatives, other antihistamine-containing preparations (including topicals and cough and cold medicines) or tricyclic antidepressants and other drugs with anticholinergic action, alcohol, use of MAOIs within 2 weeks. Side effects: Fatigue, attention disturbance, dizziness, dry mouth, confusion, paradoxical excitation, GI disturbances, hypersensitivity reactions including anaphylaxis and skin rash, thrombocytopoenia, angiodema, Stevens-Johnson syndrome, bronchospasm, hepatic dysfunction, tachycardia, palpitations, unsteadiness. Overdose: Immediate medical advice should be sought in the event of an overdose, even if symptoms of overdose are not present. Legal Category: Pharmacy only. MA Number: PA 678/39/8. MA Holder: GlaxoSmithKline Consumer Healthcare (Ireland) Limited, 12 Riverwalk, CityWest Business Campus, Dublin 24. Text prepared: July 2016. Further information available on request. Panadol is a registered trade mark of the GSK group of companies. Contains Paracetamol. Always read the label/leaflet. Panadol is a registered trade mark of the GSK group of companies. CHGBI/CHPAN/0092/17

CPD: Obesity Page 47

DYNAMIC 100: Ireland’s Pharmacy Dynamic 100 Page 52


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Foreword

Contents

This months issue of IPN features our annual IPN Dynamic 100. This special supplement recognises the contributions made by 100 industry professionals who have displayed motivation and dedication to the development of pharmacy in Ireland. Inclusion in the Dynamic 100 is an acknowledgement of the expertise, unique capabilities and individuals preeminent status for consistently enhancing pharmacy within Ireland.

Page 5: Mandate Trade Union launches claim against Pharmacy Chain

Page 6: IPU warns overuse of antibiotics is a huge risk to public health

Turn to Page 52 to see who has made the list. We have a unique glimpse into the IPU’s year-past successes. It was a year of collaboration for the IPU with the professional body launching a number of new initiatives such as the pilot for a New Medicines Service, which included 96 pharmacies across 23 counties in participation. Turn to Page 14 for the full review.

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Page 10: Profile – Olivia Lyons – Irish Pharmacist talks about her experience working in pharmacy in New Zealand

On page 28, after the PSI’s report into ‘Future Pharmacy Practice in Ireland – meeting patients needs’ which examine how the role of the pharmacy sector, both hospital and community based, can be capitalised on for the enhancement of patient care. We spoke to local community pharmacists to get their take on how better their role could be utilized.

Page 28: Pharmacists call for expanded role in patients healthcare

Elsewhere, with a wave of crimes in pharmacies across the country recently. We look into why Pharmacists in Ireland have warned that the criminal justice system is not giving them adequate protection amid growing fears that they are a soft target for criminals. Speaking to a pharmacist whose pharmacy was held up at gun point and also President of the IPU, Darragh Connolly who shares his experience of a crime in the pharmacy, we have the full story on page 30.

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Page 34: Surge in Social media in the pharmacy PUBLISHER IPN Communications Ireland Ltd. Clifton House, Lower Fitzwilliam Street Dublin 2 00353 (01) 6690562 MANAGING DIRECTOR Natalie Maginnis n-maginnis@btconnect.com IPN COMMUNICATIONS GROUP EDITOR Kelly Jo Eastwood kjeastwood@hotmail.com ACCOUNTS Jon Dickinson accounts@ipncommunication.com COMMERCIAL MANAGER Barry Maguire Barry@ipnirishpharmacynews.ie ADVERTISING MANAGER Nicola McGarvey nicola@ipnirishpharmacynews.ie EDITORIAL CO-ORDINATOR Laura Greenhill Editorial@ipnirishpharmacynews.ie PHOTOGRAPHY DESIGNER Matt Wright Matt@ipnirishpharmacynews.ie CONTRIBUTORS Aidan Walsh | Darragh O’Loughlin Deirdre O’Malley | Finian Murray Paul Mulholland | Jonny McCambridge DecemberIPN-Final.pdf

Regulars

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The IIOP have held their Annual All Ireland Conference. Even against the backdrop of some adverse weather, delegates turned out in force, to the conference to hear the engaging keynote address from Chief Pharmaceutical Officer for Scotland Professor Rose-Marie Parr. Parr’s presentation entitled “Building Capacity in Healthcare was in keeping with the conference’s theme of “Pharmacy’s role in Health Service Capacity Building and focused on the strategy for achieving excellence in pharmaceutical care in Scotland. Turn to page 18 for full coverage.

20 Irish Pharmacy IRISH News is circulated PHARMACY to all independent, NEWS multiple and hospital pharmacist, government officials and departments, pharmacy managers, manufactures and wholesalers. Buyers of pharmacy groups and healthcare outlets. Circulation is free to all pharmacists subscription rate for Irish Pharmacy News ¤60 plus vat per year.

ehealth also held their annual Health Innovation Week which showcases the future of healthcare and how a pioneering approach to digital health can help to transform the Irish healthcare system. Only in its 2nd year, the week was a series of interactive events to encourage creation, learning and collaboration by showcasing the innovations that have the power to build a better health service. Featuring over 30 exhibitors and 40 speakers, The Innovation Showcase was moved to the purpose built Printworks in Dublin Castle and was a huge success. We have full coverage of the week on page 24.

All rights reserved by Irish Pharmacy News. All material published in Irish Pharmacy News is copyright and no part of this magazine may be reproduced, stored in a retrieval system of transmitted in any form without written permission. IPN Communications Ltd. have taken every care in compiling the magazine to ensure that it is correct at the time of going to press, however the publishers assume no responsibility for any effects from omissions or errors.

10/11/2017

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We would like to take this opportunity to wish all our readers a very Happy Christmas and a Prosperous Year. See you all in 2018!

Feature: Smoking Cessation 26

Feature Winter Skin

44

Product Profiles

95

CPD Obesity

Feature Mens health

90

Clinical Profiles

98

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News news brief RWA FINALISTS IN THE DATSCI AWARDS FOR IMPROVING PATIENT CARE IN IRISH PHARMACY

Mellerick’s Pharmacy Crowned Pharmacy of the Year Retail Excellence has announced the winners of its 2018 Awards in association with Barclaycard with Mellerick’s scooping the coveted Pharmacy of the Year title. The 2018 Awards drew more finalists than ever before, with 600 of Irish retail’s greats gathered to mark the occasion. in store and in-service delivery. We are particularly pleased that across all of our categories of awards Irish retailers, both big and small, urban and rural competed to deliver that exceptional standard of service to customers regardless of their size.”

Real World Analytics’ (RWA) Irish pharmacy group customers had the raw data to impact the long-term health of patients but they had no way of identifying the summary levels to enable effective analysis of patient conditions. These Irish pharmacy groups can now correctly identify patients in each risk category. This initiative has put RWA through as finalist in the DatSci Awards for Best Use of Data Science to Achieve Social Impact. In one group with over 50,000 patients, RWA identified over 8,000 patients that were affected by Asthma each year. By isolating the prescribing balances of the BNF categories Bronchodilators V’s Corticosteroids, RWA could identify that a high percentage of their Asthma patients had potentially uncontrolled or unmanaged Asthma. Following this discovery, the pharmacy group then ran an initiative in each pharmacy in association with the Asthma Society of Ireland to inform and re-educate these identified patients on the use of their inhalers and the importance of managing their medicines correctly. Affected patients were offered a peak flow test to check the stability of their condition at that time with many referred to their doctor for further assessment of their condition & prescribed medicines. Furthermore, in another pharmacy groups with over 35,000 patients, RWA identified that they were treating over 1,000 patients for Diabetes. Based on the associated risk factors for diabetes in the BNF categories for Hypertension, Stroke/Heart Disease & Cholesterol RWA identified that across their group there could be a potential 5,000 patients across the risk groups that where not diagnosed but could potentially be at risk for diabetes. Over 900 of these patients had all 3 of the major contributing risks to diabetes. Using this data, the group ran initiatives in the pharmacies to better educate these patients at a series of health and wellbeing evenings.

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The title marks a two years in a row win for the Patrick Street pharmacy in Fermoy, Co. Cork. With the business being crowned best pharmacy in Ireland of 2017 as well.

Mellerick’s Pharmacy collecting their award The Awards celebrated the best of every facet of Irish retail across stores, people, managers and team members, ecommerce and suppliers. Speaking about the award CEO of Retail Excellence David Fitzsimons

said “We are delighted to recognize and award Mellerick’s Pharmacy for being the very best in their retail sector. They have shown an unquestionable commitment to meeting and exceeding customer expectations as well as innovation

Delighted with their win the pharmacy paid tribute to their customers stating that they couldn’t have won the award without them. Taking to their facebook to make a statement they said “We are always striving at Mellericks to be the best that we can, from our customer service to what we stock and all that's in between. We are unbelievably proud to have our efforts recognised by Retail Excellence. We would also like to take this opportunity to thank all of our loyal customers. Without you and your support we couldn't have done it!”

GMS medications cost less in the West GMS drug costs are significantly lower for all age cohorts in Donegal and the North West region, according to new research. The study, which was published recently in the European Journal of Health Economics, aimed to explore how GMS drug costs depend on age, gender, income, health status, community drug scheme coverage rates and whether they display significant differences across regions of Ireland. The authors also aimed to find out whether the GMS drug costs of high and low income cohorts respond similarly to changes in their health status. The paper projected GMS drug costs in 2026 and examined the separate cost of population ageing and population growth over the period. “We find that GMS drug costs depend on age—but not gender—on income, health status, community drug scheme coverage rates, and they are significantly lower for all age cohorts in Donegal

and the North West region,” according to the research.

determining GMS drug costs in Ireland.

“The GMS drug costs of high income cohorts tend to increase as their health status improves, whereas they tend to decrease as the health status of low income cohorts improves.”

An age cohort and region breakdown of the simulated GMS drug costs, of both projected demographic trends and public policy measures that have been adopted or are under consideration, were also investigated.

The authors added that a uniform one per cent gain in health status has little impact on total GMS prescribing costs. The authors also aimed to simulate the estimated model to show how much giving free prescription drugs to all persons aged ‘under 5’ would add to 2026 GMS drug costs. They constructed a multivariate logistic regression model of GMS community drug costs in Ireland. The authors also progressed the methodology used in earlier studies by explicitly modelling how regional incomes and regional health status interact in

“If the health status of all Irish regions improved to match that of the East region in 2010 it would only have reduced public prescription costs by around ¤32 million of the ¤1.8 billion GMS drugs bill,” they concluded. “We find that giving free prescription drugs to all persons aged ‘under 5’ in 2010 would have only a minor impact on 2010 GMS drug costs, whereas giving universal GMS coverage to all persons would have doubled public prescription costs from ¤1.8 billion to circa ¤3.6 billion.”


Mandate Trade Union lodges claim against pharmacy chain A trade union has lodged a claim with the Labour Court calling for Ireland’s largest pharmacy chain to stop using zero hour contracts. The claim, which also says staff have been denied basic sick pay, has been filed by members of the Mandate Trade Union who work in Lloyds Pharmacy. Lloyds operates 94 stores in Ireland, employs almost 1,000 people. The Labour Court claim addresses a number of issues which the union says includes calls for a “fair pay increase”, calls for security of hours (eliminating zero-hour contracts) and the introduction of a sick pay scheme. Gerry Light, Mandate Assistant General Secretary, said: “After ignoring our requests to address the issues of concern for Lloyds workers earlier this year, the Company eventually agreed to attend talks at the Workplace Relations Commission (WRC). “However, after just one session at the WRC, management withdrew unilaterally from the process. Unfortunately this means our members have been left with no option but to escalate the matter to the Labour Court.”

Regarding the use of zero-hour contracts and lack of sick pay scheme in the Lloyds Pharmacy, Mr. Light said: “It beggars belief that the largest pharmacy chain in Ireland, owned by one of the world’s largest and most profitable healthcare corporations, is refusing to provide staff with secure working hours and a sick pay scheme.” He added, “The workers in Lloyds Pharmacy look after the healthcare needs of the people in their communities. Yet if they get sick, they have the added stress of dealing with the financial and personal implications associated with being unable to work. “Of course, what this means is, many are forced to come into work sick because they simply can’t afford to take time off to recover from their illness. That’s not healthy for anyone.” Mr. Light concluded: “It is our hope the company will re-consider its position and engage positively in order to address our members’ issues and concerns without delay.”

Mandate is Ireland’s largest retail workers’ union representing staff in retail pharmacies across Ireland including Boots, McCabes and Hickeys. The Union represents staff in approximately two-thirds of all Lloyds Pharmacy locations in Ireland. Irish Pharmacy News contacted Lloyds Ireland but had received no response at the time of going to press. Meanwhile Lloyds Pharmacy UK has announced it will close nearly 200 stores across England because of changes in government policy. In an internal letter to staff Cormac Tobin, managing director of parent company Celesio UK, said around 190 pharmacies would cease to trade through a combination of closures and disinvestments. The internal memo cited the reason for the cuts saying the business had been hit by pharmacy funding cuts from the government as well as higher business rates and an apprenticeships levy.

Sam McCauley pharmacy chain lining up takeovers Sam McCauley’s chemist chain is seeking acquisitions of rival pharmacy multiples, with at least one takeover deal is already in the pipeline. The news comes as part of a strategy to accelerate the scale-up of the business under new private equity owners. The group has recently strengthened its board, bringing in Jimmy Tolan, the former boss of health insurer VHI as nonexecutive chairman and Tony Keohane, the former head of Tesco Ireland, as non-executive director.

the board, was the opportunity to gain a stake in the group, which ranks as the third-largest pharmacy chain in Ireland with over 30 stores and almost 600 employees nationwide.

The pharmacy chain was bought in a ¤50m deal over the summer by Carlyle Cardinal Ireland (CCI) a private-equity partnership of US buyout giant, Carlyle Group, and local investment house, Cardinal.

The new appointments come as the CCI Fund, ramps up an ambitious growth plan for the pharmacy chain in an apparent effort to challenge the market dominance of the two biggest players, Lloyds and Boots.

Founder and executive chairman Sam McCauley retained a minority stake after that deal and will stay with the business as non-executive director, following the latest reshuffle.

Sam McCauley, which has most of its outlets in Munster and runs a number of stores in Cork and Dublin, has been snapping up a string of single, ownermanaged pharmacies.

Part of the attraction for both Mr Tolan and Mr Keohane in joining

But it is understood the chain is now eyeing larger-scale

acquisitions with sources telling the Independent a bigger deal is in the pipeline. Mr Tolan and Mr Keohane are expected to help steer this expansion strategy, as well as mentor executives within the business. But the pitch for greater growth comes as Lloyds, which is owned by the US pharmacy giant McKesson, also continues to expand its market share. The chain remains the biggest player in the sector with over 90 stores and it intends to roll out a range of new service as part of its integration strategy for the Irish pharmaceutical distribution, UDG Healthcare, which Lloyds acquired in 2015 for ¤408m.

news brief RWA SIGN MULTIYEAR AGREEMENT WITH SAM MCCAULEY’S Real World Analytics (RWA) has announced the signing of a multiyear agreement with the Sam McCauley Chemist Group (SMCC) for its Data Analytics Support solution. The business of pharmacy is complicated with so many transactions in the dispensary and on the retail side of their business. A well implemented Data Analytics solution can help the management team of pharmacy groups to manage; sales, margins, inventory, availability, productivity and shrinkage. In the environment of constant change and margin pressure the pharmacy groups need to be able to efficiently analyse their business to ensure that they are optimising their operations. McCauley’s occupy a unique niche in the pharmacy retail market thanks to their 'One Stop Health & Beauty Shop' concept of prestigious Department Stores embracing a huge range of products and services, including Digital Photo Centres, Prestige Cosmetics and Perfumery, Beauty Salons, and expanded Healthcare Services. In addition they provide the core traditional services of a pharmacy provided by experienced friendly pharmacists and staff. Commenting Tony McEntee CEO of SMCC said, “As a previous user of the RWA solution I am delighted that we have now implemented it’s roll out in the SMCC group. Having decided to implement the RWA solution 3 weeks ago, my colleague and the SMCC Group Superintendent, Mark Sajda, orchestrated the roll out and as a new management team we are delighted with the ease of implementation and the immediate quality of the analysis being delivered. As we accelerate our growth plans it is essential that we will be able to measure, analyse and influence our performance with the aid of the RWA solution.” Commenting Conall Lavery CEO of RWA said, “SMCC is the third largest pharmacy group in Ireland and considered to be one of the most innovative. We consider it a great vote of confidence in our solution which helps pharmacy groups maximise their business performance.”

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News IPU warns that overuse of antibiotics is news brief huge risk to public health PHARMACY CHAIN TO CREATE 70 NEW JOBS CarePlus, Pharmacy is to create 70 new jobs through the addition of 12 pharmacies to its franchise. The new pharmacies will open in Dublin, Kerry, Cork and Tipperary in the coming months. The announcement brings the number of CarePlus pharmacies across Ireland to 51, with an expansion to 12 in Dublin alone since 2015. As part of the announcement CarePlus also said that it is in advanced negotiations with a number of national pharmacy operators, with significant new partnerships expected to be announced in early 2018. The company, which is owned and managed by community pharmacists, has aggressive growth plans to reach 150 pharmacies across Ireland by 2020. Niamh Lynch, Commercial Director of CarePlus spoke about the announcement saying "We have recently invested ¤5m in new technology, which is helping our community pharmacists offer a better experience to their customers. Through this announcement, and those that will follow in 2018, we can say with confidence that CarePlus is Ireland’s fastest growing pharmacy brand CarePlus has installed leading edge technology in each of its new stores, including drug dispensing robots, digital shelf-edge display labels and interactive customer screens. In addition, CarePlus has an award winning app, which allows customers to send their prescription to the pharmacy before leaving the doctor’s surgery, thereby cutting the in-store wait time.

Pharmacists have warned that the overuse of antibiotics is one of the greatest risks to public health in Ireland. The Irish Pharmacy Union (IPU) said that 25,000 people die in Europe each year from superbugs that have become resistant to antibiotics. The IPU said too many people take antibiotics when they experience a cough, cold, sore throat, flu, vomiting, or diarrhoea despite them only being effective for bacterial infections. Daragh Connolly, president of the IPU, said antibiotic resistance would “cripple our ability to fight routine infections but will also undermine the treatment of more complicated infections, especially in patients with chronic diseases”. The comments came during European Antibiotics Awareness Week in which the public were advised to ensure they finish the full course of antibiotics even if their symptoms go away.

resulting in high costs and bed closures,” Mr Harris said.

The threat of antibiotic resistance was recently dubbed an “antibiotic apocalypse” by Sally Davies, Britain’s chief medical officer.

Mr Harris said international experience indicated that CPE and antimicrobial resistance needed to be tackled at national level.

Mr Harris who declared a public emergency for the recent sharp increases in CPE said the disease had been declared as a public health emergency, so that it would be managed in line with the public health plans which had been previously put in place for influenza.

Antimicrobial resistance happens when microorganisms (such as bacteria, fungi, viruses, and parasites) change when they are exposed to antimicrobial drugs (such as antibiotics, antifungals, antivirals, antimalarials, and anthelmintics). Microorganisms that develop antimicrobial resistance are sometimes referred to as “superbugs”.

“We have seen a rapid and worrying increase in the incidence of CPE in Ireland, with a significant increase in numbers of cases of CPE in recent years. Known outbreaks have occurred in eight healthcare facilities in Ireland,

As a result, the medicines become ineffective and infections persist in the body, increasing the risk of spread to others.

Trinity professor receives ¤4m grant for cell research A Professor from Trinity College Dublin’s School of Pharmacy & Pharmaceutical Sciences has been awarded almost €4m in funding for research into how certain cells in the circulatory system can contribute to resistance to anti-cancer drugs. Professor Lorraine O’Driscoll has been given the Horizon 2020 funding for a programme entitled ‘Training in Extracellular vesicles for benefit in Health and Disease’. The programme is in collaboration with European partners at Institut Curie Paris, Utrecht University, Ghent University, Semmelweis University Budapest, Freiburg University, University of Porto, and industry including Lonza, HansaBioMed, Bioinf2Bio, GVS SpA, AJ Innuscreen GmbH, Exosomics Siena SpA, BD Biosciences and Thermo Fisher. This H2020 Marie SkłodowskaCurie Innovation Training Network will train 15 PhD students over its 4-year lifetime and will work on establishing standards and best practice for exosomes and other extracellular vesicles (EVs) research. It will focus on cancer and determining how EVs contribute to cancer metastasis, immune suppression and resistance to anticancer drugs, but also how EVs may be used as naturally-occurring drug delivery systems. The hope would be to subsequently make use of this knowledge for societal and economic purposes. Speaking about the objectives of the programme, Professor

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They were also advised not to save the drugs for later use.

O’Driscoll said: “TRAIN-EV’s objective is to develop academic and industry EV leaders for the future through excellent and integrated multi-disciplinary and inter-sectoral training of a critical mass of early-career researchers.

thought to be mini-maps of their cells of origin. Their contents includes proteins, RNAs and DNA.

“The researchers will have outstanding potential in the academic, clinical, and industry/ business components of exploiting exosomes and other EVs. They will also perform novel, cuttingedge research and generate new knowledge. This will be achieved by training 15 PhDs in leading universities, clinics and industries offering secondments.”

In cancer, studies of cell lines, animal models and body fluids (including blood, urine, saliva) from patients and healthy individuals have advocated EVs in a positive light as minimallyinvasive diagnostics and predictive biomarkers, based on relative EV quantitative and/or contents.

As well as attending a range of research training courses in the partner universities, clinics and industry, the PhD Fellows will take courses run by the Innovation Academy on how to commercialise research discoveries. Increasing evidence indicates that substantial "cargos of information" involved in cell-to-cell communication are transported in the bloodstream in exosomes and ectosomes. These membrane-surrounded vesicles released from cells -collectively termed extracellular vesicles or EVs- were originally considered as junk, but are now

Some EVs are released from healthy cells and are associated with a range of physiological functions.

In parallel, mounting evidence has strongly implicated EVs in causing havoc as a mechanism of cell-tocell communication, transferring undesirable information in cancer. Examples include passing on drug-resistance characteristics; attracting cancer cells to secondary sites, including the brain, as metastases; helping cancer cells evade the immune system; stimulating recipient cell proliferation, motility, invasion; and inducing neovascularisation and angiogenesis. Recent studies have also suggested EVs having a role as naturally-occurring drug delivery vehicles.


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Profile

Changing role of Pharmacists in New Zealand points way to the future Olivia Lyons tells how she hopes to use lessons learnt when working as a community pharmacist in New Zealand to improve experiences in Ireland

Pharmacy Manager Alexis Mirkin, Pharmacy Owner Ian McMichael and Olivia Lyons outside Pharmacy 547 in New Zealand I was fortunate enough to begin my pharmacy career in New Zealand at Pharmacy 547. Located on the east side of Hamilton city, the pharmacy is what all community pharmacies aspire to be. My first impression was that this was not your regular pharmacy‌even in New Zealand. The pharmacy is organised into departments: Front dispensary, Community Mental Health and Resthome dispensaries. The pharmacy has a busy dispensary team with currently eight pharmacists and 10 pharmacy technicians employed.

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The pharmacy currently serves a large number of patients and offers free delivery of medication to its patients. In contrast to HSE prescription schemes, New Zealand offers a one size fits all when it comes to prescriptions. The Prescription Subsidy Scheme aims to reduce the costs of prescriptions for patients. All New Zealand citizens and residents are eligible for the scheme irrespective of their income. Most medicines are subsidised by the government and will cost $5 per item. Once a family or individual reaches 20

items in a 12 month period they are then issued a subsidy card. A subsidy card entitles patients to be exempt from the $5 charges on their medication. Not all medicines are subsidised however. The pharmaceutical Management Agency (PHARMAC) is a government agency in NZ. PHARMAC decides which medicines are publicly funded and eligible for subsidy. PHARMAC will complete a pharmacoeconomic evaluation for each application for funding for a medicine. This is based on need, health benefits, costs

and savings, and suitability. Therefore, this standardises prescribing, as patients are often reluctant to pay for medicines that are not subsidised. Community pharmacies in New Zealand offer a number of clinical pharmacy services which are funded by the Ministry of Health. An example of this is the Community Pharmacy Anticoagulant Service which enables community pharmacists to manage patients on warfarin. Patients are referred to the pharmacy by the GP or the hospital. Once signed up by the pharmacy, the pharmacists completes an INR (International


Product Information: Please consult the summary of product characteristics for full product information. Panadol Extra 500mg/65mg Soluble Effervescent Tablets, paracetamol, caffeine. Indications: Relief of mild to moderate pain such as that associated with rheumatism, neuralgia, headache, musculoskeletal disorders, menstrual pain, toothache, fever, symptoms of colds and flu. Dosage: Adults and children 12 years and over: 2 tablets up to 4 times a day. Max 8 tablets in 24 hours. Do not give to children under 12 years. Minimum dosing interval: 4 hours. The lowest dose necessary to achieve efficacy should be used. Contraindications: Hypersensitivity to paracetamol, caffeine or any of the other ingredients. Precautions: Do not use with any other paracetamol-containing products. The concomitant use with other products containing paracetamol may lead to an overdose. Paracetamol overdose may cause liver failure which can lead to liver transplant or death. Patients with depleted glutathione levels / glutathione depleted states. Diagnosed liver or kidney impairment, hereditary sugar intolerance, pregnancy, excessive caffeine intake, low sodium diet. Do not exceed the stated dose. Prolonged use except under medical supervision may be harmful. Side effects: Very rare cases of serious skin reactions have been reported. All very rare: Hypersensitivity reactions including anaphylaxis and skin rash, thrombocytopenia, angiodema, Stevens-Johnson syndrome, bronchospasm, hepatic dysfunction. Frequency unknown: Nervousness. dizziness. Legal Category: Pharmacy Only. MA Number: PA 678/39/10. MA Holder: GlaxoSmithKline Consumer Healthcare (Ireland) Limited, 12 Riverwalk, CityWest Business Campus, Dublin 24. Text prepared: July 2017. Further information available on request. Panadol is a registered trade mark of the GSK group of companies. Contains Paracetamol. Always read the label/leaflet. CHGBI/CHPAN/0090/17


Profile Normalised Ratio) test via a finger prick and receives the result instantly via the Coaguchek® machine. The pharmacist can then alter the patient’s warfarin dose based on this. We found that the service not only reduced GP time but also improved multi-disciplinary relationships between GPs and the pharmacists. Currently, in our pharmacy alone we manage 188 patients on warfarin. This service is funded by local district health boards in NZ making it an attractive service for Community Pharmacies to engage with. Another pharmacy group in which community pharmacies can engage with are Midlands Community Pharmacy Group (MidCPG). MidCPG aims to strengthen and support the role of community pharmacists in primary healthcare. This group works on behalf of community pharmacies to negotiate service contracts for a range of pharmacy services with the District Health Boards. For example, community pharmacists that provide SSRI (Selective Serotonin Reuptake Inhibitors) counselling, smoking cessation, gout and anticoagulant counselling can claim for this service. This has proven effective in recognising the clinical work that is done in community pharmacy while also receiving financial reward for this. The group have worked hard to expand our role as community pharmacists in primary healthcare. When I began working first at Pharmacy 547 I took on the role as mental health pharmacist. I was impressed by the delivery of care to mental health patients in the community. In contrast to Ireland, clozapine can be dispensed in the community. The pharmacy has to be nominated as a ‘Community Specialist Pharmacy’ and engage in clozapine training. Community Pharmacies then have access to blood tests results online and can issue clozapine based on this result. As this cohort of patients can be very vulnerable and often reluctant to engage with healthcare services, meeting

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a familiar face in their local community pharmacy, improves access to medical care. Furthermore, by dispensing in the community the patient can then be followed up and monitored. Pharmacists are required to check compliance to clozapine and also check for constipation given the potential for intestinal obstruction. Currently we manage 160 patients on clozapine at Pharmacy 547. We also worked closely with the Crisis Assessment and Home Treatment team (CAHT). This team is a community based service providing crisis mental health assessment for individuals who require an urgent response and are likely to require the support of community or inpatient mental health services. Following up in the Pharmacy

it can be unsafe to have medications unsupervised in the home. Overall, the service has been found to reduce hospital admissions secondary to medication adverse effects and also reduces the requirement for residential care. A community pharmacy located next to a medical centre has historically been very popular due its financial gains. However, a “one stop shop” model has been implemented at Pharmacy 547. This involves the community pharmacy in the same building as the general practice clinic. I found that this healthcare model improved our relationships with the GPs and also patient care. The patients could access all their healthcare needs in the one place and any issues identified could be resolved quickly and easily.

Through this multi-disciplinary relationship, the pharmacy guaranteed daily delivery of medication to the crisis respite centres. Furthermore, for patients discharged from hospital, all medications are organised between the CAHT and the pharmacy ensuring a good transition into the community. Patients can then be followed up by the pharmacy and any concerns or issues are reported to the CAHT.

Collaborative approach

As a community pharmacist in New Zealand there are ample services to which you can refer patients to. One example of this is the Medication Oversight programme. Medication oversight is a service available to patients over 65 years of age that are living independently in the community and are non-complaint with their medication. Eligible patients are visited daily and observed taking their medication by support workers.

Due to our fruitful relationship with the medical centre, a clinical pharmacist role was implemented. I began working in the medical centre alongside three GPs and nursing staff. Overall in New Zealand, the placement of a clinical pharmacist in general practice was a relatively new concept. This started as a pilot study to determine the effectiveness of a clinical pharmacist in general practice.

In order to be enrolled in the programme, a referral has to be made by a healthcare professional and each patient case is assessed for eligibility. Overall, this service has proven to be very valuable for elderly patients in the community. I have made a number of referrals to this service for patient with dementia or cognitive impairment in which

Both the medical centre and the pharmacy had access to the same computer software Medtech®. Therefore, the pharmacy had access to the patient’s medical notes and lab results. Furthermore, the pharmacy could document any issues with the patient’s medication allowing all healthcare professionals to be on the same page.

The clinical pharmacist role involved the delivery of clinical pharmacy services mentioned above (warfarin management, SSRI counselling, smoking cessation etc). Furthermore, the service expanded to provide Medication Use Review (MUR). This is a structured, systematic, documented and consultationbased service undertaken by an accredited pharmacist. It helps the patient find out more

about the medicines they are taking, identify any problems the patient may be having with their medicines and improve the effectiveness of the medicines being taken. This is another clinical service, which is funded by district health boards to community pharmacy. In order for patients to be eligible they have to be living independently in the community and have one of the following: cardiovascular disease, respiratory disease or mental health problem. MUR has been found to be extremely beneficial to patients in the community. When patients are educated about their medication, this increases adherence, reduces medication adverse effects and medication error in primary care. Furthermore, I met with the GPs at the medical centre to determine how else I could expand my role as a clinical pharmacist in general practice. After a number of meetings, a medication reconciliation process was decided upon. This involved reconciling patients’ medicines post discharge from hospital. Often patients are discharged with a number of changes to their medication and the transfer of information to primary care can be lost. I was therefore involved in reviewing discharge summaries and clinic letters. Under the authority of the GP’s I would update all regular medicines on the patients file. This helped to ease the transition from secondary to primary care and reduce medication error. Overall, I feel I arrived in New Zealand during a time of change in Community Pharmacy. It was clear that pharmacists were motivated to expand their scope of practice given previous budgetary cuts to dispensing fees. I feel that there are exciting times ahead for community pharmacy, not only in New Zealand. I will be returning home in December. I would love to be able to implement some of the pharmacy services available in New Zealand and hope that we can further broaden our scope as pharmacists in Ireland.


Traditionally used to relive overactive bladder symptoms

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The only remedy without prescription for relief of urgency and frequency of an over active bladder. UROSTEMOL Men capsules (P) contain crushed pumpkin seeds, pumpkin seed oil and saw palmetto fruit extract. A traditional herbal medicinal product for use in the relief of lower urinary tract symptoms in men related to an overactive bladder or bladder weakness, such as urgency to urinate, urinary incontinence, frequent urination day and night, exclusively based upon long-standing use. Prior to treatment, other serious conditions should have been ruled out by a doctor. Adults aged 18 and over: One capsule three times a day. Not recommended for use by pregnant or breast-feeding women, or children and adolescents under 18 years. Contraindications: Known hypersensitivity to ingredients. Caution: Seek medical advice if symptoms worsen during use or persist after 4 weeks, or if fever, spasms, blood in the urine, urinary retention, painful urination or loin, abdominal or back pain occurs. Patients taking anticoagulant or antiplatelet medication, or patients due to undergo surgery. Rare hereditary intolerance to some sugars. Side effects: Mild gastrointestinal complaints - abdominal pain, dyspepsia, nausea/vomiting, stomach discomfort, dysphagia, oesophageal pain and diarrhoea. Allergic reactions – rash, urticaria, erythema, pruritus, oedema and anaphylactic shock. Nervous system disorders – headache. Intraoperative haemorrhage. TR1186/7/1. TR Holder: Chefaro Ireland Limited, First Floor, Block A, The Crescent Building, Northwood Office Park, Dublin 9, Ireland. RRP: 60s €23.00 120s €40.00 SPC:http://www.medicines.ie/medicine/16690/SPC


IPU Review

IPU’s year of collaboration By Darragh O’Loughlin, Secretary General, Irish Pharmacy Union 2017 was another extremely busy year for the Irish Pharmacy Union (IPU). At the beginning of the year we launched a pilot for a New Medicines Service, with 96 pharmacies across 23 counties participating. The outcomes from the Pilot are extremely good and results show that adherence improved by 9%; a report is being published and launched shortly. Service Capacity and the National Biosimilar Medicines Policy. In 2017 the IPU collaborated with Hibernian Healthcare to set up Pharmacycare, a platform for paid services in community pharmacy. The initial Pharmacycare service is a sharps service for injectable devices for Roche (RoActemra), Novo Nordisk (Norditropin), Biogen (Benepali) and Nordic Pharma (Nordimet). We are currently working with a number of pharma companies on potential POM to P switches and will continue to pursue this agenda in 2018 and beyond.

Darragh O’Loughlin, Secretary General, Irish Pharmacy Union The IPU continued to push for the introduction of a pharmacybased Minor Ailment Scheme. Frustratingly, although the final evaluation report on last year’s successful and well-received Minor Ailment Scheme pilot has been with the Department of Health for consideration since the beginning of the year, we have had no further engagement with them on it, but we will continue to press for the introduction of this very valuable service which could ease some of the obvious pressures in primary care and GP surgeries in particular. We also made a proposal to the Department of Health for the introduction of a service which would allow medical card holders to access nicotine replacement therapy and smoking cessation counselling from their community pharmacy without needing a prescription. Such a scheme would reduce the barriers that currently prevent medical card holders accessing help that would greatly improve their chances of successfully quitting smoking. Our very high profile partnership with RTE’s Operation Transformation continued in 2017, when 750 pharmacies signedup to participate in Operation

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Transformation’s Live Longer, Live Better campaign. We were involved in the Stroke and Heart Attack element of the campaign, which involved participating pharmacies carrying out free blood pressure measurements for one week. The campaign was highlighted on the programme. On the lobbying front, earlier in the year we met with Minister Catherine Byrne TD, Minister for State for Communities and the National Drug Strategy to discuss our written submission on the National Drug Strategy. The topics covered included a rehabilitative approach to possession of drugs; administration of naloxone by pharmacists; methadone treatment scheme; needle exchange scheme; vaccination against blood borne viruses; and amendments to the Misuse of Drugs Regulations. We also worked very closely and constructively with the Department of Health on the new Misuse of Drugs Regulations 2017, and were pleased that much of our feedback was reflected in the final version of the regulations. After extensive lobbying over a number of years we were delighted that our proposal to introduce a pharmacy service allowing GMS

patients to access EHC without a prescription directly from their pharmacist was introduced in July, and was so well received by the public. We also made a proposal to the Minister for Health on expanding the pharmacy vaccination service to include many other suitable vaccines and also advocated that pharmacists be allowed to vaccinate patients in residential care facilities rather than being restricted to vaccinating within the pharmacy premises as at present. Among the many submissions we made to various organisations and stakeholders we made a submission to the Minister for Health seeking an unwinding of FEMPI for pharmacists. In the submission, we demanded an immediate reversal of cuts to our payments and implementation of a higher dispensing fee, and pointed out that pharmacists have cooperated with a range of HSE audit and validation measures, which have come at a significant cost to pharmacies while being of no benefit to pharmacists or patients. We also made submissions to the Department of Health on Clinical Guidance on Cannabis, Health

The IPU collaborated with a number of patient groups in 2017 including COPD Support Ireland through the launch of a COPD awareness campaign in June. We also participated in the Men’s Health Forum Ireland national awareness campaign promoting Men’s Health.

We worked very closely and constructively with the Department of Health on the new Misuse of Drugs Regulations 2017, and were pleased that much of our feedback was reflected in the final version of the regulations


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IPU Review The Business Department has added to the significant number of groups schemes specifically negotiated on behalf of IPU members in order to save them time and money. A Life Insurance affinity scheme with Halligan Insurance was introduced, along with an affinity scheme with Cornmarket Financial Services providing a comparison tool for Health Insurance. Both new schemes are proving very popular with members. As part of our involvement in the Department of Jobs, Enterprise and Innovation’s Retail Consultation Forum, we developed a policy document around town centre revival. The document was launched by the Minister for Jobs, Enterprise and Innovation. We are also involved in the National Strategic Retail Forum with An Garda Síochåna and other retailers. This Forum works to ensure that a Crime Prevention and Reduction approach is adopted. This Forum is particularly important considering the spate of crimes perpetrated against pharmacies. The IPU has assisted a number of members who have had experience of crime. The Communications Department has issued a considerable number of media releases and responded to multiple media queries throughout the year. Our releases have garnered significant coverage in both national and local media. Alongside this, the IPU Advertising campaigns continue to highlight the important role and services provided by pharmacists, with a number of campaigns throughout the year on national radio and through social media and video on demand. The Contract Unit continues to liaise with the HSE PCRS in pursuit of greater transparency

Daragh O loughlin at the launch of the Minor Ailment Scheme Pilot which the IPU continued to push for this year

and fairness in its dealings with pharmacists, and we continue to advocate for key policy changes such as exploring and proposing new sources of revenue for pharmacists and ensuring that pharmacists are not over-burdened by excessive or unnecessary administration. The Unit also advocated on behalf of individual pharmacists in their dealings with the HSE PCRS in order to reach a fair resolution of issues.

We have assisted Members in dealing with Inspections and Fitness to Practise Issues and have produced a range of SOP templates, which members can download from the IPU website and personalise for their pharmacy. We also introduced a tool to help make completing the PSI Pharmacy Self-Assessment as easy as possible.

introduce new training initiatives and business services that are beneficial to pharmacists and pharmacy business. Continuing Professional Development is actively supported and promoted by the IPU, with IPU Academy developing and delivering an extensive programme of educational activities across the country throughout the year.

The IPU Training and Business Departments continue to

Looking forward to 2018, the IPU will continue to promote the role of the pharmacist and seek the introduction of recognised international pharmacy services including the New Medicine Service, a pharmacy-based Minor Ailment Scheme and chronic disease management services together with seeking an increase in the number of medicines available without prescription, in line with other countries such as the UK and New Zealand

We will continue to champion the cause of pharmacy, by promoting the pharmacy agenda and the interests of the community pharmacy sector, and seize every opportunity 16

We will continue to champion the cause of pharmacy, by promoting the pharmacy agenda and the interests of the community pharmacy sector, and by seizing every opportunity not only to secure the future of community pharmacy services, but to enhance the role of the pharmacist at the centre of primary healthcare in Ireland.


DAY & NIGHT

BENYLIN DAY & NIGHT TABLETS: Composition: Each white (day) tablet contains: Paracetamol 500 mg, Pseudoephedrine Hydrochloride 60 mg. Each blue (night) tablet contains: Paracetamol 500 mg, Diphenhydramine Hydrochloride 25 mg. Pharmaceutical form: Day Tablet, White biconvex tablet in oblong form with dissecting score on one side; ‘A7C’ engraved on both sides of the score. The score is to allow breaking for ease of swallowing. Night Tablet FilmCoated Tablet (Tablet). Blue, odourless, round and biconvex tablets. Therapeutic indications: For the relief of symptoms associated with colds and influenza. Posology and Method of Administration: For oral use. Adults and children over 12 years: Four tablets should be taken daily. One white tablet to be taken every 4 to 6 hours (one tablet in the morning, at midday and in the afternoon). Do not take more than 3 white day-time tablets in 24 hours. One blue tablet to be taken at night. Do not take the night-time tablets during the day. Elderly As for adults. Children Not recommended for children under 12 years. Contra-indications: Use in patients hypersensitive to the active ingredients. Use in patients who are currently receiving or have within two weeks received, monoamine oxidase inhibitors (MAOIs). The concomitant use of pseudoephedrine and this type of product may occasionally cause a rise in blood pressure. Use in patients with severe hypertension or coronary heart disease. Special warnings and special precautions for use: Although pseudoephedrine has virtually no pressor effects in normotensive patients, Benylin Day and Night should be used with caution in patients suffering mild to moderate hypertension. The product should also be used with caution in patients with heart disease, diabetes mellitus, hyperthyroidism, elevated intraocular pressure and prostatic enlargement. Caution should be exercised when using the product in the presence of severe hepatic impairment or moderate to severe renal impairment (particularly if accompanied by cardiovascular disease). The hazards of overdose are greater in those with non-cirrhotic alcoholic liver disease. Concomitant use of other products containing paracetamol or decongestants with Benylin Day and Night could lead to overdosage and should, therefore, be avoided. Night time tablets only: May cause drowsiness. If affected do not drive or operate machinery. Avoid alcoholic drink. If you are taking medication, or are under medical care, consult your doctor before using. Prolonged use without medical supervision may be harmful. If symptoms persist please consult your doctor or pharmacist. Keep medicines out of the reach of children. Do not exceed the stated dose. Immediate medical advice should be sought in an event of an overdose, even if you feel well. Immediate medical advice should be sought in an event of an overdose, because of the risk of irreversible liver damage. Do not take with any other paracetamol containing products. Use when only clearly necessary. Undesirable effects: Serious side-effects associated with the use of pseudoephedrine are extremely rare. Symptoms of central nervous system excitation may occur, including sleep disturbances and rarely hallucinations have been reported. Urinary retention has been reported occasionally in men receiving pseudoephedrine, prostatic enlargement could have been a predisposing factor. Skin rashes, with or without irritation, have occasionally been reported with pseudoephedrine. Adverse effects of paracetamol are rare but hypersensitivity including skin rash may occur. There have been reports of blood dyscrasias including thrombocytopoenia and agranulocytosis following paracetamol use, but these were not necessarily causally related to the drug. Side effects of diphenhydramine include drowsiness, dizziness, blurred vision, gastrointestinal disturbances, dry mouth, nose and throat, or urinary retention. Hypersensitivity reactions have been reported, in particular, skin rashes but also bronchospasm, angioedema and anaphylaxis. Marketing authorisation number: PA 823/19/1. Date of revision: September 2010

IRE/BE/17-2465


IIOP Conference

IIOP All Ireland Conference 2018 The 8th All Ireland Pharmacy Conference took place in the place in the Ballymascanlon House Hotel, Dundalk on 17 October 2017. The theme of the conference was Pharmacy’s role in Health Service Capacity Building. It was attended by individuals with an interest in pharmacy practice from all of Ireland. Following the keynote address the conference broke into the morning parallel sessions, chaired by pharmacy leaders, North and South, on the themes of Developing the Pharmacy Workforce and Medicines Optimization. Each session was made up of 6 presentations which addressed the sessions theme from a different perspective. Presenters were allowed 10 minutes with a further 5 for questioning.

Catriona Bradley, Executive Director, IIOP, Mark Timoney, Chief Pharmaceutical Officer for Northern Ireland and Colin Adair, Director of Northern Ireland Centre for Pharmacy Learning and Development Professor Colin Adair and with keynote speaker Rose-Marie Parr, Chief Pharmaceutical Officer at the Scottish Government The traditional pre-conference dinner was due to take place on 16 October 2017. Unfortunately, due to the adverse weather conditions created by ex-hurricane Ophelia, the conference dinner was somewhat smaller than anticipated. Delegates who had already made the journey to the hotel ahead of the weather were treated to a somewhat more intimate dining experience. Those who were present found the occasion very enjoyable. With the restrictions on travel lifted by the morning of the conference, 140 delegates made their way from all across the island. The conference was opened by Chief Pharmaceutical Officer for Northern Ireland Dr Mark Timoney who welcomed delegates and wished everyone success for the day ahead. Director of Northern Ireland Centre for Pharmacy Learning and Development Professor Colin Adair and Executive Director of the Irish Institute of Pharmacy Dr. Catriona Bradley then set out the agenda for the conference. Before the delegates broke off for the parallel oral sessions Chief Pharmaceutical Officer for Scotland Professor Rose-Marie Parr delivered an engaging keynote address entitled Building Capacity

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in Healthcare which focused on the strategy for achieving excellence in pharmaceutical care in Scotland. She effectively and evocatively described the challenge of meeting the healthcare needs of the nation, particularly those in lower socioeconomic groups, before describing the Scottish strategy for achieving excellence in pharmaceutical care. The challenge of improving pharmaceutical care whilst simultaneously enabling pharmaceutical care transformation is being addressed by Parr, as Chief Pharmaceutical Officer, through nine commitments and associated actions, which she outlined during her presentation.

A conference lunch break allowed the delegates time to network with colleagues and provided delegates had the opportunity to view the extensive poster presentation. Over 80 posters on a range of topics had been accepted for the conference. During this break, a judging panel assessed each of the posters and selected “Impact of a pharmacy-led screening service for Group A ß-haemolytic streptococci on general practitioner visits and antibiotic consumption: a non-randomized controlled study” by Ms Claire O’Neill from the School of Pharmacy in RCSI as the best poster.

The conference reconvened into the afternoon parallel sessions which were included a second session Medicines Optimization and a session examining putting Research and Policy into practice. The conference was closed by HSE Chief Pharmacist Ms Kate Mulvenna who commended the both the oral and poster presenters on the quality of the work which had been presented, and again remarked on how the All Ireland Pharmacy Conferences as a cross border conference allowed all involved the opportunity to look at their practice from a different perspective and make a meaningful impact on the profession. At the end of the day delegates were asked to complete a short evaluation. The feedback received was overwhelmingly positive, with a number of constructive comments which were gratefully received. The conference proceedings and a copy of Professor Rose Marie Parr’s presentation are available now on the IIOP website.

Parr’s presentation effectively and evocatively described the challenge of meeting the healthcare needs of the nation, particularly those in lower socioeconomic groups

Adverse weather doesn’t stop delegates attending the IIOP All Ireland Conference


Our passion is in the detail There are occasions when your patients have to deal with difficult challenges and you may need to arrange for special medicines. PharmaSource can help you source these medicines in a timely, reliable and safe manner. With over 70% of Irish pharmacies ordering from us every day, we are Ireland’s leading supplier of unlicensed medicines, manufactured specials and once off procured items to the Irish market. Our service is tried and tested and valued by our loyal customers. PharmaSource can help reduce the valuable time our customers are spending searching for medicines that are currently in short supply or discontinued in the national market. We can source these products for you, simply give our team a call.

Our team is made up of qualified pharmacists and pharmacy technicians who understand the importance of delivering your order on time every time. When you call PharmaSource you will be speaking to your peers.

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Review

HPRA Review

Our role in protecting public and animal health The Health Products Regulatory Authority (HPRA) is the government agency responsible for the regulation of health products in Ireland. The HPRA has a wide-ranging remit which includes the regulation of medicines as well as all medical devices and equipment used for medical purposes. New medical devices legislation

HPRA Lorraine Nolan, CEO Health products can be life-saving and can also improve the health and the quality of all our lives. At the HPRA, it is our role to ensure that the health products used by those working in our health service, and by patients directly, are as safe as possible and do what they are intended to do. The products and areas we regulate

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numbers of patients. Ongoing surveillance of new medicines and the reporting of suspected adverse reactions observed by healthcare professionals to the HPRA is therefore essential to help in the identification of potential safety problems which it may not be possible to detect during premarketing evaluation.

Our regulatory remit, which has expanded over a number of years, includes human and veterinary medicines, clinical trials, medical devices, blood and blood components, tissues and cells, and cosmetic products. Along with the HSE, we are also one of the competent authorities under the legislation pertaining to human organs intended for transplantation.

In addition to reports of reactions to newly authorised products, we also encourage reports of suspected serious reactions to established medicines and suspected reactions to medicines undergoing additional monitoring. Reports related to vaccines or medicines used in pregnancy are also crucial. Details of how to report and access to our online report form can be found on our website, www.hpra.ie.

Monitoring the safety of medicines

Monitoring the safety of medical devices

The HPRA is responsible for granting marketing authorisations for medicines following a review of their safety, quality and effectiveness. Once a medicine is available for use in Ireland, we continue to monitor its safety and effectiveness through the operation of a national pharmacovigilance system which relies to a significant extent on the contribution of those working in our health system. This is because clinical trial data will tell us much about the effectiveness of a newly authorised medicine but its associated safety profile must continue to be monitored as it becomes available to greater

The HPRA also operates a national reporting system for medical devices. We encourage users of devices to report incidents or problems associated with their use to the HPRA through our website or by contacting us or the manufacturer directly. When new safety or quality information emerges we ensure that medical device users are informed and we advise them of any actions that they may need to take. Issues or concerns about any piece of medical equipment can be quickly submitted through our online reporting system available on www.hpra.ie.

This year, the HPRA welcomed the publication of two new European Regulations relating to medical devices and in vitro diagnostics. This enhanced legislation will strengthen and improve the regulatory system for medical devices throughout Europe and will help to ensure that medical devices are safe and effective. It will have a number of positive benefits including improved oversight of the product approval process, increased market surveillance, clearer product requirements and improved information, transparency and governance. The legislation will have a number of positive benefits for healthcare professionals specifically including: • Enhanced protection for users of medical devices • Improved identification and traceability of products • More up-to-date product information which will be available to healthcare professionals. This will include access to increased clinical data relating to the performance and safety of devices The Future • Promoting medicine and medical device safety to healthcare professionals: The HPRA will continue to make available free and easy-to-access product information, including safety updates, through our website, www.hpra.ie, In particular, in respect of medicines safety, we encourage all healthcare professionals to sign-up to receive our Drug Safety Newsletter. This is published at various stages throughout the year and includes the most up-to-date safety developments including information published by the European Medicines Agency (EMA). You can also request a subscription to this newsletter by emailing: medsafety@hpra.ie.

• Promoting the safe use of medicines among the general public: The HPRA will run a number of public information campaigns in the year ahead which will focus on encouraging the general public to take medicines as directed and to read the product information supplied with all medicines, both prescription-only and over-the-counter products. We will also continue to distribute public information leaflets which promote the safe use of medicines and medical devices to hospitals and GP surgeries. • Communicating the risks of purchasing medicines online: The HPRA will continue to emphasise to the general public the risks associated with buying prescription-only medicines online. Through our enforcement role, in 2016 alone we detained over 670,000 dosage units of falsified and other illegal medicines including anabolic steroids, sedatives and erectile dysfunction products, among others. The HPRA regularly advises the general public of the importance of speaking to a healthcare professional before taking any medicinal product. • Safeguarding the future of health product supplies post-Brexit: Finally, in advance of Britain’s exit from the European Union, the HPRA’s strategic planning to safeguard the supply of health products to Irish patients in the future is now underway. While the outcome of the ongoing Brexit negotiations are still unknown, due to our shared marketplace with the UK there are potentially significant implications for Ireland as regards medicines availability. The HPRA will continue to focus in 2018 on planning for all possible eventualities and outcomes that may occur with Brexit and it is our intention to regularly engage with all impacted stakeholders to offer guidance and support to ensure the continued availability of medicines and other health products within the Irish health system.


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from *Provides significant improvement in quit rates vs. patch alone. †216 person sensory study. NiQuitin Fresh Mint 2/4 mg Medicated Chewing Gum is to be used for the treatment of tobacco dependence by relief of nicotine withdrawal symptoms and cravings. Indicated in adults (18 years and over). NiQuitin Fresh Mint Medicated Chewing Gum 2 mg is suitable for who smoke who smoke 20 cigarettes or less. NiQuitin Fresh Mint Medicated Chewing Gum 4 mg is suitable for smokers who smoke 20 cigarettes or more. Gums should be chewed as directed whenever there is an urge to smoke, to maintain complete abstinence from smoking. Maximum 15 per day. In general, the use of the medicated chewing gum is 2-3 months then the use of gums may be reduced gradually. When daily use is 1-2 gums, use should be stopped. Abrupt cessation: Use a lozenges whenever there is an urge to smoke, maximum of 15 lozenges a day. Continue for up to 6 weeks, then gradually reduce lozenge use. Adolescents (12-17 years): only with advice from a healthcare professional. Contraindications: hypersensitivity to nicotine or any of the excipients and children under the age of 12 years. Precaution: Supervise use if recent MI, unstable or worsening angina, severe CA, uncontrolled hypertension or recent cerebrovascular accident, diabetes, renal/hepatic imapairment, phaeochromocytoma, uncontrolled hyperthyroidism, GI disease. Side effects: Allergic reactions, anaphylactic reactions, insomnia, irritability, dizziness, headache, lightheadedness, tremor, palpitation, tachycardia, atrial fibrillation, hiccups, sore throat, pharyngitis, cough, pharyngolaryngeal pain, dyspnoea, nausea, GI discomfort, sore mouth, vomiting, indigestion, mouth irritation, mouth ulceration, dyspepsia, abdominal upper pain, diarrhoea, dry mouth, constipation, flatulence, oral discomfort, stomatitis, erythema, urticaria, increased sweating, jaw pain, chest pain, arthralgia, myalgia, malaise, parageusia, metallic taste, taste perversion. Legal classification: GSL: PA 1186/19/1 & PA 1186/19/2 MAH: Chefaro Ireland DAC, Treasury Building, Lower Grand Canal Street, Dublin 2, Ireland. RRP (ex. VAT): 30’s €9.99 100’s €24.99. SPCs: http://www.medicines.ie/medicine/17205/SPC/NiQuitin+Fresh+Mint+2mg+Medicated+Chewing+Gum/ NiQuitin 21 mg/24 hrs transdermal patches is indicated for the relief of nicotine withdrawal symptoms including cravings as an aid to smoking cessation. Indicated in adults and adolescents aged 12 years and over. NiQuitin patches should be applied once a day, at the same time each day and preferably soon after waking and worn continuously for 24 hours. Therapy should usually begin with NiQuitin 21 mg/24 hrs. Therapy schedule: Step1 NiQuitin 21 mg/24 hrs transdermal patches for 6 weeks, Step 2 NiQuitin 14 mg/24 hrs transdermal patches for 2 weeks, Step 3 NiQuitin 7 mg/24 hrs transdermal patches for final 2 weeks. Light smokers (e.g. those who smoke less than 10 cigarettes per day) are recommended to start at Step 2 (14 mg) for 6 weeks and decrease the dose to NiQuitin 7 mg/24 hrs for the final 2 weeks. Apply a patch to non-hairy clean dry skin surface, a new skin site should be used every day. Contraindications: non-smokers, children under 12 years and occasional smokers. Precaution: Supervise use if hospitalised for MI, severe dysrhythmia or CVA, If haemodynamically unstable, susceptible to angioedema, urticara, discontinue if severe persistent skin rash. Renal/hepatic impairment, hyperthyroidism, diabetic, phaeochromocytoma, current/previous epilepsy. Pregnancy and lactation: oral formats preferable to patches unless nauseous. Remove patches at bedtime. Side effects: Transient rash, itching, burning, tingling, numbness, swelling, pain urticaria, heaviness, hypersensitivity reactions. Headache, dizziness, tremor, seizures, sleep disorders, nervousness, palpitations, tachycardia, dyspnoea, pharyngitis, cough, GI disturbance, dry mouth, sweating, arthralgia, myalgia, asthenia, malaise, influenza-type illness, fatigue and anaphylaxis. Legal classification: GSL: PA 1186/18/1, PA 1186/18/2 and PA 1186/18/3. MAH: Chefaro Ireland DAC, Treasury Building, Lower Grand Canal Street, Dublin 2, Ireland. RRP (ex. VAT): 14 Day €37.73, 7 Day €20.94. SPCs: http://www.medicines.ie/medicine/6829/SPC/NiQuitin+7mg+24hrs+transdermal+patch es/, http://www.medicines.ie/medicine/4308/SPC/NiQuitin+14+mg+24hrs+transdermal+patches/, http://www.medicines.ie/medicine/4311/SPC/NiQuitin++21mg+24hrs+transdermal+patches/


Report Prescribers and pharmacists should adopt integrated approach when dispensing controlled drugs, new guidance urges Drug prescribers and pharmacists should adopt a collaborative approach to the treatment of patients in high risk groups who receive controlled drugs, a new guide has urged. The Medical Council and Pharmaceutical Society of Ireland have jointly published the new guidance booklet ‘Safe Prescribing and Dispensing of Controlled Drugs’. The resource aims to facilitate safer prescribing and dispensing of controlled drugs (CDs) for all prescribers and pharmacists involved in the care of patients in a primary care setting. The guidance takes note of the new Misuse of Drugs Regulations 2017 which has replaced the now revoked Misuse of Drugs Regulations. Controlled drugs include all substances, including certain medicines, that are known to be dangerous or harmful to human health, including being liable to misuse or cause social harm and are subject to control under the Misuse of Drugs Acts 1977 to 2016. The regulations categorise controlled drug substances into five schedules (ranging from the most tightly controlled in schedule 1 to the least tightly controlled in schedule 5). Schedule 4 is divided into parts 1 and 2. CD1s have the most restrictions and CD5s have the least. Some schedule 5 drugs can be purchased without prescription. The guide urges that all prescribers and pharmacists must familiarise themselves with, and refer to, the complete lists of controlled drugs contained in each schedule. It stresses that the Health Products Regulatory Authority (HPRA) website should be checked for accurate information regarding classification.

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may result in patients receiving inadequate care and unnecessary and unacceptable burden and stress.

• Record all supplies of schedule 2 controlled drugs (CD2) in the pharmacy’s controlled drugs register

The guide states: “Any patient requiring a controlled drug for their treatment is entitled to a correctlywritten prescriptionin order for them to lawfully access them.

• Communicate with the medical practitioner if there is any query about the prescription, or care of the patient

“It is also an offence for medical practitioners to incorrectly write a controlled drug prescription, and it is an offence for a pharmacist to supply controlled drugs from an incorrectly written prescription. “It is therefore incumbent upon both medical practitioners and pharmacists to ensure they are aware of their responsibilities and obligations under the Misuse of Drugs legislation to ensure the safe and appropriate supply of controlled drugs to their patients.” Prescribers are obliged to • Provide a valid prescription which meets the requirements of the legislation • Be satisfied as to the identity of the person for whose treatment the prescription is to be used • Follow relevant national and international prescribing guidelines • Within reason, be available to confirm or discuss any matters related to the prescription and the patient • Ensure the safe keeping of prescription pads to reduce the risk of theft and forgery • Facilitate appropriate withdrawal of controlled drugs and follow-up and refer as necessary

There is a strict system of control in place, both nationally and internationally, around the movement and supply of controlled drugs to enable safe access and avoid potential for abuse.

Pharmacists are obliged to

In Ireland these controls include restrictions on the people who can possess or obtain controlled drugs, and the strict legal obligations placed on pharmacists and prescribers charged with responsibility for the safe control of these substances.

• Prior to supply, be satisfied as to the identity or bona fide representative presenting the prescription or collecting controlled drugs

Failure to adhere to the regulations laid out in the Misuse of Drugs Regulations 2017 is an offence and

• Store controlled drugs in a safe manner, in accordance with the relevant legislation

• Only dispense on the basis of a legally valid prescription • Be satisfied that the signature of the prescriber is genuine

• Be vigilant for forgeries or unusual prescribing patterns

• Adhere to national guidelines and facilitate appropriate withdrawal of controlled drugs and follow-up and refer as necessary. The guideline booklet contains a series of sample prescriptions for the dispensation of CDs, including repeat prescriptions and a methadone prescription. It also points out the value of a collaborative relationship between prescribers and pharmacists, particularly in the cases of high risk patients. It states: “Good communication is essential to the effective functioning of healthcare teams. The existence of good, open communication channels between pharmacists and prescribers is of particular importance in assuring the safe and efficient supply of controlled drugs to patients. “By having in place a strong system of partnership, firmly based in the shared care of patients, efficiencies can be achieved in assuring that patients receive the best possible care in a more integrated system. These links are well established. “In prescribing and dispensing controlled drugs, where there is any doubt or confusion around the prescription, dosage, supply and administration, pharmacists and medical practitioners should engage with the relevant health care professional without delay. “This is particularly important at transitions of care and the initial prescriber should have clear communication with the patient’s GP and the pharmacist, as necessary.” The guide states that the partnership approach is particularly vital in the care of high risk patients, such as those with drug dependency issues, those receiving addiction treatment services or those who have mental health difficulties or who are homeless.

“Engagement within and between the professions in the shared care of patients in these groups is particularly important to meet patients’ care needs. “This includes shared responsibility for follow-up and after-care for all patients, and collaborative working in the implementation of appropriate withdrawal procedures for controlled drugs.” The guide also states that it is essential in the prescribing, dispensing and supply of controlled drugs that pharmacists and prescribers are aware and have access to national resources and adhere to all national and international guidelines. Examples of controlled drugs in each schedule is given • Schedule 1: Substances not ordinarily used as medicines such as Raw Opium or Coca Leaf • Schedule 2: Opiate substances such as Morphine, Fentanyl and Oxycodone. Also includes some stimulants such as Lisdexamphetimine • Schedule 3: Certain Benzodiazepines and painkillers such as Temazepam, Flunitrazepam, Pentazocine and Ketamine • Schedule 4, part 1: Most Benzodiazepines and ‘Z drugs’ such as Diazepam, Alprazolam, Clonazepam, Midazolam and Zolpidem • Schedule 4, part 2: Certain anti-epileptics such as Phenorbarbitone <100mg and certain MAOIs such as Selegiline • Schedule 5: Lower strength painkillers such as Codeine (when below specified concentration) Schedule 1 controlled drugs are not commonly prescribed or supplied as they are normally not regarded as having any therapeutic purposes. They may only be prescribed subject to Ministerial Licence. The full report can be accessed at https://medicalcouncil. ie/Professionalism/SafePrescribing-and-Dispensing-ofControlled-Drugs/


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Valeo Healthcare Office: 01 4031499


eHealth

Health Innovation Week showcases the future of healthcare A pioneering approach to digital health can help to transform the Irish healthcare system, the second Health Innovation Week has been told. The event, organised by eHealth Ireland, is a series of interactive events that encourage creation, learning and collaboration by showcasing the innovations that have the power to build a better health service. In his opening address, eHealth Ireland CEO Richard Corbridge said: “Last year we held the first ever Health Innovation Week and I promised to bring it back, bigger and better. I think we met that goal. We repeated some things, grew some others, and introduced some new elements.” This year the event expanded outside of Dublin, with a seminar hosted in Cork University Business School. It also featured an eHealth Innovation Challenge and launched One Health Tech Ireland, with the aim of creating more diversity in health innovation as a result. The Innovation Showcase was moved to the purpose built Printworks in Dublin Castle with over 30 exhibitors, 40 speakers and a national competition called eHealth Digital Natives for school children was held. The HIMSS Executive Leadership Summit came back to Dublin for the third time with a partnership that continues to develop, providing leadership and learning to health care professionals in Ireland. Mr Corbridge said: “Health Innovation Week has yet again has been a huge success. Innovation Showcase and indeed Health Innovation Week are collaborative efforts that could not happen without all of you – our partners, exhibitors, speakers, attendees, hosts, staff, everyone. “This event allows for sharing of ideas, and knowledge and in both structured and unstructured ways. The feedback we’ve gotten for the day and the week has been phenomenal.

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Health Minister Simon Harris, with CEO of ehealth Richard Corbridge and Richard’s soon to be replacement Jane Carolan at the ehealth summit “When we put this week on, it reminds me so much of the passion we all have for what we do. We are on a mission to bring digital health to Ireland, and it feels great to share that with you and to be part of building a better health service.” Cork University Business School (CUBS), University College Cork and eHealth Ireland collaborated to kick off Health Innovation Week with an event called ‘Unlocking the digital thread’. This kick-off event explored the opportunities, challenges and next steps associated with eHealth within the Irish health management landscape. Prof. Mark Hutchinson (CUBS) welcomed Mr Jim Daly, Minister of State for Mental Health and Older People and Fianna Fáil party leader Micheál Martin to UCC. Richard Corbridge CIO of the HSE and eHealth Ireland CEO outlined his views on the direction for developing the “Digital Thread” in Ireland, placing EHR rollout at the centre of this strategy. The keynote addresses were delivered by Professor Richard

Greene, Director of the National Perinatal Epidemiology Centre and Professor of Clinical Obstetrics (UCC) and Dr. PJ Fitzpatrick, CEO of Educate4Health. Some highlights from the day included the recognition that active collaborations between the Cork University Business School (UCC), School of Medicine (UCC), eHealth Ireland, the HSE, the Health Innovation Hub, high technology health start-ups, and the concentration of ICT giants, pharmaceutical and medical device makers are strategically placing Ireland as a potential world leader in the development of digital healthcare technologies.

The theme of the Hackathon was mental health in older people and participants were asked to build a working prototype of something that could harness the power of technology to help our medical staff, patients and HSE network to better tackle this issue. At an Ecosystem event a working group had come up with a brief for the Hackathon and this and other resources were at the teams’ disposal (e.g. Personas & Scenarios, open data and more). Also throughout the weekend, various mentors from Accenture, Oracle & the HSE came into talk to and support the teams.

Furthermore, the ways in which data can make a transformative impact on Ireland’s healthcare sector and the lives of patients were debated.

After an intense one and half days work the five teams pitched to the panel of judges.

Following the event, Minister Jim Daly commented on Twitter “Really inspired by the visionary and pioneering approach to digital innovation in healthcare at UCC conference today”.

• Overall winner: Team Sparked

The eHealth Innovation Challenge took place over two days at Accenture’s The Dock.

The winning teams were:

• Best User Experience: Team Connect • People’s Choice Award: Team Mindcare The 2017 Innovation Showcase aimed to demonstrate to the public


the progress in the creation of a digital fabric that is transforming the Irish healthcare system. Featuring over 30 exhibitors, 20 presentations and panel discussions, the event intended to reveal highlights of eHealth projects in Ireland and showcase the leading digital and connected technologies, which will revolutionise Irish healthcare by 2030. This year’s showcase included a huge selection of exhibitors, with small start-ups, large technology companies, Irish and International organisations, companies from Canada, the UK, Finland, Denmark and the Netherlands. Each of these companies were there to showcase their ideas, their products and the hope was to allow patients, healthcare professionals and the general public to touch, see and experience healthcare innovations that exist right now, platforms that are going to be the systems of the future. This also enabled the companies to engage with the potential users of their technology. Futuristic innovations on display for attendees to see and interact with included exciting Samsung Virtual Reality technologies, the robotic surgeon, The Da Vinci Robot; flying around the human body with a swipe of your finger with Pocket Anatomy. From Ireland and beyond clinicians, health tech experts, patients and others shared their knowledge, experience, ideas with over 20 sessions throughout the course of the day. It was a day full of energy, of connections, of new ideas, of inspiration. One of the main objectives of Health Innovation Week is to inspire clinicians, university students, children of all ages and the general public to think about modern healthcare and to participate in putting Digital Health at the heart of the national agenda and the Innovation Showcase definitely helps achieve this. The 2017 eHealth Digital Natives competition was a success.

eHealth Ireland, Samsung and Microsoft worked together to reach out to primary and secondary schools to ask them to be a part of Health Innovation Week. Pupils were challenged to think about the impact technological innovation will have on healthcare by 2030. Even though it was the first year of this competition, there were over 250 individual entries from over 40 schools across Ireland. The pupils shared their vision. Finalists were invited to the Innovation Showcase and with the support of some fantastic mentors from a range of backgrounds & organisations, they worked on their project before pitching to the judges. The winners announced on the day were: Overall winner and post primary junior winner • Sutton Park School PROJECT: Melius - Melius is a device designed to facilitate longterm drug release with big implications for patients with complicated treatment plans or illnesses that make it hard to keep track of medication. Post Primary Senior winner • Castleknock Community College PROJECT: Looking At Vision This entrant developed a design for damage-resistant glasses lenses that adapt throughout their user’s life to account for the growth of their eyes and deterioration in their vision. Primary winner • Scoil Mhuire Aughnagarron PROJECT: SignApp - SignApp is an app with a range of features to improve the lives of deaf people, from games to help teach sign language to vibration alerts to supplement fire and house alarms. The third Executive Leadership summit in Ireland was held in the Mansion House Round Room. Chaired by Dr. Mark Davies, Chief Medical Officer at HIMSS UK, there were three streams, each with a moderator and a number of different speakers. Following presentations, the panel of speakers was questioned by

The event really inspired the visionary and pioneering approach to digital innovation in healthcare

the moderator and from the floor, generating thought provoking discussion and shared learning. Over the course of the day there were 13 different presentations from a range of experts with diverse backgrounds. As well as the three tracks, CHIME, an internationally-renowned leadership development organisation, led a workshop on the challenges and opportunities for health IT leaders. Reflecting on the day, Dr. Mark Davies CMO, HIMSS UK said: “ELS Ireland brought together all those leading the digitalisation of healthcare in Ireland. “Suppliers, policy leads and those leaders from the service engaged in lively discussion of the priority areas namely; implementation challenges, lessons from international experience and patient engagement. “It is impressive seeing the progress that Ireland is making and we look forward to pulling everyone together again at ELS Ireland next year.” The three areas the day focused on were: • Using innovation to build a better health service in Ireland, moderated by Sean Donaghy, Director of eHealth, Health and Social Care Board, N Ireland. • Overcoming barriers to digital change: international insights, moderated by Richard Corbridge, Chief Information Officer, Health Service Executive.

Innovation is a cornerstone of the eHealth Strategy. eHealth Ireland is committed to creating an innovative environment for working together to improve Irish digital healthcare. The eHealth Ireland Ecosystem met to consider the existing projects in Ireland that empower patients to manage their own treatment, and to highlight the ways that patients should be involved in the innovation process. The ecosystem gathering is a useful tool to collate expertise and opinions from the attendees around what the challenges they face, within their own fields and organisations, in realising and/ or adopting new ideas. The three areas the day focused on were: • To introduce stakeholders – clinicians, researches, academics, industry – to existing patient innovation initiatives. • To compile expert opinions on the challenges and solutions facing innovation. • To support and encourage ideas. The plenary session began with HSE CIO Richard Corbridge providing an update on eHealth Ireland and the importance of involving patients in the process of digital technologies from design to implementation. Derick Mitchell, CEO IPOSSI, echoed his sentiments and presented on the on-going work within the health system in Ireland where industry groups and healthcare professionals are ensuring that patients are at the centre of developments.

• The empowered patient: how patient centred design principles lead to success moderated by Dr. Mark Davies, Chief Medical Officer, HIMSS UK

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Feature

Ready, Steady…. Quit The latest Healthy Ireland Survey, published in October, revealed that 22% of the population are current smokers. This is a drop of 23% from last year. As the New Year approaches, many more smokers will pledge to quit cigarettes. Although some will succeed on their own, pharmacy advice and products can be a great support to help them to quit for good. The facts - 22% of the population are current smokers. 18% smoke daily and 4% smoke occasionally. Men are more likely to smoke than women - 25% of men are current smokers, compared to 20% of women. Smoking rates are highest among those aged 25 to 34. 34% of this age group are current smokers. Smoking rates are higher in more deprived areas than more affluent ones. 32% of those living in the most deprived areas are current smokers, compared to 16% of those living in most affluent areas. 27% are ex-smokers. This is highest among men aged 65 and older, 47% of whom are exsmokers (compared to 16% who currently smoke). Quitting - 47% of all who have smoked in the past 12 months have made an attempt to quit. 42% of current smokers have made an attempt in the past 12 months. 13% are currently trying to quit, and 57% are at least thinking about quitting. Of those who have smoked in the past 12 months, 12% have successfully quit during this time. Almost half (45%) did so through willpower alone, and 37% used e-cigarettes. A smoker of 20 premium brand cigarettes per day can save over ¤4,300 annually by quitting. Interactions with health professionals - 35% of smokers who saw their GP in the past 12 months discussed ways of quitting smoking. 25% of those who saw a hospital doctor had this discussion, as did 22% of those who saw a nurse. Those aged 25 to 34 (where smoking rates are higher) were less likely to discuss with their GP ways of quitting. 30% of this age group who saw their GP discussed ways of quitting. In the Pharmacy - A well-stocked, prominent display of NRT products can be supplemented with educational literature for smokers or to highlight any smoking cessation services available in

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the pharmacy. These materials can also be flagged at strategic points in the retail area of the pharmacy, such as in the dentalcare section of the pharmacy, as smokers may be conscious of teeth discolouration from nicotine or ‘smoker’s breath’. What works for one smoker might not suit another, so a range of NRT formats that deliver nicotine in different ways and at different strengths should be on offer. When discussing NRT with a patient, the type of replacement used will depend on the patient’s own personal preference, any previous smoking cessation medication that they have used and any side effects the products may cause. NRT products - Gum Many people chew gum when they are trying to quit smoking because it provides oral gratification similar to a smoking habit. Gum is convenient and allows the patient to control how much nicotine they use, and how often. Patches best suit regular smokers, who smoke throughout the day to help with their cravings and withdrawal symptoms. Patches deliver a continuous, controlled dose of nicotine through the skin over 16 hours or 24 hours. The nicotine is absorbed quite slowly compared to smoking a cigarette, so the patient should be prepared to wait a little for the nicotine to get into their system. Lozenges dissolve on the tongue, delivering therapeutic nicotine quickly to help relieve cravings and other withdrawal symptoms. For best results, the patient should be advised to suck the lozenge slowly – they should not chew or swallow it and neither should they eat or drink while the lozenge is in their mouth – it can take between 16 and 19 minutes to dissolve. Cigarette-shaped inhalers replace the ‘hand-to-mouth habit’ of smoking. The inhaler should be used whenever they feel the urge to smoke. Over time, they should need to use the inhalator less to control nicotine cravings and withdrawal symptoms. The aim is for the patient to gradually reduce the number uses per day.

Sprays - The patient uses the nicotine nasal spray when required, so is particularly suited to smokers who require rapid relief of tobacco withdrawal symptoms as it is the quickest-acting form of NRT. The nicotine reaches peak plasma concentrations in the blood after only 10 minutes. Prescription Medications - Two medications are currently licensed to help people give up smoking. Bupropion, originally designed to treat depression, was discovered to also help people quit smoking. It is thought that the medication affects that part of the brain that is involved in addictive behaviour. Bupropion is prescribed in tablet form, with people taking one to two tablets a day. It should be taken for 7-14 days before the patient tries to quit smoking, as the medication takes this amount of time to reach its maximum effect. A course of treatment usually lasts for seven to nine weeks. It can, however, cause dry mouth, stomach upset, insomnia or headaches. It can also cause dizziness or drowsiness, so pharmacists should advise patients not to drive or operate machinery if they are affected by any of these side effects. Varenicline has been specifically designed to help people to stop smoking. It prevents nicotine from binding to receptors in the brain that ordinarily respond to the drug, easing cravings and reducing the rewarding and reinforcing effects

of smoking. If the patient has not stopped smoking completely before starting varenicline, they should be advised to do so within 7-14 days of starting treatment. The recommended duration of varenicline is 12 weeks. Side effects are similar to bupropion but some patients may also experience depression on rare occasions. The Pharmacists role Pharmacists are ideally placed to advise their customers of the health and financial benefits of smoking cessation. When a customer buys a NRT in the pharmacy, it is a golden opportunity for intervention – Ask if they have tried to quit before and what made them start smoking again. Then discuss the options and find out the most suitable product for the individual. It should be much more than a purely transactional exchange – knowledge and professional experience should be passed on, too. Motivated and helpful pharmacy staff can make it much easier for the patient to give up for good. Most smokers do want to quit and would likely be happy for the topic to be brought up by a health professional, provided it is done in a supportive and non-judgmental manner. Studies show that patients, even those who intend to continue smoking, prefer that health professionals advise them to quit.


Report

Pharmacists call for expanded role in patients’ healthcare Pharmacists have said they should be given an expanded role in the community as part of a new integrated solution to patient and healthcare demands. and GPs massively. We could be doing vaccinations, looking after minor ailments, patients managing chronic diseases, lots of things. There have been several reports that have suggested we should have a bigger role in healthcare. "The future of pharmacies has to change. Yes, they need to be commercially viable but that doesn't mean they can't be at the centre of healthcare. The network is already there and it could be utilised to work more effectively with GPs and nursing homes. "People need to see the pharmacist as more than just a retailer of medicines but the change of mindset. "Two million people in Ireland visit the pharmacy every month because it is such a comfortable, familiar environment. We are perfectly placed to do more." Clodagh Bowles, pharmacist at Castle Pharmacy in Castlemartyr, agreed that there was a much wider role that the community pharmacist should play.

Paul Candon, CEO of McCabes Recently the Pharmaceutical Society of Ireland (PSI) published a report ‘Future Pharmacy Practice in Ireland – meeting patients’ needs’ which examined how the role of the pharmacy sector, both hospital and community based, can be capitalised on for the enhancement of patient care. The report made a series of recommendations which included the evolution of pharmacists’ roles in health promotion and their greater involvement in managing chronic diseases in the community. It also recommended pharmacists working increasingly outside of pharmacies, providing medicines, advice in GP surgeries and nursing homes.

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Paul Candon, chief executive officer at McCabe’s Pharmacy Group, said there was a wide range of services which community pharmacies could provide which would take pressures off doctors. He said: “I agree that there is a lot more that community pharmacies could and should be doing. It has to change and the opportunities to expand our role are there. “There are 1,800 pharmacies in Ireland and they need to play a wider role in the community, that would be an enormous benefit to the pharmacies, but to the patients as well.” Mr Candon added: “We could take the pressures off hospitals

She said: "In the communities there is a lot more we can do. We are the link, we know what patients need and how to help them but we often have to send them off to the doctor when we could treat them very well. "If we were allowed a slightly larger role to do some of these things then it would stop so many people having to go to the GP and help to shorten the queues and speed the system up." She added: “We have a legal requirement to get out of the surgery but I think that is something that can be expanded. I also would like to see a more collaborative approach with the doctors, more contact, more working together in terms of patient review. “I have a small pharmacy at the minute but I’m hoping to move to new premises where I will have

more room and will be able to offer more. "The community pharmacy has the local links and knowledge. It is an awful lot handier for people to come to the chemist than go to the doctor or hospital.” The PSI report said that as the health system in Ireland continues to be reformed, policy makers should consider the role that pharmacists, with their unique expertise in medicines, could play as part of an integrated solution to patient and healthcare demands. The report states: “In order for pharmacy practice to achieve its potential and contribute most effectively to improving the public and patients’ health, there are significant implications for pharmacists at all levels. “Practising pharmacists, regulators, policy makers and researchers will need to display leadership and strategically coordinated focus to achieve an enhanced role for the profession. Pharmacists must continue to adapt their skills to become more patient centric rather than medicine/product centric, with changing delivery models requiring a continued focus on delivering the best outcomes regardless of the setting or channel. “As technology becomes a more significant aspect of healthcare delivery, regulators and policy makers will need to foster and lead the implementation of technology solutions through appropriate guidelines, to ensure that the outcomes remain safe and take advantage of advances in technology infrastructure to support healthcare professionals deliver better healthcare.” The report continues: “The future of pharmacy practice is one whereby the unique skills of the pharmacy profession are utilised to their full potential to meet the health requirements of the public. “Through the implementation


The resource that the pharmacy sector, both hospital and community, provides within the health system should be capitalised on for the enhancement of patient care of the recommendations of this Report, this future is an expanded role working in greater collaboration with all other healthcare professionals for the benefit of patients.” The resource that the pharmacy sector, both hospital and community, provides within the health system should be capitalised on for the enhancement of patient care. The report says that as pharmacists are the most accessible health practitioner in Ireland, with approximately 2 million people visiting a pharmacy monthly, both healthy and ill, they are ideally placed to support patients to protect and improve their health and further contribute to the national health and wellbeing strategy. The PSI report recommended that the role of pharmacists as an integral part of the health sector delivering on the goals of Healthy Ireland should be strengthened and expanded. This includes the delivery of national information and awareness campaigns, prevention and early intervention initiatives, as well as initiatives supporting and empowering people to look after their own health and wellbeing. It also recommended that the role of pharmacists in supporting self-care and health behaviour change should be expanded to capitalise on their high level of contact with patients and the public to ensure prevention of and early intervention in illness. Pharmacists should be included in the training and development on health and wellbeing interventions and skills rolled out by the health service. Furthermore, community pharmacies should be considered as a possible provider of national screening services. The existing role that pharmacists play in supporting patients treating minor and self-limiting conditions, in the community should be further expanded, the PSI said.

The report suggested that because of the frequency of attendance by patients with chronic disease, community pharmacists are ideally placed to support patients living with chronic disease in Ireland in self-care and self-management of their condition. Pharmacists should be integrated into building the capacity for patients’ self-care and selfmanagement of chronic diseases, including helping patients manage their medicines. This could be provided through structured education and medicines management programmes to atrisk chronic disease patients, the PSI said. Pharmacists should provide a structured patient education and adherence programme for newly diagnosed chronic disease patients to improve adherence and their health outcomes. Supporting chronic disease management through advanced pharmacy practice and collaborative shared care. Where monitoring of patients with a chronic disease can be appropriately managed in the community, consideration should be given to establishing advanced pharmacy services for this purpose, the report stated. As integrated programmes of care are rolled out, the PSI report stated that mechanisms should be explored to enable pharmacists and GPs to work more closely together to support patients in the management of their chronic conditions. This could include supplementary prescribing activities such as dosage adjustment or therapy continuation by the pharmacist in line with agreed protocols. The report said that with rising levels of polypharmacy, coupled with more complex medicines, the knowledge and expertise of the pharmacist should be used to ensure the safety and efficacy of patients’ medication in all care.

Clodagh Bowles, Pharmacist, Castle Pharmacy

It said that pharmacists should provide enhanced support to patients with complex medicines needs in the community. This could be provided using targeted medicines review and medicines management strategies for at-risk patients. These reviews should be in collaboration with other professionals including GPs. Patients in formal care settings, such as residential care, would benefit from targeted structured medicines review conducted by pharmacists and in collaboration with the patient’s doctor or GP, the report stated. In keeping with government policy to manage patients at the lowest level of complexity and as close to home as possible, consideration should be given to provide for pharmaceutical domiciliary care for at-risk patients, the PSI report recommended. It also said that in line with HSE Integrated care guidelines, patients should receive pharmacist-led medication reconciliation and medicines review upon entry to and discharge from hospital, which should involve the community pharmacist when returning to primary care.

The report said that a wider range of patients in acute hospital settings would benefit from having their medicines screened for pharmaceutical and therapeutic appropriateness by the pharmacist. It also said that patients with with illnesses that require treatment with complex medicine regimes should have access to trained specialist pharmacists (e.g. palliative care). The specialist expertise should be used effectively throughout the new hospital group structure. In order to enhance patient outcomes and increase medication safety, multidisciplinary teams, which include pharmacists should be used to develop collaborative models of medicines management, the PSI said. This includes development of appropriate pharmacist prescribing models. Supplementary prescribing by pharmacists in the first instance would aid the patient management process and should be developed. Longer term consideration should be given to giving pharmacists independent prescribing rights, the PSI report added.

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Feature Call for criminal justice system to protect pharmacies Pharmacists in Ireland have warned that the criminal justice system is not giving them adequate protection amid growing fears that they are a soft target for criminals.

The most recent statistics gathered by the Irish Pharmacy Union show that pharmacies nationwide are under attack with three out of every four having been a victim of crime. The majority of these have been targeted more than once, and a quarter of all incidents involves the use of violence. Daragh Connolly from Haven Pharmacy Connolly’s in Dungarvin said many pharmacists were left feeling isolated and fearful after their experiences of crime. Mr Connolly, who is also the President of the Irish Pharmacy Union, told how he had been physically attacked when working in his own pharmacy.

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forced to show that I hadn’t done anything to upset or provoke this individual who attacked me. “We had really good CCTV footage of the attack but in the end the Gardai advised me to go for a lesser charge otherwise we would have got no justice at all. You take your chances when you go through the courts system. “The whole process goes on for so long and there are so many adjournments and pharmacists can’t keep taking days off work to go to court. The advice I was given was to accept affray rather than assault because there was a better chance of a conviction.

He said: “Yes, I was attacked, punched and spat at. I think for me and pharmacists in general the experience was that the Gardai were very good, we are happy with their response rates and times.

“Then most of these people are repeat offenders and they will have lots of charges which are considered concurrently. I’m not sure that the individual who attacked me served a single day in prison. The whole system is stacked against the victim.”

“But the problem arises when you get to the courts. The burden of proof needed to get a conviction is so high, the whole system is stacked against the victim.

Mr Connolly said pharmacies could consider more security measures but didn’t want to lose their community ethos and access to the public.

“In my own case it took so long and I was essentially being

“It’s a difficult balancing act. We don’t want people coming in to see

their pharmacy and having to talk to us through some glass partition like some inner city in England. We have a fantastic rapport with the public and great support from them and we want them to feel comfortable coming in to their local pharmacy.

Store manager Hannah O’Brien said pharmacists and staff are left feeling vulnerable. “In our store we have very good cameras and a panic button, but we always tell our staff only to press the button if they are in a safe position to do so.

“Thankfully incidents like this are still quite rare. However, there is a psychological impact when you’re a victim of crime, not just for the individual but for all the people in that shop.

“The panic button goes straight through to the police. But then the police tell us that nine out of 10 alerts they get through this system are false alarms so it is better to phone them directly.

“I was very conscious when I was being attacked that I could do nothing more than lift my hand to defend myself. If I went any further I would be the one in the dock. The system needs to change to take more notice of the victims’ needs.”

“But if someone comes into the shop with what you think is a firearm then you’re not going to be in a position to make that phone call. Some people assume it isn’t a real gun they have but you can’t take any chances.”

Meanwhile a pharmacist whose premises was targeted in a terrifying gunpoint robbery has spoken to Irish Pharmacy News about the life-changing effect of the crime on her staff.

She added: “When something like this happens you are left with a feeling of fear and vulnerability. You ask yourself ‘Do I feel protected?’ I’m very conscious of my staff members’ safety as well.

The pharmacy in Sligo was targeted last month after a man with a suspected firearm entered the premises. He threatened staff members before leaving with a quantity of drugs.

“The police were very good. They were here quickly and gave us lots of reassurance and good advice but it was very traumatic for the girls. Thankfully this sort of thing is very rare in Sligo.


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Feature “Since then we’ve serviced our panic buttons to make sure they are working well. The cameras are very good but if someone comes in and covers their face then what can you do? “You could have a security guard in the shop but how would that look? “A lot of the public were very good after the raid but there are a lot of people who come in just to hear about what happened and that means the staff have to go through it all again.” Hannah said that pharmacists were viewed as a soft target because of the access to prescription drugs. “In society today a lot of people are addicted to prescription drugs because they are so easy to get hold of. They start off by stealing them from their granny and then move onto the pharmacy.

Of those who have experienced crime 78% said they had been victims on more than one occasion, with 23% describing the incident as violent. In one in five cases where there was a robbery or raid, the perpetrators had a weapon. A knife was used in 81% of these robberies and a gun in 18%. A number of pharmacies in Ireland have been targeted in terrifying raids this year. In September a pharmacy at the Lower Drumcondra Road in north Dublin was targeted after a robber entered the shop pretending to be a customer. However, after watching the staff for a short period he pulled a gun from a plastic bag and pointed it at them, demanding the cash from the register. One staff member gave him cash.

“But what the people who do this sort of thing don’t real is the lifechanging effect of what they are doing. That incident will stay with the staff member forever.

In another robbery at a pharmacy in Lucan in February a gunman threatened to "blow the head off" a pharmacy worker if he did not hand over cash during a terrifying raid.

“My advice to any pharmacy caught in this situation is just to give them what they want. Don’t press the panic button unless it is safe to do so. Don’t make eyecontact with them. Just get it over with as quickly as possible so they are out of the shop.”

The robbery took place only a few metres from a creche and a primary school.

The Irish Pharmacy Union (IPU) Crime Survey 2016, published this year, revealed that 77% of pharmacies they surveyed had experienced some form of crime, including shoplifting, robbery and raids.

The raider entered the pharmacy and terrorised staff working behind the counter. Brandishing a handgun, he forced them to hand over the money from cash registers. In July staff in a Dublin pharmacy were subjected to a terrifying robbery, in which a man with a hammer escaped with drugs and cash.

But what the people who do this sort of thing don’t realise is the life-changing effect of what they are doing. The incident will stay with the staff member for ever The man is understood to have used a hammer during the robbery. In September a pharmacy in the Northside area of Limerick City was targeted after a man wearing a balaclava entered the store brandishing a knife. He demanded cash and a quantity of tablets. The Pharmaceutical Society of Ireland, in association with An Garda Siochana, publishes security guidelines and advice for pharmacies on its website. The advice, for the interior of the premises, includes • Use of mirrors to facilitate visibility in concealed areas, and the positioning of gondolas on the shop floor to allow clear lines of sight is recommended. • High value goods and prescription-exempt pharmaceutical products should be protected.

• Service counters should be elevated above floor level, which allows for enhanced visibility for staff. Till guards, drop safes, panic alarm buttons should be utilised. Display shelves should not be sited in such a manner as to impede visibility. Floor standalone units should not exceed 5 feet in height. • Access to the dispensary should be restricted, with appropriate surveillance in place. Consideration should be given to the layout of the dispensary – products liable to abuse out of line of sight. • Adequate staffing levels should be maintained to ensure no unauthorised access occurs. • Controlled drug storage conditions should be as required by legislation, with the required standard of a safe anchored into a permanent wall or floor. • Medicines, either stock held or returns for disposal, should not be stored in a manner which allows unauthorised access by staff or others. • Entry to any and all staff rooms, including stock rooms, toilet facilities and administration offices, should be controlled and restricted. • Good cash security procedures should be employed, with floor limits set as low as possible and observed by staff. Till should only be opened and supervised for a transaction. Cash safes can be fitted with time-delay locks, with prominent notices displayed to this effect. Cash should not be handled or counted in view of the public and more than one individual should be involved in the counting process. • Access to behind counters should be minimised through the use of barriers or other measures.

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Feature

Social Media Surge in Pharmacy The world of communication is rapidly changing and more and more pharmacists are using social media to reach out to their customers. But while the immediacy and range of social media outlets such as Twitter and Facebook is undeniable, promoting your services on such a public and accessible platform carries added risks and responsibilities for a pharmacist. One business which has combined its traditional base with embracing new technology is Conefrey's Pharmacy on Dublin's Pearse Street. Founded in 1955, the late Caillin ‘Con’ Conefrey, ran the business until he passed away in 1988. Following Con’s death, his widow Peggy took over, introducing computerised systems of payment and record-keeping until the couple’s son Tomás qualified as a pharmacist in 1998. Now Tomas has recognised the value of services such as Twitter to promote his business which is facing up to the growing threat from major pharmacy chains and supermarkets which sell medicinal goods. “My whole take on advertising has changed in the past three or four years with the impact of social media,” says Conefrey, who is active on Twitter and Facebook and does the Conefrey blog. “I suppose I am quite an introvert but I have had to come out of my shell somewhat in order to get the word out about what we do, to get and to keep people interested and coming through the door. I’ve had to engage people more than I’ve ever had to before in my life.” Tomas has more than 11,000 Twitter followers and sends out on average a dozen tweets every day. He uses the platform to promote events or services or sometimes just to pass on useful information and quotes. He said: "It was soon after I joined Twitter that I saw the potential of it from a professional perspective. It had huge reach and it seemed the obvious thing to do to use it to help our business. "Generally I look and see what sort of information is out there, health articles, etc, and then I try to pass as much of that

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Tomas Conefrey, Pharmacist, Conefrey’s pharmacy

information on to my customers as I can. "Obviously I can't sell products on social media so I sell myself and I talk about the services that we provide. It's a different way of talking to people. "And it's not just younger people who communicate with us through social media. We see lots of people of a more advanced age. They like it too, the immediacy of it, the fact that you make contact straightaway." Tomas says they occasionally get contacted by people explaining their symptoms and seeking medical help. "That's something I can deal with up to an extent but you have to be careful and know the limits of what you can do. You just have to keep your wits about you and be careful. Always be consistent with the message that you are putting out there." Another business which has embraced the social media revolution is Meaghers Pharmacy.

The business launched its online store two years ago and has seen its social media presence grow by tens of thousands since. Their proactive approach to social media was demonstrated recently when Gillian Whelan from Meaghers recently took part in a live webcast explaining how they have grown their social media profiles. She said: "We decided social media should represent all of our core values, positivity, putting the customer first, innovation. We wanted people to get a sense of who we were and to make it a destination where people could come to get answers and to get the product they might not be able to get elsewhere. "We saw there was a space for us to be a little bit different and to step into a market that was there but which wasn't being met. We felt there was a customer there that needed to be listened to. "All the followers have come organically since then through

working with brands, working with influencers and listening to what our customers want. People start telling their friends about it. It has been amazing, a great journey. In the summer Gillian shared a post featuring a blog article by the beauty, fashion and lifestyle vlogger, FacesByGrace featuring her top ten products for the summer. This timely article was very popular with their audience with an organic reach of 26,203, 1,057 post clicks and 124 reactions, comments and shares. When Superintendent Pharmacist Eugene Renehan won Superintendent Pharmacist of the Year, Meaghers broadcast the awards ceremony live on their Facebook page. But the use of social media also provides challenges for pharmacies around such issues as confidentially of patient information and privacy settings. With this in mind the Pharmaceutical Society of Ireland (PSI) has published guidelines for pharmacists.


The rapid growth in the use of digital and social media has prompted many regulators to produce guidance to healthcare professionals in order to ensure patient safety and reduce the possibility of behaviour that might give rise to patient complaints It states: "The rapid growth in the use of digital and social media provides both opportunities and challenges to all healthcare professionals, including pharmacists, as it has changed the way many people seek and receive health information. "Embracing digital media, as an additional patient communication tool, has great potential to contribute to public health and patient education. Responsible use of digital and social media has the ability to bring many benefits to pharmacist education and professional development. "However, pharmacists should also consider the potential consequences of providing information, services and products online.

must be accurate and relevant. Patient confidentiality must be preserved. Patient interactions should be respectful and ensure that patients are afforded the best possible pharmacy care, treatment or service." The PSI details a number of key points for pharmacists to consider: • Interactions through digital and social media are subject to the same professional standards and ethical considerations as other personal or public interactions.

"Nonetheless pharmacists should aim to assure the greatest degree of personal protection when selecting privacy settings. All engagement should consider the possibility for other persons to assume false identities and present misleading information online. "Pharmacists should consider who could claim ownership of the data which they post or acquire online and the potential rami cations of such a claim i.e. is data owned by the pharmacist, the patient, the web application provider etc." The PSI says: "Use of digital and social media can lead to the blurring of professional and personal lives e.g. it may be a violation of professional boundaries to introduce patients to certain

"Standards of privacy and patient confidentiality must be maintained online, and pharmacists must not post confidential patient information without the patient’s informed consent. Where anonymised patient data is posted, ensure that this data cannot be linked back to the patient. Remember that, although individual pieces of information may not alone identify a patient, a combination of online information could unwittingly compromise confidentially and give rise to patient complaints. All online interactions must comply with Data Protection Legislation." It adds: "As healthcare professionals, pharmacists should be cognisant that their actions, including those online, are held to a higher standard of accountability by the public and should therefore think carefully about the implications of these interactions. "Pharmacists should ensure that all information posted online is appropriate for the audience that can access it and for the location in which it is posted."

• Preserve patient confidentiality and privacy. • Ensure that all information posted online is appropriate for the audience that can access it and the location in which it is posted.

"The Code of Conduct for pharmacists requires that pharmacists exercise their profession

• Develop policies for the professional management of digital and social media.

"Pharmacists must ensure that their online interactions promote the highest standards of patient safety. Information provided

It adds: "The internet should be treated as a virtual public space assuming that privacy settings can be changed and that privacy technology may be breached. Information posted online is likely to be permanent and may be impossible to delete.

aspects of your private life. Consider how best to separate your online professional and private profiles and interactions.

• Consider how best to separate your online professional and private pro les and interactions.

"The rapid growth in the use of digital and social media has prompted many regulators to produce guidance to healthcare professionals in order to ensure patient safety and reduce the possibility of behaviour that might give rise to patient complaints.

in a manner that is directed to maintaining and improving the health, wellbeing and safety of patients and the public. Pharmacists should ensure that their professional online interactions are in accordance with the principles laid down in the Code of Conduct.

with digital and social media should be subject to the same professional standards and ethical considerations as other professional interactions."

• Evaluate health information for quality and accuracy before posting online.

The PSI states: "Pharmacists may use social media in a professional or personal capacity. Regardless of the capacity of the engagement, common sense and professional judgement should always be exercised. The possible consequences of all interactions should be considered in advance including the potential for breach of patient confidentiality and defamation. "In keeping with principle four of the Code of Conduct, interactions

Eugene Renehan at the Irish Pharmacy Awards

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totalhealth Awards

totalhealth Pharmacy Gala Ball & Pharmacy Awards 2017 The totalhealth Pharmacy Group recently held their annual Gala Ball & Pharmacy Awards Ceremony in the Radisson Blu Hotel Galway. The celebratory event was attended by over 300 pharmacists, staff and employees of the totalhealth Pharmacy group nationwide along with industry partners. Dáithí O’Se, Rose of Tralee host and RTE personality proved to be a very popular host and MC for the evening. The event was an opportunity for the totalhealth pharmacy group to honour and thank the staff from all our pharmacies across the country for the role they play in making the totalhealth Pharmacy brand the success it is. The evening was a celebration of another fantastic year for the group. Totalhealth Pharmacy recognises that it is the teams in our pharmacies who make the difference delivering quality knowledge based customer service and value every day in their local communities. Chairman Rory O’Donnell addressed the members and guest by saying, “It is a great privilege

for me as Chairman of the Board to be addressing you now. I am delighted to be able to say we are the largest and fastest growing pharmacy group in the country. The totalhealth brand is strong and we have developed it into a brand we can all we proud of and value.” Pharmacy Awards 2017: The focus of the night was the Pharmacy Award Ceremony which was a celebration of excellence within the group. The winners came from right across the country and that connectivity and partnership among members was truly evident on the night.

The Gala Ball was organised to celebrate and thank every staff member in every totalhealth pharmacy for their contribution to the brand and to ensure they had a wonderful time on the night. And by all accounts they did!

Left to right: Rory O’Donnell, Chairman totalhealth Pharmacy Group; Jackie Nihill, RX+ totalhealth Pharmacy; Brian Fagan, Cosmetic Active

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The winners in their categories were:  Ambassador of the Year 2017 Jackie Nihill, RX+ totalhealth Pharmacy, Shannon  Medicine Counter Assistant of the Year 2017 Mary Niland, Curley’s totalhealth Pharmacy, Ballyhaunis  VIP Loyalty Pharmacy of the Year 2017 Rose Finlay’s totalhealth Pharmacy, Tullamore  Social Media Pharmacy of the Year 2017 Malone’s totalhealth Pharmacy, Kilrush  Customer Service Pharmacy of the Year 2017 - Overall Flanagan’s totalhealth Pharmacy, Headford  Customer Service Pharmacy of the Year 2017 - Most Improved Concannon’s totalhealth Pharmacy, Athlone  Community Pharmacy Team of the Year 2017 Tully’s totalhealth Pharmacy, Castlerea  Brand Pharmacy of the Year 2017 Joanne Hynes totalhealth Pharmacy, Ballinrobe

The team at McGuinness totalhealth Pharmacy with Daithí O’Sé


Left to right: Phil Osbourne, Teva; Team at Rose Finlay’s totalhealth Pharmacy; Rory O’Donnell, Chairman totalhealth Pharmacy Group

The team at Andrew Buckley’s totalhealth Pharmacy with Daithí O’Sé

Left to right: Rory O’Donnell, Chairman totalhealth Pharmacy Group; Jarlath Philips, Flanagans totalhealth Pharmacy, Headford; Gregg Farrell, Accord

The team at Gleeson’s totalhealth Pharmacy with Daithí O’Sé

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News Pharmacists Shortlisted for Having a Positive Impact on Individuals and Communities 24 pharmacists from across the country have been shortlisted for the Clanwilliam Pharmacist Awards this year. 2017 saw the highest ever level of nominations for the awards, from both pharmacists and patients, with over 400 submissions received. Earlier in the year, organisers called on the public to nominate pharmacists who go above and beyond for their patients. An adjudicating panel comprised of respected pharmacists from various branches of the profession then met to go through the nominations received. Together they selected three finalists for each category recognising each of them for having a positive impact in the life of an individual and in some cases, a whole community while performing their duty. Speaking about the shortlist, previous recipient and Pharmacist Award Committee member, Kathy Maher welcomed the shortlist announcement. “I am delighted to be supporting the 2017 Clanwilliam Pharmacist Awards by sitting on the committee. As an award recipient last year, it’s an honour to be a part of the decision-making process this year. It’s so important to

Eileen Byrne, Managing Director, Clanwilliam Health; and Daragh Connolly, President, Irish Pharmacy Union acknowledge the individuals and teams who are nominated in each category for their contribution to the healthcare system in Ireland as a whole. These awards also offer support for the Pharmacy Benevolent Fund, which helps

those who have been associated with pharmacy and who are now in need of assistance. None of us can prepare for the unexpected events of being unable to work due to serious illness or the premature death of a working

spouse. These are the primary reasons people need assistance from the Benevolent Fund and why it’s such an important cause to support.”

New training toolkit launched for pharmacists to help customers suffering with LUTS A new training toolkit to give pharmacists the knowledge and confidence to have conversations about LUTS with customers has been launched. Over 350,000 adults in the country suffer from lower urinary tract symptoms (LUTS) – overactive bladder (OAB) or bladder weakness. Its pharmacists who are best placed to help suffers and the makers of treatment *Urostemol®, Perrigo have designed the toolkit to look at different types of LUTS that can affect women and men, includes the treatment options available and the advice to give customers to help them manage their symptoms. The training is focused on understanding LUTS caused by an overactive bladder (OAB) and benign prostatic hyperplasia (BPH). It also explores how these conditions affect a sufferer’s quality of life; being familiar with the current treatment options for LUTS and being able to

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confidently offer self-care tips to LUTS sufferers. Speaking about the toolkit Geraldine Mangan, assistant brand manager, Perrigo says: “LUTS can have a significant impact on sufferers and their quality of life, causing them great discomfort and distress. Until

now, there have been very few products available in the pharmacy to relieve symptoms. It is important to remember that bladder problems can be managed with appropriate treatment and that the pharmacy team can play a huge role in helping LUTS sufferers.”

Urostemol® is a range of traditional herbal medicinal products (THMPs) tailor-made for men and women to relieve LUTS related to an overactive bladder or bladder weakness, based upon long-standing use as a traditional remedy.


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1. Pinto-Bonilla, J.C et al. Ther. Clin Risk Manag (2015); 11: 595-603 2. Dews, Ocul Surf 2007; 5: 75-92


Feature

Not a dry eye in the pharmacy By Deirdre O’Malley, Pharmacist, O’Donnells Pharmacy, Wesport

Introduction - On a near daily basis in a community pharmacy setting, a person requires information and often treatment for an eye condition. Generally most of these conditions are relatively mild and may be treated effectively in a community pharmacy environment. Eye care incorporates a number of conditions and may affect any age group. Dry Eye Syndrome Keratoconjunctivitis most commonly known as dry eye syndrome happens when eyes do not make enough tears or tears evaporate too quickly. This can lead to eyes drying out, becoming red, swollen and irritated. It is a common condition which can affect any age, but is more prevalent in people greater than 60 years. It is estimated that 1 in 3 people over the age of 65 experience dry eye syndrome and it tends to affect women more than men. Dry eye syndrome occurs when the complex tear production process is interrupted in some way. This can happen for many reasons but there is as yet no single identifiable cause. Common causes include; hot or windy climates and wearing contact lenses. Certain underlying conditions such as blepharitis- a condition characterised by inflammation of the eyelids- may contribute to the development of dry eyes. Side effects of medicines, for example anti-histamines, beta-blockers, antidepressants, diuretics are also a causative factor. . Hormonal changes in womenthe menopause, pregnancy, contraceptive pill usage- can cause dry eye syndrome; which may explain the greater incidence of this condition in females. Aging as previously mentioned is also a significant factor. People often present to the pharmacy with a feeling of dryness, grittiness and soreness in the eyes which can worsen throughout the day. They may describe symptoms of a burning sensation and redness of the eyes. Eyelids may stick together upon waking. There may be temporary blurred vision which improves upon blinking and sometimes watery eyes occur when eyes try to relieve irritation by producing more tears There are a number of treatments in the form of eye drops and ointments to relieve the symptoms of dry eyes. Lubricant eye drops are essentially tear substitutes

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which mimic the properties of tears. They can be used on a when required basis. If a person complains of severe dry eyes and requires eye drops more than six times per day, it is recommended to use a preservative free preparation, as preservatives in eye drops when used on a frequent basis may further irritate eyes. Preservative free preparations are also more suitable for people who wear soft contact lenses. Eye ointments may also be recommended. It is preferred to use eye ointments at night as they may cause blurring of vision. For contact lens wearers, ointments which contain paraffin should be avoided. In severe cases where eyes may also be inflamed, anti-inflammatory medicines may be beneficial to reduce swelling. Anti-inflammatory eye drops; subject to prescription; may be considered if deemed appropriate by a doctor. In certain cases it may be important to ascertain whether dry eye syndrome is a result of a side-effect of a medication. If so it may be appropriate to refer to the doctor to see if a change in medicine is suitable, if dry eyes are particularly problematic. When counselling a patient who presents with dry eyes, it can

be useful to impart some self- care advice. Recommend to keep eyes and eyelids clean. This can be achieved using cotton wool and warm water or specific eye lid wipes. Sufferers should protect eyes from dusty, smoky, windy and dry environments. Humidifiers which moisten air may be beneficial. Recommend a diet which is high in omega 3 and 7 fats. Also persons should be advised to use computers and laptops correctly to avoid eye strain. Conjunctivitis Conjunctivitis is a common condition which causes redness and inflammation of the conjunctiva- the transparent membrane that covers the white part of the eye and inner surface of eyelids. This condition may be the result of a bacterial or viral infection (infective conjunctivitis), contact with an allergen (allergic conjunctivitis) or irritant (irritant conjunctivitis). In a community pharmacy setting, the most commonly encountered forms of conjunctivitis are generally bacterial or allergic in origin. Bacterial Conjunctivitis Bacterial conjunctivitis is a common eye condition with an

estimated 13 to 14 cases for every 1000 people per year. Childrendue to close contact with other children- and the elderly- due to potential weakened immune systems- are most commonly affected but it should be noted that it can occur in any age group. Other risk factors include recent upper respiratory infections, blepharitis, and any condition or medicine which can weaken the immune system. People often present with red, watering eyes and often complain of “sticky” eyelids particularly in the morning time upon waking. In bacterial conjunctivitis the discharge is generally yellow in colour and affects one eye first before frequently spreading to the other eye. Symptoms can include slight soreness in the eyes and possible enlarged lymph nodes in front of the ears. Additionally symptoms of upper respiratory infection- coughing, sore throat, headache, aching limbs and high temperatures- may be present. Most cases do not require treatment and usually resolve in one to two weeks, but in a community pharmacy a number of over the counter products such as Golden Eye can be recommended to alleviate symptoms. Propamidine isetionate


Encourage self-care for eye infections and recommend

Propamidine isetionate (P)

Dibrompropamidine isetionate (P)

Actively treats minor eye infections and irritations Can be used for all the family

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Therapeutic Indications: As an anti-infective for use in local infections of the superficial structures of the eye due to microorganisms sensitive to its action Golden Eye 0.15% w/w Eye Ointment (Dibrompropamidine isetionate) PA0980/004/002 Golden Eye 0.1% w/v Eye Drops Solution (Propamidine isetionate) PA0980/004/001 Posology: Drops: One to two drops in the infected eye up to four times a day. Ointment: Apply to the inside of the lower eyelid, once or twice a day. Indications: As an anti-infective for use in local infections of the superficial structures of the eye. Side effects: Hypersensitivity to any of the ingredients. Reactions include increased erythema or ocular inflammation. Precautions: If there is no improvement after 2 days, seek medical advice. The preservative in the drops is Benzalkonium chloride which may cause eye irritation and is known to discolour soft contact lenses. Contraindications: Do not wear contact lenses when using the drops or the ointment. Adverse events should be reported. Reporting forms and information can be found at www.hpra.ie/homepage/medicines/safety-information. Adverse events should also be reported to Cambridge Healthcare Supplies Ltd., T: +44 (0) 1953 607856 E: medinfo@cambridge-healthcare.co.uk Marketing Authorisation Holder: Cambridge Healthcare Supplies Ltd, Unit 1 Chestnut Drive, Wymondham, NR18 9SB, UK. Legal Category: P 1GE12/1711 Last updated November 2017


Feature troublesome in the morning and rhinitis may also be present.

drops or dibrompropamidine isetionate ointment, both antiinfective agents for use in the local infections of the eye, are indicated for the treatment of bacterial conjunctivitis. Drops are used during the day and ointment at night. The use of aforementioned lubricant eye drops may ease soreness and stickiness in eyes. The discharge may be removed gently with cotton wool and warm water. Sterile eye lid wipes are also available which allow effective removal of discharge from the eyes. It is noted that if there is no significant improvement within two days or worsening of condition, referral to doctor may be necessary. There are two main antibioticssubject to prescription, which are used in the treatment of bacterial conjunctivitis. Chloramphenicol eye drops are often the first choice. This medicine is ideally used every two hours for the first two days of treatment and reduced to four times daily thereafter. Treatment should continue for up to two days after symptoms have resolved. This product is subject to refrigeration. Fusidic acid viscous eye drops may be considered also and are sometimes preferable for the young and elderly as administration is not as frequent as chloramphenicol and is not subject to refrigeration. Side effect profiles for both drugs are similarblurred vision, slight stinging or burning sensation- and are generally short lived. As bacterial conjunctivitis is contagious, it is important to emphasis to patients the need to adhere to good hygiene to avoid spreading of this condition. It is advised to wash hands on a regular basis, avoid rubbing of eyes and sharing of pillow and towels; all of which will limit spreading. There is no need to for children to stay at home from school unless the child is feeling particularly unwell. Adults working in close contact with others

42

and sharing equipment such as computers and telephones are advised to avoid returning to work until discharge has cleared up. It is also imperative to inform contact lens wearers to remove lenses until signs and symptoms are gone and up to 24 hours after they have finished treatment. Allergic Conjunctivitis Allergic conjunctivitis occurs when the eye comes into contact with an allergen resulting in the immune system reacting abnormally- leading to irritation and inflammation- ultimately giving rise to itchy swollen eyes. Unlike bacterial conjunctivitis, both eyes are simultaneously affected. Allergic conjunctivitis is classified into four groups dependent upon the allergen; seasonal allergic conjunctivitis; perennial allergic conjunctivitis, contact dermatoconjuncitivitis and giant papillary conjunctivitis. Seasonal allergic conjunctivitis is frequently encountered at specific times of the year in community pharmacies. The most common causative agent of this allergic response is pollen released from grass, trees or flowers. Contact with dust mites or flakes of dead animal skin may also be causative factors. It is often more prevalent in people with other allergies such as asthma. As mentioned, it usually affects both eyes. Itchy, red eyes are the main symptom. This is accompanied by a clear watery discharge. Eyelids may be swollen and eyes may be sore with a burning sensation. Symptoms can arise immediately after contact with the allergen or there may be a delayed response of up to 48 hours. Seasonal allergic conjunctivitis occurs at a particular time of the year and may be accompanied by allergic rhinitis- runny or blocked nose, sneezing, itchy nose- namely symptoms of hay fever. Perennial is similar to seasonal but is persistent throughout the year, symptoms are usually more

There are a number of treatments which will alleviate symptoms and treat seasonal and perennial allergies of the eye. Some may be purchased over the counter, others are subject to prescription. Anti-histamine eye drops-; azelatine, emedastine, ketotifen, antazoline with xylometazoline may be considered and selected dependant on age and also whether OTC or prescription. Patients and carers should be informed of the correct usage of the eye drops and that drops may cause some blurring of vision, and a burning or stinging sensation, which is usually short lived. Oral anti-histamines may also be considered, cetrizine, loratadine or fexofenadine - all are once daily preparations. Mast cell stabiliser eye drops are also a potential treatment. Unlike antihistamines, they will not provide rapid relief, but they are more effective at controlling symptoms over prolonged periods of time. Often at initiation of treatment it may be beneficial to use both antihistamines and mast cell stabilisers concurrently; so the patient may experience relief of symptoms immediately as it may take several weeks to feel the effects of mast cell stabiliser eye drops. Examples of mast cell stabilisers include lodoxamide, nedocromil sodium and sodium cromoglicate. If symptoms are particularly severe, the patient may be prescribed a short course of steroidal eye drops to reduce inflammation. It is recommended that such drops are used for the shortest period of time; usually three to four days and are only prescribed if considered absolutely necessary. In order to prevent this allergic response; some self care tips may be imparted to patients. Firstly to avoid pollen; doors and windows should be kept closed on high pollen count days. It is advisable where possible to avoid going out at certain times of the day when pollen count is higher; the mornings and evening. Wraparound sunglasses can protect the eyes and pollen air filters may be fitted to cars to limit exposure. If dust mites are the causative allergen; it is advisable to wipe surfaces regularly with damp cloths, wash bedding and soft toys weekly and avoid soft toys on beds. Special sheets and pillows are also available. It is noted that some of the preventative measures

for dust mites are expensive and there is limited evidence to suggest their efficacy. In addition to seasonal and perennial allergic conjunctivitis people may present to the pharmacy with an allergic reaction due to makeup products, face creams or eye drops. This type of allergic response is referred to as contact dermatoconjuncitivitis. Symptoms are similar to seasonal and perennial conjunctivitis, but in addition there is often allergic dermatitis of the eyelids. Often anti-histamines may be used to reduce symptoms. There are also a number of creams (La RochePosay Toleriane Ultra eyes,) which are safe to use in eyelid dermatitis and may provide relief. The patient should be advised to stop using whatever has caused the reaction and to find suitable alternatives where possible. Giant papillary conjunctivitis is caused by foreign objects in the eye most commonly contact lenses. Symptoms are as described above, but often small spots are present on the inside of the upper eyelid. Symptoms progress at a slower rate and usually resolve when contact lenses are removed. The spots may take longer to treat. The patient will need to be referred back to an optician or optometrist to discuss options. Mast cell stabilisers can be recommended to prevent symptoms in this type of conjunctivitis. Referral For all of the above discussed eye conditions- dry eye syndrome, bacterial and allergic conjunctivitis, it is important to know when to refer the patient to an optician or doctor. If there is extreme sensitivity to light, very painful or red eyes or deterioration in vision the patient should be immediately referred as these may be symptoms of more serious eye conditions. Conclusion Eye care is a very important topic in community pharmacy, as the above mentioned conditions will be encountered on a frequent basis. It is an area where the community pharmacist may offer valuable advice, not only on treatment options, but preventative measures and self care tips. The presenting symptoms may often be similar, but there are key identifiable symptoms for each condition which will allow the pharmacist to impart the most appropriate advice and treatment with confidence.


News

Westport Boots is best of the best A Westport pharmacy has won the best award for the best Boots store in UK and Ireland. Around 500 colleagues from across Boots UK and Ireland were joined by members of the Boots Executive team in Manchester, for the highly-anticipated annual Best of the Best gala celebration. The glittering awards ceremony and dinner celebrated and recognised colleagues who have consistently gone above and beyond to champion everyone’s right to look and feel good. Boots Ireland Westport took home the prestigious Boots Store of the Year award. They were applauded for their unshakeable pride in themselves and their community and for providing outstanding services and exceptional care. The tight knit team is known for their blend of professionalism, friendliness, expertise and fun. The atmosphere in store instils a sense of confidence in colleagues as well as customers and patients. Despite their small size, they’ve raised more than ¤100,000 for the Irish Cancer Society through fundraising initiatives in-store. Commenting on the award, Store Manager Ann Mullarkey said: “We are delighted to have won the award. “We were put forward for overall Boots store of the year having been selected as winners of store of the year for the Republic of Ireland.

Boots Pharmacy Westport, Celebrating their win on stage “We were thrilled when we were announced overall winner and I am very proud of our team here and excited to bring our trophy home to Westport where it will have pride of place in our store. “Our customers and patients are at the heart of what we do and

have been incredibly supportive. “We have been inundated with congratulations, and are honoured to be part of an amazing community here in Westport.” Bernadette Lavery, Managing Director Boots Ireland added: “Our store in Westport is a very special

store and this award recognises the tremendous dedication, hard work and focus on customer care from each member of the team under the guidance of store manager Ann Mullarkey.” Boots Ireland operates 84 stores.

Pharmacy wins customer service award A Dundalk pharmacy has been rewarded for its exceptional customer service at the Louth Business Awards. Smyth’s Life Pharmacy won the Best Customer Service award in the retail sector at the glittering black-tie event held in the Carrickdale Hotel. Smyth’s owner/manager Anne McEntegart said the prize was a fitting reward for the ethos of public service which is evident in all staff at the business. She said: “They have the awards annually and last year we were finalists for Care of the Elderly. This year we were finalists for Best Customer Service. “A mystery shopper was sent to visit all of the finalists and we scored 100% in every category. They couldn’t fault us at all. All of my staff take great pride in how they interact and deal with the public. We have 15 staff members here and they are all exceptional. “We didn’t know in advance of the awards that we were the winners so it was a lovely surprise and a good reflection on the service that our customers enjoy.” The President of Dundalk Chamber of Commerce Michael Gaynor congratulated the winners. Best Customer Service in the Retail Sector

“All these companies here tonight are winners in their own field and this is a great opportunity to recognise them.”

43


Feature

Taking care of our skin this winter By Aidan Walsh, Pharmacist, Aidan Walsh Allcare Pharmacy, Ferbane

For many people, the cold days of winter bring more than a rosy glow to the cheeks; they also bring uncomfortable dryness to the skin of the face, lips, hands and feet and even other parts of the body. This is particularly so where people already suffer from eczema, psoriasis or just common-or-garden dry skin. Cold reduces secretions of sebum from sebaceous glands, which are essential to lubricating the skin and chilly winds have a drying effect on skin, but the major damage occurs when the heat is turned on indoors and this causes the skin to dry out. The function of Skin The skin is the largest organ in the body and it is essential to our overall health and wellness. It helps to maintain body temperature, which it achieves, among other means, by increasing or decreasing perspiration and the cooling that evaporation causes; it also acts as a barrier to the entry of irritants, allergens and microbes into the body and, to achieve this, it must maintain its hydration. The outer layers (the epidermis) reduce the evaporation of water and in the healthy epidermis the cells, plump with water, are tightly packed together and they are surrounded and topped off by lipids (fats) that provide support and maintain the skinâ&#x20AC;&#x2122;s structural integrity. If the water levels are allowed to drop, the skin feels dry, tight, brittle and/ or rough and, if its protective effect is lost, redness, inflammation, irritation, itching and even infection may develop. In winter the cold temperatures outdoors both cause the underlying blood vessels to constrict, reducing the water supply to the epidermis, as well as causing the sebaceous glands to reduce the secretion of sebum, whose functions include renewing the upper lipid layer. Increased indoor temperatures and reduced humidity cause increased perspiration, evaporation and dehydration of the skin; this is especially so when the lipid levels have been reduced by the use of soaps or the types of detergents found in shampoos, bubble baths, shower gels, etc. and/or by the use of harsh peels, masks and alcoholbased toners and astringents. Moisturise, moisturise, moisturise Since the common cause of these problems is dehydration, the answer lies in increasing and maintaining the moisture levels of the skin. Traditionally, emollients such as Emulsifying Ointment which contain hard and soft paraffins and waxes are used to

44

create an occlusive layer on the top of the skin to retain moisture; water based creams such as Epaderm are less greasy. In general, it should be remembered that emollients that might work well in the other three seasons are often not up to the demands of winter and, at this time of year, the oil-based rather than water-based products tend to perform better. In an attempt to achieve the same levels of moisturisation with lighter (water based) products, a number of options have been developed. Humectants such as glycerin, urea, lactic and hyaluronic acids are naturally found in the skin and they attract water into the epidermis - both from the environment and the underlying layers of the body; increasingly

they are being incorporated in products such as the Elave and Eucerin ranges. Ceramides are lipids found in the outer layers of the epidermis, which are essential to the maintenance of its waterproofing function; they are very susceptible to attack by surfactants, particularly sulphates, and they can be replaced by some products in the Eucerin range. Humidity Because the air moisture levels drop with the use of indoor heating, consideration should be given to lowering the temperature levels and/or using a humidifier (or even a pan of water placed beside the heat source), so as to reduce the drying effect on the skin.

Inner hydration Care should be taken to ensure that sufficient water is consumed and that use of alcohol and caffeine (which both tend to dehydrate the body) are kept within healthy limits. A balanced diet is important; Omega-3, in particular, which comprises the essential fatty acids EPA and DHA, can be obtained from oily fish or supplements and has been shown to be essential for the maintenance of the skin lipid barrier and thus skin hydration. Exfoliation and cleansing Exfoliants may be necessary to clear off dry skin and allow moisturisers to penetrate; they have been shown to reveal and


produce softer, smoother skin, to increase epidermal thickness and even promote the synthesis of collagen. They also however increase sensitivity to sunlight (so sun protection should be applied after treatment) and excessive use can lead to redness and inflammation. Alpha hydroxy acids, such as lactic, glycolic, salicylic, malic, citric, tartaric have traditionally been used as exfoliants. Glycolic acid, in combination with amino acid arginine has been shown to be particularly effective and together they form the active ingredients in Elave Rejuvenating Night Cream. Likewise cleansing and makeup removing products containing alcohol and some other astringents that remove the skin’s lipid layers should be avoided; rather, micellar water, which consists of tiny clusters of cleansing oil molecules suspended in soft water, gently cleans the skin with minimal interference with its natural oils. Traditional surfactants, such as sulphates, which generally provide the cleansing activity in shower gels, bubble baths and shampoos tend to exacerbate dry skin by stripping the lipid layers from the skin; fragrances can also cause problems for sensitive skin. Soap

also strips lipids and, by affecting the pH balance, they damage the skin’s protective acid mantle, which is important in repelling infective organisms. The Elave range, for instance, offers milder surfactants and are acidic: they are sulphate free and also contain glycerine. While super-hot showers or baths may feel great when it’s cold outside, they serve to break down the lipid barriers of the skin; better to shower or soak (not for too long) in lukewarm water with emollients and soap substitutes such Emulsifying Ointment or Silcock’s Base or one of the various Elave washes. Alternatively colloidal oatmeal, which has been shown to relieve dry, itchy skin might be added to the mix: Aveeno Dermexa is one such and is suitable for babies as young as three months. Emollients of choice should be applied immediately after washing and the skin should be patted dry rather than abrasively rubbed. Hands and feet The skin on the back of the hands and the top of the feet is thinner and has fewer oil glands; this means it is harder to keep them

In winter the cold temperatures outdoors cause the underlying blood vessels to constrict moist in cold, dry weather; warm, dry gloves and socks should be worn outdoors. Wet socks and gloves can irritate the skin and should be replaced as soon as possible. Mild hand wash products such as the Elave Sensitive Hand Treatment should be used and creams such as the Eucerin Hand Cream (urea 5%, lactic acid and glycerin) should be applied afterwards; Foot Cream (urea 10%, lactic acid and glycerin) is a somewhat similar product. Where dry, hard, thickened and/or scaly skin builds up on the lower surfaces of the hands or feet then a product such as Dovocare is sufficiently exfoliating, while also moisturising. Chapped lips The chilly outside temperatures, the drying indoor heat, the wetting of the winter whistle and even excessive licking of the lips (and, of course, smoking) can wreak havoc on them; they should be shielded from extreme cold by a scarf or other protection. Traditionally solid paraffins, e.g. Vaseline, have been used in lip balms. The Elave Daily Lip Defence uses coconut oil and Shea butter to moisturise and beeswax which is mildly exfoliating; it has a sun protection score of 20%. Acne The accumulation of dry, dead skin cells that tends to happen in winter can provide a breeding ground for infection as well as blocking the pores; in susceptible people this can lead to the initiation or an increase in acne. Again, a strategy of moisturisation to avoid the buildup of dry skin and mild exfoliation should be followed.

Furthermore, many of the active ingredients, such as benzoyl peroxide and salicylic acid, that are used to treat acne serve to dry and irritate the skin surface, creating the possibility of a vicious circle. In this case, products with lower concentrations of the offending medications might be considered; moisturisation is again essential. Sun protection Just because the sun does not appear to shine as brightly in winter does not mean that there is not sufficient UVA and UVB to cause skin problems; indeed in situations of high reflectance, such as on water or in snow (skiing holidays), the amount of harmful radiation might equal or exceed that of most summer days. It must also be remembered that exfoliation treatments render the skin more susceptible to the effects of ultraviolet radiation and increase the necessity for solar protection. The Elave Daily Skin Defence has an SPF 45%. Age Both younger children and the elderly have a thinner epidermis (the outer layer of skin) and are therefore more sensitive to all these factors. In babies and the young the skin has a less effective (or no - depending on age) acid mantle and they do not produce the same amounts of sebum to lubricate the skin until they reach puberty; in the elderly, the level of lipids in the epidermis are diminished and many of the same factors apply so that, at both ends of the age spectrum, the susceptibility to dry skin increases. The same principles apply just more so.


Uriage is a thermal spring water based skincare brand that has highly effective and soothing ranges to treat all types of skincare needs. The key ingredient unique to the dermatological skincare range is the thermal water from the French Alps; this is the richest thermal water, with the highest concentration of minerals and trace elements (52x richer than other Thermal Water available). The thermal water’s unique composition enables it to strengthen the skin barrier. Thanks to its high concentration in mineral salts, similar to the skin’s natural moisturizing factors, it offers unique moisturizing benefits as well as restoring the cutaneous barrier. It soothes sensitive skin due to the high level of calcium and magnesium salts while silicon strengthens the skin’s hydrolipidic film.

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BARIÉDERM Uriage Bariéderm is a range for isolating and repairing skin, specially designed to meet the needs of specific problems such as chapped and cracked skin.

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OBESITY –

A

modern,

mismanaged

&

misunderstood malady – By Dr. Heli Goode, MD, Naturopath CPDAs published 85: OBESITY in Positive Health Online – Issue 232, August 2016

a growing and serious health concern that has, by Biography - Dr. Heli Goode,Obesity ARH, isSOH, TCM, specialised in Ear, Nose & now, reached epidemic proportions, mostly in the Westernised Throat surgery in her native Estonia before starting her complementary practice world. Increased consumption of unhealthy food coupled with in England nearly 20 years ago. She integrates naturopathy, homoeopathy, decreased physical activity, in part, has led to rising obesity acupuncture, hypnotherapy rates and over traditional Chinese Medicine. She is available for the past three decades. The WHO (World Health consultations from her clinics in Leicester and Harley Street, London. Dr. Goode Organisation) reports that since 1980, worldwide obesity ratesis a lecturer for holistic medicinal practices. have increased by almost 200%. By the end of 2015 nearly 2.3

billion adults were reportedly overweight and 700 million of these obese. Obesity has been linked to certain cancers, diabetes and may shorten the human lifespan bybased eight to ten years.1 Welcome to the Continuing Professional Development Module. CPDcardiovascular is mandatorydiseases, professional requirements for pharmacists. Journal A grim prediction by theand government suggests that obesityThis will module continue can to rise up toin50% education programmes are an important way of keeping up to date with personal clinical professional development. be -used your personal learning log and can be completed in the magazine orofonline byand completing thewill reflection questions at the end Youwill canhave women 60% of men be overweight by 2050 and up of to the 25%module. of children 2 also track your progress of you development by going to www.pharmacynewsireland.com/cpdtraining where you can register to record your learning. weight issues by that indicated timeframe.

Who is classed as overweight or obese?

OBESITY – A modern, mismanaged & misunderstood malady Obesity is a growing and serious health concern that has, by now, reached epidemic proportions, mostly in the Westernised world. Increased consumption of unhealthy food coupled with decreased physical activity, in part, has led to rising obesity rates over the past three decades. The WHO (World Health Organisation) reports that since 1980, worldwide obesity rates have increased by almost 200%. By the end of 2015 nearly 2.3 billion adults were reportedly overweight and 700 million of these obese. Obesity has been linked to certain cancers, cardiovascular diseases, diabetes and may shorten the human lifespan by eight to ten years.1 A grim prediction by the government suggests that obesity will continue to rise - up to 50% of women and 60% of men will be overweight by 2050 and up to 25% of children will have weight issues by that indicated timeframe.2 Who is classed as overweight or obese? In the 17th Century, a Belgian mathematician and astronomer, Lambert-Adolphe-Jacques Quetelet, became fascinated in possible numerical links between different human body parts. After some calculations he concluded that by taking a person’s weight in kilograms (kg) and dividing it by the height in meters (m2), it would give a specific numerical figure which is unique to every individual. He termed it the Body Mass Index (BMI) which, according to some experts, expresses the correlation between the body weight, coronary insufficiencies, cholesterol level and expected lifespan. Even though the BMI does not take into account the differences in people’s ethnic background, ethnic characteristics and the way some individuals store fat, in clinical practice it is still a widely used method for assessing weight/health-related issues. A greater BMI leads to a greater risk of developing comorbidities such as type 2 diabetes. Anyone’s BMI figure of more than 25 indicates “the level at which there is a significant increase in mortality” and is classified as overweight.3 In our healthcare system it is a key factor in deciding who qualifies for surgical weight reduction procedures.4,5 Many clinicians prefer the Waist Circumference Measure to BMI - a simpler anthropometrical

Reflection - Is this area relevant to my In the 17th Century, a Belgian mathematician and astronomer, Lambert-Adolphe-Jacques practice? What is your existing knowledge Quetelet, became fascinated in possible of numerical links area? between different human any body parts. the subject Can you identify knowledge in the topicinarea? After some calculations he concluded that by taking agaps person‟s weight kilograms (kg) and dividing it by the height in meters (m2),Planning it would -give specific numerical figure which is Willathis article satisfy those unique to every individual. He termed knowledge it the Body Mass to gaps Index or will(BMI) more which, readingaccording be some experts, expresses the correlation required? between the bodyresources weight, coronary insufficiencies, What are available? cholesterol level and expected lifespan. Even though the BMI does not take into account the Action - After reading differences in people‟s ethnic background, ethnic characteristics and the way some the article complete the summary individuals store fat, in clinical practice it is still a widely used method for assessing questions at www.pharmacynewsireland. weight/health-related issues. A greater BMI leads to aand greater riskyour of learning developing cocom/cpdtraining record for future usefigure and assessment morbidities such as type 2 diabetes. Anyone‟s BMI of more thanin25your indicates “the measure which is “also a criterion for the .3 personal log. level at is a significant metabolic syndrome”. A which waist there measurement of increase in mortality” and is classified as overweight In our healthcare system it is a key factor in deciding who qualifies for surgical weight Evaluation - How will you put your learning more than 35 inches (88cm) for women and 40 4,5 into practice? inches (102cm) for men indicates a significant reduction procedures. health risk.3 Still, however we weigh or measure I identifiedMeasure further learning the Waist Have Circumference to BMIneeds? - a simpler it, obesity and its Many relatedclinicians conditionsprefer are costing the healthcare system nearly £6 billion annually. anthropometrical measure which is “also a criterion for the metabolic syndrome”. A waist It is estimated that by 2050 theofcost have measurement morewill than 35 inches (88cm) for women and 40 inches (102cm) for men risen to £50 billion per single year.6 health risk.3 Still, however we weigh or measure it, obesity and its indicates a significant profits for the medical institutions, it is clear that conditions are costing the healthcare system nearly are £6 billion annually. is estimated surgical solutions not suitable for Iteveryone. Bariatric Surgeryrelated - A promising solution 6 is aper farsingle moreyear. complicated issue than for some that by 2050 the cost will have risen toObesity £50 billion meets the eye. 1 According to some opinions ‘bariatric surgery What causes weight issues? is currently the only modality that provides a significant improvement in obesity-related Several factors can be indicative such as co-morbidities.’7 Despite the widespread environmental toxins or pollution, life style, acknowledgement that surgical interventions food trends, eating habits, low immunity and in general are risky on obese patients and may a lack of sufficient physical activity. Toxicity be associated with long-term and sometimes can have consequential effects on cellular, unpredictable complications, they have metabolic, mitochondrial and endocrine system become more popular throughout recent years. functioning. These are widely believed to be There are now even guidelines of bariatric responsible in the development of weight issues interventions for obese children under the in both sexes of adults and children.11 age of 16.5 Michel Gagner MD, from Florida International University, believes that the time has come for bariatric surgery to become as common as coronary artery bypass surgery.7 Clinical outcomes show that it does attribute to a rapid weight loss while at the same time significantly reducing the risks of possible co-morbidities and therefore improving overall health and life expectancy in general.8

On the other hand, clinicians have also noticed that bariatric surgery seems to contribute to the loss of bone mass and change in bone metabolism and structure, causing fractures at sites that are classical of osteoporosis.9 The weight losses achieved by the surgical interventions are not always sustainable long-term and statistics say that bariatric reoperations are on the increase. There are also reports of post-bariatric depression, attempts of self-harm and suicide.10 The overall aim of bariatric surgery is to restrict the volume of food and absorption of certain nutrients, especially fat. However, it does not address or resolve accompanying psychological or cultural aspects of certain human populations, characteristic traits and personal circumstances, emotions, thoughts, habits and most of all food trends and addictions.4 Despite clinical success and

Though increasing prevalence of obesity is partly attributed to a lack of physical activity and the popularity of high-calorific foods, there are other significant factors which play an important part in the widespread development of obesity. For example, a modern lifestyle in our current Western society seems to ensure that every generation is heavier than the last. This is called ‘passive obesity’. There is some evidence that humans are predisposed to weight gain by their biology and are overwhelmed by the effect of today’s so-called obesogenic environment, with its abundance of energy-dense food, motorised transport and sedentary lifestyles.2 Obesogenes A well-researched link exists between a dysfunctional endocrine system and several environmental toxins which act like endocrinedisrupting chemicals. These are called obesogens and affect the endocrine system by mimicking the effects of the body’s own natural hormones. The brain’s messages disrupt hormones by altering appetite and lowering metabolism thus forcing the fat cells to grow and multiply. As a result of this, adipose tissue


CPD 85: OBESITY becomes very difficult to control. Adults of average weight can have about 25 billion fat cells. However, severely obese individuals may have up to 6 times more – 150 billion fat cells which are at the same time enlarged as well.12

inflammation leads to a general mitochondrial dysfunction and in many cases permanent cellular damage. In turn, this may accelerate the natural biological ageing processes and further development of chronic age-related disease.14

Obesogens interfere in all sorts of different cell activities and in many different ways. One of the most important interactions is with the heatproducing brown fat cells, making them lazy which stops them converting food into heat so that calories are retained in white adipocytes as fat. One particular powerful obesogen is high-fructose corn sweetener which is found in many processed foods and popular drinks.13

Excess of insulin inhibits the breakdown of stored fat resulting in increased waist-hip ratio, or central obesity, which makes the obesity in actual fact, a structural issue.13 Structure, it has been found, has a direct effect on function. It is important to know what the building blocks are and how they work. Until the underlying structural issues are resolved, the problem itself remains. Here the obesityrelated building blocks in question are the fat containing cells called adiposytes. For a long time medicine did not pay very much attention to fat cells other than acknowledging the fact that these cells store fat. Recent research however, has shown that adipocytes produce and distribute messengers called adipokines. Adipokines, such as previously mentioned leptin, adiponectin and resistin send signals to the body, some of them ‘friendly’, some ‘angry’. In response to a high sugar, high calorie meal the adipocytes release angry adipokines, which race around the body influencing the immune system, heart, arteries, liver, brain, kidneys and pancreas – where, of course insulin is produced. In his book, ‘The Disease Delusion’, Dr. Bland explains how angry adipokines can cause inflammatory conditions throughout the body involving every organ system. Because the original signal comes from the gastrointestinal immune system, most angry fat is stored around the midriff. High levels of estrogen and cortisol, the well-known stress hormone, also contributes to fat storage around the waist.12,13,14

Leptin, Insulin & Mitochondria In his book, ‘Hormonal Balance’, Dr. Scott Issacs discusses how scientists, over the past thirty years, have developed a better understanding of how fat produces hormones that control appetite, cravings and metabolism. Fat produces many hormones but in terms of obesity, the most important is leptin. This particular hormone targets the Limbic System and especially the hypothalamus, where regulation of weight and food intake occurs. Leptin sends the brain specific information regarding the amount of fat the body has and is therefore responsible for the body weight set point. In a lean, healthy body it acts as a protector against starvation, stimulating appetite and motivating search for food. However, once the obsessive search for an ideal body shape starts or yo-yo dieting takes over, the brain receives mixed messages from disrupted and fluctuating hormone levels. The majority of overweight individuals produce far too much leptin due to the body’s previously developed resistance to it. Leptin resistance can cause a false alarm in the limbic system’s appetite, motivation and pleasure circuits. This can lead to increased cravings, specifically for high-calorie sugary foods, which are sometimes refered to as comfort foods. In an attempt to overcome leptin resistance, the white fat tissue increases the overall leptin production. Even after a proper meal and full stomach, an extra amount of this powerful hormone is not enough to satisfy the food cravings and stop over-eating. Excess fat, especially around the abdominal area, coupled with inflammation caused by adipokines - polypeptide chemicals which are also produced by white adipose tissue - are key contributors to body’s leptin and insulin resistance.12 Insulin is an integral hormone produced by the pancreatic cells which carries out the important task of metabolising blood sugar and transporting it to cells, either to be used as fuel or to be stored in the body’s fat reservoirs for the future usage. Imbalance of this hormone can lead to disruptions in the endocrine system resulting in excessive appetite, carbohydrate cravings, weight gain and consequent co-morbidities. Insulin resistance and its closely related cousin – Type 2 diabetes – reduces mitochondrial function in the brain which can in many cases lead to a development of dementia, another condition in increase.13 People with high levels of insulin tend to suffer from various chronic inflammations – arthritis, eczema, upper respiratory and ear infections, to name but a few, and which leads to a constant lack of energy. Energy is produced by mitochondria in the cells. Longterm chronic conditions and accompanying

Though out of balance waist-to-hip ratio is a valid indication of possible future issues, it is worth mentioning that the amount of fat around the waist is still not a cause of illness itself. It all depends on how ‘angry’ are the messages from the adipokines. It is found that many toxic, environmental chemicals are capable of disrupting mitochondrial function by directing excess calories to be stored in adipose tissue for possible rainy days. There is a confirmed link between persistent organic pollutants (POPs) in the body, Type 2 diabetes and weight gain. POPs can cause significant damage to the mitochondria, disrupting the basic function - energy production from our daily food - and directing excess calories to be stored in adipose tissue thus leading to functional and pato-physiological changes in structure and causing development of many chronic maladies.13

coined the ‘hunger hormone’. Hunger is one of our basic life-saving sensations. An empty stomach produces ghrelin, which, as a hunger messenger, directly stimulates the hypothalamic feeding centre.16 However, in obese individuals, it is suggested that a dysfunction between the gut, adipose tissue and brain-hypothalamic axis (via the ghrelin-leptin hormonal pathway) may play a contributory role in abnormal appetite control and excessive energy intake.11 Ghrelin remains active around the clock, playing an important role in sleep-deprived individuals. Dysregulation of ghrelin secretion is implicated in the mechanism through which sleep disturbance contributes to obesity. Subjects with short sleep duration have elevated ghrelin levels, reduced leptin, and high BMI compared to subjects with sufficient sleep duration. It should be also noted that a specific area, the suprachiasmatic nucleus of the hypothalamus, is responsible for the body’s internal biological circadian rhythms, influencing the sleepwake patterns.15,16,17 Therefore, sleep plays an essential role is a healthy weight control. The Hormonal Brain Body organs and tissues are not sole contributory factors to hormonal activities. Psychological responses can also affect weight. The brain produces several hormones which are capable of regulating appetite, metabolism and satisfaction. So far it is known that neoropeptide Y, produced in the hypothalamus, is the most powerful appetite stimulator influenced by leptin. Leptin, in normal circumstances keeps neuropeptide Y levels under strict control. However, failure to do so leads to neuropeptide Y overproduction, promoting appetite and slowing down physical activity in response to dropping blood sugar levels. It also increases the constriction of blood vessels and stimulates the growth of fat cells. High Neuropeptide Y levels have been found in insomniacs, proving yet another link between poor sleeping pattern and obesity. It has been confirmed by many studies that nightshift workers are more prone to weight gain than people working normal office hours. Research has also found that regular binge eating, high stress levels and a diet comprised mainly of sugary or processed fatty foods seems to have an effect on the production of neuropeptides. The hypothalamus secretes neuropeptide Y during emotional stress, raising anxiety levels and stimulating the stressed individual to eat, consume alcohol or other addictive substances, and therefore further reducing resilience to emotional trauma and survival.16,17,18

Ghrelin – The hunger messenger

Another influential chemical responsible for hunger, appetite and especially carbohydrate cravings is serotonin. Although around 80% of the body’s serotonin is produced by the gut, it still plays an important task in the brain’s serotonin pathways. It is known that a release of serotonin lifts the mood, improves memory and sleep. It is thought that while closely interacting with dopamine pathways, serotonin creates and magnifies a satisfaction-dependence mechanism relating to consumption of carbohydrates and high-sugary foods and substances related to well-known addictions in humans.

Another culprit in case of adiposity is a hormone called ghrelin, produced by the stomach and to the lesser amount, in the duodenum. It is also

Serotonin’s close ally dopamine is secreted by neurons that originate in substantia nigra, an area related to the basal ganglia in the brain’s

To summarise, insulin and adipokines are partners in crime in many ways. Whatever affects insulin does the same to adipokines, including leptin and vice versa. So far, we know that the worst offenders are sugary, high calorific, processed foods and a certain level of environmental pollution. These cause disruptions on a cellular level, affecting mitochondria which, in turn, results in chronic inflammatory processes and long-term ill health, early ageing and persistent problems with weight.


CPD 85: OBESITY limbic system. A surge of dopamine to the brain leads to emotionally high expectations of ‘what is going to happen’ – consequently influencing motivation and making us seek pleasure and reward. While working hand in hand with the brain’s own opiate system, the result is similar to a heroin high. It is a well-known fact that satisfaction from certain foods, especially sugar, can be very similar to pleasure from alcohol and drugs. This has led some scientists to speculate the idea that being too heavy results in over-consumption of more delicious highcalorie foods in order to satisfy the key factor – dopamine related rewards. Several studies have shown the correlation between obesity and low levels of dopamine.19,20 Endocannabinoid System & Satisfaction Reward seeking and satiety is closely related to the brain’s endocannabinoid system, with its complex actions in immune-, nervous-, endocrine system and many body organs. It is literally a bridge between the body and the mind. Although there is still a lot to learn about it, it is already known that endocannabinoids are very powerful appetite stimulators with similar properties to cannabis. It has been found that activation of the cannabinoid receptors in the brain increases the activity of appetiterelated neurons, called endorphins, which then travel to the brain’s appetite-control centre, the hypothalamus, stimulating the desire to eat calorie-dense foods such as chocolate.21,22,23 Stress – our everyday companion Stress, with its complex chemical reactions, activates the brain’s limbic system including the endocannabinoid pathway, which is an important central stress mediator, controlling the surge of stress-induced neurotransmitters, especially cortisol. Constant stress leads to cortisol activation, which in turn increases insulin and leptin resistance. Both insulin resistance and elevated cortisol levels stimulates the hypothalamic hunger centres in the limbic system, causing uncontrollable eating habits and, in many cases, severe addictions to certain food substances. Hunger hormones - leptin, ghrelin, neuropeptide Y and several other chemicals magnify the stress response even further by increasing appetite and slowing down the overall metabolic rate. The whole situation becomes even more complicated with lack of sleep and poor lifestyle choices.15,24 What is the Limbic System? The word limbic means border in Latin. Initially this term was used to describe the border structures around the basal regions of the cerebrum. However, with recent neuroscience developments, we now know that the limbic system represents the entire neuronal circuitry that controls and regulates our emotional behaviour, influencing our desires and motivations, and regulating the “fight or flight” response to stress. The limbic system, as it is understood now, consists of many structures. One of the most influential parts of it is the hypothalamus, representing less than 1% of the entire brain mass. The hypothalamus has communicating pathways with all levels of the limbic structures - sending output signals towards the brain stem and into the reticular area of the mesencephalon, upwards to the higher areas of the diencephalon and cerebrum, to the anterior thalamus and the

limbic cortex onto the secretory parts of the anterior and posterior pituitary glands. In summary, several vegetative and endocrine functions, including aspects of certain emotions and behaviour, hunger, thirst, temperature and water regulation are all associated with different parts of hypothalamus.19, 24 The Love Hormone & Loss of appetite There is a hormone synthesized in the paraventricular nuclei of the hypothalamus called oxytocin. Oxytocin has some possible clinical significance in relation to appetite. Some researchers have called it the ‘love hormone’ as it plays an important role in socialising, flirting, bonding and reproduction of mammals, improving perception of social cues and increasing trust between the individuals. A recent study suggests that oxytocin is also anorexigenic, meaning appetite suppressive in its action. An increase in oxytocin can reduce the amount of food intake with the additional benefit of improved blood sugar regulation. Anyone who has ever been in love can easily relate to the feelings of excitement, excess energy, immense happiness and lack of appetite - all thanks to this ‘love hormone’. Although oxytocin’s appetite regulative effect may sound very promising, it is too early to make any conclusion yet and larger studies are needed to understand its full mechanism related to calorie intake.25, 26 The Amygdala As part of the limbic system, this complex tissue is about the size of almond. Gerard Tortora, Professor of Biology, suggests that the amygdala seems to be a behavioural awareness area that operates at a semiconscious level. It projects into the limbic system one’s present status in relation both to surroundings and thoughts.19 On this basis, the amygdala is believed to help form the individual’s most appropriate responses to all life events, including constant stress, threats, a consequent fear and related food choices in these specific circumstances.24 The Hippocampus The hippocampus collects all our sensory information, translates and stores it in the brain’s long-term memory bank. Adults often dwell on happy childhood memories, such as mother’s cooking. Just a brief whiff of a pleasantly smelling food may retrieve old memories, stimulate appetite and in many cases, especially under stress, encourage unnecessary eating. A combination of occasional episodes of comfort eating and distant sweet memories may become powerful enough to activate the brain’s reward circuitry, leading to a well-developed and often difficult to control food-related addictions.21 The list of structures and functions of the limbic system will certainly expand in the future as neuroscientists learn more about it, but so far it is understood that our actions, reactions and emotions are products of the limbic function. It is the area where all information from the specific sense organs meet, where the neuropeptide receptors are most concentrated and where most important decisions are made. Detrimentally however, some of them are not necessarily health preserving.19, 24 Can we become addicted to food? The idea to link food addiction with other

widely known addictions is relatively new and has therefore not yet been researched well enough to make any fundamental conclusions. The topic though is hotly debated amongst scientists and clinicians. Growing evidence supports the idea that some ingredients in foods, especially sugar, can elicit similar brain responses as highly addictive substances, such as cocaine and heroine. For a better understanding of human addictive behaviour we need to look at the three main components of addiction.20 Firstly, a person can have obsessive thoughts and feelings about certain foods/substances which can lead in some cases to cravings. These cravings may well be linked to the pleasant memories from the past relating to consumption of certain highly addictive substances, such as sugary foods. The personal memory bank - the hippocampus stores all conscious memories from near or distant past, whereas the amygdala stores our subconscious, highly charged emotions with previously learned conditioned responses. These make us act on them, almost impulsively, whenever necessary. The next stage leads to a loss of control over cravings, particularly when things go wrong or stress levels are high. This is where the amygdala steps in again, rising irrational emotions and expectations of a pleasant on-coming satisfaction from the substance. Once these difficult-to-control emotions take over, the overall behavioural pattern becomes hard to manage. The final stage leads to a repeated consumption of addictive substances, even regardless of constant health warnings or already developed health issues, with high emotional expectations of satisfaction. We, as human beings, can exhibit all three of these traits in our relationships with high calorie, highly processed sugary foods and drinks. It is a well-known fact that true addiction provides less satisfaction from the substance the more it is consumed. The thrill is not as high any more and we need to increase the amount to satisfy the needs. The increased dopamine levels lead to high expectations of ‘what is going to happen’, motivating and pushing us to do what we want to do. In normal circumstances, as we succeed, we would feel rewarded and happy. However, real addiction never fully satisfies. Increased dopamine levels combined with the effect from the over-stimulated endocannabinoid system tricks the mind to seek out something which promises to be physically and emotionally highly rewarding.21, 22, 23 What the patients say All the knowledge of possible pato-physiological dysfunctions, all these statistics and measurements make no sense without knowing what really happens in the lives and heads of our patients. Complementary medicine practitioners or CAM Providers who deal with weight issues have all seen frustrated patients who, in their own words, have done everything to reduce their weight. They have endured yo-yo dieting, tried different exercises and personal trainers, gastric band hypnosis and promising diet pills. A fraction of them admit to eating too much in general and some of them recognise the fact that food has become an overwhelming addiction, similar to alcohol or cigarettes. Many gastric band patients have regretted their decision trying to resolve the weight problems with bariatric surgery only. When asked why, the


CPD 85: OBESITY

answer more often is that nothing has actually changed. They still have the same stressful job, a challenging domestic life and complicated relationships. Wine and chocolate are still tempting. Even though the initial weight loss gave a certain amount of excitement and a boost of confidence, they are still unhappy. Many patients say that they have not been fully understood by the medical profession; feelings, thoughts and the way the patients cope with everyday life difficulties are not the priorities in medicine. What is the solution? Sleep more, less stress. less chocolate, join a gym, Weight Watchers? As already explained, the human brain, behaviour and health are multi-level complexities. They are always in constant inter-action with each other, highly influenced by external environmental toxins, life styles, personal temptations, emotions, social needs and events. Too heavy & too light Dr. Rosina Sonnenschmidt, one of the Western world’s leading experts in diet-related issues, introduces in her book “The Way to your Ideal Weight” a unique concept of the weight-health problems with a hope and possible solutions to many patients. Over the years, having seen numerous patients with various weight-related illnesses, she has come to the conclusion that ‘feeling too light makes people overweight’ and ‘feeling too heavy makes people underweight’. A thorough questionnaire, or in medical terms – anamnesis, from the patient provides Dr. Sonnenschmidt with a ‘psychogram of the personality’. The psycho-analysis of this information directs the patient in his or her search for the possibilities of new ways of grounding themselves. By strongly projecting their thoughts and hopes on a better and healthier future, they can stop referring back to an unhappy past. The idea of the need to be grounded comes from the overweight person’s perceptions that they feel too light and therefore must eat more to get sufficient body awareness and come down back to the earth. Interestingly, Dr. Sonnenschmidt explains how we, as human beings, survive extreme situations and daily stress. Under constant pressure we wind ourselves up so much that we reach a very specific, unique and uplifting energetic state, which helps us perform the task exceptionally well, feel excited and enjoy our own sweet success. However, it is impossible to remain high for too long. We need to wind down, refuel, have a rest and recharge the batteries. As a ‘rule’ or habit, we, as human beings with high stress levels, tend to wind down by indulging in grounding foods, which are usually high in carbohydrates and hidden sugars, or worse, using other well-known addictive substances. Due to the Western lifestyle and life’s high demands in general, this pattern of behaviour becomes easily a norm in highly-stressed situations with a resultant weight gain.27, 28 The altered structure of our food As we naturally tend to indulge in high calorific foods after stressful events, it is important to pay attention to what we eat and how we cook it. We have already looked at the importance of the healthy structure of our main building blocks – cells and mitochondria. Food and how it is cooked has its own structure, which

can dangerously alter the body’s structure and function. Precisely, a structural alteration of food proteins can modify the functions of these specific proteins. This process is called glycation. Cooking food at high temperatures leads to glycation which in turn produces glycotoxins. A high consumption of highly processed foods leads to an increased intake of glycotoxins. According to research, there are links between glycotoxins and the rise of type 2 diabetes, kidney problems and dementia.14 Lesser cooking temperatures result in reduced production of glycotoxins. The closer to nature and the less processed, less structurallyaltered our food is, the better it is for the bodily functions and overall structure.13, 28, 29 Stress affects everyone in some way. It guides reactions and determines the appropriate or sometimes inappropriate actions for survival, too often leading to easily available and socially acceptable self-medication with hidden sugars and high calorie foods. Expanding waistlines are a continuous and growing concern and a huge burden on the already over-stretched healthcare system. However, obesity is caused by more than just too many calories and lack of exercise. It is also a result of persistent organic pollutants, environmental obesogens and structurally altered proteins in our everyday foods. Before we make surgical weight reduction as widely available as a cardiac bypass operation, we should acknowledge the fact that life in general does not always provide us with easy shortcuts - what may be suitable for some may not be for the others. Any weight issue is a highly individual matter. It requires a holistic approach incorporating a thorough understanding of each individual’s circumstances, available mental and emotional resources, coping mechanisms and habitual choices. Instead of reducing the sizes of stomachs en masse we need to empower our patients with better knowledge and coping strategies. We must raise awareness of the hidden risks in certain foods and food preparations, emphasizing the importance of health and wellbeing for the next generation. We must work to reduce the intake of dangerous toxins and addictive substances in our food such as sugar and educate patients on the better management of weight-related concerns. Jan. 2016 REFERENCES 1. Obesity Epidemic Is Global, New Study Confirms. Medscape Medical News, 2014-05-29 2. The Government Office; Foresight project “Tackling Obesities: Future Choices” www. gov.uk 3. Steven McGee. Evidence Based Physical Diagnosis. 3rd edition, Elsevier Saunders, 2012 4. Bariatric Surgery. Alan A Saber, MD Diseases/Conditions, Procedures, Feb 10, 2015 5. Tucker ME. New guidelines address bariatric surgery in children. Medscape Medical News. January 19, 2015 6. Public Health England Obesity Knowledge and Intelligence. https://www.noo.org.uk

7. Call to Make Bariatric Surgery as Common Coronary Bypass. News, Jul 02, 2015 8. Regulation of Appetite to Treat Obesity. Gilbert W Kim; Jieru e Lin; Michael Valentino; F. Colon-Gonzalez; Scott A Waldman. Expert Review of Clin. Pharmacology. 2011; 4(2): 243-259 9. Bariatric Surgery May Up Risk, Change Pattern of Fractures, Society of Bone and Mineral Research Annual Meeting 2015. Medscape Medical News, 2015 10. Bariatric Surgery Linked to Suicide Attempts. Medscape Medical News. October 14, 2015 Pam Harrison review 11. Obesity in Children. Steven M Schwarz, MD Diseases/Conditions, Jun 24, 2015 12. Scott Isaacs MD. Hormonal Balance. Bull Publishing Company, 2012 13. Jeffrey S. Bland. The Disease Delusion. Harper Wave. 2014, Kindle edition 14. Jim Hunter. Weight Loss Hormones. Jagger Publishing, 2015, Kindle edition 15. Appetite-Regulating hormones From the Upper Gut: Disrupted Control of Xenin and Ghrelin in night Workers. Clinical Endocrinology, 2013-12-01 16. The Gut Hormones in Appetite Regulation. Suzuki K, Jayasena CN, Bloom SR. J Obes. 2011;2011:528401 Epub 2011 Sep 22 17. Endocrine System Anatomy. Jasvinder Chawla, MD Diseases/Conditions, Jun 04, 2014 18. Neuropeptide Y: History and Overview. K. Tatemoto www.springer.com 19. Gerard J Tortora. Principles of Anatomy and Physiology. 14th edition, Wiley, 2014 20. Food Addiction, Substance Dependence Share Common Ground. Medscape Medical News, 2011-04-07 21. Joe Griffin, Ivan Tyrrell. Freedom from Addiction. HG Publishing, 2008 22. Marijuana Munchies are All in the Brain. U.S.Study, Nature 2015, Reuters Health Information, 2015-02-18 23. Endocannabinoids. G. Griffing, MD. Diseases/Conditions, Procedures, Feb 05, 2015 24. Guyton. Textbook of Medical Physiology. Eight edition 1991 chapter 58 p.651-658 25. Intranasal Oxytocin Cuts Calorie Consumption in Healthy Men. Elizabeth Lawson MD study. Medscape Medical News, 2015-03-09 26. Oxytocin a Promising New Treatment for Anorexia. Medscape Medical News, March 18, 2014 27. Rosina Sonnenschmidt. The Way to Your Ideal Weight. Narayana Publications, 2011 28. Slash Sugar Intake to Fight Obesity, Tooth Decay – WHO. Reuters Health Information, 2015-03-04 29. Fructose intake may contribute to overeating. Heartwire from Medscape, 2013-01-03


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IRISH PHARMACY NEWS DYNAMIC 100


DYNAMIC 100 - 2017 Top 100 Customer Service at Ahern’s Dan is Superintendent Pharmacist at Aherns Pharmacy, Farranfore, Co. Kerry. Dan has a wide range of experience across a broad spectrum of community pharmacy as he has worked in large multinational pharmacy chains through to his now independently owner managed pharmacy. Dan’s ethos is provide the highest possible levels of service and care in both a professional and personal manner. This ethos is something he maintains throughout the pharmacy, and his team have undergone bespoke training in areas such as hay fever, Pain management, Cough/Cold & smoking Cessation to deliver high standards of customer service in over the counter medicines and responding to symptoms. This year Aherns was recognised as one of the Top 100 stores in Ireland in the Retail Excellence Ireland Store of the Year Awards 2017.

Dan Ahern, Superintendent Pharmacist, Aherns Pharmacy

Excelling in Entrepreneurship Karen is a pharmacist with almost 13 years experience in Community Pharmacy both in Ireland and the UK. In 2013, Karen embarked on an Advanced Certificate in Health and Wellness Coaching at The Institute of Health Sciences in Dublin. Qualifying as a Health and Wellness Coach completely transformed how Karen interacted with patients and carers as well as improving the quality of consultations she was able to give. Karen believes this enabled her to become more aligned with the needs of the patients and carers alike and understanding the value of active listening which facilitates greater empathy and being able to truly address the needs and expectations of the patients and carers in the most efficient and effective manner.This year Karen gained admittance to Exxcel an Enterprise Ireland funded Female Entrepreneurship Programme, based in CIT, to develop the business case for ‘Transformation Prescription’ a self care programme for healthcare professionals and carers. Karen presented the programme at the Social Entrepreneurs Bootcamp 2017. Karen Ahern, Pharmacist and qualified health and wellness coach, Institute of Health Sciences

Online totalhealth Training Portal John Arnold, Commercial Director totalhealth Pharmacy group and is responsible for the General Management and operations of the totalhealth Pharmacy group. In 2017 the group has continued to go from strength to strength and Arnold has overseen this growth with the group now having 69 pharmacies as members. Totalhealth had a fantastic 2017 with the complete roll out of the new ordering software into all member pharmacies. This software enables members to identify the best margin deals in the market place at any given moment. We have also expanded our training areas with our bespoke online training portal now hosting over 400 staff trainings in area like OTC and Vitamins. Early 2017 saw totalhealth reach our milestone of over 100,000 loyalty card customers and has continued to grow. These areas and many others have provided totalhealth members with the ability to focus on the patients.

John Arnold, Commercial Director, totalhealth


DYNAMIC 100 - 2017 GSK show roots with Made in Ireland campaign There have been several of highlights in GSK Consumer Healthcare Country Manager Dave Barrett’s year, but it is the ‘Panadol: made in Ireland’ campaign that is the stand out success. The fact that Panadol is manufacturing in GSK’s facility in Dungarvan, Co Waterford, was one of Ireland’s best kept secrets, not anymore! Thanks to an extensive above the line campaign, and outstanding support from the retail sector, Panadol has accelerated had a new lease of life. This is another example of how GSK brands are promoting self-care, a topic close to Dave’s heart. Through his work as Chair of the Irish Pharmaceutical Healthcare Association’s consumer healthcare division, Dave is the driving force a new policy document that is set to launch early next year. The goal is to help consumers to take a greater role in maintaining healthy lives and in the event of illness have extensive and convenient access to a wide choice of appropriate, effective OTC medicines.

Dave Barrett, Consumer Healthcare Country Manager, GSK

Exceptional Citizens and Future Leader with Brenson Lawlor Jason, originally from Delgany, Co. Wicklow is a partner with JPA Brenson Lawlor, which specialises in providing support, solutions and expert advice to owner managed small and medium size businesses. Jason has a wealth of experience in the nursing home sector, community pharmacy, primary care centre developments, franchises and has helped various pharmacies and bodies in the industry including the IPU which JPA Brenson Lawler were appointed auditors and business advisors for. This year the company also partnered with University College Cork to sponsor the “Exceptional Citizen and Future Leader” Award at the UCC School of Pharmacy 2017 This is the first year of our association with this award at the university, where Brenson Lawlor lectures on the business issues related to running a pharmacy. Jason Bradshaw, Partner, JPA Brenson Lawlor

4th Branch For Brennans

Fergus Brennan, Managing Director, Brennans Pharmacy group

Brennans Pharmacy group is an independently owned group of four pharmacies in County Donegal founded and led by managing director Fergus Brennan. Fergus opened the first branch of Brennan's Pharmacy in Buncrana in 1992 followed by pharmacies in Clonmany and Carndonagh in Inishowen in the following decade. The group added its fourth branch this year with the opening of Brennans Pharmacy Creeslough in Summer 2017. As the Brennans team has grown from just two staff in 1992 to our current twenty two across four branches, Brennans have developed a strong culture of caring and teamwork, founded on seven core company values. Fergus’ focus this year has been on the development of a comprehensive internal 'Excellence in OTC' training programme for all staff. Working with Rachel Dungan of 4Front OTC training, the Brennans team is completing a year long monthly modular OTC training programme, making full use of the 4Front online learning platform, audio visual seminars and remote learning technology. 2017 has also seen Brennans complete a redevelopment of Brennans branding and signage which is currently being rolled out across the group.Brennans were honoured to have won 'Pharmacy Team of the Year ‘ and 'Business Innovation' awards at the 2013 National IPN awards. Fergus holds a professional qualification in personal coaching and a Diploma in Leadership from IMI.

The Real Cost of Cancer Revealed Donal is Head of Services at the Irish Cancer Society. With over 15 years experience in a number of leadership roles in the charity sector and working in the community and healthcare sector prior to joining the Irish Cancer Society, Donal’s primary area of responsibility is to run programmes which are aimed at improving lives for cancer patients, survivors, their careers and supporters. In 2017 the Irish ISSUE Cancer Society campaigned to reduce out of pocket payments as part of its “The Real Cost of Cancer” 2018 campaign which found that cancer patients would spend an average of ¤303 a month in medical costs that could not be claimed back on things like OTC medications, specialist dressing and GP’s visits.

FOR FIRST AID NEEDS FOR FIRST AID NEEDS

Donal Buggy, Head of Services, Irish Cancer Society


Course of the Year for UCC Prof Byrne continues to lead the Internationally renowned School of Pharmacy Staff at University College Cork with the roll-out of its 5 year integrated Masters of Pharmacy degree programme. This year again saw the School of Pharmacy, UCC receiving a ‘Top 100’ ranking by the QS world rankings system by subject areas. The Schools MSc in Clinical Pharmacy was also the winner of the GradIreland Postgraduate Course of the year during 2017. The School maintained its pole position amongst Leaving Cert students in Ireland for Pharmacy Education. Prof Byrne, has continued to grow his research team in the area of Clinical Pharmacy and has co-authored several peer review papers during 2017, amongst which was a paper in the New England Journal of Medicine entitled “Thyroid Hormone Therapy for Older Adults with Subclinical Hypothyroidism”. Prof Byrne is looking forward to overseeing the exciting changes that will occur during 2018 in Pharmacy Education in Ireland, e.g. 4th year MPharm students commencing their 1st ever 4-6 month placements during the latter part of 2018.

Professor Stephen Byrne, Head of School, School of Pharmacy, University College Cork

Pharmacy best performing in eCommerce

David Campbell, eCommerce Manager, Retail Excellence

eCommerce Manager at Retail Excellence David’s primary role is to enhance the ecommerce opportunity for retailers. Retail Excellence’s eCommerce group functions to bring together retailers to share experiences, access online expertise and represent the needs of online operators. Developing skills and standards to ensure retailers, multi-channel and pure play operators make best advantage of the domestic and international opportunity online, David has worked with a number of pharmacies to help them discover their true potential using eCommerce to their advantage. Over the last year the use of eCommerce in pharmacies has seen a huge increase with pharmacy, beauty and cosmetic retailers becoming the best industry performers online.

Healthcare Insights from United Drug As United Drug’s Consumer Director, Christy Canavan ensures that United Drug provides a best-in-class service while delivering high-quality, life-saving healthcare services to patients via a customer-centric supply chain. Christy lauds United Drug’s implementation of a new ERP operating system, called SAP. As the largest change in IT in the United Drug Consumer division in the last 20 years, the new system will improve United Drug’s supply chain and, in turn, it’s consumer services. United Drug’s consumer services business works with retail pharmacists to supply and distribute general consumer products, like fragrances, cosmetics and over-thecounter medicines. In addition to United Drug's cornerstone medical supply chain services, its new healthcare insights division provides pharmaceutical companies with unique, actionable healthcare insights through specialist data analytics tools. Christy is a graduate from University of Limerick with a degree in Business Studies. He has held a number of senior commercial roles in the FMCG sector and is now the Consumer Director heading business units such as Pemberton, Profitlines, Intrapharma, Blackhall and Orthodontological Supplies.

Christy Canavan, Consumer Director, United Drug

Out of Hours Medication Messaging

Nuala Carey, Pharmacist, Glengarriff Pharmacy

ISSUE

2018

Nuala has spent the last 12 months promoting fitness in the community and has raised Glengarriff Pharmacy’s substantially on social media, increasing their facebook numbers by over 1000 and twitter followers by 200. Nuala won Irelands Best Young Entrepreneur for Best Established Business in Cork North and West. The competition recognized the difference the pharmacy has made to the quality of the community’s health and wellness and was awarded an investment fund of €15000 to develop business further to enhance the pharmacies services. One service that Nuala has been influential in is the pharmacy’s website and blog which accompanies the already successful online profile and includes an out of hours messaging service on facebook which allows patients to contact her with medication and health queries.


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DYNAMIC 100 - 2017 Clinical Services Advancement at Hickey’s Sarah began her career with Hickeys in 2012 as a pharmacy intern in the Tallaght Fortunestown store. Sarah’s diligence and passion coupled with her natural disposition to benevolence and empathy has made her a popular team member with patients and colleagues alike. Striving for excellence in her practice, Sarah has been a driving force in the advancement of many clinical services in Grafton Street such as “lets get checked” STI screening, ambulatory Blood Pressure monitoring, cholesterol and diabetes screening and advanced vaccination services which are also available to corporate clients as well as the public.

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Sarah Chambers, Pharmacist, Hickey’s Pharmacy Dublin

1

Vitamins, Mi erals

&

Smart Social Media and Supplem "ts i

Aisling is Social media and digital marketing executive for LloydsPharmacy. Over the last year a major part of her marketing strategy has been to focus on bloggers and how they can help build awareness and use their influence to encourage positive changes in people’s lives. Aisling wanted to build quality relationships with carefully selected influencers and accomplished this through product drops, social media, organising the first Facebook live ever carried out in a pharmacy in Ireland and activities such as Lloyds ‘Best Version Of You’ event. Our seasonal health and wellness campaign, ‘Best Version Of You’, which kicked off in October . The aim of the campaign was to get the nation winter ready by engaging with health and wellbeing influencers to raise awareness of LloydsPharmacy and demonstrate the expert health advice and service offering available online (Ask the Pharmacist) and in Lloyds 94 stores. Lloyds colleagues underwent a combined 15,000 hours of training in the last year, to be able to provide expert advice. The Best of You event involved a ski lesson on the slopes, a wholesome winter themed meal, followed by a bespoke one-on-one health consultation with a Pharmacist, a personalised winter health plan, and a skin analysis. Each attendee left with a ‘winter ready’ goodie bag containing products that have been tried, tested and recommended by LloydsPharmacy colleagues themselves.

Uniphar are delighted to launcH our new Vitamins, Minera Supplements range. It marks the next step for Uniphar, as

Aisling Charmant, Social Media and Digital Marketing Executive, LloydsPharmacy

Established Brand expansion Laura is the Brand manager for the totalhealth Pharmacy group and has been instrumental in establishing the brand throughout the group and in the communities, totalhealth members are positioned in. Laura runs is responsible for driving brand awareness through marketing, training programs and customer service and is a source of support for all group members. Starting out with the original member buying group, Pharmasave, Laura has been instrumental in making sure the brand expansion into 69 pharmacies across 19 counties has gone smoothly and her expertise has stimulated the growth.

61

Laura Clarke, Brand Manager, totalhealth

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DYNAMIC 100 - 2017 Strategy from Scotland John was appointed Chief Operating Officer at the Health Service Executive in April 2017. John Has over 30 years experience of both the private and public sector and joins the HSE from the Scottish Government where he was NHS Chief Operating Officer. John’s role at HSE is performed in close liaison with the Chief Strategy and Planning officer and in collaboration with the wider HSE Leadership Team and other key Stakeholders. John is responsible for the overall operational performance management of the service delivery system within the health services including Acute Hospitals, Community Care, National Ambulance Services, Primary Care Reimbursement Services (PCRS) and the Special Delivery Unit (SDU). His role allows greater integration of all services delivered and supports the delivery of healthcare in the most effective , way to ensure greater value for patients and taxpayer especially in terms of quality safety, effectiveness and efficiency.

John Connaghan, Chief Operating Officer, HSE

World Regulation of Medicines Emer Cooke was appointed Head of Regulation of Medicines and other Health Technologies (in HIS/EMP). Until recently she held the role of Head of International Affairs at the European Medicines Agency in London. She worked at the Agency since 2002, during which time she also served as Head of International and European Cooperation and Head of Inspections. The world health organization is responsible for he R&D Blueprint. A global strategy and preparedness plan that allows the rapid activation of R&D activities during epidemics. Its aim is to fast-track the availability of effective tests, vaccines and medicines that can be used to save lives and avert large scale crisis. With WHO as convener, the broad global coalition of experts who have contributed to the Blueprint come from several medical, scientific and regulatory backgrounds. WHO Member States welcomed the development of the Blueprint at the World Health Assembly in May 2016. Emer Cooke, Regulation of Medicines and other Health Technologies, World Health Organisation

Integrated Operations For Combined Business

Catherine Cummings, Operations Director, United Drug

In February, Catherine Cummins was appointed Operations Director for the combined United Drug and LloydsPharmacy business. Today, Catherine has responsibility for a number of different teams including quality and master data, warehouse operations, facilities and engineering, health and safety, projects and IT. With so many people working across the various teams, Catherine relishes the opportunity to find ways of integrating everyone into one large team with the same common purpose. Since starting her new role, Catherine has worked on the highly complex SAP Warehouse Management System, which she successfully implemented in United Drug's Limerick facility. The new system provides United Drug with an infrastructure for growth and global alignment within McKesson, its parent company. Catherine holds an Msc in Instrumental Analysis, a Post-Graduate Diploma in Pharmaceutical Validation Technology as well as primary degree in Science and a green belt. Catherine has previously worked in a variety of senior roles in the pharmaceutical manufacturing sectors. Catherine, as Operations Director, is responsible for United Drug’s Operations, Quality and IT functions.

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Decoding Diabetes Paul studied Diabetes as part of a pharmacy course in college, shortly before starting the course Paul himself was diagnosed with Type 1 Diabetes and has used his personal experience to help patients and pharmacies understand the diagnosis. Paul was amazed by how confusing pharmacists seemed to find the Blood Glucose testing world and has dedicated his time to ensuring his stores are the first point of call for patients with knowledgeable educated staff. Paul spends as much time as possible with patients, engaging with them and helping them with any queries and fears they may have when they are first diagnosed. He also helps them get set up with an LTI card. Paul also goes the extra mile by giving patients his personal mobile number so they can contact him at any time they need. Paul Cunningham, Owner Cunningham’s Pharmacy

Identifying Pharmacy Patients Customer Success Manager with Real World Analytics (RWA) who analyse the dispensary and retail data for group pharmacies, Adele was a finalist at this years DatSci Awards. Recognised for her work on helping pharmacies identify patients at risk of Diabetes and Asthma, Adele’s goal is to work alongside customers to identify areas where the company can make an impact on long -term health of patients and in turn impacting undiagnosed, untreated and mismanaged health conditions which have an effect on the countries health system. Across RWA pharmacy groups, over 1.4 million patients from dispensing practices in Ireland (North & South) can be analysed. Adele Curran, Customer Success Manager, Real World Analytics

Profit Protection for Pharmacies Director of TONiC Consultancy, with an MSc in Security and Risk Management. Aisling is a highly experienced security, risk and profit protection professional who has been instrumental in focusing the businesses efforts on providing innovative software solutions that save clients time and money as well as giving them financial and regulatory peace of mind. The “Compare your Claims” software offers pharmacists to have complete trust that their claims are being paid in full and in 2017, further developments now allow ongoing automated claims management and a “head office” facility for pharmacy chains, meaning they have an overview of each branches performance instantly. Aisling has also linked the system to TONiCs already established E Learning software package, giving access to their popular Claims Training without the need to leave the store. This offers Pharmacies an end to package by preventing rejects, identifying all discrepancies, and helping manage their repayment. Aisling Daly, Director of TONIC Consultancy

Primary focus on Pharmacy technology

Kieran Daly, Chief Technical Officer, HealthBeacon Ltd

Kieran is Chief Technical Officer and Co-Founder of HealthBeacon Ltd. With a primary focus on leading the technology strategy and development tracks from hardware through to the cloud, Kieran has 20 years experience in the technology arena with a particular focus on the intersection of technology and healthcare. Focusing on medication adherence technologies, Kieran is responsible for leading the world’s first smart connected disposal bin for used injections in the home. This innovative tool addresses the needs of the patient by providing gentle reminders of when they are due to take their injections to help them stay on track with their treatment.


SOLUBLE TABLETS Paracetamol, Caffeine

FAST ACTING PAIN RELIEF

Solpa-Extra 500mg/65mg Soluble Tablets (P) contain paracetamol and caffeine. For the treatment of mild to moderate pain. Adults and children over 16 years: 1-2 tablets dissolved in water every 4-6 hours. Max 8 tablets a day. Children 12-15 years: 1 tablet dissolved in water every 4-6 hours. Max 4 tablets a day. Not suitable for children under 12 years. Contraindications: Hypersensitivity to the ingredients. Caution: Particular caution needed under certain circumstances, such as renal or hepatic impairment, chronic alcoholism and malnutrition or dehydration. Precautions needed in asthmatic patients sensitive to acetylsalicylic acid, patients on a controlled sodium diet and with rare hereditary problems of fructose intolerance. Interactions: Warfarin and other coumarins, cholestyramine, probenecid, chloramphenicol, metoclopramide, domperidone, sedatives, tranquilizers and decongestants. Pregnancy and lactation: Not recommended during pregnancy and breastfeeding. Side effects: Rare: allergies. Very rare: thrombocytopenia, anaphylaxis, bronchospasm, hepatic dysfunction, cutaneous hypersentitivity reactions, TEN, SJS, drug-induced dermatitis, sterile pyuria. Unknown: neutropenia, leucopenia, nervousness, dizziness. PA 1186/017/001. MAH: Chefaro Ireland DAC, Treasury Building, Lower Grand Canal Street, Dublin 2, Ireland. Date of preparation: 05/04/2017.


DYNAMIC 100 - 2017 Intergraded Pharmacy Placements Programme Maria returned to University College Cork (UCC) as an APPEL Practice Educator in 2016, having studied both for her pharmacy degree and her Ph.D. in Pharmaceutics at UCC. As a Practice Educator she has been responsible for the recruitment, preparation and support of pharmacists who wish to provide practice placements as part of the new integrated pharmacy programme. This innovative role sees her working with pharmacists in community, hospital, industry and other practice settings. Students in UCC have also been prepared and supported by Maria as they now undertake placements in a breath of practice settings from much earlier in their education as pharmacists. During her career, Maria has worked in community pharmacy, hospital pharmacy and regulatory affairs in industry. In addition to her role as Practice Educator, she continues to practice in both community and hospital pharmacy. Dr Maria Donovan, APPEL Practice Educator

The Fabulous Pharmacist Laura has been a qualified pharmacist since 2003. Supervising Pharmacist Manager at LloydsPharmacy in Stillorgan, Dublin, Laura is passionate about helping people to live healther lives and regularly advises on medicines, illness, nutritional supplements, health and wellness. Laura’s key area of expertise is in women’s and children’s health and skincare and she has an avid following on social media regularly blogging about healthrelated topics. Laura is known as the “Fabulous Pharmacist” and her success comes from her aim to bring answers to the huge range of questions, patients would ask her on a day to day basis in the pharmacy, in an easy to understand and unbiased way.

Laura Dowling, Pharmacist Manager, LloydsPharmacy

At the 4front of Pharmacy In 2017, Rachel became the 3rd person in Ireland to attain the designation of Professional Medical Coach (PMC), during which time she developed 4Front's 'STEPS Consultation Skills Process'® to support pharmacists and pharmacy teams to transform their impact at the pharmacy counter. 4Front has become known as pharmacy's lead provider of DiSC® Behavioural Style Profiling, accompanied by coaching. DiSC® is a validated tool to support pharmacy excellence through leadership skills, pharmacy management, customer service, workplace harmony, productive conflict and cohesive teams. During 2017, 4Front led Irish Pharmacy's use of online systems to deliver hassle-free, world class, interactive coaching and training, from the comfort of your own home. Hosted from Lismore in Co Waterford, a total of 2145 participants, from 23 countries engaged in online learning with 4Front in 2017. They participated in programmes such as 4Front's 'STEP into Engagement' online Leadership Development Mastermind Programme for pharmacy leaders, 4Front's OTC Pharmacy Excellence Programme for Pharmacy Teams, 'Supporting Mental Health in Pharmacy Practice' Online Workshop and CPD Online Trainings for both Pharmacists and Professional Coaches.

Rachel Dungan, Owner, 4Front

Progressing the PMI With her can do approach, Fiona has strived to maintain and develop, the PMI’s standing as a platform for pharma managers in Ireland. Informing them of emerging strategic trends, developing insight from thoughtprovoking business leaders; and providing topical education. Fiona has 20 years of experience spanning various fields such as marketing, operations, event management, and major account management. Giving the PMI a complete overhaul this year, the PMI have hosted around 4 times as many seminars than in previous years and her presence has made a significant impact for the better at the PMI.

Fiona Dunphy, Commercial Manager, PMI

working together to deliver value


DYNAMIC 100 - 2017 Nutritional Knowledge in Pharmacy Ola set up her pharmacy Lily’s in Ratoath with her daughter El-Banna in 2007. Since then Ola and her daughter have been filling the gap in people’s knowledge about nutrition and diet which can attribute to a lot of health problems. Ola is a qualified diet councilor and also has training in sports nutrition and in the pharmacy, uses her knowledge of complimentary therapies as well as nutrition, to encourage patients to improve their wellbeing. Ola’s professional journey as a pharmacist began in the late 1980s when she started studying in Egypt. She moved to Ireland in 1990 after her husband was offered a place at the Royal College of Surgeons. Ola El-Garawany, Owner and Pharmacist, Lily’s Pharmacy, Ratoath

Holistic approach for Health Town Rose is the Owner/Superintendent Pharmacist of Rose Finlay totalhealth Pharmacy, Tullamore. Rose is passionate that patients and customers alike get friendly, informative, professional care. Using a holistic approach to her business, successful improvements have been made to maximize the potential of the business, and to ensure best practice standards in the provision of patient care and advice. Rose is very active in the community, most recently involved in the ‘Pfizer Healthy Town initiative’, and drives her team to follow her lead. She is involved with many local organizations and groups, including the Chamber of Commerce. Rose also arranges local fundraising for Charity, and The Irish Cancer Society is just one of the charities to benefit from the commitment and care of Rose and her team. This dedication to providing excellence in service to her customers and community, has gained Rose and her team several awards, and most recently, the totalhealth ‘VIP Loyalty Pharmacy’ of the year 2017 at the totalhealth annual awards.

Rose Finlay, Owner and Superintendent Pharmacist, Rose Finlay’s totalhealth Pharmacy

Better Initiatives at The Burren Marcella has over 25 years’ experience working in community pharmacy. Working as Counter Assistant/dispensing technician at The Burren Pharmacy, Lisdoonvarna, she has introduced and led many new initiatives in the pharmacy to better the pharmacy’s outreach and public engagement. Marcella has taken on an extraordinary range of duties which contribute to the smooth running of the pharmacy including caring for patients with hospital prescriptions and those with specific conditions such as diabetes. Marcella Fitzgerald, Counter Assistant and Pharmacy Technician, The Buren Pharmacy


Award winning Advice in Acquisitions Stuart has been with Fitzgerald Power since 2003 and was appointed director of the frim in 2012. In January 2017 Stuart authored “The Irish Community Pharmacy Wages & Employment Report 2015 / 2016” and in July released the third in a series of annual reports entitled “Review of the Irish Community Pharmacy Sector - Measuring the contribution”. Both studies involved an in-depth analysis of the key forces currently shaping the Irish pharmacy sector and were commissioned by the Irish Pharmacy Union. In March he co-hosted the Pharmacy Growth Seminar in conjunction with Davy and William Fry which was attended by more than 150 leading sector figures. Stuart was also responsible for advising on some of the largest transactions in the industry this year including the Carlyle Cardinal Ireland Fund’s acquisition of Sam McCauley’s Chemists and Cara Pharmacy’s purchase of Abbey Healthcare. Fitzgerald Power’s pharmacy team won “Advisory Team of the Year” at this year’s Irish Accountancy Awards for their work in the sector and by the end of the year will have completed more than ¤35 million worth of pharmacy acquisitions and disposals.

Stuart Fitzgerald, Director, Fitzgerald Power

Foody’s for thought

Olivia Foody, Owner and Pharmacist, Foody’s Pharmacy

Olivia Foody, Owner and principle pharmacist, Foody’s Pharmacy – Olivia owns Foody’s Pharmacy, an independent Irish Pharmacy which has two stores, one in Ballina, Co. Mayo and the other in Dublin City on Harcourt Street. The pharmacies priorities are simple – People and care. Olivia prides herself on her pharmacy delivering great service and great products in order to bring this ethos to life. Olivia runs a very successful blog as part of the pharmacy’s website and offers advice on a range of health and wellbeing topics such as skincare and womens health. Olivia is a previous finalist in both the Irish Pharmacy Awards in the Community Pharmacist of the year awards and also the Best Shop in Ireland awards.

Pharmacy Globetrotting Professor Paul Gallagher is the Head of the School of Pharmacy at the Royal College of Surgeons and a member of the Steering Group at the Irish Institute of Pharmacy. Professor Gallagher was recognised in with the Utrecht University Prize for Advancement of Practice of Pharmacy and delivered a lecture at the University entitled “Spoon feeding in the long run teaches us nothing but the shape of the spoon.” Along with the RCSI Dean of Medicine and Health Sciences, Prof. Hannah McGee Prof. Gallagher signed a Renewed Vision of Indefinite Duration with the CEO, Ms. Emma Balmaine, Director, Prof. Richard Blennerhassett and Head of Pharmacy at St John of God Hospital Dublin, Ms. Dolores Keating. As well as this Prof. Gallagher chaired a session at the 8th Deans Forum of the Academic Institutional Membership of the International Pharmaceutical Federation (FIP) 77th World Congress of Pharmacy and Pharmaceutical Sciences (Seoul, S. Korea) and delivered a lecture entitled Implementation of Curricular Change and Sub-titled ”Global Perspectives, selected models, theories and resources on how to manage major planned curricular change" and was chosen to deliver the prestigious Inaugural Lecture of the Faculty of Medicine and Health RCSI which was entitled ”Building on a noble tradition: my vision for Pharmacy in the Royal College of Surgeons in Ireland.

Professor Paul Gallagher, Head of School of Pharmacy, Royal College of Surgeons

Investigative Innovator

Professor Anne Marie Healy, Head of School of Pharmacy, Trinity College Dublin

ISSUE

2018

Anne Marie Healy is Professor in Pharmaceutics and Pharmaceutical Technology at the School of Pharmacy and Pharmaceutical Sciences, TCD and is Head of School. Over the course of the last year Professor Healy has continued to lead the School in the development and delivery of its innovative five-year integrated pharmacy programme, with the first cohort of students on the new programme now in the third year of their studies. Professor Healy remains heavily involved in research. She holds a Science Foundation of Ireland Principal Investigator Award, is an Investigator on two SFI-industry co-funded research centres - the Solid State Pharmaceutical Centre (SSPC) and the Advanced Materials and BioEngineering Research (AMBER) centre and is a collaborator on an NIH-funded research project led by the University of California, San Francisco. Earlier this year Professor Healy was appointed as an academic member of the Board of IPPOSI (Irish Platform for Patient Organisations, Science & Industry) and hopes to extend her expertise as a pharmacist, academic and scientist to the activities and strategic priorities of IPPOSI.

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DYNAMIC 100 - 2017 Excellence in Local Health Matters Joan Hennessy is the Owner/Pharmacist of Banagher totalhealth Pharmacy, Co. Offaly, which she opened in 2005. Since then Joan has worked tirelessly to build her reputation as a community pharmacist who provides her patients and customers with a service that reassures, resolves and delights. Joan regularly speaks to local groups on health matters and arranges informative event days. This commitment to the Instore Experience and Wellbeing of her patients and customers was recognized this year when Joan and her team achieved recognition as one of the Retail Excellence Ireland top 100 retail stores 2017. Joan Hennessey, Owner and Pharmacist, Banagher totalhealth Pharmacy

Quality Guaranteed

Maria Hennessey, Clinical Governance Pharmacist, Lloyds Pharmacy

Maria first joined Lloyds Pharmacy in May 2015 as Supervising Pharmacist Manager in their Thurles pharmacy store. In September 2016 she stepped into the role of Clinical Governance Pharmacist. Though community pharmacy and patient interaction will always be her main passions, she enjoys the aspects of regulation and quality assurance that this role brings. Key achievements this year were the successful implementation of the PSI self-assessment system across all 90 pharmacies, delivering a claims and rejects training guide, and assisting in the launch of the seasonal influenza vaccination service. Maria successfully launched the May Measurement campaign in all our pharmacies, where all our trained colleagues ran a blood pressure monitoring service during the month of May. The data from this service was then used as part of the World Wide May Measurement (MMM17) study. Understanding the need to support all our pharmacist colleagues, Maria created a new pharmacist checklist to assist new colleagues to the business. With the implementation of FMD in February 2019, she is overseeing this within Lloyds Pharmacy and is heavily involved in the national pilot to drive this.

Proactive Pharmaceutical Buying Darren Hoare joined the Hickey’s Pharmacy Group in June 2015 in the newly created role of Dispensary Buyer. He adopted best in class policy and practice that delivered efficient buying, and freed up front line staff to focus on patient care. Through improved dispensary buying strategies and working closely with suppliers, he increased group profitability while reducing capital tied up in stock, and achieved this without impacting service levels to patients. The group’s generic and parallel import profitability improved as tenders and increased buying efficiencies bore fruit. He has worked proactively with manufacturers to improve forecasting and planning on short or difficult to source lines, and continues to do so. Through such partnerships with manufacturers, he has introduced new/ alternative offerings for patients, benefiting all involved. Darren has achieved this with the Hickey’s Pharmacy Group core values in mind. Darren comes from a background in pharmaceutical buying of over 11 years and holds a Bachelor of Business Studies degree specialising in procurement and supply management from the IIPMM as well as a Marketing Management Degree from IT Tallaght.

Darren Hoare, Dispensary Buyer, Hickey’s Pharmacy Group


DYNAMIC 100 - 2017

Improving Inefficiencies in Pharmacy John is the Co-Founder & Chief Data Scientist of Real World Analytics, a decision analytics company who transform PMR and EPoS data into actionable insights so that smarter decisions can be made faster. This year, John was a finalist in the DatSci Awards, in the ‘Data Scientist of the Year’ category. This nomination recognised John’s initiative in bringing business intelligence to retail pharmacies so that they can improve inefficiencies and increase profitability in their business.

John Hogan, Co-Founder and Chief Data Scientist, Real World Analytics

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Commitment to Community

Uniphar are delighted to launcH our new Vitamins, Minera Supplements range. It marks the next step for Uniphar, as

Joanne is an Owner/ Pharmacist of Joanne Hynes totalhealth Pharmacy Ballinrobe. Joanne has being honoured with numerous awards citing her commitment to the brand and excellence in Customer Service and Community involvement. Joanne is presently chairperson of the Mayo Roscommon Hospice who are commencing a ¤15million euro hospice building this year. She also has been on the executive of the IPU for the last six years. Joanne and her team work hard to be the best for all their patients and they recently received the ‘Brand Pharmacy of the year’ 2017 award from totalhealth. She also represented the brand on RTE’s Today show as the pharmacy professional advice segment on a number of health topics. This showcased her extensive knowledge, professionalism and extremely friendly approach.

Joanne Hynes, Owner and Pharmacist, Joanne Hynes totalhealth Pharmacy

Breaking Boundaries

Jack Kavanagh, Trinity College Dublin Graduate

Jack sustained a spinal cord injury in 2012 only weeks before entering year two of Pharmacy in TCD. As a result he is paralysed from the armpits down with 15% muscle function remaining an is now a wheelchair user, however this has not deterred him from achieving success in a manner of fields. Having returned to college in 2013 he completed a BSc Pharmacy in TCD in May 2017 and is currently pursuing an M. Pharm at RCSI. A strong believer in the concept "limitations are only perceived" he was included in a list of '50 Incredible People Who Are Shaping Modern Ireland' for his inspiring including his TEDx talk Fearless Like A Child, the award winning documentary Breaking Boundaries he and some friends produced and the talks and workshops he continues to deliver on concepts such as resilience, personal leadership and the power of choice.

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Digital Age of Pharmacy John is a community based pharmacist in Mullingar, employing 35 people locally throughout 4 pharmacies – Green Road, Pharmacy, Market Point, Mullingar, Jordanstown Road, Enfield and also Keanes Primary Care Centre. The family run business rebranded as Keane’s CarePlus Pharmacy in 2015 and prides himself of offering the highest levels of care, value and service to the community. Keane’s are a digitally proactive pharmacy with the latest technology used to promote products and prices. Their Electronic Shelf Edge Label service provides real time prices and accuracy to their customers. The pharmacy also has a robot that handles a large volume of prescriptions and the CarePlus app allows customers to order prescriptions online. Keane’s pharmacy is one of the most digitally advanced pharmacy in Ireland providing a vital service to the community in Mullingar. John Keane, Pharmacist, Keanes CarePlus Pharmacy

Pharmacystore.ie Proudly Serving You Rory Keating graduated from Aston University, Birmingham, in 1999 with an Honours Degree in Pharmacy. He then spent a few years travelling and gaining valuable experience in various types of Pharmacies before returning home to Limerick in 2002. After 3 years working with a large Pharmacy chain in Limerick City, the opportunity arose for Rory to open his own Pharmacy in the town of Newcastle West in Co. Limerick, close to Rory’s home. “Daarwood Pharmacy” was opened in December 2005, providing the town with its first Pharmacy open late and 7 days a week. The decision to remain open until 8pm every evening proved popular with the public and very soon, Daarwood Pharmacy had a very strong and loyal customer base. Over the years, the business has gone from strength to strength and Rory is committed to ongoing team development to continually deliver pharmacy excellence to customers both in store and online.

Rory Keating, Owner, Pharmacystore.ie

Open All Hours Seamus graduated from University of Brighton in 2003 and took over Friar pharmacy, Cashel, Co.Tipperary in 2005. Since then he has overseen the steady growth of the pharmacy within the local community. Seamus credits his business success to his staff ability to always be able to help any patient, at any time. Building strong relationships with his patients and other healthcare professionals in the area is important to Seamus and he offers a 24 hour service, 7 days a week at his pharmacy. Seamus’ ethos of a combination of patient counselling along with making sure the patient fully understands their respective medical treatment, has helped the pharmacy grow substantially in the community. Seamus Kennedy, Pharmacist, Friar Pharmacy, Cashel

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DYNAMIC 100 - 2017 Leading the Independents Amy opened Kieran’s Avenue Pharmacy in Dundalk Co. Louth in September 2014 at a time when no independent pharmacies were being set up in the country. Since then Kieran’s has established itself as one of the towns leading pharmacies. The business has gone from strength to strength with Amy creating a community within the pharmacy. From a social group that meets in the pharmacy weekly, to Nail Art Camp for children, Kieran’s caters for all ages. Amy has concentrated on developing the pharmacy’s presence online through the design of a new online store and the strengthening of existing Twitter, Snapchat, Facebook and Instagram accounts. This has allowed Kieran’s to place itself at the forefront of what’s new in pharmacy and brings the brand to her customers in their own homes. In 2017 Kieran’s Avenue Pharmacy was a finalist in the Innovation and Service Award at the Irish Pharmacy Awards.

Amy Kieran, Owner, Kieran’s Avenue Pharmacy

Business Recognition for Burkes

Joan Kilgallen, Owner, Burkes Pharmacy Group

Joan is the owner of Burkes Pharmacy Group, which consists of Burkes Pharmacy, Naas, Kilcullen and Ranelagh, Poplar and Fairgreen Pharmacies in Nass and Leonards Corner Pharmacy. Starting the pharmacy chain in 1994 Joan continuously strives to find new ways of taking care of the health needs of our customers. Recently Joan teamed up with the Age Friendly Business Recognition scheme which showed a number of practical steps, the pharmacy can take to facilitate important groups of customers as well as being verified for stocking the appropriate merchandise. The chain also made improvements to their signage, seating and interactions as well as initiating a prescription preparation and notification service which allows older customers or their carers to be made aware when their medication is ready for collection. They can also request a delivery as well, meaning the pharmacy is able to maximise compliance whilst maintaining the maximum level of customer independence. In 2017 Joan also is working with Project Search (a partnership of KARE and Naas General Hospital)to facilitate work placement to increase the skillset of people with an Intellectual Disability.

s Older customer lly ca lo d en not only sp of t lo a ve ha d an t in Coffey's Allcare Roscrea in July 2013. In Paul Knox started hasing power, bu purcOctober the he and his wife, Tanya, took over the business. have2016, so al Providing op a service and educational oriented pharmacy is time to sh to.them; and to this end Paul has given lectures on important various ailments to the staff of St. Anne's care homes in an effort to supplement their training; written CPD articles on 'Improving Communication in Community Pharmacy', HIV and its societal people wear glasses or lenses. impact, Significant erectile numbers have dysfunction and PMRs. Paul also participated some physical restriction caused conditions in by IPU's Newlike Medicines Service Pilot Scheme launched earlier in arthritis or diabetes or perhapsthe a bad hip orand a knee that year actively promotes the flu vaccine service and others is giving them trouble. in the pharmacy. Paul, Tanya and his staff are heavily involved in local fundraising and community events - ¤4000 was raised Knowing this, and making small changes in the areas for the local hospice branch in April. The pharmacy was also of sound, sight and mobility, can give your business the represented at the local Age Action Day in September.

Providing Pharmacy Promotion

customers: ps

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edge it needs.

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Paul Knox, Pharmacist, Coffey’s Allcare Pharmacy, Roscrea


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Our highly experienced team of formulation pharmacists continue to develop and produce new formulations to meet the customer’s needs. All of our products are manufactured in-house at Nova Laboratories, and not sourced from external companies.

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DYNAMIC 100 - 2017 1st class pharmacy relaunch Enda Lannon is a Pharmacist at Ballislodare Pharmacy in Sligo. Enda’s vision was to create a superior standard of customer service, better the customer experience and create events that involve the whole community. After carrying our research, the pharmacy decided to relaunch and has since increased its footfall and sales. The pharmacy has also increased its online presence and Enda has encompassed a revised product and purchasing strategy that improved operational efficiencies. With a fresh approach Enda has seen significant increase in enthusiasm from his customers and is getting recognition from bloggers online. The relaunch has given the pharmacy an insight in to the importance of listening to customers and providing a first class pharmacy service in the local community.

Enda Lannon, Pharmacist, Ballislodare Pharmacy

Pharmacy flagship

Padriag Loughrey, Owner and Pharmacist, Loughery’s Pharmacy

Padraig runs and operates three pharmacies in Co Longford, two in Longford town and one in Drumlish Co Longford. His second pharmacy in Longford town only opened in the last year above, is a state of the art visionary pharmacy. He also recently renovated and doubled the size of his flagship store on Dublin St in the heart of Longford town. Padraig is a true ambassador for the profession; as well as being a young pharmacist with a young family, he was also a County Councillor and is very highly respected in Co Longford and does huge amount of work on behalf of the local community he represents.

Developing Diabetes Services Digitally Garvan is currently working in partnership with his old MBA supervisor from Imperial College’s Health department. Together they are developing a medical device for diabetes, which will be able to predict a Hypoglycaemic event or a hyperglycaemic event. The medical device will also allow Pharmacists to monitor their diabetic patients in real time, 24 hours a day. At the moment there is nothing like this in the market anywhere in the world. Included in the team are Granite Digital, who are in the process of building the medical device which is almost ready for testing. Garvan has also met with the Health Innovation Hub and the Pharmacy Department of University College Cork who are onboard and helping to develop a proof of the study which hopes to run in March 2018. The project has also been shortlisted for funding from the European Union Health innovation fund.

Garvan Lynch, Owner, Lynch’s Pharmacy

Chain that Cares

Niamh Lynch, Commercial Director, CarePlus Pharmacy

Niamh Lynch is the Commercial Director of CarePlus Pharmacy, and has overseen a ¤5 million investment in new technology across the chain in the past year. Throughout her career, Niamh has consistently focused on her true passion - customer service. She is now translating her experience working with a leading grocery retailer to the pharmacy sector.“The grocery sector was seriously disrupted by increased competition. I can see the same thing will happen in pharmacy, albeit on a smaller scale and with even fewer brands. There will be successful independent operators, but they will use the support structures offered by a brand such as CarePlus.” CarePlus has enjoyed significant success in 2017. There will be 50 pharmacies operating under the brand by the end of 2017. In addition to their rapid growth plans the company was delighted to win two awards at the Irish Pharmacy Awards in 2017.

working together to deliver value


DYNAMIC 100 - 2017 World Record for Pharmacy Jeanette works in a supervisory role in Tullyallen Pharmacy, Louth and for the last 10 years has dealt with customer queries, supported and trained other members of staff as well as supported the manager and Pharmacy Owner. Jeanette is a keen innovator and is always looking for ways to improve the pharmacy with new products and ideas. Her keen eye of business and her passion for children’s health led to the organisation of a Baby Day where she co-ordinated a dental nurse, baby advice and infant first aid training to be available on the day. She also was a driver of the pharmacies Guinness Book of records world record which they achieved through involving the local community and raising money for local charities.

Jeanette Matthews, Supervising Pharmacist, Tullyallen Pharmacy

Elearning education David is the owner of CPD Sessions limited. The company is an experienced provider and developer of digital marketing, rich media educational programmes and mobile applications for healthcare professionals. Providing elearning resources across the pharmaceutical industry, David has served the medical community by helping those who provide education and training and giving them a platform to bring and share peer reviewed professional development and assist healthcare professionals achieve accredited CME (Continuous Medical Education). David McClean, Owner, CPD Sessions

Professional Pharmacy Knowledge Donal is a locum pharmacist in the Dublin area who cofounded PharmaBuddy Irelands pharmacist only forum. The PharmaBuddy team recognized that given that pharmacists work in isolation of their professional relevant clinical knowledge and pharmacy knowhow was siloed in individual pharmacies. As a result they developed the PharmaBuddy platform with over 2000 pharmacist members from around the country.

Donal McConnell, Co-Founder, PharmaBuddy

Facilitating Pharmacist Patient Communication Keith is Managing Director of McLernons and heads up Ireland’s leading pharmacy business systems suppliers, McLernons, and during his tenure has watched the company develop new products and expand into new marketplaces. The McLernons MPS Retail (EPOS) solution is used across the water in GB and a collaboration with a pharmacy IT systems provider in Southern Africa has seen the widespread roll out of MPS software adapted to suit market conditions in several countries in Africa. Continually innovating, the McLernons’ Medi Marshal app is now being used by Irish pharmacists and their patients – it facilitates two-way communication between the pharmacy and its patients, as well as giving patients visibility of their dispensing records. In 2017 the McLernons e-prescribing solution first piloted in Cork was adopted by the HSE as the national model for Ireland’s e-prescribing programme.

Keith McLernon, Managing Director, McLernons


Managing McCauley Growth Following the acquisition of a majority stake in the Sam McCauley Group by Carlyle Cardinal in August of this year Patrick decided that after 26 years it was time to look at other opportunities . Along with his team and Sam McCauley as Executive Chairman Patrick was instrumental in managing the growth of the Sam McCauley group from two stores and less than 30 team members to 30 stores and a team of 600.He was also instrumental in completing the successful sale of the business and Patrick is very confident that the group will continue to be the market leader under new CEO, Tony McEtee as they continue to grow and seek further acquisitions. During his tenure at the helm the group was universally recognised as one of the leading pharmacy chains in Ireland . Patrick has also been deeply involved in Retail Excellence as a board member and spoken publicly at many national retail and pharmaceutical events throughout Ireland. Patrick McCormick, Former Executive Chairman, Sam McCauley

Supporting Pharmacy Acquisitions

Nigel McDermott, Founding Partner, Cardinal Capital Group

Nigel is a founding Director of Morrigan Partners and also a founding partner of Cardinal Capital Group. The proprietary investment boutique with capital allocations to private equity and wholesale financial market trading. Cardinal’s private equity investments are focused predominantly in financial services. Nigel was a founding Director of International Investment & Underwriting (“IIU”), a proprietary investment vehicle regulated by the Central Bank holding memberships of the London and Dublin Stock Exchanges. Nigel was responsible for capital allocation both to internal trading strategies and external investments. Prior to establishing IIU Nigel co-founded NCB Group. Nigel is also a Fellow of the Chartered Institute for Securities and Investment (FCSI). Nigel has been responsible for leading some of the biggest acquisitions in the pharmacy industry this year including the takeover of Sam McCauley’s.

Enhancing customer care across the communities Dervila is Head of Marketing at LloydsPharmacy. After a comprehensive in depth customer research study it was apparent that LloydsPharmacy needed to reposition to highlight their relative strengths and USP.Dervila developed a new brand and marketing strategy that is customer centric and focuses on delivering the best customer care and experience. This new strategic direction puts colleagues and customers at the heart of their business with new tagline “Say hello to the people that know”. LLoydsPharmacy now has a clearly defined mission and brand purpose and the colleague’s priority is to use their expertise to help customers achieve a positive healthier life. Dervila overseen the integration and alignment of the strategy highlighting the 15,000 hours of colleague training each year, raising awareness and running customer information events and clinics across their 94 stores on Diabetes, Asthma and Heart Health, organising quarterly national Blood Pressure measurement days in the pharmacies, collaborating with charity partners for research, training, PR and eventing, proactively communicating with customers on health and well-being through PR, social media, bloggers and influencers including the first ever Facebook live interview on preventing Type2 Diabetes with Dr Bryne, Jules Coll and a Lloydspharmacy pharmacist. Dervila and her marketing team have coordinated and led these initiatives delivering growth across the key brand and marketing KPI’S and enhancing customer care across the communities.

Dervila McGarry, Head of Marketing, LloydsPharmacy

Mentor in McCabes

Catriona McGovern, ISSUE Supervising Pharmacist,2018 McCabes Pharmacy, Ballymun

In February 2015, Catriona was appointed to the position of Supervising Pharmacist at McCabes Pharmacy, Balymun. Working in the local community of Ballymun for a number of years, Catriona has great understanding of the patient base and continuously involves herself in numerous community projects. Working with a local business, Catriona has involved herself in an action group in order to improve the community and the lives of individuals in Ballymun. Catriona leads by example and is seen as a mentor at McCabes Pharmacy and believes in maximising the potential of everyone on her team.

FOR FIRST AID NEEDS FOR FIRST AID NEEDS


DYNAMIC 100 - 2017

The People’s Pharamcist Kilian is third generation pharmacist who has been involved in the development of McGreals Pharmacy for over 15 years and has taken his business from a thriving pharmacy in the heart of Blessington to 8 new McGreals Pharmacies across Leinster. Kilian also recently completed the development of a state of the art Primary Care Centre in Co. Wicklow. In 2017, Kilian received the prestigious People’s Pharmacist of the Year Award in 2017 – The only award nominated and voted for by the general public to which Kilian received an overwhelming 9000 votes on social media for. Since winning the award, his business has seen a great response since winning the award and Kilian continues to dedicate his work to the business becoming the integrated patient care specialist.

Kilian McGreal, Pharmacist, McGreals Pharmacy

Pharmaceutical Pride in manufacturing Graduating with a degree in Pharmacy from University College Cork in 2010, Peter worked as a Supervising Pharmacist with the Mari Mina Pharmacy group before starting with QM Specials in 2012. Part of the Quantum Pharmaceutical group, QM Specials was founded in 2008 and is currently the only EMP manufacturing facility licensed by the HPRA on the island of Ireland. Based in Lismore, Co. Waterford, Peter leads a team of 14 people comprising of pharmacists, skilled operators, quality and customer services staff and supplies wholesale and compounded medicines to both pharmacies and hospitals alike. In a competitive marketplace, Peter takes great pride in providing a 24-hour turnaround on manufactured items as well as outstanding customer service that has helped attract the loyal custom of hundreds of pharmacies. Through Peter’s leadership and vision, QM Specials is looking to lead the way in the conversion of unlicensed to licensed medicines in Ireland in the near future.

Peter McNally, Managing Director, QM Specials

President of the Pharmacy technicians Elaine left Uniphar/Allcare in February 2017 after successfully completing a greenfield project. During that project she reduced Rejections to the PCRS from 16% to 0% by training staff and auditing. Elaine then launched her own private consultancy Pharmacy Wizard, a role which she has relished. She was also voted in as President of the Irish Association of Community Pharmacy Technicians, a voluntary role which she is honoured to uphold despite many challenges. Elaine was also asked to be a judge at the IPN Awards in May 17. Elaine Lorigan McSweeney, President, Irish Associations of Community Pharmacy Technicians


Providing Pharmacy Partners Pharmax Buying Group has grown significantly since it was founded just over 15 months ago.Pharmax.ie, through its supply partners, provides group negotiated medicinal and front of shop products through its software which interacts with pharmacy dispensary and EPOS systems. Simple procurement solutions are the foundation of the business and that is the company’s principle aim, however Pharmax has recently expanded procurement solutions and innovation in areas of EPOS ordering and significantly around business reporting. While providing highly discounted medicines efficiently is critical, reporting on missed opportunities and margin improvements are vital in a competitive business environment. This will help independent pharmacy remain independent and reduce workload on pharmacy staff. This is where real innovation in dispensing and service provision will be provided. Pharmax will expand its independent pharmacy base further in 2018 and continue roll out of services to members. Paddy Meehan, Managing Director, Pharmax Buying Group

Evolving Pharmacy

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Vitamins, Mi erals and Supplemi"ts

Ultan is a pharmacist with a successful community pharmacy business in Co. Mayo. He has moved his focus in recent years to working with other pharmacists and pharmacies. Ultan has developed a profitable community pharmacy business in a way that it delivers to their customers, their staff, and to him as the business owner. He works with others in the pharmacy sector to achieve this for themselves and their businesses. Ultan is an executive performance coach and teambulder and through his venture, PharmEvolve, assists others in developing their businesses and personal goals. He works with them to gain clarity and then implementing what they need to apply to move things to their next level. His pharmacy business is a recent nominee for the International Coaching Foundation at the Coaching Culture in Organisations Awards and is a previous recipient of the Retail Excellence Ireland Mark of Excellence Award.

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Uniphar are delighted to launcH our new Vitamins, Minera Supplements range. It marks the next step for Uniphar, as Ultan Molloy, Proprietor pharmacist at HealthWest Community Pharmacy

Marron’s mentor Jonathon Morrissey, Supervising Pharmacist and Director of Marrons Pharmacy Kildare is also a Consultant Pharmacist on Value Added Services. Started by his Grandfather, Marrons Pharmacy started in 1957. Jonathan is extremely active within the local pharmacy community and won the Actavis Education and Mentoring Bursary in 2017 for his Community Pharmacy Triage idea, which sees Jonathon able to help people get better diagnosis for their ailment and more importantly understand their diagnosis. As well as continuing to help lead pharmacy services across the country, Jonathon continues to keep Marron’s a thriving business and is a previous winner at the Irish Pharmacy Awards. Jonathon Morrissey, Supervising Pharmacist and Director, Marrons Pharmacy

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DYNAMIC 100 - 2017 Caring Community Pharmacist Often described as Mr C.A.R.E by his colleagues, Conall is a true community pharmacist with a passion for helping people in his pharmacy and the community. Conal upholds high professional standards in his work with great attention to detail and a focus on maintaining high governance standards for patient safety. He has an innovative approach to addressing the healthcare needs of the local community and has hosted a number of health promotion events in his pharmacy.

Conall Mulhern, Pharmacist, Boots Pharmacy, Rathmines

Customer Experience in Pharmacy Johnny is the commercial director for A. Menarini consumer. The company is a fully owned subsidiary of A. Menarini Farmaceutiche Rinute which is a Florence based research and development pharmaceutical company established in 1886. The Irish division of the company began trading in 1999 and the company markets products across a number of therapeutic areas. Jonny this year was responsible for conducting the “Customer Experience in Pharmacy” survey which seen an overwhelming response. The company also has sponsored a number of awards this year including the Irish Pharmacy Awards. Johnny Murphy, Commercial Director, A. Menarini

Professional Pharmacy advice Linda from Kieran’s Avenue Pharmacy is an award winning Pharmacy counter assistant. Previously, Linda was crowned KRKA Counter Assistant of the Year at the IPN Pharmacy Awards. Linda has excellent customer service skills and ability to connect with customers, having undergone extensive OTC training so that she can offer the highest professional advice to her customers. Linda employs her professional role as a beautician running the in-store beauty room & nail bar. In addition to this Linda runs several workshops throughout the year including nail art camp, makeup tutorials & private masterclasses. Linda Nevin, Counter Assistant, Kieran’s Avenue Pharmacy

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DYNAMIC 100 - 2017 HPRA Innovation Dr Lorraine Nolan is the Chief Executive of the HPRA, a position she took up in 2015. Within this remit she has continued to maintain and drive excellence across the Irish healthcare products regulatory sector to ensure public and animal health protection. Developing the role further, Lorraine has expanded the scope of engagement of the organisation, with the launch of the HPRA Innovation Office and subsequent innovation stakeholder event. In the context of an ever-changing external environment, she continues to prioritise communication with stakeholders and to promote timely, appropriate access to medicines. Her key priority for the year ahead is enhancing the HPRA’s role in the coordination of medicines shortage management.

Lorraine Nolan, Chief Executive, HPRA

Driving Retail Services David joined the Uniphar team in December 2016 bringing with him over fifteen years of senior commercial FMCG experience having previously worked with both the Kerry Group and Coca-Cola Hellenic. Since joining the retail services division; he has been responsible for driving the commercial and sales strategy with a particular focus on unlocking category growth opportunity and retail pharmacy margin expansion. David holds a Masters from UCD along with an International Bachelor of Commerce from NUI Galway. David O’Brien, Commercial Director, Uniphar Retail Services

Success with Social media Joanne, originally from Co. Tyrone is a qualified marketing professional who has experience working in HR, sales and marketing. A key member of Meaghers group management team, Joanne has been integral to the growth of the business. Passionate about retail and the role of the pharmacist within the community, Joanne leads Meaghers in a collaborative and engaging manor in order to deliver the very best for the customer. In 2017, Joanne has been leading the social media revolution in the pharmacy at Meaghers and has been integral in the companies popular use of snapchat to diagnose patients.

Joanne O’Hagan, Area Manager, Meaghers Pharmacy Group

Entrepreneur of the year Its been a busy year for Oonagh. She was named as lead on the Cycle 9 Going for Growth Campaign which supports female entrepreneurs grow their business. She was also elected back onto the Preliminary Proceedings Committee in the PSI and now named as Acting Chairperson and has taken up a second term on the Finance committee of the Royal College of Surgeons. This is as well as taking u her new board position Pharma Medicine Insights. Her company Meaghers Pharmacy Group was named again as a Deloitte Best Managed company and heading for Gold Standard this year and to top it all of she was also named as Image Magazines Entrepeneur of the year.

Oonagh O’Hagan, Owner and Managing Director, Meaghers


Digital age of Healthcare Maria is the digital advisor to eHealth Ireland and throughout 2017 has driven a change in the way digital in healthcare is perceived by the entire healthcare system. In the spring of 2017 the digital maternity strategy was created, this document was the fastest strategy ever produced created in a 24 hour period ‘live’ from every maternity unit in Ireland and published by the minister for health on the same day. Maria is one of the leaders in the EU wide Digital Health Society taskforces, she has been instrumental in the creation of the EU wide Health Cloud Council and in the autumn of this year founded One Health Tech Ireland, a networking group focused on the creation of a networking group to increase diversity in health technology. Maria O’Loughlin, Digital Advisor, eHealth, Ireland

Pharmapod for the Maple Leaf

Leonora O’Brien, CEO, Pharmapod Ltd

Ms. Leonora O’Brien founded and serves as the Chief Executive Officer of Pharmapod Ltd. Ms. O’Brien MPSI has 16 years’ experience in community pharmacy practice, policy development and regulatory affairs at a national and EU level. Prior to founding Pharmapod, Ms. O’Brien worked as Pharmacy Governance and Professional Development Consultant for the PSI - the Pharmacy Regulator in Ireland. She was also one of 11 members of the National Pharmacist Reference Group in Ireland (NPRG) which was established by the PSI to progress and facilitate the expansion of the professional services role of the pharmacist. In 2017 the company was selected by the Ontario College of Pharmacists (OCP) to implement a medication safety program across all the pharmacies in Ontario.

Doctorate for discovering Juliette O’Connell is a second year PhD candidate in the School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin. Juliette completed her BSc (Pharm) in Trinity College and MPharm in RCSI and qualified as a pharmacist in 2014. She worked full-time in community pharmacy prior to commencing her doctoral research in 2016. Her research interest is medication burden on older adults with intellectual disability. This research focuses on the Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing (IDS-TILDA). She is carrying out this research under the supervision of Dr Martin Henman and Dr Máire O’Dwyer.

Juliette O’Connell, PhD Student, Trinity College Dublin

Virtual Journey to Pharmacy

Stephen O Donoghue, Country Board Member, United Drug

An industry veteran of over 30 years, Stephen O’Donoghue is proud to have been part of a team that achieved growth in all areas of the business in 2017, despite operating in what continues to be a challenging industry. Stephen was appointed to the Country Board of the combined United Drug and LloydsPharmacy business in 2017 and leads by example in delivering best-in-class service to United Drug’s customer base. In particular, Stephen notes the success of this year’s United Drug Pharmacy Show. Now in its 11th year, the Pharmacy Show remains the number one event in the retail pharmacy calendar, attracting sell-out crowds every year. This year’s Pharmacy Show showcased United Drug’s continuing investment in technology, taking visitors on the virtual journey of the tote from warehouse to pharmacy. Stephen is a graduate of The Marketing Institute of Ireland. He has held various Marketing, Commercial and Purchasing roles within the business and is now Director with responsibility for procurement. Stephen has an in-depth knowledge of how to develop and maintain long-term supplier partnerships, coupled with a very strong commercial acumen.

working together to deliver value


Injecting insulin? You wouldn’t use this...

so why use this? NEW

PEN NEEDLE*

USED

PEN NEEDLE*

x370 times zoom

one injection = one needle 4 Less painful injections1

4 Only for single use

4 Reduced contamination of the needle1

4 Re-use of Insulin pen needles is associated with the development of Lipohypertrophy2

4 Reduced damage to your skin1

Talk to your pharmacist or diabetes specialist for more information.

Lipohypertrophy is a build up of fatty lumps that may develop from improper injection technique1 3. BD Medical – Diabetes Care, 1030 Eskdale Rd, Winnersh, Wokingham RG41, UK Tel: +44 (0) 118 921 600 * Photographs showing the kind of damage that can occur with needle reuse. Photographs from Dieter Look & Kenneth Strauss : “Nadeln merfach verwenden?” Diabetes Journal 1998, 10 : S.31-34 1.

Misnikova I.V. et al. The risks of repeated use of insulin pen needles in patients with diabetes mellitus. Journal of Diabetology 2011; 1:1-5

2.

Blanco M, Hernández MT, Strauss KW, Amaya M. Prevalence and risk factors of lipohypertrophy in insulin-injecting patients with diabetes. Diabetes Metab. 2013 Oct;39(5):445-53.

3.

Definitions from Medline Plus, an online service of the US National Institutes of Health (NIH)

The Guaranteed Irish Mark is a Trademark™ of Guaranteed Irish. Based on all pen needle production after January 1st 2016 in Ireland. BD, BD Logo and BD Micro-Fine are trademarks of Becton, Dickinson and Company. © 2017 BD


DYNAMIC 100 - 2017 Whole world of Food Ronan joined wholefoods over 3 years ago having come from a long established sales background in both health and giftware, making him a strong asset to the wholefood sales team. Ronan has been instrumental in increasing sales for the company as well as winning new brands to promote. Wholefoods is Irelands largest and longest established wholesaler of natural products and healthcare. From their distribution facility based in Dublin, they are a nationwide Irish wholesale distributor of over 8,000 products lines and represent the leading market brands.

Ronan O’Flynn, National Account Sales Manager and Brand Manager, Wholefoods

Leading the way online Director and Superintendent Pharmacist based at Inish Pharmacy, Buncrana Co. Donegal. With a community pharmacy background, Paul is passionate about excellent patient care and takes a multichannel approach to growing the business. His determination to make www.inishpharmacy.com the leading online pharmacy in Ireland, along with his dedication to customer services has led him to have one of the most successful e-commerce businesses in the country. Inish Pharmacy has the customer at the heart of everything they do. Which is why they offer their delivery service, which guarantees delivery of a prescription by 9am the next day provided it is ordered by 4pm the day before. Paul’s progressive and open mindedness in embracing both technology and trends has improved all the services Inish Pharmacy offers, such as physiotherapy, podiatry and audiology in their consultation rooms. Paul O’Hea, Director and Superintendent Pharmacist, Inish Pharmacy

Circle of Life for Brands Sean is GSK’s National Accounts Manager working primarily in the company’s Classic & Established Products (CEP) division. Sean started working for GSK in 2003 and has held several different roles both in the Pharma & Consumer Healthcare businesses. He currently manages the National hospital and retail pharmacy business as well as having life cycle brand responsibility for some of the company’s best known brands. The Classic and Established Products division continues to be a star performer for the company as a whole, with some of the more traditional brands enjoying all time market share highs. Sean has developed a vast network across all aspects of the pharma supply chain and is respected for both his business acumen and his customer relationship management. Sean graduated from DIT and Trinity College Dublin with a B.Sc in Marketing.”

Sean Hyde, National Accounts Manager, GSK

Reaching Retail Pharmacy Paul is Sales Director of Easilocks and is responsible for launching the brand into retail pharmacy as well as structuring the company to maximise sales and growth. The company started 3 years ago and has since been going from strength to strength. Previous to Easilocks Paul was Area Sales Manager for Eurosales International and responsible for maintaining and developing key national account relationships as the large independent portfolio in both Pharmacy and Grocery channels for the company. Paul O’Neill, Sales Director, Easilocks


DYNAMIC 100 - 2017 All in Aid of Charity Feargal is Key Accounts manager at IQVIA where he delivers Pharmacy panel management ,consultancy services and project co-ordination services to 100’s of pharmacy clients. Feargal is known for his avid support of charities such as Hugh’s house and has organised a number of fundraising events to raise money for non for profit organisations. In 2017 his most recent fundraising achievement consisted of organising a cycle which saw 23 volunteers cycle cross country through 650km of road travelling from Mizen Head, West Cork to the Innishtown peninsula, Co. Donegal, raising ¤50,000 for charity Hugh’s House.

Feargal O’Shea, Key Accounts Manager, IQVIA (formely Quintiles IMS)-

Encyclopedic knowledge - Paula O’ Sullivan has a vast knowledge of community pharmacy having worked in this field for the past 30 years. She began working in Sam McCauley Chemists Tralee when it opened in 2002 and she qualified as a technician in February 2006. Paula is committed to enhancing her skills and staying current on Pharmacy trends. She reads articles on new medications and receives in-house training from her supervising pharmacist in many health topics including Asthma, COPD, Diabetes, Epilepsy and many more. She has completed a number of OTC training courses
to keep her knowledge on this field updated also. Paula is extremely experienced in all areas of Pharmacy, she has an almost encyclopaedic knowledge of medicines and OTC products. She supports her colleagues and can quickly assess and determine the best treatment course for patients when asked for her recommendations.

Paula O’Sullivan, Sam McCauley Chemists Tralee

Pharmacy to your door Shane O’Sullivan, CEO, Healthwave Pharmacy – Shane is CEO of Healthwave Pharmacy, a pharmacy that was started to give Irish people access to affordable medication and delivering it straight to the door of the patient. Shane takes a different approach to his pharmacy practice believing that community pharmacies should be set up more like hospital pharmacies in that there should be a team of pharmacists sharing expertise. The company has recently launched a new website myprescription.ie which allows patients and doctors to see whether a generic version of a medicine in available in Ireland. It also allows them to easily compare medicines by price and calculate potential savings. So far the website has generate thousands of enquiries every week. Shane also makes home visits to patients personally and sits down with them to talk about their prescription. This method gets great results as patients tend to be more open about medical issues in their own home and Shane finds he can better assist a patient and address their needs. Shane O’Sullivan, CEO, Healthwave Pharmacy

Offering additional Alternative Services

Laura Phelan, Superintendent Pharmacist, Bagnalstown Pharmacy

Laura is Superintendent Pharmacist at Bagnalstown Pharmacy in Co. Carlow. The pharmacy, established by her mother, Anne Phelan 30 years ago, the pharmacy has always believed in providing additional services in the community. The staff at Bangalstown Pharmacy have undergone training in homeopathic therapies and have always had an interest in complementary and alternative therapies (CAM). Laura’s belief that Homeopathic medicines definitely have a place alongside allopathic treatments, allowed the pharmacy to offer kinesiology as an additional service to patients. Looking at CAM therapies with an open mind Laura knows how alternative therapies can be used to help patients who are unable to take more ISSUE traditional remedies due to drug interactions. Laura believes it’s important to be able to offer patients with 2018 more choice in their health decisions and whilst she would never suggest that CAM therapies will cure cancer, they can help patients achieve a better state of mind alongside traditional remedies.

FOR FIRST AID NEEDS FOR FIRST AID NEEDS


Leading the way with Innovation

Michelle Quinn, Superintendent Pharmacist, Burren Pharmacy

Michelle Quinn is Superintendent Pharmacist at the Burren Pharmacy, an independently owned, progressive and busy community pharmacy based in Lisdoonvarna, Co. Clare. Michelle has introduced many innovative services and new technologies to the Burren Pharmacy in recent years. Two specific examples includes spirometry testing and atri fibrillation diagnostics. At the Burren Pharmacy, Michelle and her team continuously strive to improve the level of service offering to patients. Patient led care is central to what the Burren Pharmacy is about; knowing and understanding the individual, their circumstances and their needs. Michelle has also directed significant efforts over the last year into improving counter staff procedures through training. Over the last year, several event days have been run in the Pharmacy including skin clinics and bump to baby days. These event days help to promote the Pharmacy and allow customers access to knowledgeable professionals whom they can ask for specialist advice on their particular concerns.

Shining a light on investment In April, Paul Reilly, Managing Director of the combined United Drug and LloydsPharmacy business, announced a ¤40m investment in technology and innovation at its headquarters at Magna Park in Citywest, Dublin. The investment centred on enhancing systems and technologies at the company’s headquarters to further support the business in providing best-quality healthcare solutions to pharmacies, who, in turn, can focus on delivering the same to their patients. United Drug is already seeing a return on this investment and, according to Paul, will continue to invest in technology, particularly automation, to maintain the company’s high operational and quality standards. More recently, Paul Reilly led colleagues in support of this year’s annual Focus Ireland ‘Shine A Light Night’. Paul joined hundreds of other business leaders in the annual sleep out at Christchurch Cathedral, while other colleagues held their own sleep out in Magna Park. Paul graduated from the University of Limerick with an Industrial Engineering Degree. Prior to becoming Managing Director of United Drug in 2014, he held several senior roles in Engineering and Operations across Ireland and North America through which he has developed extensive leadership, strategy development, operational and risk management skills.

Paul Reilly, Managing Director, United Drug

Pharmacy Professor

Eugene Renehan, Superintendent Pharmacist, Meaghers Pharmacy Group

Eugene is Superintendent Pharmacist for the Meaghers Pharmacy Group. Eugene graduated with a B.Sc. (Pharm.) from TCD in 2005 and has a Diploma in Leadership and Management. Joining Meaghers in 2007 he progressed up through the company and as superintendent Eugene now oversees the work of over 80 employees. Eugene had a keen interest in developing the role of the pharmacist and oversees the Meaghers Intern Programme. In October of this year Eugene became an Adjunct Assistant Professor in Practice of Pharmacy in Trinity College. As part of the Higher Management Team Eugene plays an integral part in Business Development and is working with new technologies to improve patient’s access to quality pharmacist information. The Meaghers.ie Snapchat handle allows a younger demographic the opportunity to engage with their pharmacists at an earlier stage and has proven to be incredibly successful. In the past year Eugene won Superintendent Pharmacist of the Year and on top of this Meaghers were awarded Deloitte Best Managed Company for the third year running. Earlier this year he was appointed to the Drugs and Therapeutics committee in the Mater Misericordiae University Hospital and is the Community Pharmacy (Groups) appointee to the IIoP Steering Group and a Strategic Advisory Board member for the School of Pharmacy and Pharmaceutical Sciences Trinity College Dublin.

Practical Pharmacy Education In 2016, Róisín took up the newly established role as APPEL Practice Educator at the RCSI. Róisín utilises her 20 years of practice experience, in both community and hospital pharmacy, to prepare and support RCSI’s students for the practice placements they now undertake in the 2nd, 4th and 5th year of the new integrated pharmacy programme. In addition, her role involves recruiting, training and supporting pharmacists who would like to provide experiential learning placements to pharmacy students. During her career Róisín has practiced at the Coombe Women’s Hospital, the Royal Women’s Hospital Melbourne and at the Mater Private Hospital. She completed her degree in pharmacy at Trinity College Dublin and holds a Certificate in Health Promotion from NUI Galway, and a Postgraduate Diploma in Clinical Pharmacy Practice from Robert Gordon University.

ISSUE

2018

Roisin Reynolds, APPEL Practice Educator, RCSI


DYNAMIC 100 - 2017 Prize Pharmacy Rep Sophie is a pharmacy representitive at Pamex. The company specialises in the promotion of prescription pharmaceutical medicines and personal healthcare products to the Irish consumers. Sophie travels around the company providing the best quality customer service and information to all her customers. Her expertise and dedication to providing the best representation of pharmaceutical products won her the coveted title of Pharmacy Representative of the year at the 2017 Irish Pharmacy Awards.

Link up

Sophie Rickleton, Pharmacy Representative, Pamex

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Vitamins, Mi erals and Supplemi"ts

&

Focus on Pharmacy Investment opportunities Dan is owner of Frawley's Pharmacy, with a wealth of experience, Dan has been instrumental in the pharmacies growth in sales and profitability. Always looking for an opportunity, Dan is currently looking for new projects to invest in and provide his extensive knowledge to. His primary focus is early stage, pharmacy retail, medical and pharmaceutical businesses which he can get involved with. As well as a source of investment and knowledge, Dan is also a strong advocate for the community, often participating in events that help the patients better understand ailments and conditions. Recently Dan participated in the Age Friendly event Roscrea, where he provided older people with advice and information on Osteoporosis.

Uniphar are delighted to launcH our new Vitamins, Minera Supplements range. It marks the next step for Uniphar, as

Dan Ryan, Owner and director of Frawley's Pharmacy

Peer support in Pharmacy Dr. Paul Ryan co-founded Pharmabuddy which is an online free pharmacist resource having over 2,000 Irish pharmacists registered and over 200 logging on over day solving every day problems encountered in a pharmacy. He also launched an online version of Prescription Revision which has clinical tutorials for pharmacy and medical students. Paul is a clinical pharmacist, a General Practitioner, a peer support pharmacist with the IIOP and an IPU academy tutor. Paul Ryan, Co-Founder, Pharmabuddy

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Going back in time

Astrid Sasse, Associate Professor, Trinity College Dublin

Using a novel approach combing oral history and research in the (Irish) National Folklore Collection at UCD a team of researchers from Trinity College Dublin, led by Assoc. Prof. Astrid Sasse, and the UCL School of Pharmacy, UK just published ground-breaking research which sheds new light on the early history of Ireland and the role of medicinal plants during this period. In the 1930s, a concerted effort was made to collect information on ‘Irish folklore’ where thousands of children were sent out to interview family and friends about a wide range of topics. The material was deposited at the Irish Folklore Archive at UCD with over 700,000 pages of information, including ethnomedicinal and ethnobotanical traditions. In 2016 the research team around Astrid Sasse contacted the last remaining survivors who had participated in this survey and interviewed eleven of them on their recollections and understanding how this survey has impacted on the way Irish culture is perceived by those who participated. Astrid Sasse is an Associated Professor in Pharmaceutical Chemistry at the School of Pharmacy and Pharmaceutical Sciences with a research interest in histamine receptors as well as traditional and alternative approaches to health.

Innovators in IT in the Pharmacy Daire Scanlon Bsc (Pharm) MPSI, founder of Scanlons Limitless health pharmacies in Limerick & Dublin. Daire believes automation further enhances patient care. Scanlons’ partnership with Synmed rx guarantees patient care, delivering a 99.98% dispensing accuracy and obeying the 10rights with respect to medication dose, time of administration, name of medication & batch number, unique patient identifier through the barcoding relationship between patient and medication. Using an automated blister pack fulfilment along with PMR as part of the blister, Scanlon’s consider themselves innovators and have unique IT solutions such as their e-mar, their easily designed integrated pharmacy service to residential and care home facilities.

Daire Scanlon, Founder, Scanlon’s Limitless Health Pharmacies

Proceeding with Practice Review Michelle is the CPD Quality Assurance Pharmacist & Practice Review Lead at the Irish Institute of Pharmacy. Working there since 2016, Michelle has been instrumental in the IIOP’s vision for Practice Review, which is being introduced to pharmacists this year. The ePortfolio Review is the process by which pharmacists are required to submit an extract from their ePortfolio which demonstrates that they are appropriately engaging in CPD. The IIOP ePortfolio Review process enables pharmacists to submit extracts from their ePortfolio for review by the IIOP.

Michelle Scott, CPD Quality Assurance Pharmacist & Practice Review Lead, IIOP

Promoting the Profession Neil Sokay is a second generation pharmacist serving the community in Kells. Following in the footsteps of his father Jai who took over Lynch’s totalhealth Pharmacy in 1992, In 2017 Neil, opened a state of the art pharmacy in the heart of Kells, and has gained a big following, due to his embrace in the use of social media. Creating informational videos on pharmacy related topics and promoting the profession, Neil is an example of a modern pharmacist and is as popular as he is on social media with colleagues and the community in Kells.

Neil Sokay, Pharmacist, Lynch’s totalhealth Pharmacy

PROVEN'

®

PROBIOTICS

Proven Probiotics is a revolutionary range of products for intestinal


DYNAMIC 100 - 2017 Home from Home at Hugh’s House Following the tragic death of her son, founder of Stack’s pharmacies, Ade Stack was inspired to embark on a project that has opened a house to provide a temporary but very real home for the parents of sick children, called ‘Hugh’s House’. She has created a ‘home from home’ for parents with sick children and ended last year with a People of the Year award for her work. This year has been spent working on opening a second house, just next door. Ade purchased her first Pharmacy in Skerries in 2000. Her second pharmacy, in Darndale North Dublin, followed less than a year later. Stacks has now grown to more than 16 pharmacies.

Ade Stacks, Founder, Hugh’s House

Forwarding Fertility Graham Stafford founded Ocean Healthcare 15 years ago. Ocean Healthcare is recognised as a leading sales, marketing and distribution company within the Irish market. Ocean has a varied range of innovative brands within its portfolio. In March 2017 Ocean introduced the unique advanced fertility supplement PROCEIVE®. PROCEIVE® was the result of five years of research and development by fertility experts. "PROCEIVE® is the most tailored and comprehensive pre-conception supplement on the market, it is now recommended by many of the fertility clinics in Ireland" say Stafford. Educating pharmacies on Ocean's range of healthcare products as been a key objective for 2017, it has given great results and has been embraced by our customers. "At Ocean we have built a great sales, marketing and customer service team to support the brands we manage" says Stafford, Managing Director. Graham Stafford, Founder, Ocean Healthcare

Complete Customer Service Pharmacy runs in the family for Joanne whose parents ran a pharmacy for over 50 years. Since then Joanne has prided herself on her customer focused ethos. Joining family run business Stauntons Pharmacy Group in Castlebar as a Supervising Pharmacist, Joanne is very proactive in offering a wide range of services to the customers in the pharmacy having completed a number of training courses such as administration of medicines, heart saver AED and epipen injection. Joanne has also been the driving force behind a number of information and awareness days that the pharmacy has held which is something she enjoys. The events are always a huge success and patients receive friendly, practical and correct advice on topics such as Diabetes, Osteoporosis and Smoking Cessation.

Joanne O’Brian, Pharmacist, Stautons Pharmacy

Skin Deep

Dayna Stirrat, Pharmacy Technician, Higgins Pharmacy

Dayna is caring, diligent forward thinking pharmacy technician. Her expertise in dealing with customers and ordering is something she strives to better in order to benefit the business and the customer Dayna has an indepth knowledge of skincare and has done a lot
of extra training courses and CPD in this area. She has built up one of the biggest Decleor accounts in the North West. As well as a qualified technician she is also a qualified beautician and has enormous interest in improving and selling the cosmetics and skincare ranges.


Prestigious Brands for Pharmacy Padraig is the Managing Director of Eurosales International which brings innovative independent brands to the Irish market. Bringing in additional beauty sales experts and appointing a Pharmacy Group Sales Manager, Padraig has been responsible for bringing in a vast range of prestigious cosmetic brands that add category value to the pharmacy channel in Ireland. Eurosales has strived to adapt to changes in the market and aims to deliver and drive elusive cosmetic brands to Irish pharmacy.

Padraig Stokes, Managing Director, Eurosales

Customer Centric Cormac 2017 has been another busy year for Cormac Tobin, managing director of Celesio UK, a leading provider of integrated healthcare services.Their family of brands has enjoyed a successful 12 months. This has included Lloyds Pharmacy being named as the UK’s most customer-centric brand, AAH was recognised as the UK’s most trusted pharmaceutical wholesaler, Lloyds Pharmacy Online Doctor won the digital customer experience of the year, John Bell & Croyden was again granted the Royal Warrant which means they dispense medicines to the Queen and Betterlife won retail store design of the year. Cormac’s vision for Celesio UK is all about creating a healthcare eco-system which operates at the intersection of the digital and physical worlds so customers and patients can live life to the fullest. He was appointed managing director of Celesio UK in 2013 after successfully leading their operations in Ireland. Prior to that he enjoyed a successful seven year period leading DocMorris and Unicare Pharmacy in Ireland. Cormac Tobin, Former Managing Director, Celesio

Community Pharmacist of the Year Nial Tully is a 3rd generation pharmacist working in the family Pharmacy which his grandfather started in 1940. Nial has proudly worked alongside his father to lay proper foundations allowing them to reach set goals. Nial was recently the winner of Community pharmacist of the year 2017 at the IPN awards and his team were also awarded the totalhealth ‘Community Pharmacy Team of the year’ 2017 at the totalhealth annual awards. Nial as a totalhealth member and current Board Member, has used his involvement with the group to ensure excellence in his own business but also make sure other members benefit from members learning and he has been instrumental in managing members support areas within the group.

Nial Tully, Pharmacist, Tully’s totalhealth Pharmacy

Quality Dispensing Dermot established Cloyne Pharmacy in Cork in 1997. Since then he has expanded his pharmacy three times over the past 18 years. Dermot set up the first pharmacy led anticoagulation clinic in Ireland in early 2010 for patients who were prescribed warfarin. He completed extensive training in both University College Cork and Cork University Hospital and ensured his clinic met international standards for the provision of anticoagulation services. Dermot has since provided the service to over 90 patients locally and has carried out over 3,200 International Normalized Ratio (INR) checks. In 2017 Dermot has turned his attention to quality and risk assessment in dispensing at making this subject area, an area of expertise.

working together to deliver value

Dermot Twomey, Owner, Cloyne Pharmacy, Cork


Winter Wellness

LloydsPharmacy encourage people this winter to be “The best version of you” Dervila McGarry, Head of Marketing at Lloyds talks about why its important to be prepared this winter. 1. What is the aim of the campaign? The Best Version of You campaign is about raising awareness of the in-store services provided by LloydsPharmacy colleagues across the 94 stores, to help customers to get winter ready. Committed to ensuring our service is best-in-class, Our colleagues have collectively undergone 15,000 hours of training over the last twelve months. This means we’re able to provide our customers with important services, like the flu vaccination, as well as personalised healthcare programmes and advice for medication, pain management, asthma, diabetes, skin care, and heart health. The results have been incredibly positive. We’ve had buy-in from a number of influential health and wellbeing bloggers, and this has helped to drive customer footfall. 2. What do you hope patients do this winter to better prepare i.e going to their local pharmacy to get vaccinated etc Winter is a season for celebration and family, but the chilly weather can bring an abundance of bugs, like the cold and flu viruses. Customers can talk to their local pharmacist and get advice on keeping winter bugs, sore throats and flus at bay. A few simple changes during winter can help to stay in tip top health during the winter months. Things like adding more vitamin C rich foods into the diet or boosting your diet with a multivitamin can all help in keeping healthy during the winter season. Getting the flu vaccination will give peace of mind, even to those who don't fall in traditional ‘at-risk’ categories. The flu vaccine is now available in 32 of the LloydsPharmacy stores with customers in the at-risk categories eligible to get it for free.

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Laura Dowling, Managing Pharmacist at LloydsPharmacy with a patient

Customers can fortify their immune system by staying hydrated, taking multivitamins, and making sure they continue to eat, exercise and sleep normally. Winter dryness also plays havoc on skin, especially for those with dermatitis, eczema and psoriasis, so it’s important to prioritise skincare. LloydsPharmacy colleagues are trained to provide expertise in all these areas, particularly to customers with pre-existing conditions. 3. As well as this campaign what other benefits can customers expect? As well as a flu vaccination service, LloydsPharmacy provides a number of additional, value-added services all year round, like free blood pressure and BMI measurements, asthma advice (like inhaler technique and

compliance) and a prescription delivery service for those less able to get around. Our Colleagues have expertise in many areas of healthcare and chronic illness, so customers can expect a high standard of personalised care. 4. For the more at-risk patients (i.e older patients) how will the campaign help them? The Best Version of You campaign helps to raise awareness about the flu and encourage those at risk to be proactive about their health. Pharmacists are at hand to give advice, create tailored health plans and give tips to customers to help them be winter ready. Prevention is better than cure, especially for older patients or those in the at-risk categories.

5. Why is it important for a pharmacy to be prepared for this time of year and also patients why they should be aware of being prepared for this time of year? Naturally, winter is a busy time of year for pharmacies. People are more likely to get sick and come looking for treatment. The Best Version of You campaign is about being proactive: we want to stop people getting sick in the first place. We want our customers to be winter ready. By getting the flu vaccination, or taking a multivitamin or health supplement recommended by a specially trained LloydsPharmacy colleagues, the chances of being ill over Christmas and during the winter months are decreased.


Advertorial

Certified service providers facilitate GDP-compliant shipping The GDP guidelines require the pharmaceutical industry to ensure comprehensive, end-to-end safety along the entire supply chain. Managing Director Andreas Rickert explains how GLS Ireland prepared to meet the demands. The parcel service provider recently obtained certification according to GDP. Ever since the “Good Distribution Practice of medicinal products for human use” (2013/C 343/01) guidelines came into force across the EU, quality and duty of care obligations have extended far beyond production. Distribution managers within the pharmaceutical industry must, for instance, ensure that their products are monitored and delivered in an appropriate manner to authorised dispensers – i.e. pharmacies and hospitals. In the event that the services of a transport company are engaged, the guidelines state: “The contract giver is responsible for the activities contracted out.” In order to make it easier for interested customers to evaluate our services, we have introduced GDP compliance across the board at GLS Ireland. DQS, an internationally renowned audit company, handled the certification. Transparent safety We started by identifying the GDP requirements that we already met. We were able to build on the ISO 9001 certification of our quality management system, which has been regularly audited and updated since 2006. The safety and transparency levels required for our customers were already in place, not least due to our expertise in the shipping of high-tech products. Thanks to scanning processes at all links in the transport chain, the GLS IT system always records the precise location of a consignment at any given time. Using their dispatch system, customers have access to this information, giving them monitoring and documentation capabilities stipulated in the GDP guidelines. GLS’ standard security measures include parcel-specific video surveillance at depots and extensive building protection procedures.

New processes and qualifications Project teams from Sales, IT and Operations devised supplementary measures. Virtually the entire company was then involved in the actual implementation – whether at the Dublin head office and hub or at each of our six depots. Each and every employee was trained in GDPcompliant shipping – from the customer service team and the depot staff who sort the parcels through to the delivery drivers employed by our transport partners. Ultimately, they all make an important contribution to the pharmaceutical supply chain. We also introduced documented and more stringent hygiene management for all vehicles and sites within the Irish network, whilst preventive pest control measures were standardised. Certified quality across the board Our GDP certification covers non-temperature-controlled consignments nationwide. GLS Ireland ensures that medicinal products are delivered solely to the stated recipients and/or their business premises. On request, we will guarantee delivery of products provided by companies in validated thermal packaging within 24 hours. This means we can also deliver temperature-sensitive, passively temperature-controlled products with the appropriate packaging in accordance with GDP. In fact, evaluating and qualifying all the contractors with whom we work was the greatest challenge, also for us. Our successful certification makes this task easier for our customers in the pharmaceutical industry – and we look forward to offering them our high-quality parcel services.

Andreas Rickert, Managing Director, GLS Ireland

GLS in Ireland and Europe GLS Ireland went into operation in spring 2004, with the aim and aspiration of being the quality leader in Ireland. The company is a subsidiary of the GLS Group, which covers 41 European countries with its own companies and partner organisations. At GLS Ireland, high-quality parcel delivery means reliable shipping within a standard delivery time of less than 24 hours across Ireland (including Northern Ireland), minimal damage rates, a good price-performance ratio and a strong customer focus.

GDP in other countries GLS is also GDP-certified in France, Germany and Denmark. Expansion to other countries is already planned.

Interested in shipping with GLS? Call the Sales Department on 01 8606252 or mail at pharmasales@gls-ireland.com www.gls-group.eu

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Feature

The Trouble with Men: Masculinities and Men’s Health By: Finian Murray, Men’s Health Forum in Ireland

In general women are encouraged to be knowledgeable about their bodies, to recognise and acknowledge susceptibility to illness, and to freely express their emotions. The gender pattern for men is very different. So what is gender...? Gender Firstly, it is important to make a distinction between sex and gender. Sex relates to genetic make-up, hormones, body parts, in other words the biological and physiological characteristics that define males and females. Gender in contrast refers to differences between women and men that are socially constructed and may influence health behaviour and health outcomes. In a nutshell, sex is what you’re born with; gender is what you’re given, or sometimes, choose. We are born male or female, but we actively work out and negotiate what it is to be ‘masculine’ or ‘feminine’ that typically reflects societal expectations of particular masculine and feminine roles. This happens from the moment we are born. For example, one study analysed the words used about newborn babies by medical personnel attending births. Newborn male infants were described as ‘sturdy’, ‘handsome’ or ‘tough’; female infants were more often talked of as ‘dainty’, ‘sweet’ or ‘charming’, but there was no overall size or weight difference between the infants in question. Some people feel that their gender identity does not match their biological sex. This person may identify as transgender. Until recently gender and health has been identified with women’s health. However, new studies have started to look at the impact of gender on men’s health. This theme emerged in the 2001 men’s health report Men Talking, where the main finding was that ‘masculinity’ determines men’s decision-making processes and behaviour and has far-reaching implications for men’s health. More recent studies show that there is no one pattern of masculinity that is found everywhere. It is now more appropriate to think about ‘masculinities’ rather than ‘masculinity’ – reflecting different relations of power between men and women, and between different groups of men. The

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Australian sociologist RW Connell identifies the relations between and among masculinities in terms of hegemony, subordination, complicity and marginalisation. ‘Hegemonic’ masculinity refers to the culturally exalted position afforded at any given time to one form of masculinity over others, and emphasises many of the masculine traits associated with more traditional constructions of masculinity (‘big boys don’t cry’, ‘no sissy stuff’, ‘man up’ etc.). In today’s world it is often seen to be embodied in white, middle-class, heterosexual, highly educated, able-bodied, employed men. Sporting heroes are taken as exemplars of hegemonic masculinity. Hegemonic masculinity is defined against a range of subordinated (e.g. straight versus gay masculinity) or marginalised masculinities (e.g. Traveller men). A quote from one of the participants in the report Men on the Move captures it perfectly: ‘You’re asking me about the way men relate to men. I’ll tell you. It’s about dominance, acceptance, finding your place in the hierarchical structure. It’s not acceptable to show a soft side or weakness.’

Men’s Health Gender inequality is not just a women’s issue. An overview of the statistics on men’s health in Ireland confirms that men have higher death rates at all ages, and for all leading causes of death. Men often adopt poor lifestyles which are responsible for many chronic diseases and present late to health services, leading to some problems becoming untreatable. Men are less likely than women to report concerns relating to mental or emotional problems. Boys and young men continue to be socialised to appear in control, to be strong and to take risks. They are still brought up to believe that they must be tough and strong and behave as if they were indestructible (hegemonic masculinity). Subsequently, the young male learns to be stoical and suppress feelings and eventually fails to recognise the bodily symptoms that indicate he is heading for trouble. This is not just confined to boys. Men are also encouraged to conceal vulnerability, be stoic and independent, and may turn to unhealthy behaviours and indeed risk behaviours that are culturally defined as masculine. The extent to which men endorse ‘traditional’

or ‘dominant’ definitions of masculinity relates to unhealthy behaviours such as poor diet, excessive alcohol consumption, and the non-use of health services. However, the good news is that many of these conditions can be avoided and positive action can be taken. The National Men’s Health Policy in Ireland (http://www. mhfi.org/menshealthpolicy.pdf) acknowledges that men underuse pharmacies ‘despite their potential as a source of advice, information and self-treatment.’ Research highlights that Pharmacies can play an important role in promoting and improving the health of men and boys (www.mhfi.org/ menandpharmacies.pdf). Getting men to use local pharmacies more regularly, thus building a strong relationship with men is also good for business! Pharmacy staff can play a crucial gatekeeper role for men’s health. They are well positioned to talk to men about their health needs, explore possible options and if necessary suggest they may need to seek further expert assistance. Pharmacies have characteristics that men look for in a service, such as accessibility (no appointments necessary), flexibility and informality. Stores are


Irish natural health company expands into UK In 2006, brothers John & David Burke established ECI Natural Health as a company that produces and distributes premium natural health supplements into the Irish market. Their ethos has always been to offer products formulated using the latest in nutrition science that are safe and highly effective.

PREMIUM QUALITY Working closely with their Norwegian and Irish manufacturing partners their aim was always to be at the cutting edge of nutrition science and to be one step ahead of their competitors. “ Nature has provided us with powerful, effective and safe ingredients to work with and what we are producing today are simply amazing products compared to say 10 years ago”. Some best-selling products recently introduced into the Irish market include the likes of: Reumex Curcumin, Curminol, Arteri Gold, Crystal Mind and Crystal Dream. The company have recently turned their attention towards the UK market and look forward to expanding their product range throughout the UK during 2018. HEALTH CLINIC ECI Natural Health also runs a clinic providing a range of tailored health services and therapies, offering individuals Health Assessments, Personalised and Corporate Health Programs also including Heart & Stroke Screenings. EXPANDING SALES DIVISION The company is delighted to welcome two recent key additions to their sales force: Michael Griffin joined as a Key Account Manager in August 2017. Michael is very confident that ECI’s exciting product range will complement well the existing Vitamin and Mineral Supplement sections of Pharmacy leading to increased sales. His key roles previously were management of key pharmacy accounts and ensuring customer satisfaction with the services provided by Uniphar and prior to that Boileau and Boyd. Margaret Harper joined the ECI Natural Health sales team in September 2017, and brings extensive retail and area sales management experience spanning over 20 years. Working in the pharmacy and health store sector in both Ireland and Cambridge UK, Margaret’s knowledge and understanding of the industry has gained her key skills and excellent customer service care. “ I am very excited to be part of this dynamic sales team at ECI Natural Health. www.Ecihealth.ie


PX310S-M Physiologix Ultimate Back Support Small - Medium

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PX302 Physiologix Knee OSFA C100 100% 1 Support 1 100% M0

white spot

CYAN

Y0 0

MAGENTA

1/1 C0 M100 Y0 K0

100%

C0 14.09.17 M0

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Y100 K0

YELLOW

100%

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PX301 Ultimate Ankle Support - OSFA

1

1

14.09.17

PX305 Ultimate Wrist C100 100% Support - 100% OSFA M0

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C100 100% 100% PX306R Ultimate M0 Y0 Support 1 0 CYAN MAGENTA Right OSFA

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These are the professionals’ choice for more severe and permanent injuries or injuries with reduced function. Each Physiologix Ultimate product has been designed by Irish Physiotherapists to provide firm support that enables ULTIMATE ULTIMATE ULTIMATE effective stablisisation andSUPPORT targeted compression for each stage of recovery. SPORTS SUPPORT SPORTS SPORTS SUPPORT CYAN

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SUPPORT SPORTS SUPPORT SPORTS SUPPORT SHOULDER SPORTS SUPPORTSPORTS KNEE Removable Sacrum pad included for additional support and increased comfort

+

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COOLMAX® fabric wicks moisture away to keep the body dry throughout the day

The support wraps around the upper torso

Soft perforated NEOPRENE blend, ultimate material for for base support andthe maximum stability compression and heat retention helps improve blood circulation Lined with COOLMAX® fabric which moves moisture away Integrated provides mobility from your body keeping sleeve you coolsystem and comfortable Removableassistance Sacrum pad and compression Anchoring system and high tension straps for ultimate support and atability Custom design for maximum airflow

+ + + +

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ULTIMATE

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YELLOW

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ULTIMATE

SPORTS SUPPORT

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SPORTS SUPPORT

SPORTS SUPPORT

Soft perforated NEOPRENE blend, the ultimate material for compression and heat retention helps improve blood circulation Lined with COOLMAX® fabric which moves moisture away from your body keeping you cool and comfortable Tension straps on top and bottom offer controlled compression and custom fit Contour design minimises bunching behind the knee Padded double-layer stabilisation around the knee cap

ULTIMATE

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retention helps improve blood circulation keeping you cool and comfortable

Stretch Nylon Layer

3

Stretch Nylon Layer

NG: Before use always seek medical advice from your doctor. If the support used following a sprain seek medical advice if no improvement is seen 2 hours. Always take advice on duration of usage. Ensure product is not ortably tight and blood flow is not restricted. Only use on clean intact skin.

3

LEVEL

use if you have a known allergy to any of the materials listed. The product be applied as directed. If a rash develops, pain is prolonged or conditions discontinue use and seek medical advice.

ULTIMATE

+ + +

AIRPRENE™ Layer + Removable support bars to increase flexibility of the support

Integrated sleeve and underarm strapping for maximum comfort and compression

WARNING: Before use always seek medical advice from your doctor. If the support is being used following a sprain seek medical advice if no improvement is seen within 72 hours. Always take advice on duration of usage. Ensure product is not uncomfortably tight and blood flow is not restricted. Only use on clean intact skin. Do not use if you have a known allergy to any of the materials listed. The product should be applied as directed. If a rash develops, pain is prolonged or conditions worsen, discontinue use and seek medical advice.

Ultimate Support Controlled Compression Custom Fit

AIRPRENE

Ultimate Compression Material

SMALL TO MEDIUM

COOL MAX Keeps you Cool & Comfortable

LOT

Stretch Nylon Layer

3

LEVEL

FIBRE CONTENT:

+ + +

Stretch Nylon Layer

+ Sectional design minimizes slippage and bunching

5% Polyester PX310S-M 3% Elastic Rubber

AIRPRENE COOL MAX

Keeps you Cool & Comfortable

LOT

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FITS LEFT OR RIGHT

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www.flemingmedical.ie

AIRPRENE

™ ™

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ONESIZE SIZE ONE FITS LEFT OR RIGHT

OO O LL M M AAXX CCO Keeps you you Cool Cool & & Comfortable Comfortable Keeps

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Fleming Medical Ltd Corcanree Business Pk Dock Rd, Limerick, Ireland www.flemingmedical.ie

ONESIZE SIZE ONE FITS LEFT OR RIGHT FITS LEFT OR RIGHT

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+ Essential: Mild + Advanced: Mo + Ultimate: Firm

80% Airprene Rubber 10% Nylon 10% Coolmax® (polyestor)

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Keeps you Cool & Comfortable

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Fleming Medical Ltd Corcanree Business Pk Dock Rd, Limerick, Ireland www.flemingmedical.ie

LEFT WRIST ONE SIZE ONE SIZE FITS ALL FITS LEFT OR RIGHT

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FREEPHONE 1800 307 777 • FREEFAX 1800 313 395 pharmacy@flemingmedical.ie • www.flemingmedical.ie

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+ Wrap around adjustable strap helps provide extra support

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SPORTS SUPPORT SPORTS SUPPORT

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SUPPORT LEVEL

gh tension straps to provide added compression

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provides a therapeutic treatment to muscle and joint pain or injury.

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+

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MAGENTA

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COOL MAX Keeps you Cool & Comfortable


Feature recent report from safefood found Irish men consume excessive amounts of salt (7.4g/day), have higher intakes of processed meats (30g/day), but not enough fruits and vegetables Pharmacy teams should advise men to reduce their salt and meat intakes and ensure they are eating enough fibre. Weight loss products and/ or books on healthy eating may be recommended to some clients. Urinary incontinence

local and offer a non-threatening environment to men. Staff are friendly and approachable and don’t rush men in and out. Pharmacists are also recognised by men as experts on medication and giving advice in this area. Advice and support Pharmacy teams are in a unique position to offer advice and support to men in a wide range of areas including fitness, cancer prevention and mental health. Here are some of the most common areas pharmacies are asked to provide support for: Baldness Male baldness can be a serious concern to many men and can have significant impacts on their confidence, particularly in clients dealing with premature hair loss. Men experiencing hereditary hair loss should be given information about the range of products available which may be able to help slow down hair loss, or in some case, encourage regrowth. Keep in mind that some of these products will not be suitable for people with alopecia or hair loss as a result of chemotherapy. Most people with alopecia can expect their hair to grow back within 12 months without treatment. Erectile dysfunction ED is a condition, which can cause a lot of anxiety for men, particularly if it is something, which they have not experienced before. Older men can often think that ED is just part and parcel of the ageing process, but while the chances of ED increase as you age, it is important to remind clients that it can also be

caused by emotional issues such as stress, may be as a result of alcohol, illegal drug or medicine use or could actually be a warning sign of illness such as prostate cancer.

of cancer. The Code can be accessed at; http://www. cancer.ie/europeancode#sthash. SHimrxOl.dpuf

Men experiencing ED should be assured that it can be quite normal to experience issues surrounding premature ejaculation or difficulty in maintaining an erection, but that this is easily treated. Persistent issues should be assessed by their GP to find the underlying cause.

Pharmacy technicians and assistants should be alive to clients showing signs of depression and/ or other mental health problems and should make themselves aware of local mental health supports and services so that they can provide information about same if asked. The HSE website, www.yourmentalhealth.ie provides a wealth of information on mental health issues, advice and support contacts and is a great resource for anyone looking to educate themselves about mental health issues or find information for their patients.

Men’s cancers The latest data shows us that non-melanoma skin cancer was the most common cancer in men, followed by prostate cancer, bowel cancer, lung cancer, melanoma skin cancer and testicular cancer. While each of these cancers has different signs and symptoms, there are some signs of illness that should never be ignored, and which pharmacy assistants and technicians can urge their customers to watch out for. These include changes such as a lump or a swelling, weight loss, pain that doesn’t go away, bleeding after a bowel movement or after sex, coughing up blood or noticing blood in urine. Persistent coughs, bloating, heartburn, mouth ulcers or sores should not be ignored. Any changes to bowel or bladder habits, to the breast (yes, in men too) or changes to moles also warrant a trip to the doctor. The European Code Against Cancer is a great resource for pharmacy teams looking for general advice on how their patients can look after their health and help reduce their risk

Mental Health

Obesity The latest CSO figures tell us that 63% of men are overweight or obese, compared to 48% women. New data from the World Health Organisation shows Ireland is on course to become the most obese country in Europe with the proportion of obese Irish men expected to increase from 26 percent to 48 per cent by 2030. This will put Irish men at the top of an “overweight” table of 53 countries. As obesity is closely linked with a wide range of chronic diseases, it is imperative pharmacy assistants and technicians counsel clients about the importance of losing weight and encourages them to improve their diet and get more exercise. One way perhaps to do this is to offer basic health checks to men in your area. A

Urinary incontinence, loss of control of your bladder, is a common condition that affects one in ten men. It can affect anyone, regardless of age. There are four types of incontinence namely, stress, urgency, overflow and reflex. Urgency and overflow are the two types of incontinence that are more common in men. The former is when a man cannot hold on long enough to reach a toilet whereas the latter happens when the bladder does not empty completely. Both may be may be due to an enlarged prostate gland, but constipation may also be a cause. The good news is that it can be improved and is often cured completely with the help of professional advice and treatment. Incontinence can be managed through medication, exercise and bladder retraining programmes. Top lifestyle tips include: drink plenty of fluids (six to eight glasses of water every day), drink water, milk or fruit juices instead of tea, coffee and fizzy drinks as these may irritate your bladder, eat plenty of fibre to avoid constipation and stay as active and mobile as possible. Conclusion How men view ‘masculinity’ is often at the heart of how they act. This is very true in the area of looking after their health. The way that health professionals, women, decision makers, etc. see masculinity will also have an impact. Men’s health must not be solely defined as a set of malespecific, biomedical problems but also in the way men perceive themselves within a specific culture. The impact of hegemonic masculinity on men’s health must be constantly kept in the equation if we are to improve mortality and morbidity rates for men. As Men Talking concludes ‘it is the ‘rules of manhood’ which prop up the myth of the invulnerable man that must be changed.’ Local pharmacies are well positioned to assist this process of change at a practical level. References available on request

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News

Studies suggest use of Vitamin D in prevention of disease A recent study from the University of Birmingham, which compares the ability of immune cells in blood from inflamed joints in people with rheumatoid arthritis and how they respond to Vitamin D, has found that the vitamin may provide a source of prevention for the disease. Experts have found that tissue that was not diseased responded well to Vitamin D, suggesting that it could be effective at preventing the onset of rheumatoid arthritis. Results however also showed that the vitamin proved much less effective once the disorder was established, suggesting that much higher does may be needed in combination with other antiinflammatories such as steroids. There have been calls for vitamin D to be added to food. Essential for healthy bones, teeth and muscles, a global study earlier in the year suggested that the vitamin can reduce the risk of colds, flue and other dangerous infections such as pneumonia. The recommended daily intake is 3 micrograms however the Department of health

has suggested that this been increased to 10 micrograms to protect against bone and muscle conditions. Exactly how much vitamin D is needed to overcome rheumatoid arthritis will be the subject of further research by the authors of the study who want to determine whetehr the same effect is seen in other inflammatory diseases such as multiple sclerosis and inflammatory bowel disease. In another study vitamin D has also been found to have a significant bearing on the development of breast cancer. Higher blood levels of vitamin D are associated with a lower risk of breast cancer compared to women with lower levels of the vitamin. An example of this was a Harvard study that

found, that women who got plenty of vitamin D in early life – either in their diet or by spending time outdoors, where sun exposure triggers vitamin D production in the skin – had lower risk of breast cancer.

stave off risks of breaks cancer and to facilitate early detection such as, regular screening, self-breast examination as well as lifestyle related amendments such as 30 minutes of exercise, 5 days a week and a balanced diet.

The World Health Organisation suggests preventive strategies to

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Real Techniques Ireland launch the latest collection in Wexford Real Techniques Ireland chose Wexford Town to celebrate the launch of the new MultiTech Collection of makeup brushes which has recently hit Irish pharmacies nationwide. The launch was hosted by Jade Mullett, Professional Makeup Artist, who has been collaborating with the brand as Irish Brand Ambassador over the past 6 months with a series of Jade’s Techniques’ Masterclasses nationwide. The new MultiTech Collection was unveiled and gifted to all of the attendees. Jenni Fenlon, Brand Manager, Real Techniques Ireland, spoke of how the brand has been in Ireland for four years and it still remains the original in makeup brush innovation. The new MultiTech Collection is Real Technique’s latest in brush innovation, specifically designed with the same unique universal cut across the brushes and beauty sponge.

New and Different! – Adex® Gel Emollient with an ancillary anti-inflammatory action

Adex Gel offers a new, simple and different approach to the treatment and management of mild to moderate eczema, and other dry skin conditions prone to inflammation, such as psoriasis. Adex Gel is different from other emollients as Adex Gel is a highly moisturising and protective emollient which also contains an added extra, anti-inflammatory medicinal substance to help reduce inflammation and redness. Recommend Adex Gel and see the results. Adex Gel - A product of research and development from a leading independent company specialising in dermatology for more than 50 years. Trade price: €3.75 for 100g tube, €8.36 for 500g pump pack.

Keep feet in top condition with SVR XÉRIAL 50 Extrême Foot Cream (Crème Pieds) with 50% Urea: For hard-skin, corns & callouses This is a foot care that overcomes corns and calluses in 7 days and remove the horn without evidence of rebound. This cream utilises 50% Urea which enables it to reduce normal and stubborn calluses whilst also working on areas of hands and elbows that have thickened skin. This Cream has a non-greasy and non-sticky formula that is specifically formulated for the feet. It spreads easily and rapidly, and is fragrance free. Apply the Xerial 50 Extrême Foot Cream daily to the affected areas

XÉRIAL 50 Extrême Foot Cream (Crème Pieds) RRP ¤13 – Available at grahamanthonyonline.ie NEW Bioderma Mini H2O Christmas Giftset

Lusso Tan Organic Tanning Range-3 Steps To Tan Perfection

French dermo-cosmetic brand, BIODERMA launches a fabulous Giftset for every skin type

Since launching earlier this year, the Lusso Tan ritual steps have been winning praise and loyalty nationwide due to their innovation and performance.

French dermo-cosmetic brand, Bioderma launches a new fabulous Bioderma Giftset this winter, perfect for Christmas. The Bioderma giftset is an ideal gift to please any Bioderma fan - contains: • Sensibio H20 Micellar Water 100ml • Hydrabio H20 Micellar Water 100ml • Sébium H2O Micellar Water 100ml

RRP ¤12.00

Mist on Primer, smooth on Tan with a velvet mitt and take tan to the next level with a finishing touch for intensity or shimmer. Each product can be applied independently, but combine them into the full ritual to elevate a golden glow to tanned perfection.

Experience indulgence with the new flavours in Labello Lip Butters For over 100 years, Labello has been one of the most trusted and iconic lip-care experts in Europe and many other parts of the globe. Its formula provides a 12-hour moisturising effect that restores softness and suppleness to even the driest of lips. These delicious additions to the range offer a unique flavour and fragrance experience.

RRP ¤2.49**


Feature Good Practise at the Counter- The Role of the Pharmacist in administering Emergency Contraception Pharmacists play a vital role in providing emergency contraception to customers, where the vast majority of women choose to visit a pharmacy over their GP. Emergency contraceptive pills are available without a prescription directly from pharmacists in Ireland, making pharmacists key emergency contraception providers. Women may also like the anonymity of the pharmacy as they can feel embarrassed about needing emergency contraception (EC). The availability of emergency contraceptive pills from pharmacy without a prescription is critical to increase access and minimise delay of intake. This is especially significant given that emergency contraceptive pills are more effective the sooner they are taken after unprotected intercourse. From the 1st of July this year, changes to the GMS scheme mean that emergency hormonal contraception (EHC) is now available in pharmacy, without a prescription, for women with a medical card. The quality of the pharmacy interaction is an important determinant of appropriate use of the EHC product. It is also likely to be an important factor in a woman’s decision to take action in the event of future unprotected sexual intercourse. • Pharmacists promote dialogue on contraceptive alternatives and influence the beliefs and the outcomes through effective counselling on EHCs. The supply of emergency contraception from pharmacies can be accompanied by patient education from pharmacists, who have expertise on this topic • Pharmacists provide information to patients at the time of EHC supply, which allows women to understand proper use of this medicine. Good Pharmacy Practise Good Pharmacy Practise can include: - Asking the right questions; avoiding unnecessary, personal or intrusive questioning

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• Intrauterine device (IUD), to be fitted in the womb

for women and it can also be uncomfortable for pharmacists.

IUD

You can help by:

IUD’s are considered the most effective EC option however they may not be a practical option for many women, as an IUD fitting takes time and involves an invasive procedure by a specifically trained healthcare professional.

- Being matter-of-fact

There are two oral EHCs available - One containing ulipristal acetate (ellaOne®), which is effective up to 5 days (120 hours) after unprotected sex - One containing levonorgestrel which is effective up to 3 days (72 hours) after unprotected sex EHCs work by inhibiting or delaying ovulation (the release of an egg), so that fertilisation cannot take place. Taking emergency contraceptive pills as soon as possible after unprotected sex gives the best chance of success. EHCs have no effect on fertilisation if ovulation has already happened. They do not interfere with an implanted egg (pregnancy) so they do not cause abortion. Emergency contraception can best prevent pregnancies when used soon after intercourse. It provides an important back-up in cases of unprotected intercourse or contraceptive accident (such as forgotten pills, torn condoms) and after rape or coerced sex. How women might explain their need for EC - Condom broke or slipped off

- Providing quality advice in a sensitive way, without lecturing

- Missed pill, forgot to insert contraceptive ring or apply patch

- Providing an environment where women feel comfortable and not judged, for requesting emergency contraception.

- Diaphragm or cap slipped out of place

Types of Emercency Contraception

- No contraception used

Current emergency contraception solutions are:

- They were forced to have unproteced sex

• Oral emergency hormonal contraception, as a tablet

Discussing emergency contraception can be distressing

- Failure of withdrawal method

- Re-assuring them they have done the right thing - Offering them a more private place to talk if possible (e.g. the consultation room) - Using customer’s language (referring to the “Morning-after pill” or “Day-after pill” instead of EHC) - Having a warm and positive approach Training Your Pharmacy Team Your Team should know that: - Your pharmacy offers EHC - Your aim is to offer women EHC in a reassuring way In training sessions you could develop more examples or roleplay the scenarios to build the team’s confidence so they can deal with requests for emergency contraception smoothly. You can encourage your team to make the process of obtaining EHC as least embarrassing as possible. They should recognise that this may be an emotional time for the woman so a welcoming, professional approach is appropriate. Other women may ask for EC in a way that may make you or your team members feel uncomfortable, maybe by providing too many intimate details or having a loud or brazen manner. Exploring ways to deal with this can also form part of a training role-play. SIX STEPS OF AN EHC CONSULTATION Step 1 - Listen When a woman comes to your pharmacy and asks for the morning after pill, listen to her needs. Women may be embarrassed to approach the counter when others are around, they may request somewhere more private to talk, or advise that they wish to speak with the pharmacist. Ensure that you and your team are prepared to be approached in this way and be as discreet as possible.

Step 2 - Reassure Tell her that she has done the right thing coming into the pharmacy for help. Explain that emergency contraceptive pills work by preventing or delaying ovulation so sperm will not find an egg to fertilise. Step 3 - Encourage Immediate Action Emergency contraception is most effective when used as soon as possible after unprotected sex Step 4 - Advise about sex after EHC A rapid return to fertility is likely following treatment with an emergency contraceptive pill. A barrier method of contraception must be used until your next period – even if you are continuing with a regular method of contraception. The emergency contraceptive pill is for occasional use only and it should not be used to replace a regular contraceptive method. If the woman requires advice, suggest she visit her GP or Family Planning Clinic for information about regular contraceptive options. Advise that Emergency contraceptive pill does not protect from STIs. Only condoms protect against STIs. Step 5 - Advise what to do if the woman is sick If vomiting occurs within 3 hours of taking emergency contraception, advise the woman that she should take another tablet as soon as possible. Step 6 - Advise about the next Menstrual period After taking oral emergency contraception, menstrual periods can sometimes occur earlier or later than expected by a few days. If your period is more than seven days late or pregnancy is suspected for any other reason (symptoms of pregnancy, abnormal bleeding at the expected date of menstrual periods) or in case of doubt, you should do a pregnancy test or visit your doctor to make sure you are not pregnant.


Available in pharmacy

But emergency contraception has.

ellaOne® is the most effective emergency contraceptive pill1

www.ellaonepharmacists.ie

exécution

Further information available from: HRA Pharma, Haines House, 21 John Street, Bloomsbury, WC1N 2BF, London. Freephone: 1800 812 984. Email: med.info.ie@hra-pharma.com

30, rue Saint-August 75002 PARIS (France tél. : +33 (0)1 42 66 4 fax : +33 (0)1 42 66 www.byagencydesign

ÉTAPE / STEP :

01

DATE :

13 / 03 / 14

DOCUMENT D’EXÉCUTION / ARTWORK FILE : HRA Pharma Women Health Circle Quadri Com CLIENT : HRA Pharma FICHIER / FILE : HRA Pharma Women Health Circle Quadri Com.eps LOGICIEL / SOFTWARE : Illustrator CS6 DIMENSIONS / SUPPLIER : ÉCHELLE / SCALE : 100 %

Adverse events should be reported. Reporting forms and information can be found at www.hpra.ie. Adverse events should also be reported to HRA UK & Ireland Ltd on Freephone: 1800 812 984 or email: med.info.ie@hra-pharma.com

*unprotected sexual intercourse

1. Glasier AF et al. Lancet 2010; 375: 555-62.

Date of preparation: March 2016

PLAN / CUTTING LINES : IMPRESSION / PRINTING PROCESS : OFFSET SUPPORT / PRINTING MEDIUM : WHITE CARDBOARD POLICES / FONTS : GILL SANS

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Quadri

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BRAILLE :

DOCUMENT D’EXÉCUTION Ce document nécessite l’aperçu de la surimpression pour sa visualisation complè WARNING l’impression de la surimpression pour effe une sortie correcte. La réalisation techniqu que la surimpression des encres, les grossi-maigri, l recouvrements, restent à l’entière charge de l’imprim La taille et les positionnements des Gencods sont à va par le fabricant. Un BàT imprimeur doit être soumis client avant l’impression définitive.

ARTWORK FILE Please make sure to check the artwork with the Over Preview is on. Trapping, overprint colours, colour adjustments, must be processed in photoengra Barcods must be checked by the Printer. A Printer Approval is required before the final printi


Clinical Profiles ACCORD LAUNCH TADALAFIL ACTAVIS 10 MG & 20 MG FILM-COATED TABLETS Accord Healthcare is delighted to announce the launch of Tadalafil Actavis 10 mg & 20 mg Film-coated Tablet in pack sizes of 4 tablets. Tadalafil 10mg & 20 mg Filmcoated Tablets are indicated for treatment of erectile dysfunction in adult males. Please refer to the Summary of Product Characteristics (SPC) available at www.accord-healthcare.ie for further information. Tadalafil Actavis 10 mg & 20 mg Film-coated Tablets are now available from Uniphar and United Drug. For further information please contact your Accord representative, call Accord in Cork on 021-461 9040 or visit www. accord-healthcare.ie Your Accord Representatives are: John MacHale, 086 884 1114, Cork, Kerry, Limerick, Waterford, Kilkenny. Richard Doherty, 087 667 1725, Clare, Donegal, Galway, Tipperary, Mayo, Offaly, Sligo. Louise Mooney, 086 044 3956, South County Dublin, Carlow, Kildare, Laois, Wexford, Wicklow.

GRÜNENTHAL CLOSES AGREEMENT WITH ASTRAZENECA TO ACQUIRE GLOBAL RIGHTS TO MIGRAINE TREATMENT ZOMIG® (ZOLMITRIPTAN) • The acquisition of this wellestablished migraine treatment further strengthens Grünenthal’s pain portfolio. On June 30, 2017, the Grünenthal Group announced that it had closed the agreement with AstraZeneca for the global rights to Zomig® (Zolmitriptan) excluding Japan. Zomig®, available in film-coated and orodispersible tablet, is indicated for the acute treatment of migraine headache with or without aura. “Migraine is a very debilitating disease with half a million people in Ireland suffering from attacks that can lead to sensitivity to light or sound, to nausea or even vomiting”, explains Tom Coogan, General Manager of Grünenthal Pharma Ltd1. “The acquisition of Zomig®, a wellestablished brand, complements our existing pain portfolio. Migraine has been one of the very few main pain indications we haven’t yet

98

been able to offer a solution for. This acquisition is an important addition to the Grünenthal portfolio further reinforcing Grünenthal as a patient centric company, providing solutions with true benefits to patients suffering painful conditions.” Reference: 1. The Migraine Society of Ireland (http://www.migraine. ie/what-is-migraine/ accessed August 2017) Zomig® (Zolmitriptan) is indicated for the acute treatment of migraine headaches with or without aura. Zomig® is available in two formulations: an oral tablet and an orally dispersible tablet.

JANSSEN ANNOUNCEMENT Janssen announced on 13th November 2017 that STELARA (ustekinumab) has been reimbursed in Ireland for the treatment of adult patients with moderately to severely active Crohn’s disease who have had an inadequate response with, lost response to, or were intolerant to either conventional therapy or a tumour necrosis factor alpha (TNFα) antagonist or have medical contraindications to such therapies.[i]

option for people who are living with moderate to severe Crohn’s disease in Ireland who have an inadequate response or are contraindicated for existing therapies. The IM-UNITI study showed that two-year clinical response and remission rates were sustained, meaning that this offers these patients an effective therapeutic option,” said Professor Laurence Egan, Consultant Gastroenterologist, Galway University Hospitals. The recommended dosing regimen for ustekinumab in moderate to severe Crohn’s disease patients is an initial induction dose (~6 mg/kg) given via a single intravenous (IV) infusion. The first subcutaneous (SC) administration of 90mg ustekinumab should take place at week 8 after the intravenous dose. After this, dosing every 12 weeks is recommended. Patients who have not shown adequate response at week 8, after the first SC dose may receive a second SC dose at this time. Patients who lose response on dosing every 12 weeks may benefit from an increase in dosing frequency to every 8 weeks. Patients may subsequently be dosed every 8 weeks or every 12 weeks according to clinical judgement.[vi]

surfaces. Antimicrobial resistance to gram positive, negative and spore forming pathogens has been achieved by an inventive patented step using both metal and organic based additives. The hybrid coating has been designed to adhere to all metal surfaces with thicknesses ranging from 0.5 to 10 microns. Combining organic and inorganic functionalities has enabled this coating to be chemically resistant to strong acids/bases, detergents and cleaning agents. • In April 2016, it was announced that a team of scientists had developed a solution to help protect against antibiotic-resistant superbugs. • Using nanotechnology, the new water-based solution can be used on surfaces during the production process, rendering the surface 99.9 per cent resistant to superbugs like MRSA, E. coli and other fungi. • The discovery is the culmination of almost 12 years of research by a team of scientists, led by Prof. Suresh C. Pillai initially at CREST (Centre for Research in Engineering Surface Technology) in DIT and then at IT Sligo’s Nanotechnology Research Group (PEM Centre). The research started at Dublin Institute of Technology (DIT)’s CREST and major researchers included Dr Brendan Duffy and Dr Nigel S. Leyland.

Two-year data from the ongoing IM-UNITI long-term extension (LTE) study evaluating the efficacy and safety of subcutaneous (SC) STELARA in patients with moderate to severe Crohn’s disease, maintained clinical response and remission for up to two years, and a long term safety profile consistent with placebo through to two years, with no new safety signals observed.[ii]

IRISH TECH LEADER KASTUS LAUNCHES INNOVATIVE FORMULA TO PROTECT METAL SURFACES FROM SUPER BUGS

Ustekinumab received marketing authorisation from the European Medicines Agency in November 2016. It is the first biologic therapy for Crohn’s disease that targets interleukin IL-12 and IL-23 cytokines, known to play a key role in inflammatory and immune responses. The EC approval was based on data from three pivotal Phase 3 trials which included approximately 1,400 patients with moderate to severe Crohn’s disease. Among these patients, the Phase 3 studies showed that treatment with ustekinumab induced clinical response as early as week 3 in both conventional therapy failures and anti TNF failures. It also maintained clinical remission in a significantly greater proportion of adult patients after one year of therapy compared to placebo with the more recent IM-UNITI trial results further supporting long term remission after two years of therapy.2,[iii],[iv],[v]

• Kastus Metal can be used to protect medical devices, mobile phones, consumer electronics, ATMs, door handles, handrails, taps and showers

Tadalafil Clonmel is indicated for the following: 1

• Showcased at the ‘Med in Ireland’ exhibition last month at the RDS, Dublin.

Tadalafil 10mg and 20mg Filmcoated Tablets are available in a 4 pack

The company displayed its Kastus Metal product - an effective and practical antimicrobial solution that kills harmful bacteria and microorganisms such as MRSA and E. Coli on metal surfaces including steel and aluminum. The coating also provides superior anticorrosion properties.

Full prescribing information is available on request or alternatively please go to www.clonmel-health. ie. Product is subject to medical prescription.

Kastus Metal - a novel and patented technology can be used to protect a range of everyday high touch surfaces, including medical devices, door handles, handrails, sanitary ware fittings against the spread of deadly superbugs.

Ref 1. Tadalafil Clonmel Summary of Product Characteristics

“The availability of ustekinumab provides an important treatment

• Kastus launches its new lifesaving product that kills harmful antibiotic-resistant bacteria on metal surfaces

• Kastus Metal© uses patented antimicrobial additives to deliver a clear, thin, scratch resistant, anti-corrosion, antimicrobial bright finish on bare and treated metal

CLONMEL HEALTHCARE ARE DELIGHTED TO ANNOUNCE THE LAUNCH OF TADALAFIL CLONMEL 10MG AND 20MG FILMCOATED TABLETS

• Treatment of erectile dysfunction in adult males

Please contact Clonmel Healthcare on 01-6204000 if you require any additional information on Tadalafil Clonmel.

PA 126/283/3-4 PA Holder: Clonmel Healthcare Ltd, Waterford Road, Clonmel, Co. Tipperary. Prescription only medicine. Date Prepared: October 2017. 2017/ADV/TAD/049


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Product Information: Please consult the summary of product characteristics for full product information. Panadol Night Film-coated Tablets, paracetamol 500mg, diphenhydramine hydrochloride 25mg. Indications: Short-term treatment of bedtime symptoms of cold and flu pain, rheumatic and muscle pain, backache, toothache, headache, menstrual pain. Dosage: Adults and children 12 years and over: 2 tablets 20 minutes before bed. Max 2 tablets in 24 hours. Minimum dosing interval between this and any other paracetamol containing product: 4 hours. Other products containing paracetamol may be taken during the day but the total daily dose of paracetamol must not exceed 4000mg. Do not give to children under 12 years except on medical advice. Not to be taken by the elderly with confusion. Max duration of continued use without medical advice: 10 days. Contraindications: Hypersensitivity to paracetamol or any of the other ingredients, closed angle glaucoma, porphyria. Precautions: Liver or kidney impairment, epilepsy or seizure disorders, myasthenia gravis, narrow-angle glaucoma, prostatic hypertrophy, urinary retention, pyloroduodenal obstruction, asthma, bronchitis, COPD, hereditary sugar intolerances, the elderly, pregnancy and lactation, concomitant use of sedatives, other antihistamine-containing preparations (including topicals and cough and cold medicines) or tricyclic antidepressants and other drugs with anticholinergic action, alcohol, use of MAOIs within 2 weeks. Side effects: Fatigue, attention disturbance, dizziness, dry mouth, confusion, paradoxical excitation, GI disturbances, hypersensitivity reactions including anaphylaxis and skin rash, thrombocytopoenia, angiodema, Stevens-Johnson syndrome, bronchospasm, hepatic dysfunction, tachycardia, palpitations, unsteadiness. Overdose: Immediate medical advice should be sought in the event of an overdose, even if symptoms of overdose are not present. Legal Category: Pharmacy only. MA Number: PA 678/39/8. MA Holder: GlaxoSmithKline Consumer Healthcare (Ireland) Limited, 12 Riverwalk, CityWest Business Campus, Dublin 24. Text prepared: July 2016. Further information available on request. Panadol is a registered trade mark of the GSK group of companies. Contains Paracetamol. Always read the label/leaflet.

Panadol is a registered trade mark of the GSK group of companies. Contains Paracetamol. Always read the label/leaflet. CHGBI/CHPAN/0092/17

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