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TOP 100 Our tribute to the province’s top healthcare professionals! NORTHERN IRELAND HEALTHCARE AWARDS Meet your finalists… NEW DENTISTRY SECTION! Features you can really get your teeth into! MRI The problems facing claustrophobics
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Since it’s a new year, it’s always good to welcome something new to the magazine, so say hello to the fantastic new dentistry section of NIHR! For some years now we’ve had healthcare professionals asking us to include dentistry in the magazine and we’ve reluctantly had to say ‘no’ due to the overwhelming depth and richness of NI medical and pharmacy life.
professionals and so, in this issue, we pay tribute to them with our Top 100 feature (p56). Elsewhere in the magazine you can meet the finalists of this year’s Northern Ireland Healthcare Awards (p15), read about claustrophobia in MRI (p54) and find out about the new ISO guidelines for blood sugar monitors (p10). Enjoy!
But now, with many linking dental care with other health issues (as particularly shown in our feature on the Impact of Periodontal Therapy on General Health), we’ve decided to bring dentistry into our healthcare ‘stable’ (34). At NIHR we’re very aware of the immense talent of our healthcare
INSIDE THIS ISSUE... ‘WE CHANGE OR WE FAIL.’
Health Minister axes ineffective Board
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CEO, Heather Weir, gives NIHR the lowdown
One award-winning pharmacist shows how it’s done…
A round-up of the day’s events
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IN WITH THE NEW MEDCOM has immersed itself in the spirit of all things new – with the launch of an exciting website! Simply a click away, and equipped with rolling updates to keep you firmly in the know, www.nihealthcare.com is the all-in-one healthcare hub for professionals.
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04 BRAIN DISORDERS 06 THROUGH UU research could help better SPANISH EYES understanding
05 GRAPHENE A new material
Local graduate set to revolutionise global medical industry
20 NI HEALTHCARE AWARDS Meet your finalists…
New ‘Expert Panel’ announced!
New ISO guidelines launched
The problems facing claustrophobics
73 COMMONWEALTH PHARMACISTS ASSOCIATION
04 29 DENTISTRY SECTION NOW ADDED!
FEATURES 34 NEW DENTISTRY SECTION!!
Features you can really get your teeth into!
43 TOP 100
Our tribute to the province’s top healthcare professionals!
Northern Ireland’s fifty shades of grey….suits
How community pharmacists can help underdeveloped countries
NIHR / 2016 / 5
UU could hold key to better understanding of brain disorders
Kongfatt Wong-Lin In a world first, researchers at Ulster University have found how to measure the speed and direction of visual signals between parts of the brain: a major discovery that could help medical professionals globally to better understand and treat brain disorders, such as stroke and neurodegenerative diseases. Computer science experts at
Ulster University, in partnership with Trinity College Dublin, used 3D computer modelling of the brain to explore the speed and pathway that visual signals travel from the optical lobe, the part of the brain that first interprets what we see, to the frontal, parietal and temporal lobes, which process more complex cognition, such as
decision making. ‘This Ulster University research lays an important foundation for better understanding of the human visual system,’ said lead researcher, Dr KongFatt Wong-Lin from UU. ‘Due to the generality of the method, it can be used to understand other sensory or cognitive processing. It also provides us with a new, scientific method to identify areas of the brain that are dysfunctional. ‘As a potential clinical application, stroke sufferers can have brain functional pathways that are effectively blocked or redirected, and thereby changing their cognitive processing. This method may be used to identify specific pathway alterations of individuals, and hence providing more precise treatments, for example, through specific rehabilitation or neurofeedback.’
National award for Sexual Health Team
The Sexual Health Team in the South Eastern Health & Social Care Trust The Sexual Health Team in the South Eastern Health & Social Care Trust has been awarded ‘Clinical Team of the Year’ at the recent national General Practice Awards ceremony in London. The award was presented to Dr Fiona Carey, Consultant Physician in Sexual Health for the 6 / NIHR / 2016
team’s success in developing a new model of providing sexual health check-ups in local GP practices. In a unique partnership between the Trust’s Sexual Health Service and GP practices in the North Down and Lisburn areas, anyone who does not have symptoms can have a sexual health check for sexually transmitted infections with their GP or Practice Nurse. An evaluation of the service found that 293 patients availed of the service in the first six months, with over seven per cent of these testing positive for
Chlamydia. ‘The positivity rate for Chlamydia in young men attending GP practices was actually higher than the rate found in young men attending the specialist sexual health service, clearly identifying an unmet need in the local area,’ said Dr Fiona Carey, Consultant Physician in Sexual Health. ‘Accessibility for this population not only means availability, but one within easy reach. We now plan to extend the project to GP practices in the Ards and Down localities in the new year.’
Of mice… and hopefully soon of boys and men!
Researchers in America have used a system known as CRISPR-Cas9 to treat mice with Duchenne muscular dystrophy (DMD). In the US study, researchers worked with a mouse model that has a debilitating mutation on one of the exons of the dystrophin gene, programming the new CRISPR/Cas9 system to snip out the dysfunctional exon, leaving the body’s natural repair system to stitch the remaining gene back together to create a shortened - but functional version of the gene. ‘A major hurdle for gene editing is delivery,’ says Chris Nelson, who led the work. ‘We know what genes need to be fixed for certain diseases, but getting the gene editing tools where they need to go is a huge challenge. The best way we have to do it right now is to take advantage of viruses, because they have spent billions of years evolving to figure out how to get their own viral genes into cells.’ While this research was carried out in mice, the study has raised hopes that a treatment will be available to humans in the future.
Eating disorders ‘a serious health issue’ - Hamilton Health Minister, Simon Hamilton, has welcomed the publication of the RQIA report on the review of eating disorder services in Northern Ireland, which was commissioned by his Department. The report contains eleven recommendations, including the possible need for a feasibility study to determine if a more local specialist eating disorders unit should be developed. It also outlines the wide range of excellent work done by professionals in the Health and Social Care service and by voluntary organisations contracted by Trusts.
‘Eating disorders are a very serious health issue for many people in our community,’ the Health Minister said. ‘One estimate states that between 18,000 and 20,000 individuals will be living with an eating disorder in Northern Ireland at any one time. The effects can be devastating for sufferers, and their families and friends. ‘I have already taken steps to address this issue. Back in October I asked my officials to consider the evidence and engage with the relevant stakeholders to explore creating such a unit.’ The report is available at www.rqia.org.uk
Graphene proves perfect fit for wearable healthcare devices Academics from the University of Manchester have demonstrated that cheap, flexible, wireless graphene communication devices such as mobile phones and healthcare monitors can be directly printed into clothing and even skin! In a breakthrough paper in Scientific Reports, the researchers showed how graphene could be crucial to wearable electronic applications due to its highlyconductive and ultra-flexible nature. The research could pave the way for smart, battery-free healthcare and fitness monitoring, phones, internet-ready devices and chargers to be incorporated into clothing and ‘smart skin’ applications – printed graphene sensors integrated with other 2D materials stuck onto a patient’s skin to monitor temperature, strain and moisture levels. Examples of communication devices include: • In a hospital, a patient wears a printed grapheme RFID tag on his or her arm. The tag, integrated with other 2D materials, can sense the patient’s body temperature and heartbeat and sends them back to the reader. The medical staff can monitor the patient’s conditions wirelessly, greatly simplifying the patient’s care. • In a care home, battery-free printed graphene sensors can be printed on elderly people’s clothes. These sensors could detect and collect elderly people’s health conditions and send them back to the monitoring access points when they are interrogated, enabling remote healthcare and improving quality of life. ‘This is a significant step forward,’ said Dr Zhirun Hu from the School of Electrical and Electronic Engineering. ‘We can expect to see a truly all grapheme-enabled wireless wearable communications system in the near future. ‘The potential applications for this research are huge – whether it be for health monitoring, mobile communications or applications attached to skin for monitoring or messaging. This work demonstrates that this revolutionary scientific material is bringing a real change into our daily lives.’ NIHR / 2016 / 7
Through Spanish eyes… As Professor Rafael Bengoa is named as Chair of the new ‘expert panel’ which will plot the way ahead for NI healthcare, NIHR looks at what Professor Bengoa brings to the table… When the Health Minister, Simon Hamilton MLA, announced in November that he was not only axing the Health & Social Care Board, but was establishing an expert panel to ‘lead the best debate on the best configuration of Health and Social Care services in Northern Ireland’, he was quick to point out that he would not only be drawing on the experience of people working here, but would also use international expertise as and where appropriate. The recent announcement of this new ‘expert panel’ has clearly highlighted Simon Hamilton’s direction of travel and it is particularly interesting to note that the panel is to be chaired by Professor Rafael Bengoa, who, in addition to working as a doctor for seven years in both hospital and primary care, and who holds an MsC in Community Medicine 8 / NIHR / 2016
from London School of Hygiene and Community Medicine and an MsC in Health Care Management, was also Minister for Health and Consumer Affairs in the Basque Government in Spain between 2009 and 2012. During that time, ironically, the then Health Minister, Edwin Poots, met with Professor Bengoa, and agreed to work together to tackle the common challenges facing the healthcare systems in both countries. ‘Our two countries have much in common,’ Edwin Poots said at the time, because we are devolved administrations with similar-sized populations. It is also clear that Northern Ireland and the Basque Country face the same challenges in delivering healthcare. I want to identify where we can adapt solutions developed elsewhere, including in the Basque Country,
to our own health and social care system and am keen to share our own learning so we can provide the best possible care for the people we serve with the budgets given.’ So, what exactly did Professor Bengoa achieve in the Basque Country during his stint as Minister for Health? Well, similar to NI, the Basque Country health system provides public healthcare to around two million inhabitations, of which nearly 18 per cent are already more than 65 years old. As a result of this ageing population, chronic disease prevalence and complexity have increased, along with total health expenditure. Working in conjunction with global management consulting services company, Accenture, the Basque Country’s health system worked on providing a multichannel health services centre
that allowed access to healthcare through several innovative communication channels, which helped them to build a remote elderly patient monitoring system known as TEKI. The Basque Country’s approach was a holistic one based on the Kaiser Permanente model, in which the top level is those who are most difficult to treat and who were driving the majority of the healthcare costs. The initial move was to set a multi-channel centre in the region – something akin to a ‘healthcare call centre’, which was staffed by clinicians and nurses. Callers would be recommended to either go to hospital or reassured that they didn’t need to attend secondary care. This centre reduced the cost of care and provided greater agility and more decisionmaking capacity for clinicians. The region’s healthcare system
EXPERT PANEL – again in conjunction with Accenture - produced iPhone and Andrioid apps which could be downloaded by users to enable them to obtain mobile appointment confirmation and medical advice, and which also allowed them to access their personal health folders. More than 20,000 accesses were recorded in the first two days after the public announcement of the new service. The results that were achieved by this new system were amazing: • 11,000 acute hospital stays reduction between 2010-2011, which created savings of 8.9m EUR for the same year, or 42.5m EUR between 2009-11 • Surgical discharges increasing (.6.7 per cent) and medical discharges decreasing (-1.5 per cent) • An increase of 48.9 hospital at home stays With statistics like these, the future under the watchful eye of Professor Bengoa and his superb record of achievement, is muy bueno!
THE OTHER FIVE MEMBERS OF THE PANEL ARE: Dr Alan Stout is a GP principal in East Belfast, based
in the Arches Centre. He is the deputy chairman of the Northern Ireland General Practitioners Committee (NIGPC) and assistant secretary of Eastern LMC. ‘I am very pleased to have been asked to be involved in the expert panel,’ Dr Stout told NIHR, ‘particularly at a time that sees unprecedented pressure on all parts of the health service in Northern Ireland. There has never been a greater need or time for change, and I hope and know we can be innovative to improve access and services for patients in a planned and cost-effective manner. There is no doubt that this will be challenging, but encouraging new ways of thinking, and true collaboration between different sectors is going to be vital. If we concentrate on identifying, designing and delivering the best care for patients, I believe some of the more difficult decisions will look after themselves.’
Mairead McAlinden is currently Chief Executive of Torbay
and South Devon NHS Foundation Trust in England. Mairead was Chief Executive of the Southern Trust between 2010 and 2014, having held the position of Acting Chief Executive since September 2009. She joined the Southern Trust in 2007 as Deputy Chief Executive and Director of Performance and Reform.
Professor John Øvretveit is Director of Research and
DEADLINE FOR EXPERT PANEL!
Professor of healthcare innovation implementation and evaluation at the Medical Management Centre, The Karolinska Institute, Stockholm, and previously Professor of Health Policy and Management at Bergen University Medical School, Norway and at the Nordic School of Public Health, Gothenburg, Sweden.
Bronagh Scott is currently the deputy chief nurse for the
NHS England London region. She has held a number of senior management posts and executive directorships in health and social services in Northern Ireland and London.
The Health Minister, Simon Hamilton, has asked his new ‘expert panel’ to report to him in June, just after the May elections.`
Mark Taylor is a Consultant in General and Hepatobiliary Surgery. He has over twenty years of experience and is currently lead clinician at Belfast’s Mater Hospital. He is also currently Secretary of the Great Britain and Ireland Hepato Pancreato Biliary Association.
NIHR / 2016 / 9
NEWSHEADLINES Keep Us Well Campaign launched!
UU uncovers first ever profile of deaths by suicide New research at Ulster University has uncovered a pressing need for suicide prevention work to specifically target people in Northern Ireland who have difficult life experiences. In the first study of its kind in the UK looking at events prior to death over a six-year period, Ulster University researchers studied over 1,660 coroner’s files which record suicides and undetermined deaths in Northern Ireland. The results showed that: almost half (47.2 per cent) of the deceased had prior suicide attempts and almost one fifth (18
per cent) were known to have made two or more suicide attempts prior to the fatal event There was evidence of alcohol in 56 per cent of the cases and that this was most common among young males. In addition, 8.2 per cent of people were recorded as having had difficulties with substance misuse. Handwritten notes were the most common means of communication with one third (30.6 per cent), while just under five per cent sent text messages. ‘The circumstances surrounding death by suicide can give us insight into the factors affecting suicide risk in Northern Ireland,’ said Professor Siobhan O’Neill. (left)
‘Suicide is an important and preventable cause of mortality and these results go a long way to help understand prior suicidal indicators and help the identification of measures that could be taken to prevent such deaths. ‘It is really important that services for people who have adverse life events and suicidal thoughts are retained and promoted. Many of those at greatest risk do not identify themselves as having a mental illness and are not likely to present to mental health services to help them with, what they perceive are difficult life circumstances.’
Local graduate set to revolutionise global medical industry
An engineering graduate has secured a £300,000 investment to expand his new 3D medical printing company into European and US markets. Established in 2014 by Daniel Crawford, a biomedical engineering graduate from Ulster University, Axial 3D has already revolutionised the UK market by 10 / NIHR / 2016
manufacturing orthopaedic models for the medical industry. Using 3D printing technology, Axial 3D uses patients’ CT and MRI scans to manufacture individual scaled 3D models of the injuries. Surgeons use these patientspecific models to practise and plan procedures, which saves valuable time in the operating theatre, while also giving their patients a much more comprehensive insight into injuries. ‘With healthcare budgets under increasing pressure, Axial 3D can help surgeons
to minimise time spent in surgery,’ Daniel told NIHR. ‘This can decrease the risk of complications and reduce the time a patient spends in hospital, saving healthcare providers up to £5000 on postoperative care for each patient. This substantial investment will help develop my export expansion strategy for Axial 3D, providing the start-up with the necessary capital to expand its customer base outside the UK and Ireland, and to diversify services into other areas of medicine.’
The MS Society and British Heart Foundation NI have launched a new campaign, which is supported by the Long Term Conditions Alliance NI. The campaign is called Keep Us Well and focuses on the need to protect free prescriptions for people living with long-term conditions in Northern Ireland. The campaign has been launched in response to the consultation launched in February last year by DHSSPSNI on the Individual Funding Request process, which proposed the reintroduction of prescription charges to pay for a Specialist Medicines Fund. In response, a survey of people with long-term conditions in Northern Ireland reveals: • Just under half of people living with a long-term condition in Northern Ireland say they would worry about the cost if prescription charges were reintroduced here. • Sixty-one per cent said they thought it would affect their ability to manage their condition • More than one in four said that the cost of prescriptions had prevented them from collecting or taking their medication as prescribed before charges were abolished in Northern Ireland. To read more go to www.keepuswell.org
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NIHR / 2016 / 11
New ISO deadline looms for blood glucose meters... The International Diabetes Federation (IDF) estimates that 371 million individuals are living with diabetes worldwide. This figure includes the 50 per cent who, it is estimated, remain undiagnosed. There’s no doubt that the prevalence of diabetes is increasing across the world and it’s estimated that the figure will hit the halfbillion mark by 2030. In addition, global diabetes healthcare expenditure is estimated at around the $470m mark. In light of these alarming statistics, it’s obvious that intensive diabetes management is essential
12 / NIHR / 2016
in not only controlling the disease on a daily basis but also in preventing complications. According to the Diabetes Control and Complications Trial (DCCT), one important step in disease management is facilitated by frequent self monitoring of blood glucose (SMBG). Over the last twenty years or so, a number of accuracy standards
have been proposed. In 1987 the ADA proposed standards for SMBG device accuracy which recommended total error should be less than ten per cent for 100 per cent of glucose concentrations 30 to 400 mg/dL, but, in 1996, this recommendation was revised to support a maximum analytical error of less than five per cent. At this point, a collaborative
effort involving the International Organization for Standardization (ISO), international regulatory authorities, healthcare providers and SMBG manufacturers established minimum accuracy standards for SMBG devices. These were known as the ISO 15197 criteria and were originally released in 2003.
NIHR / 2016 / 13
C ONT I N U E D ...
There’s no doubt that the prevalence of diabetes is increasing across the world and it’s estimated that the figure will hit the halfbillion mark by 2030. In addition, global diabetes healthcare expenditure is estimated at around the $470m mark. In light of these alarming statistics, it’s obvious that intensive diabetes management is essential in not only controlling the disease on a daily basis but also in preventing complications. According to the Diabetes Control
and Complications Trial (DCCT), one important step in disease management is facilitated by frequent self monitoring of blood glucose (SMBG). Over the last twenty years or so, a number of accuracy standards have been proposed. In 1987 the ADA proposed standards for SMBG device accuracy which recommended total error should be less than ten per cent for 100 per cent of glucose
concentrations 30 to 400 mg/dL, but, in 1996, this recommendation was revised to support a maximum analytical error of less than five per cent. At this point, a collaborative effort involving the International Organization for Standardization (ISO), international regulatory authorities, healthcare providers and SMBG manufacturers established minimum accuracy standards for SMBG devices. These were known as the ISO 15197 criteria and were originally released in 2003. The major criticism of the original 2003 criteria was that the five per cent (one
14 / NIHR / 2016
in 20) threshold was too high and so allowed for too many large, medically unacceptable errors. As a result, in 2013, the ISO ruling was revised, and an updated set of standards (ISO: 15197:2013) was published: standards which need to be met by blood glucose meter manufacturers by the end of May 2016.
So, what do these new ISO standards required? Well, one of the driving factors behind the new criteria is that: ‘Medical experts involved in the development of this edition believed that better performing meters would result in more accurate insulin dosing and therefore should lead to better patient outcomes.’ While the 2003 ISO standards included system accuracy and user performance components,
NIHR / 2016 / 15
DIABETES There’s no doubt that the prevalence of diabetes is increasing across the world and it’s estimated that the figure will hit the halfbillion mark by 2030. In addition, global diabetes healthcare expenditure is estimated at around the $470m mark. In light of these alarming statistics, it’s obvious that intensive diabetes management is essential in not only controlling the disease on a daily basis but also in preventing complications. According to the Diabetes Control and Complications Trial (DCCT), one important step in disease management is facilitated by frequent self monitoring of blood glucose (SMBG). Over the last twenty years or so, a number of accuracy standards have been proposed. In 1987 the ADA proposed standards for SMBG device accuracy which recommended total error should be less than ten per cent for 100 per cent of glucose concentrations 30 to 400 mg/dL, but, in 1996, this recommendation was revised
to support a maximum analytical error of less than five per cent. At this point, a collaborative effort involving the International Organization for Standardization (ISO), international regulatory authorities, healthcare providers and SMBG manufacturers established minimum accuracy standards for SMBG devices. These were known as the ISO 15197 criteria and were originally released in 2003. The major criticism of the original 2003 criteria was that the five per cent (one in 20) threshold was too high and so allowed for too many large, medically unacceptable errors. As a result, in 2013, the ISO ruling was revised, and an updated set of standards (ISO: 15197:2013) was published: standards which need to be met by blood glucose meter manufacturers by the end of May 2016.
So, what do these
new ISO standards required? Well, one of the driving factors behind the new criteria is that: ‘Medical experts involved in the development of this edition believed that better performing meters would result in more accurate insulin dosing and therefore should lead to better patient outcomes.’ While the 2003 ISO standards included system accuracy and user performance components, the new 2013 version include additional components such as the evaluation of instructions of use and influence Dr quantities of interfering substances. As a result, the system accuracy requirements are carried out by comparing blood glucose results of meters against
the glucose level provided by a laboratory measurement. The user performance then evaluates the accuracy when the testing is performed by patients. This evaluation is designed to evaluate whether the instructions for the meter are clear enough. As a result, the new ISO standards demand new blood glucose meter standards, ie, for high blood glucose levels, the ISO
proposes a narrower Simon O’Neill range, while for both high and low levels, more readings (out of 100) must fall into the acceptable range.
NIHR / 2016 / 17
IMPROVED PATIENT ADHERENCE
comes up contrary to what they expected, and they can’t explain the reading based on previous experience (food intake, exercise, etc), then they need to test near the same site again.
Some factors that contribute to accuracy are actually under the control of the patient themselves so the following tips should be suggested to them:
Taking care of strips: It has been clearly proven that mishandled test strips can lead to errors. In fact, a 2005 study at East Carolina University in the States found that, once a vial of test strips was opened, it kept the longest in a refrigerated setting (35 to 50 days) and went bad most quickly in direct light and humidity (three to fourteen days).
Hand washing: If the patient has been handling food or drinks, or has been using some hand or body lotions, the meter reading could be affected, so it’s vital that the patients washes their hands with soap and then dries them completely before pricking their finger. Testing, then testing again: If the patient’s reading
18 / NIHR / 2016
Test strips need to be kept out of direct sunlight, away from moisture, and at room temperature or cooler (but not freezing).
New ‘hospital at home’ service for older people
Pic: (L-r): Dr Ian Clements, Chairman of the Health and Social Care Board; Dr Alan Stout, GP lead and Chairman of the East Belfast Integrated Care Partnership; and Jan Ritchie, Consultant Geriatrician at the Belfast Health and Social Care Trust.
The recently-formed integrated care partnerships (ICPs) have produced their first major success with the launch of an innovative new service in Belfast, which provides older people with expert medical and social care in their own home. The ‘Acute Care at Home’ team involves a range of healthcare professionals working together to help older people manage conditions, such as chest
infections, urinary tract infections, cellulitis and dehydration without the need for attending the emergency department, or being admitted to hospital. The 40-strong team is led by a Consultant Geriatrician and specialist doctors and nurses, but there’s also input from pharmacy, social work, occupational therapy, physiotherapy and community psychiatric nursing. Older people, age 75 and over, can be referred to
the service five days a week (9am8pm) by their GP, paramedics or Belfast Trust staff working in the community. ‘Acute Care at Home is an excellent example of a truly joined up and innovative way of working that will deliver seamless care; provide a better experience for patients, their families and carers; and reduce pressure on hospital services,’ says Dr Alan Stout, GP lead and Chairman of the East Belfast Integrated Care Partnership. ‘Patients referred to the service will have, within their own home environment, the same access to specialist tests as hospital inpatients and will receive assessment and treatment from a team of specialist professionals, including a hospital consultant.’ A similar service is in operation in parts of the Southern and South Eastern areas; and opportunities are already being considered to develop existing community services in the Northern and Western areas.
Bayer AG sells off Diabetes Care business... In June of last year, Bayer AG, announced its intention to sell its Diabetes Care business to Panasonic Healthcare Holdings Co. Ltd. Diabetes Care specialises in blood glucose monitoring systems, lancing devices and diabetes management 20 / NIHR / 2016
software. The business accounted for EUR 909 million in sales in 2014, with Contour® the principal product portfolio. Now, Bayer AG has announced that it has completed the sale of Diabetes Care for a sum of EUR 1 billion. The new stand-alone Diabetes Care
business is named Ascensia Diabetes Care Holdings and is headquartered in Basel, Switzerland. The sale not only includes the leading Contour® portfolio of blood glucose monitoring meters and strips, but also other products such as Breeze® 2, Elite® and Microlet® lancing devices.
Water way to travel! Belfast Consultant in Rehabilitation Medicine, Dr Josephine Hillan, recently undertook the challenge of a lifetime as part of the 2015-2016 Clipper Round the World Yacht Race. As part of a team of 20 amateurs and a professional skipper, Josephine sailed Leg 3 of the race, sailing from Cape Town to Western Australia in November, and tackling the notorious Southern Ocean on the way. I was delighted to be allocated a spot on board Northern Ireland sponsored boat Derry-Londonderry-Doire once my place on the race was confirmed,’ Josephine told NIHR, ‘and the crew worked really well together. After almost 5000 miles we were thrilled to come in second place! ‘Many of us hadn’t sailed before we undertook the training, but Clipper put us through our paces during four intense weeks last year, and it all paid off. That said, nothing prepares you for weeks living at a 40-degree angle, alternating watches of four hours on/ off and a complete lack of personal space. Junior doctor training helps with some of the self-management and sleep deprivation issues, but ocean sailing and it’s risks are not for the faint-hearted.’ The Clipper Race is continuing its circumnavigation, and will sail from New York to the Foyle in time for the Foyle Maritime Festival in July 2016.
NORTHERN IRELAND HEALTHCARE AWARDS
Thursday 25th February 2016 The Europa Hotel, Belfast With only a fortnight to go, the excitement is mounting for the finalists in the 17th annual Northern Ireland Healthcare Awards. The province’s most prestigious award ceremony – which takes place at The Europa Hotel on 25 February - showcases the success and accomplishments of our healthcare professionals, and, over the next nine pages, you’ll be able to read about the great work this year’s finalists have been doing in the following categories:
• Innovations in Quality & Efficiency through Technology in NI Healthcare • Epilepsy Project of the Year • Pharmacy Student Leadership • Dental Hygienist/Therapist of the Year • Hospital Pharmacist of the Year • Innovative Clinical Services in Community Pharmacy • Asthma Project of the Year • Dental Practice of the Year • Clinical Leadership Team of the Year • Special Recognition Award
17TH NORTHERN IRELAND HEALTHCARE AWARDS
Innovations in Quality & Efficiency through Technology in NI Healthcare SPONSORED BY MICROSOFT IRELAND DR AISLING GOUGH ON BEHALF OF THE CARE IN THE SUN TEAM UKCRC Centre of Excellence for Public Health, Queen’s University, Belfast
The ‘Care in the Sun’ team has developed a social media campaign focused on ‘Care in the Sun’ to promote skin cancer awareness. This campaign has utilised Twitter and Facebook to assess the feasibility of social media for delivering public health messages. Educational messages relating to skin cancer, targeting both skin surveillance and general care in the sun advice are posted on the social media platforms and, in this way, the public will become more aware of the risks of developing skin cancer.
BRIDGET SALT, OCCUPATIONAL THERAPY DEPARTMENT Craigavon Area Hospital, Portadown Bridget works in the area of hand therapy: the art of science of rehabilitation of the upper limb. Through the use of Facebook, Bridget is running a series of health promotion campaigns relevant to the area of hand therapy: a novel project in that health promotion is being delivered to a large public audience from the grassroots level of clinical practice. This initiative may evolve across different clinical areas and across the Trusts and beyond.
DR PATRICK DONNELLY Ulster Hospital, Dundonald. Dr Patrick Donnelly is a Consultant Cardiologist at the Ulster Hospital, South Eastern Health and Social Care Trust. His Evaluation of Palpitations in the Community (EPIC) project provides patients experiencing palpitations with rapid assessment, investigation, and treatment/ advice, when they most need it at the time of symptom onset through the use of innovative technology (zensor), leading to the delivery of more effective healthcare management from the patient and healthcare professional (HCP) perspectives.
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DR TOM LYNCH & EXPERIOR E-LEARNING PLATFORM TEAM Incorporating all Healthboard Trusts In addition to his role as lead radiologist for PETCT, Dr Lynch has recently been the acting lead for undergraduate radiology training in QUB. While working with the QUB undergraduates, he became increasingly aware that they were not as prepared for the demands of their foundation year as they could be. This led to him forming an alliance with a Belfast-based IT company called Experior Medical and, together, they built an intelligent e-learning system, which can identify particular areas of weakness in an individual and provide links to further information to allow that individual to improve their performance.
KERRY FINLAY (PHARMACIST), PAULA BANFORD (PRACTICE COORDINATOR), DR TIM ARMSTRONG (GP) The Surgery, Church Street, Newtownards When a new Local Enhanced Service was offered to review the monitoring of specialist, amber drugs, Kerry and the team spent considerable time developing the clinical requirements and translating them into a ‘process’, which the clinical system protocols could use. In terms of interprofessional efficiency, this allows the GPs and Kerry to be confident that the drug monitoring is up to date and, where it is not, patients are actively requested to attend.
17TH NORTHERN IRELAND HEALTHCARE AWARDS
Epilepsy Project of the Year SPONSORED BY UCB PHARMA SARAH MCCANN Epilepsy Nurse-Led Clinic for Adults with Learning Disability, Maghera Community Services Centre (NHSCT) Currently there’s one Epilepsy Nurse Specialist for adults with a learning disability within Northern Health and Social Care Trust, while the number of service users with complex health needs attending Adult Centres is
set to rise. In relation to this, the project is to skill up the newly-appointed Nurses/ Day Care Workers in epilepsy and its management, ensuring that service users attending the Adult Centres with a diagnosis of epilepsy have immediate access to a skilled worker who will be able to identify and manage concerns/ risks. This will promote best practice in the improvement of standards in the area, including the completion of Epilepsy Management Plans for all service users with a diagnosis of epilepsy within the facility. SUPPORTED BY UCB PHARMA THROUGH AN EDUCATIONAL GRANT. UCB HAS NO EDITORIAL CONTROL ON THE CONTENTS
SANDRA WYLIE AND CLAIRE MCCOOE Learning Disability Services (SHSCT)
The aim of Sandra and the rest of the team’s project, is to facilitate adults with a learning disability and epilepsy with a worthwhile daily activity/ employment in the community, while simultaneously reducing the stigma through education. Opportunities to do so emerge via training, supported employment, volunteering or social farming, and the expected positive ramifications include enabling them to move outside traditional day-care and access placements/employment in the community. The project is initiated through liaison between Specialist Epilepsy Nurses and Daytime Opportunity Staff in learning disability services, as well as providing education or training to employers/ group leaders, individualised care plans, and carrying out risk assessment as required in places of potential employment.
JULIANNE LEE, ROSIE PRUNTY AND RUTH CURRIE Childen’s Epilepsy Service, (SHSCT)
The overall intention of this project is to inspire a shared purpose for children and young people with epilepsy, building strategic relationships, improving communication, and creating supportive links between education and the Children’s Epilepsy Nursing Service. This is achieved by working in partnership with the child, parents/carers and education staff; therefore maximising the child’s potential in the learning environment. Health awareness sessions are delivered by specialist nurses to educate staff as part of a rolling programme and Epilepsy Awareness Training and Administration of Emergency Medication is provided by the Epilepsy Nursing Service. The venture additionally ensures increased visibility of the Epilepsy Nurse within the school environment, developing and building relationships and enhancing the experience of the child with epilepsy in school.
DR. MICHAEL KINNEY Neurology Registrar (BHSCT)
Michael and the team recognised a need for developing and applying a regional protocol and an agreed regional approach to the management of status epilepticus – an abnormally prolonged state of self-perpetuating and evolving seizure activity. In developing the project, they sought Guidelines and Audit Implementation Network’s (GAIN) support to help with the guideline implementation. The guideline will have a specific local protocol which allows treating physicians to be aware of the various options for pharmacotherapy, and also how to access EEG services, and neurology services locally. It’s also to encourage a good standard of care in drug administration, and what to do in unusual situations which are relatively common. Ultimately, the implementation of this project will have three main outcomes: promotion of patient safety, effective care, and a patient focus.
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Pharmacy Student Leadership Award SPONSORED BY THE PHARMACISTS DEFENCE ASSOCIATION AARON COURTENAY Queen’s University, Belfast At Queen’s University, Belfast (QUB) Aaron works as part of a team in the area of transdermal drug delivery; specifically developing a novel microneedlebased biotherapeutic drug delivery system for transdermal delivery of anti-cancer biotherapeutics and vaccine compounds. To enhance his role, he has also achieved British Sign Language Level 3 from the Belfast Metropolitan College and represented research in QUB Pharmacy at seven open days and career events.
ING HO KONG Queen’s University, Belfast
As an international student from Malaysia, Ing Ho ensures that international students are encouraged to develop personally and professionally during their time at the university. Ing therefore established a new peer mentoring scheme for undergraduate international MPharm students. Ing’s overarching vision for the future of pharmacy is to implement a more integrated working environment for primary healthcare in order to maximise patient care by respecting each other’s roles.
OLIVER MCKEE University of Ulster Oliver’s interest in this career path stretches back to when he was a child, and was fascinated by stories of interesting concoctions. At present, the increasing dominance of technology inspires Oliver’s insight that it can be utilised to aid and assist with working life. Putting this into action for his fellow students, he arranges, schedules, and files the lectures, as well as sending alerts.
OISIN KAVANAGH University of Ulster Recognising the importance of the NICE Evidence Search tool, Oisin has been at the helm of lessons and presentations for pharmacy students in Ulster – subsequently allowing them to use evidence-based medicine with confidence. His initiative and enterprising skills have also been demonstrated through his membership of the Pharmacists Defence Association for the last two years, his position as a mentor, and his involvement in the students’ union.
RYAN POTTS Queen’s University, Belfast In Level 3 Ryan was elected as the class representative for the Staff/ Student Consultative Committee (SSCC). In addition to being reelected into the role in Level 4, Ryan was chosen as school representative, and was also a member of the student council in his first and second year of the course. Under these positions, Ryan has acted as a significant stakeholder within the School of Pharmacy, engaging with students, staff and regulators to help improve the course.
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17TH NORTHERN IRELAND HEALTHCARE AWARDS
Dental Hygienist/Therapist of the Year SPONSORED BY GLAXOSMITHKLINE TRUDI FAWCETT BlueSky Dentistry, Belfast
ZARA MCKIBBIN Appletree Dental, Newry
Since qualifying as a Dental Hygienist in 2011, Trudi has worked across a diverse range of patient areas – including with special needs groups in community dental services, prisons and general practice. In fact, it was her role as part of a multidisciplinary healthcare team in the unique environment of Hydebank Wood Prison in Belfast which enabled her to devise an oral health care initiative which was the first of its kind in a prison setting. As well as helping to improve the oral health habits of the prisoners, Trudi also focused on the prison itself, including the availability of healthy snack options and oral care products. As a result, the prisoners experienced not just an improvement in their individual oral health, but an empowerment to continue to care for their own oral health through the skills they had learned.
With a continued emphasis on education, Zara ensures that patients are always informed of their own role and responsibilities within managing their disease. The process entails giving them a written copy of their oral hygiene plan, and goalposts as to what desirably should be achieved by the next appointment. Zara’s work caters not only for those with physical disabilities, but those with special needs. She also works closely with a local home for adults with special needs and their carers. The significance of education extends to Zara’s own experiences too, valuing opportunities to learn from peers and specialists. She regularly goes along to a peer study group led by a periodontist, and attended a Horton consultation training course. The Euro Perio Conference in London also provided a helpful platform for her daily working life.
DEIRDRE CANAVAN Community Dental Services, South Eastern Health & Social Care Trust
Deirdre’s long-standing career – she qualified as a Dental Hygienist in 1984 – has led to her working in a variety of settings: Health Service dental practices, independent and private practices, commerce, hospital dental services, and School of Dental Hygiene, Queen’s University, Belfast. For the past ten years she has worked within the Community Dental Service (CDS). Deirdre’s involved in a selection of evidence-based programmes, such as providing toothbrush/ paste packs to pre-school and Primary 1 settings in her electoral wards with greatest social need. The largest children’s dental health programme Deirdre is engaged with is the 3-2-1 Programme – an intervention for pre-school settings involving input to snacks, daily tooth brushing, and a dental health component. Additionally, she operates alongside other health professionals to provide timely advice to parents of six to nine-month-old babies, works with Surestart in their various preschool projects involving health advice, and has set up Time To Brush; a daily tooth brushing in Primary 1, working with her partners in community health.
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Hospital Pharmacist of the Year SPONSORED BY BOC HEALTHCARE AARON COULTER Trust-based Mental Health Medicines Management Pharmacist, Bluestone Unit (SHSCT) Since joining the hospital pharmacy sector in 2004, Aaron has worked in a number of community pharmacy posts, taking up a position as clinical pharmacist in St Lukes Hospital Armagh. It was in 2008 when the Bluestone Unit – the new acute psychiatric unit for the SHSCT – opened that Aaron moved to oversee the introduction of a medicines management service to mental health, the first (and only to date) of its kind in Northern Ireland. Aaron’s initiatives have included the development of the SHSCT Health passport.
CARLA JONES Specialist Respiratory Outreach Case Management Integrated Care Pharmacist, Altnagelvin Area Hospital (WHSCT)
Carla started her career in the Western HSC Trust in 2009, becoming an active member of the multidisciplinary ward-based team, and securing a Specialist Respiratory Outreach Case Management Integrated Care post. She was involved in the initial set-up of the satellite Acute Medical Unit Assessment (AMUa) unit and developed the adjoining pharmacy model of care.
CLAIRE MCCARTAN Knockbracken Healthcare Park (HSCT) Through Claire’s role as a medicines information pharmacist, she successfully mentors and trains other members of staff. In particular, she has helped harness a number of junior pharmacists undertaking the vocational training programme, in addition to assisting them in developing their skills and knowledge. She’s also developed and introduced a pilot of a Medicines Helpline for Patients discharged from the Belfast Trust.
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CHRIS BLACK AND STEPHEN CURRAN Belfast City Hospital (BHSCT) With the hope of specialising in neurological conditions and medications that cause falls, Chris has started work on an anticholinergic burden tool that intends to highlight medication associated with falls that isn’t immediately apparent. His other interest lies within Parkinson’s Disease. In line with Stephen’s overarching focus on elderly patients, he currently works as a band 7 Pharmacist in BCH Direct Admissions and assessment unit for older people in the City Hospital. His key consideration is polypharmacy and its impact.
STEPHEN TONER Consultant Pharmacist, Antrim Area Hospital (NHSCT) Stephen has been Lead Clinical Pharmacist for Surgery and Theatres and more recently became Principal Pharmacist for Surgery, Theatres and Women & Child Health for the NHSCT. As one of Northern Ireland’s first Consultant Pharmacists, he helped set up the Consultant Pharmacist service for patients in Intermediate Care facilities. The service development projects he has undertaken include providing smoking cessation support to inpatients.
17TH NORTHERN IRELAND HEALTHCARE AWARDS
Innovative Clinical Services within Community Pharmacy SPONSORED BY PHARMACY LIFE THE PHARMACY TEAM Randalstown
In order to extend clinical services beyond traditional roles, the pharmacy has embraced the MUR service, reaching the full quota of 120 MURs since the service was rolled out. When the service was extended to include diabetic reviews, it was decided that it could be developed further by teaming up with the diabetic nurses in the adjacent health centre, and a representative from a major drug company to devise an MUR questionnaire. A number of reasons prompted this course of action, including to improve communication between parties when patients were identified who had issues that needed to be referred from pharmacy to general practice. One of the key, and most effective, policies at Randalstown Pharmacies is that the pharmacist must engage with the patient at the point of delivery of medication or service. As a result, and to put this into place, more members of staff have been enrolled on the dispensary assistant training course.
SEAN MCGEOWN Vere Foster Medical Group Pharmacist
Having worked as a practice-based pharmacist for over six years now, Sean’s role has been largely dependent on HSCB funding and has generally involved non-patient facing work which includes medication reviews, generic switches, and clinical audits. Since 2014, however, he has taken a more patient-facing role and has been involved in analgesia reduction and benzodiazepine review clinics. This has allowed the practice to address these areas of work while also maintaining the availability of GP appointments. Furthermore, it’s the completion of the independent prescribing course in 2015 which has contributed to the success of these projects. Since these schemes of work have been undertaken there has been a significant reduction in the prescribing of both of these categories of drugs, leading to enhanced safety and quality of care for the patients of the practice in that a long-term use of these medications can have serious and potentially harmful consequences.
SHANE O’HARE AND TEAM Strangford Pharmacy
Strangford Pharmacy’s Smoking Cessation Service has been successfully received throughout the community, motivating people to quit, and providing behavioural support and supplying NRT, where suitable, to smokers weekly for up to twelve weeks. Patients have expressed that the ease of accessing this service was one of the main factors in enabling them to stop smoking and the weekly contact with the pharmacists was one of the main factors in the early weeks of quitting. Strangford Pharmacy also offers access to Medicines Management: a service aimed at those on a complicated pharmaceutical regime and who may not have had the support or opportunity to have their medicines and indications explained to them beforehand. The Medicines Use Review has garnered popular reviews, not only identifying many issues with the patients in regard to asthma, COPD and diabetes, but also highlighting other problems the patients are having, such as depression, anxiety, loneliness and other psychological problems. The team is able to identify these issues and signpost the patient to GPs and other services which they had not yet accessed.
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17TH NORTHERN IRELAND HEALTHCARE AWARDS
Asthma Project of the Year SPONSORED BY NAPP PHARMACEUTICALS LIMITED KATHY HETHERINGTON Regional Respiratory Clinic, Belfast City Hospital & QUB For their project - Kathy and the team – Professor Liam Heaney, Dr Claire Butler and Sister Jacqui Gamble – focussed on the Inhaled Compliance Aid (INCA), which is designed to work with the Accuhaler inhaler. The INCA is securely fixed to the outer casing of the inhaler and time and date stamps inhaler use. It does not interfere in any way with the mechanism of drug delivery of the inhaler. The recordings are then uploaded to a server which carries out an automated analysis and then highlights erratic timing issues, and shows phases/classification/ dose interval and provides printout graphs for clinician and patient. This technology prevents patients from unnecessarily progressing to biologic therapies and increased oral steroids by optimising their steroids through increased inhaled steroid awareness, good technique and accurate timing.
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KERRI MCCANN Clough Surgery, Clough
The team at Clough Surgery has the facility to offer input to patients from experienced GPs, an asthma nurse and Kerri, who is a respiratory pharmacist. Last year, the surgery was able to secure the use of a FeNO machine, which, until recently, was only available in secondary care and the team established a pathfinder to assess the benefit of FeNO testing in primary care. The team began by reviewing patients using inhalers who weren’t previously on its asthma register (or any other respiratory register), children presenting with chronic coughs, and those with uncontrolled asthma. The benefits of these reviews were immediately obvious, since the FeNO result helped the team in stepping up or down ICS therapy for patients to ensure inflammation was at a minimum and that patients’ symptoms were stable and improved.
MICHAEL O’NEILL & TEAM Omagh Health Centre, Omagh Following the 2014 publication of the National Review of Asthma Deaths (NRAD), Michael and the team decided that they wanted to look beyond QOF to ensure they were providing the best service and outcomes for their asthma patients. They felt that the best way to move this forward was to work across three practices in the Health Centre in order to fully address the needs of these patients, and to adopt a multi-disciplinary approach, which could bridge the interfaces of primary and secondary care. The project commenced in June and, initially, the team focussed on high-risk patients and those receiving regular respiratory medication, but who weren’t on the practice register. These patient reviews led to drug cost savings due to implementation of Formulary and to the development of practice protocols.
SINGING FOR HEALTH CHOIR Castlereagh, Knockbreda & Ashley Medical Centre, Belfast
The unique Singing for Health choir is made up of members aged between eight and 70 from across South and East Belfast, and North Down. The project was initially devised by Sophia Polatol and Brenda McKibbin - two practice nurses - who attended a Respiratory Conference in Warwick, and who had to devise a project. The Singing for Health Choir blueprint was born that weekend and, on returning to work, the two nurses - along with Joanna McKenna, a nurse from the Community Respiratory Team - the choir was established. The idea behind the choir was that it has been scientifically proven that singing improves breathing capacity, improves mood and generally improves physical and mental well-being. All members agree that the choir has enhanced their quality of life.
17TH NORTHERN IRELAND HEALTHCARE AWARDS
Dental Practice of the Year SPONSORED BY SOUTHERN CROSS DENTAL BLUESKY DENTISTRY TEAM Belfast
Established in February 2014, the ethos of Bluesky Dentistry is a multidisciplinary one, which provides the patient with continuity of care. Located in a beautiful Edwardian building in South Belfast, the practice is a very warm, comfortable and caring environment which is totally patient focused. Every Bluesky staff member is expected to push outside of his or her comfort zone, allowing the practice to provide an expanding range of services to its patients.
CURRIE AND GRIBBEN DENTAL SURGERY TEAM Armagh
In the last year Mel has not only significantly upgraded the cosmetic appearance of the premises, but has also focussed intensely on training for both himself and his staff to further develop and enhance the quality of care offered to his patients. Mel has also invested significantly in rebranding, stationery and practice literature and stationery, and this has been of great benefit to patients in terms of education and support.
APPLETREE DENTAL CARE TEAM Newry Conor Mc Enhill and Katrina Mc Kevitt started Appletree Dental Care in Newry in 2006. Newry has a strong reputation for â€˜dental tourismâ€™, and so the practice attracts a large number of patients from the South of Ireland. It also engages heavily, however, with the local community through healthy eating and dental care initiatives. Over its ten years in business, Appletree has developed a strong brand for good-value private dentistry and its sustained growth has come from many word-of-mouth referrals.
SMILES DENTALCARE TEAM Ballymena The practice is currently two thirds of the way through a growth plan which began in 2013, when it moved into new premises and converted to a four-chair practice. The growth plan has ensured that turnover has continued to increase in the last twelve months and has actually resulted in over 100 per cent growth in the last 24 months. The team regularly uses mystery shopping calls and plays recordings to staff to ensure patients are receiving an efficient and caring service.
DUNMURRY DENTAL PRACTICE TEAM Dunmurry
Dunmurry Dental Practice, which opened in 2004, is a mixed NHS and private practice, which has grown from one to three surgeries. In 2010 a major extension took place evolving the practice to a state-of-the art, fully computerised facility with digital imaging and monitors on chairside to aid patient communication. The team is currently finalising its plans for 2016 which include the development of both a TCO role and quality processes auditing in conjunction with Investors in People.
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17TH NORTHERN IRELAND HEALTHCARE AWARDS
Clinical Leadership Team Award SPONSORED BY MEDCOM DR. DAMIAN MCCALL AND THE AMBULATORY EMERGENCY TEAM Belfast Health and Social Care Trust
EAMON FARRELL, DR. PATRICIA MCCAFFREY AND THE ACUTE CARE AT HOME SERVICE Southern Health and Social Care Trust
The team’s implementation of ambulatory emergency care to unscheduled cardiology care within their Trust has encouraged engagement with a wide variety of key stakeholders. The members’ priority is to ensure patients entering their service know what to expect; they’ve developed a referral network linking the Ambulatory Cardiology Unit to both Emergency Departments within the Trust, and following a series of meetings with senior clinicians from emergency medicine, an agreed referral pathway and patient information leaflet were made available on the Trust intranet. The joint approach facilitates clinical conversations, reduces inappropriate referrals, and safeguards the patient journey within unscheduled care.
The Acute Care at Home (AC@H) service provides a dedicated Consultant Geriatrician-led multidisciplinary team whose primary focus is on maintaining older people at home in the event of an acute illness or unexpected deterioration in health. The service provides triage, assessment, diagnosis and treatment as an alternative to in-patient care specifically to those at risk of or potentially requiring admission to hospital, while the patients have access to laboratory results and diagnostic appointments as they would if they were an inpatient on an acute hospital ward. Also provided would be a service to facilitate discharge from hospital for patients requiring on-going medical input. To make the initiative as seamless as possible, the team held a number of focus groups and workshops to promote service user involvement.
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DR. JENNIFER HANKO AND THE REGIONAL HEMODIALYSIS VASCULAR ACCESS TEAM Belfast Health & Social Care Trust
With the aim of delivering and improving services, Jennifer and the rest of the team have worked across various networks; both national – being a council member of the Vascular Access Society of Great Britain and Ireland – and regional – as part of the regional Vascular Access Group in Northern Ireland. The development of local subregional vascular access clinics is also in progress, while Renal Access Coordinators are vital to the smooth running of vascular access-related services. The team’s focus on patients is ongoing, providing education regarding the importance of AVF creation and vein preservation, and helping them to negotiate predialysis pathways to ensure optimal haemodialysis start. As a result, patients have much more realistic information about the pathway and about the different options that are available to them.
DR. ROSE SHARKEY AND THE RESPIRATORY TEAM Western Health and Social Care Trust
With evidence that in the Western Trust in 2013, the deaths due to respiratory diseases accounted for 16.2 per cent of the total number, Dr Sharkey and the Respiratory team embarked on a service redesign. In a phased approach, the process mapped current services and developed current and future respiratory pathways. Integrated Care Partnerships (ICPs) were established across Northern Ireland and held their first meetings in June 2013, while multi-disciplinary groups were put in place to take forward the work in the Clinical Priority area. An integrated care service model that meets the needs of patients in the WHSCT with chronic respiratory disease has also been proposed to provide a streamlined service to provide care closer to home.
Something to get your teeth into… At NIHR we believe it’s always good to welcome something new to the magazine, so say hello to our fantastic new dentistry section! For some years now we’ve had healthcare professionals asking us to include dentistry in the magazine and we’ve reluctantly had to say ‘no’ due to the overwhelming depth and richness of NI medical and pharmacy life. But now, with many linking dental care with other health issues (as particularly shown in our feature on the Impact of Periodontal Therapy on General Health), we’ve decided to bring dentistry into our healthcare ‘stable’. This inaugural section brings you a wide and varied overview of the profession as it is today – from Dr Gerry McKenna appealing for assistance from primary care in rehabilitating head and neck cancer patients, to Peter Crooks providing an overview of the challenges facing today’s community dentists. So why not turn the page and get your teeth into our brand new section, which gives you the tooth, the whole tooth and nothing but… NIHR / 2016 / 31
As with most sectors of healthcare, the increasingly ageing population is leading to varied challenges for dentistry. Dr Gerry McKenna, the current president of the European College of Gerodontology, is a specialist in Restorative Dentistry and Prosthodonticsand a Senior Lecturer based within the Centre for Public Health in Queens University Belfast. Here, Dr McKenna tells NIHR about the important role that primary care can play in post-operative care for head and neck cancers…
REHABILITATION FOR HEAD AND NECK CANCER A LIFE-LONG ISSUE There’s no doubt that the increasing incidence of head and neck cancer has led to new and varied challenges for clinicians. These challenges are not strictly limited to Northern Ireland: in fact, it’s a growing problem around the world. The increasing number of those affected by head and neck cancer is linked partly to the quite significant changing age profile of the population. It used to be that only the very old were prone to this type of cancer, but the typical profile is now much younger. This is partly attributable to lifestyle choices such as smoking, but there is also a link to the human papillovirus. As with all cancers, the diagnosis for patients is devastating but equally, as with most cancers, early diagnosis can result in better patient outcomes. That’s where our colleagues in primary care can play a vital role in that both GPs and dentists are in a vitally important position where they are able to screen patients on a regular basis. Recent data has shown that the NI cancer service is improving all the time. People are being seen more 32 / NIHR / 2016
quickly and diagnosis is being carried out at an earlier stage, but one of the offshoots of increased incidence and diagnosis is that an increasing number of people have to live with the devastating consequences of these types of cancer. Patients are surviving much longer but clinicians are experiencing difficulties in rehabilitating these patients adequately. The problem with head and neck cancer is that, unlike other cancers which can be ‘hidden’ from public view or ‘disguised’, unfortunately, the consequences of head and neck cancer are often highly visible. Not long ago, for example, a colleague and I were in a situation where a patient’s cancer was so widely-spread that we had to remove an eye. Naturally the impact on a patient of such an outcome is both devastating and dramatic. In addition to the medical prognosis, the psychological impact can play a significant role in recovery. In head and neck oncology the rehabilitation can be lifelong, but in an increasing number of cases patients can continue to do better. The onus, unfortunately, is very much on the patient to regularly attend dental appointments so that they can be continually screened by our primary care colleagues.
For most patients treatment comprises surgery followed by radiotherapy, but it is the ongoing oral care that can be challenging in the long term. The side effects of surgery alone can be both troublesome and cause discomfort. Following surgery, for example, the levels of saliva in a patient can decrease considerably, leaving them with a dry mouth. Not only does this lead to increasing incidence of dental decay, it also leads to a great deal of discomfort in the patient. As the cure and survival rates increase, colleagues in primary care will see more and more patients needing a raised level of ongoing care. Initial rehabilitation in the dental hospital, where obturators and removable prostheses can be fitted will help to close any surgical defects, but it is the management of the side effects on a day-to-day basis in the long term, which will prove most successful to the patient’s overall rehabilitation. Primary care has a vital role to play in this, in addition to its vigilance at the prevention stage.
NURSE OF THE YEAR IMPROVES AFTERCARE FOR PATIENTS Northern Ireland’s Nurse of the Year, Ulster Hospitalbased Cherith Semple from Newtownards, scooped this year’s award after impressing judges with how her research improved aftercare for people with head and neck cancer. Cherith, a Macmillan health and neck clinical nurse specialist at the Ulster Hospital, Dundonald used a questionnaire on an iPad to help the patients. The feedback was then gathered from clinics and used to guide out-patient visits. The pilot project was in response to patients reporting that they felt most vulnerable following discharge from hospital. (The most common concerns for people
DENTAL recovering from head and neck cancer express are the fear of the cancer coming back, issues about pain or speech worries.) Cherith (41) said the questionnaire had helped patients to develop skills and confidence for selfsurveillance, and enabled fast-track referral to the follow-up clinics. ‘The patient comes in and meets a volunteer and completes the questionnaire,’ she explained. ‘They key in the concerns and are relayed to myself and a clinician on an ipad. ‘It’s basically all about empowering patients and one of the key things is ensuring the patient is an active participant in their own care,’ she said. Last year, Cherith, in conjunction with Professor Eilis McCaughan from Ulster University, also carried out research to assess the effectiveness of psychosocial interventions to improve quality of life and psychosocial well-being for patients with head and neck cancer. The two women searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the
Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; ICTRP and additional sources for published and unpublished trials. The date of the most recent search was 17 December 2012. They selected randomised controlled trials and quasirandomised controlled trials of psychosocial interventions for adults with head and neck cancer. For trials to be included the psychosocial intervention had to involve a supportive relationship between a trained helper and individuals diagnosed with head and neck cancer. Outcomes had to be assessed using a validated quality of life or psychological distress measure, or both. Two review authors independently selected trials, extracted data and assessed the risk of bias, with mediation from a third author where required. Where possible outcome measures for combining in metaanalyses were extracted and Cherith and Eilis compared continuous outcomes using either mean differences (MD) or standardised mean differences (SMD) and 95 per cent confidence intervals (CI),
with a random-effects model. They then conducted metaanalyses for the primary outcome measure of quality of life and secondary outcome measures of psychological distress, including anxiety and depression, and subjected the remaining outcome measures (self esteem, coping, adjustment to cancer, body image) to a narrative synthesis, due to the limited number of studies evaluating these specific outcomes and the wide divergence of assessment tools used. Seven trials, totalling 542 participants, met the eligibility criteria. Studies varied widely on risk of bias, interventions used and outcome measures reported. From these studies, there was no evidence to suggest that psychosocial intervention promotes global quality of life for patients with head and neck cancer at end of intervention (MD 1.23, 95 per cent CI -5.82 to 8.27) as measured by the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). This quality of life tool includes five functional scales, namely cognitive, physical, emotional, social and role. There was no evidence to demonstrate that psychosocial intervention provides an immediate or
medium-term improvement on any of these five functional scales. From the data available, there was no significant change in levels of anxiety (SMD -0.09, 95 per cent CI -0.40 to 0.23) or depression following intervention (SMD -0.03, 95 per cent CI -0.24 to 0.19). At present, there is insufficient evidence to refute or support the effectiveness of psychosocial intervention for patients with head and neck cancer. The evidence for psychosocial intervention is limited by the small number of studies, methodological shortcomings such as lack of power, difficulties with comparability between types of interventions and a wide divergence in outcome measures used. Future research should be targeted at patients who screen positive for distress and use validated outcome measures, such as the EORTC scale, as a measure of quality of life. These studies should implement interventions that are theoretically derived. Other shortcomings should be addressed in future studies, including using power calculations that may encourage multi-centred collaboration to ensure adequate sample sizes are recruited.
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Medical cost savings: the role of periodontal treatment
With the NHS searching frantically for cost savings, one US report has highlighted that periodontal treatment may provide one source of significant savings in annual health costs. NIHR takes a closer look….
Over the last couple of decades, research has shown that periodontal (gum) disease can be associated with negative systemic health consequences – particularly for patients, who are suffering from certain diseases and conditions. Periodontal disease is a chronic inflammatory disease in which a pathogenic bacterial biofilm develops on the tooth root surface of susceptible patients. If left untreated, it can lead to alveolar bone resorption, infection, and subsequent tooth loss. Some researchers have suggested that periodontal disease may also have an impact on systemic health via dissemination of bacterial species and host response factors, since the disease provides a favourable 34 / NIHR / 2016
environment for proliferation of pathogenic plaque bacteria and facilitates entry of bacteria and bacterial products into the bloodstream of otherwise apparently healthy patients via ulcerated and inflamed tissues. As a result, it has been increasingly mooted that successful treatment of periodontal disease could possibly prevent – or at least mitigate – some of the adverse effects associated with certain medical conditions such as type 2 diabetes, coronary artery disease and rheumatoid arthritis, and could consequently provide The report ‘Impact of Periodontal Therapy on General Health’ by Jeffcoat et al in 2014 (http://www.ajpmonline.org/
article/S0749-3797(14)00153-6/ abstract) was a real eye opener in terms of a potential source of significant medical cost savings. The report focused on estimating the effects of periodontal therapy on medical costs and hospitalisations among people with diagnosed type 2 diabetes, coronary artery disease, cerebral vascular disease, rheumatoid arthritis and pregnancy in a retrospective observational cohort study. The study by United Concordia involved more than 338,891 individuals over a five-year period (2005-2009) with both Highmark medical insurance and United Concordia dental coverage. All individuals had
gum disease and one or more of following conditions: type 2 diabetes, cerebral vascular disease, coronary artery disease and/ or pregnancy, and the report focused on estimating the effects of periodontal therapy on medical costs and hospitalisations among these patient groups. Periodontal treatment was associated with statistically significant decreases in annual medical costs of 40.2 per cent, or $2,840per year in patients with diabetes; 40.9 per cent, or $5,681 for those with cerebral vascular disease; 10.7 per cent, or $1,090 for those with and coronary artery disease; and 73.7 per cent, or $2,433 for those with became pregnant. Additionally,
hospital admissions decreased by 39.4 per cent, 21.2 per cent, and 28.6 per cent in patients with type 2 diabetes, cerebral vascular (stroke), and coronary artery (heart) disease, respectively. ‘We are pleased to report, significant savings in medical costs when patients with gum disease received treatment,’ said lead researcher Marjorie Jeffcoat, DMD, professor, dean emeritus at the University Of Pennsylvania School Of Dental Medicine. ‘This round of findings is the result of looking at our data in a more refined statistical manner. Specifically we accounted for the impact of diabetes on our stroke, heart disease and pregnancy data. The goal was to make sure that when we looked at individuals with multiple diseases, we accounted for the affect that diabetes may have on our findings.’ The report’s findings show that when individuals with gum disease are treated and
maintained, significant medical savings are possible, even when the individuals have multiple chronic diseases at the same time: results which are warmly welcomed by dental hygienist, Michaela O’Neill, who is the current President of the British Society of Dental Hygiene & Therapy and the first-ever Northern Irish person to hold the position. ‘It has long been suspected that periodontal disease is closely associated with serious systemic
disease,’ Michaela told NIHR, ‘and the findings from this report are positive in that they reinforce the important role which regular maintenance treatments can have, not only on oral health, but in the health and wellbeing of patients as a whole. ‘The role of clinicians, such as dental hygienists and those dually qualified in dental hygiene and therapy is to provide effective preventative treatments. If patients utilise these services
through measures, such as regular appointments and check-ups, they can avoid developing problems like periodontal disease and the cost and further medical issues which are related to it. ‘There are huge potential benefits to some of the most ‘at risk’ patient groups, such as the elderly and children, who are most likely to develop problems. Effective dental maintenance benefits include less invasive and traumatic treatments to these groups which are likely to have a larger cost associated with them. ‘What this report shows is that preventative treatment should be a commonplace and supports what we as clinicians have had anecdotal evidence of for years. The message that has to go out to the public is that looking after your oral health properly by visiting your dental hygienist regularly can help stabilise serious systemic health conditions.’
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The future for NI dentistry As NIHR launches its new dentistry section, Peter Crooks, Chair BDA NI Dental Practice Committee gives us an overview of the challenges facing the profession…
Like so many young people choosing a career, Peter Crooks wanted to do something that helped people in a practical way. Although he initially entertained the idea of medicine, he didn’t care much for the sight of blood, so plumped for dentistry assuming that blood would be a rare sight in that job. His first week in the School of Dentistry at the Royal Victoria Hospital confirmed just how wrong he was! Peter qualified in 1983 and worked as an associate with Boyd and Logue in Maghera. Four years later he bought a practice in Ballymena and has been there ever since. He currently works with two associates in a mixed practice, which means that they can provide both private care, mostly through Denplan, and some NHS care. As with many dentists, Peter finds working in today’s dental practice 36 / NIHR / 2016
both challenging and rewarding. ‘I love meeting the patients and treating them,’ Peter told NIHR. ‘They’re the reason I went into dentistry and where I still derive most job satisfaction. It’s great to actually cure dental pain and make things better for patients even if that means an extraction in some cases. By the very nature of their work, this contrasts with our medical colleagues who often have to manage a patient’s condition without being able to actually cure it. ‘One of the biggest challenges in general dental practice is the increase in regulation drawn up by the DHSSPS and inspected against by RQIA. In the wisdom of the Department, general dental practices are regulated as independent hospitals and inspected
as such. Policies are now drawn up and explained to staff; equipment may require daily, monthly and perhaps quarterly checks carried out, each check to be printed, signed or initialled, dated and filed and all carried out between patients or at lunchtime. And then there are the daily cleaning schedules to keep track of. All this is carried out when we should be thinking how best to treat the next patient in our dental chair and there are times when I wonder how much more regulation dentists can take.’
‘About ten years ago, things changed in my outlook. I reckoned I would have only one career in my life and I wanted to give it my best efforts, so I started to get involved more in the Northern Local Dental Committee (LDC) and was soon elected Chair.
Peter’s involvement with the British Dental Association began about ten years ago.
‘No other organisation brings dentists together like the BDA, whether they work in general practice, hospital or the Community
‘At that time, the Chairs of the four LDCs sat on the Northern Ireland Dental Practice Committee (NIDPC) and in 2010, eighteen months after joining, I was elected Chair of that. This is the Committee which represents the general dental practitioners (GDPs) working throughout the province, so I consider it an immense privilege and responsibility to speak up for them to anyone who will listen and even to those who won’t listen!
DENTAL Dental Service. Every year the Branch President provides an excellent series of postgraduate lectures by invited speakers and this is what attracted me to join the Association as soon as I qualified. The social programme is wide ranging and gives dentists an opportunity to relax together. ‘But the BDA is also about representing dentists in the political arena. My aim for NIDPC is to bring the concerns of GDPs to the appropriate body whether that be the DHSSPS, the Health and Social Care Board (HSCB), the Business Services Organisation, RQIA, ACCESS NI and the rest and conversely let our local dentists know what is planned for them and how it may affect their working practices. If I can influence the agenda of these organisations in any way to make our dentists’ working lives easier in their efforts to treat their patients, I will do it.’ Needless to say, Peter has witnessed some major changes in dentistry over the years. ‘There have been some tremendous changes since I qualified but I would have been disappointed if there hadn’t been any! ‘Cosmetic dentistry has improved greatly with the advent of new techniques and materials for bonding porcelain veneers, crowns and bridges onto teeth in such a way that it’s difficult to tell what’s porcelain and what’s tooth. ‘Also, tooth whitening was never heard of when I qualified. The only way to improve a tooth’s appearance then was to trim it down and cement a crown onto it. Now whitening can improve the appearance of the whole dentition without using a drill on any tooth. ‘Dental implants have become more successful for helping replace the missing teeth for patients who struggle with dentures. ‘All of these developments in cosmetic dentistry are matched by increasing patient expectations. It’s NIHR / 2016 / 38
now more common, for example, for a patient to want a white filling in a posterior tooth rather than a silver amalgam filling. ‘But while these techniques have improved our patients’ smiles, the job of running a dental practice has become increasingly difficult. Over the last five years or so, the regulations imposed upon us for the decontamination of our reusable instruments have proved both costly and puzzling as the requirements placed on dentists in the other regions of the UK differ, yet I’m sure the bacteria and viruses in their areas are no different to ours. As I mentioned earlier, the introduction of RQIA inspecting dental practices as independent hospitals has proved a big challenge. Annual onsite inspections require preparation, blocking out the appointment diary for the inspector’s visit and the added stress of an inspector challenging our working practices despite having no dental qualification and probably no experience of owning a practice.
‘On many occasions NIDPC has questioned the DHSSPS regarding the need for an annual inspection when pre-RQIA, the Health and Social Care Board was content with three yearly inspections. We will continue to question this, not only from the point of view of value for money, but because the Care Quality Commission in England regard general dental practice as a low risk sector. Should our Department not do the same?’ With so many challenges facing the profession what, in Peter’s opinion, does the future hold for dentistry in NI? ‘Well, there’s no use in denying the future promises to be very difficult. I’ve just spoken, for example, with a colleague who qualified in the last fifteen years and he worries for the young graduates qualifying now. How much more should those of us, who are qualified, much longer, worry for them? ‘In August 2015 the Health and Social Care Information Centre revealed that both the morale and motivation of dentists in
Northern Ireland was the worst in all the regions of the UK. This comes as no surprise. Dentists in Northern Ireland rely mainly on the Health Service for funding their practices. Since 2001 Commitment Payments have been paid to GDPs in recognition of their commitment to the Service. However, over the period 2008/09 to 2013/14 dentists’ taxable earnings have fallen by more than 20 per cent and the DHSSPS has now decided to phase out Commitment Payments as part of a range of measures to cut the General Dental Services (GDS) budget, with their total abolition from April 2016. ‘The BDA has called on the Department for Commitment Payments to be reinstated in full to address in some measure the fall in dentists’ income. The situation will be unsustainable for practices where there is a struggling economy, a decrease in earnings, a reduction in funding, evidence showing marked increases in expenses such as electricity and water bills and increased regulation with the associated costs. ‘Both the Department and the Board are hoping that a new contract for Health Service dentistry will somehow solve many of our difficulties. However, while we have welcomed the introduction of pilots for delivering HS payments to dentists and will continue to work constructively with the Department in the development of a new GDS contract, we are mindful that it will have to be resourced sufficiently to meet the needs of patients, practices, dentists and staff in a service fit for the 21st century. That’s a big ask.’
International delegates tackle a ‘Titanic’ problem! In October, the iconic Titanic Centre in east Belfast was the setting for the 31st Restorative Dentistry Conference: the annual joint meeting of Restorative Dentistry - UK and the Specialty Registrars in Restorative Dentistry Group. This was the first time that the conference had been held in Northern Ireland, so it was an exciting time for all those involved in Restorative Dentistry, both from Northern Ireland and from further afield. The organisers were especially delighted this year to welcome the European College of Gerodontology – thus enabling them, as Ulpee Darbar, Chair (RD-UK) said, ‘to bring different fields together to allow RD-UK to remain at the forefront of shaping the future for Restorative Dentistry’. Around 380 delegates gathered at Belfast’s best-known landmark for this event, which focussed on restorative dentistry for all ages. The hosts were particularly pleased to welcome speakers and delegates from Japan, which is about 20 years ahead of the UK in terms of dealing with an ageing population
and the dental problems related to that particular section of the population. Throughout the day, delegates enjoyed a series of presentations and workshops facilitated by some of the leading experts in their respective fields. The conference, which was opened by Professor Patrick Johnston, Vice-Chancellor of Queen’s University, first welcomed Simon Killough, Consultant in Restorative Dentistry in the Belfast Trust and Honorary Lecturer at Queen’s University, Belfast. Simon’s main interest is in head and neck oncology and he facilitated a hands-on workshop on endondontic retreatment, which focussed on the diagnostic and treatment planning abilities required in cases of failed root canal treatment, the appropriate equipment and materials used in root canal retreatment and the practical skills that can be utilised to remove or bypass root canal obstructions. Frank Burke, Vice-Dean (Academic Affairs) in the
College of Medicine and Health, University College Cork facilitated a workshop on workforce planning for the ageing population, which looked at the population demographics of the ageing population, the challenges of delivering oral healthcare to the ageing population and the use of dental teams in healthcare settings. Ulpee Darbar’s clinical expertise lies in the management of patients with complex and multidisciplinary problems including tooth loss, soft tissue loss and replacement with dental implants. Ulpee focussed on ‘The Patient Journey Across Generations’, which looked at the challenges faced by patients progressing through integrated/ multidisciplinary care, and the issues relating to clinical challenges in providing quality care against funding. Luc Van Der Sluis, who leads the Department of Conservative Dentistry in the Centre for Dentistry and Oral Health at the University of Groningen in the Netherlands also looked at the
endodontic dilemmas of both young and old in his presentation. Luc focussed on the challenges in delivering endodontic treatment as teeth and patients age and the cost benefit of such treatment against other options. Jimmy Steele, Consultant in Restorative Dentistry with Newcastle Acute Hospitals Trust chose ‘Maintaining Quality – Clinical Care vs Commissioning Challenges’ as his topic. In his presentation, Jimmy looked at the challenges faced in delivering high-quality restorative care in the current NHS and the impact of funding constrains on quality of care in line with the ageing population and increasing treatment needs. All of the delegates agreed that the day had been an overwhelming success and that the agenda had been not only wide-ranging, but highly informative. The ‘handson’ workshops had also proved very popular and had given delegates the opportunity to look at restorative dentistry from all angles. 39 / NIHR / 2016
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Why a paediatric continence service is more than just a NICE to have! June Rogers MBE The rationale for an integrated service, early intervention and savings with a robust service. Nocturnal enuresis (NE)is the most common type of urinary incontinence in children and is defined as wetting during sleep in a child aged 5 years or older. Studies have identified that as many as 1 in 5 children wet the bed with figures decreasing by 15% each year of age dropping to around 6 % at age 11 years (Kilicoglu et al 2013) There are three commonly proposed mechanisms that contribute towards bedwetting including: Excessive production of night time urine Bladder over-activity or small capacity Failure to wake in response of bladder signals (lack of arousal) The exact cause of bedwetting in individual children may be
interlinked with one or all of above and may also involve other factors such as family history, fluid intake and constipation. Bedwetting could also be a symptom of an underlying problem that parents fail to recognise as significant. For example, many parents dismiss day time bladder problems such as urgency, frequency and the odd pair of wet pants as part of the natural maturation process so do not seek help â€“ it is only when they come forward with the bedwetting problem that these potentially serious underlying bladder problems are identified. Other comorbidities, such as diabetes or the presence of UTIs, can also be excluded at this point. Constipation can also be a contributory factor and once resolved the bedwetting has been shown to improve (Borch et al 2013) It is therefore important that all children
who present with bedwetting have a comprehensive assessment which will not only exclude or identify any underlying pathology, such as constipation or bladder problems, but will also help inform the initial choice of treatment (Cederblad et al 2015, NICE 2014). Early intervention and active management is recommended for all children with bedwetting from aged 5 years (NICE 2014). A large British cohort study (Butler & Heron 2008) identified that those children who are considered to have either severe bedwetting (i.e. wet every night at age 4.5 - 5 years) or the non monosymptomatic form are likely to persist with the bedwetting throughout childhood and into adolescence if it is left untreated. NICE (2014) recommended that either desmopressin or the alarm should be considered as first line
treatment if lifestyle changes alone did not result in resolution of the problem. The choice of initial treatment should be informed by the assessment, and should take into account the preference of the child and their parents or carers. Factors such as age, associated functional difficulties and disabilities, financial burdens and living situations may affect their preferences. Unfortunately continence services for children with problems such as bedwetting are often fragmented and inconsistent which can result in children being neither assessed appropriately nor offered timely appropriate treatment. Also is the concern that any underlying co-morbidities such as constipation or bladder problems are not being identified and treated at an early stage. Often it is only when such problems have escalated, with the child ending up in A&E or 41 / NIHR / 2016
FERRING secondary care, that the problems are identified. The Psychological wellbeing of children, young people and their families affected by bedwetting can often be neglected & unappreciated. A recent study by Kilicoglu et al (2014) found that not only were the children adversely affected by the.bedwetting, particularly in terms of being afraid that someone will find out with the risk of humiliation, but their mothers also experienced perceived lower quality of life. The development of integrated nurse led community based continence (bladder and bowel) services has been shown to not only increase positive treatment outcomes and prevent
problems becoming chronic and therefore more difficult to treat but also reduce the patient journey and inappropriate secondary care referrals thereby being very cost effective (Rogers 2012, Williams et al 2015) We know nocturnal enuresis can improve with treatment and also importantly improved self esteem and quality of life have been reported after successful treatment (Redsell & Collier 2001). It is therefore important to not only offer timely treatment but to also have pathways in place to refer children on to more specialist services when first line treatments have not been effective.
June Rogers MBE December 2015
REFERENCES Butler RJ & Heron J (2008) The prevalence of infrequent bedwetting and nocturnal enuresis in childhood. Scandinavian Journal of urology and Nephrology; 42: 257-264 Cederblad M, Sarkadi A, Engvall G et al (2014) No effect of basic bladder advice in enuresis: A randomized controlled trial. J Pediatr Urology;11(3):153 Kilicoglu AG, Mutlu C, Bahali MK et al (2014) Impact of enuresis nocturna on healthrelated quality of life in children and their mothers. J Pediatr Urol ; 10(6):1261-6
NICE (2014) Bedwetting in Children & Young People. Quality Standard (QS70) https://www.nice.org.uk/ guidance/qs70/resources Redsell SA, Cllier J (2001) Bedwetting, behaviour and self esteem: a review of the literature. Child Care Health Dev; 27:149-62 Rogers J (2012) Working with families to boost children’s continence. Nursing Times. ;108(50):16, 18. Williams KS et al (2005) Clinical and costeffectiveness of a new nurseled continence service: a randomised controlled trial. British Journal of General Practice; 55(518):696-703
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ALLEVIATING THE DISTRESS OF MRI... MRI has been used for many years, with no known side effects. Despite its excellent safety record, it does, however, strike fear in the heart of those who suffer from claustrophobia
Magnetic resonance imaging, better known as MRI, is a powerful diagnostic tool that uses a strong magnetic field to produce highresolution images of the body, in multiple directions. Used for over 30 years, it is known to be the safest method of scanning with no known side-effects. Capable of identifying issues relating to muscles, nerves, ligaments and other soft tissue structures, MRI is now the investigation of choice in many medical specialities including neurological, musculoskeletal and oncological conditions. Despite its excellent safety record, it does, however, strike fear in the heart of those who suffer from claustrophobia – the fear of enclosed spaces, which affects up to fifteen per cent of all people. In fact, it’s estimated that fear of suffocation and restriction prohibits about two million people with claustrophobia from undergoing an mri each year. The actual incidence of distress
in the MR environment is highly variable across studies due to differences in outcome measures used to describe this phenomenon. Some investigations indicated that as many as 20 per cent of the individuals attempting to undergo MR procedures can’t complete the exams secondary to serious distress such as claustrophobia or other unwanted sensations. In contrast, other investigations have reported that as few as 0.7 per cent of individuals have incomplete or failed MR procedures due to distress. The physical environment of the MR system is clearly one important source of distress. Sensations of apprehension, tension, worry, claustrophobia, anxiety, fear, and panic attacks have been directly attributed to the confining dimensions of the MR system. For example, for some scanners, the patient’s ‘line of sight’ may be three to ten inches from the inside of the MR system, prompting feelings of uncontrolled confinement and
detachment. Solutions? Other distressing sensations With the confined nature of the attributed to the MRI environment the major cause of environment include: claustrophobia, the last 20 years or the prolonged duration of the so have seen an increase in the use examination of ‘open bore’ MRI systems. the acoustic noise A study in 2011 reported the temperature and humidity that the use of a wide-shortwithin the MR system, bore scanner actually increased and the stress related to restriction the examination success rate in of movement. patients with claustrophobia and Naturally, patient distress can substantially reduced the need contribute to adverse outcomes for anaesthesia-assisted MRI for the MR procedure. These examinations, even when can include unintentional claustrophobia was exacerbation of patient severe. distress, a compromise According to in the quality and Michael Ennis, consequently the MRI radiographer diagnostic aspects and Business of the imaging Development study and decreased Manager at efficiency of the MRI Northern MRI, the facility due to cancelled Michael Ennis open bore scanners studies. As a result, have proved to there may be clinical or be highly successful in reducing other related implications for the patients’ anxiety. distressed patient. ‘We see many patients coming 43 / NIHR / 2016
NORTHERN MRI for MRI scanning with varying degrees of anxiety,’ Michael tells NIHR. ‘These can range from mild distress to severe anxiety caused by conditions such as claustrophobia. We are fortunate in that we have the first open bore scanner that’s available in Northern Ireland – the Siemens Espress 1.5 Tesla - which in addition to producing superior, high-quality imaging, has the additional benefit of having a larger opening than standard MRI scanners. This not only helps reduce patient claustrophobia, but it makes the MRI experience more pleasant for our patients. ‘Our scanner is fully lit, ventilated and open at both ends. This investment has not only greatly improved patients’ comfort and reduced the potential for anxiety, but has also allowed us to carry out faster examinations, resulting in the patient having to remain in the scanner for a shorter time. ‘We firmly believe, however,
that, in addition to the open bore nature of our scanner, there are a number of steps, which referring clinicians can take to put patients more at ease prior t the procedure. ‘For a start, the clinician should take the time to explain the reason for the MRI procedure and what he or she should expect to learn from the results as regards implications for treatment and prognosis. Education is to us the most important step in informing the patient about what is to happen so that this may reduce the aspects of the MRI that the patient may be finding difficult or challenging to deal with. This includes conveying, in patient-friendly language and terms, the internal dimensions of the MRI system, the level of acoustic noise that can be expected, and the estimated duration of the examination. ‘Research findings have shown that there is a decrease in the incidence of premature examination of MRI examinations
when patients have been provided with detailed information about the procedure. We work on the basis that, in addition to personal concerns about the MRI, because of the nature of the confinement, many patients will have heard ‘horror stories’ from friends and relations, so in addition to any private concerns a patient may have, they may also be carrying the ‘war wounds’ of others who may have experienced less comfortable procedures than the patient will with us. ‘Prior to the MRI itself, we also focus on details of patient positioning in the scanner, which can not only increase comfort but can also minimise distress. Taking time, for example, to ensure comfortable positioning with adequate padding to alleviate undue discomfort or pain is important, as is providing adequate ear protection. ‘If a patient still continues to experience distress after these
measures have been implemented, we may permit an appropriately screened relative or friend to remain with the patient. Should such a person not be present, then a staff member will maintain contact with the patient during the examination to decrease psychological distress. ‘As clinicians, we are fully aware of the distress that the thought of an MRI can cause patients. Unlike many other relatively ‘simple’ procedures, we have – in many instances - to pay as much attention to the lead-up to the scan as we do to the scan itself, but we remain totally sympathetic and empathetic to patients’ concerns at all times. The feedback we have from those who have undergone MRIs with us has been positive to date, so our input – both in terms of investment and time has been worthwhile.’
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TOP100 Meet Northern Ireland’s Top 100! There’s no doubt that, when it comes all aspects of healthcare – from researchers, to technology experts, to clinicians – Northern Ireland is bursting with talent. That’s why Medical Communications Ltd is delighted to announce the Top 100 2015: the 100 most dynamic and innovative personalities in the industry today. These professionals have made a positive contribution to healthcare in Northern
Ireland over the past year in particular and we want to recognise that contribution and shine a light on the sterling work that they have done. Whether they’re healthcare professionals; industry members, who have gone that ‘extra mile’ for the profession; or academics, who are blazing the way for students in the future, you’ll find them all here in the Top 100! Read on… 45 / NIHR / 2016
THELMA ABERNETHY Thelma Abernethy has been in post as Chief Executive of Addiction NI since June 2013 and, during that time, has been actively involved in the developing service reach and influencing policy an practise to support people affected by theirs or someone else’s alcohol and/or drug use. She has been instrumental in providing a tailored programme within the workplace which supports managers to develop their knowledge about the impact of alcohol and drugs.
COLIN ADAIR Following a career in clinical pharmacy, Professor Colin Adair joined the NI Centre for Pharmacy Learning and Development as Director in 2001. He has authored over 140 research and educational publications and, in recognition of his work, has received three National Training Awards and a JISC Award for innovative eLearning in higher education. He also has membership of, or has served on/ advised numerous expert panels on the learning needs of the health professions linked to National Health Service reforms.
TOP100 Raymond has worked in community pharmacy for over thirty five years and is currently a partner in Andersons Pharmacy in Portadown and an Independent Pharmacist Prescriber. Recently, he became Chairperson and pharmacist lead of the Craigavon & Banbridge ICP. He is a former President of the Council of the Pharmaceutical Society of Northern Ireland (2006-2009) and is currently a member of the Pharmacy Forum NI. Raymond is also currently the Northern Ireland representative on PGEU (Pharmaceutical group of European Union) and President of the Commonwealth Pharmacists’ Association
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Headquartered in Craigavon, Almac Group is an established contract development and manufacturing organisation providing an extensive range of integrated services to over 600 companies globally within the pharmaceutical and biotech sectors. Leading its 4,000 staff is Alan Armstrong, a member of the Royal Society of Chemistry, who began his career in 1978 with Galen Research Laboratories (Almac’s predecessor organisation). In 2001 Alan was appointed Chief Executive Officer of the newly established Almac Group.
TOP 100 NEILL ARMSTRONG Neill Armstrong is CIGA Healthcare’s Sales Director. Over the last ten years in Ciga Healthcare he has expanded their Business in Europe, Africa, the Far East and America and CIGA are currently trading in over 70 countries across the world. Added to this he is growing CIGA’s British and Irish market share. Over the next few years he is looking forward to growing CIGA’s share of the Blood Glucose market with a Brand new Suresign Blood Glucose meter that brings value to the NHS and to the tax payer.
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TOP 100 JANICE BAILIE
Dr Janice Bailie completed a PhD in Biochemistry at Queen’s University in 1990, and post-doctoral research Ophthalmology at Queen’s, and in the Radiation Science Group, Ulster University, focusing on the role of the microvascular endothelium in angiogenesis. From 1998-2005, she was Divisional R&D Manager in Molecular Biology at Randox Laboratories Ltd, before joining the HSC R&D Office as Programme Manager in January 2005. In June 2013, Dr Bailie was appointed to the role of Assistant Director of HSC R&D Division, Public Health Agency.
Dr Pamela Bell established Pain Clinics at Bangor Hospital in 1989 and at Musgrave Park Hospital in 1995. Here she developed a clinic for children and adolescents with long-term pain, the first in Northern Ireland. She was instrumental in setting up a Masters degree in the Science and Practice of Pain at QUB. Since retirement Dr Bell has been active in raising awareness of the burden of longterm pain to individuals, families and carers, and society through the work of the Pain Alliance of Northern Ireland of which she is the Chair.
TOP100 David is the President and Managing Director of Galen Limited, a privately owned pharmaceutical sales and marketing company established in 1968. He has been in the industry for over 20 years in a wide range of disciplines and joined Galen two years ago. More recently Galen signed a long term licensing agreement to exclusively market, distribute, and supply a new emergency pain relief product, Penthrox®, throughout the UK and Ireland and signifies an exciting next step in building a specialty products’ portfolio.
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David Bingham BSc, MBA, Chartered Member IPD, CIHM, has been Chief Executive of the Business Services Organisation (BSO) for the Health and Social Care Board since 2009. As part of his current role, David is responsible for a £100 million framework agreement, which is designed to make key improvements to front-line services by transforming the regional health data centre infrastructure by refreshing regional services, including the GP network and the Patient Administration System infrastructure.
TONY BJOURSON Professor Bjourson was appointed Director of the Biomedical Sciences Research Institute (BMSRI) at the University of Ulster in late 2007. He has over 25 years’ research experience in a diverse range of molecular biological/genomic projects. As Director of the Stratified Medicine Centre he is leading the personalised medicine-based diagnostics research in cancer, autoimmune disease, cardiovascular disease, diabetes and mental health pharmacogenomics.
TOM BLACK As both Chairman of the BMA’s GP Committee in Northern Ireland, Tom also works in Derry in an inner city practice looking after a population centred on the Bogside and Brandywell with 7,000 patients and four partners He previously acted as Vice Chairman of the NI General Practitioners Committee (NIGPC) of the BMA in Northern Ireland, leading on appraisal, revalidation, and clinical and social care governance, working on the Confidence in Care programme and with the Health and Social Care Board to try to protect health visiting and district nursing services.
TOP100 At Janssen our focus is addressing unmet medical needs; our aspiration is to be a transformational medical innovator. It’s not enough for us to work on incremental improvements to healthcare. We want to improve outcomes for patients, here in Northern Ireland we work with some of Europe’s leading Clinicians to make this aspiration a reality. In Northern Ireland we collaborate with local healthcare professionals and scientists to continue to improve patient outcomes in our focus therapeutic areas: oncology, immunology, metabolic disease, neuroscience and infectious diseases.
As Assistant Director of Integrated Care - Head of Pharmacy and Medicines Management at the Health and Social Care Board, Joe Brogan is responsible for commissioning safe, effective and efficient use of medicines in the Health Service in Northern Ireland. This involves assessing needs, reviewing evidence, prioritisation,investmentanddisinvestmentstrategies, monitoring and performance management. Joe has now spent 25 years in NI healthcare following a spell in hospital pharmacy in Zambia in 1991-3.
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KIERAN CANAVAN Keiran Canavan’s passion for ophthalmology is matched by his commitment to bringing Allergan’s innovative products and supporting medical education programmes to the eye care professionals he has worked with for the past 11 years. Kieran always works collaboratively to ensure that the needs of the patients who rely on our glaucoma and tears products are top of his agenda. It’s clear to everyone that he finds working on the Allergan ophthalmology business highly rewarding and dynamic, but most of all fun.
FIONNUALA COLGAN Zimmer Dental and BIOMET 3i have joined forces to become a leader in oral healthcare solutions as the Zimmer Biomet dental division. Each company has innovated and introduced marketdefining solutions, creating long proud histories of commercial and clinical success. Together, with our combined 62 years of dental industry experience, we are committed to redefining dentistry for today. Fionnuala Colgan, our Territory Manager covering Northern Ireland has been involved in implant dentistry for over 10 years and has a wealth of experience.
TOP100 In 2009 Aisling – Consultant Nephrologist at Belfast City Hospital – became the first nephrologist appointed in Northern Ireland with a special interest in transplant. Her vast experience also boasts being Honorary Clinical Senior Lecturer at QUB, as well as Locum Consultant, Nephrology at the Royal Free Hospital in London, and Clinical Research Fellow at Belfast City Hospital. Aisling has also lent her insight and research to a number of publications, covering transplantation, general nephrology, and dialysis.
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North West Independent Hospital located in the North West has been delivering high quality healthcare since 1989 and work hard to maintain an impeccable reputation. With advanced surgical and medical facilities together with highly qualified and professional staff, we are committed to providing our patients with excellence across a wide range of specialties and always putting their needs first. Our soul endeavour is to provide an exceptional care environment which is safe and respects the privacy, dignity and independence of each patient.
ANDREW DOUGAL Now Chair at the Public Health Agency, which is responsible for protecting health and promoting health and wellbeing, Andrew Dougal has spent almost 40 years’ experience in management, with more than 30 of them spent at Chief Executive level at Northern Ireland Chest, Heart, Stroke. Andrew is also a former Chairman and President of the Northern Ireland Council of the European Movement and former Northern Ireland President of Chartered Institute of Personnel and Development
MARTINE DOUGLAS Having joined Biogen in 2012, I love that I work with a company which aims to partner with the NHS and other local stakeholders for the benefit of people with multiple sclerosis (MS) in NI. With over 30 years of clinical excellence in MS, Biogen is a leader in MS research and currently has the broadest MS portfolio in the industry with products that help treat across the spectrum of relapsing forms of MS. I live in Perth with husband Kev, and daughter Victoria.
TOP100 Now Dean of the School of Medicine, Dentistry and Biomedical Sciences at Queen’s University Belfast, Professor Elborn is also Professor of Respiratory Medicine at Queen’s and Consultant Physician in the Belfast Health and Social Care Trust. In addition to his work in Belfast, Professor Elborn has also taken the lead in the writing of International Guidelines for the care of people with Cystic Fibrosis and, in 2013, was awarded a CBE for services to medicine.
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Having worked in Health Care for over 20 years I have seen the positive difference that innovation can make to the lives of patients. A great aspect of my role with Philips is to have the chance to deliver innovative clinical solutions that make a real difference to the lives of patients in Northern Ireland. From healthy living preventative technologies and community based home care to diagnostic and treatment solutions in the hospital setting, Philips uniquely provide meaningful innovation across the continuum of care.
SHAUNA FANNIN In October last year, Dr Shauna Fannin from Ballymoney Health Centre was named as RCGP General Practitioner of the Year. The prestigious award was patient nominated and Dr Fannin received glowing patient testimonials from those in her community, testifying to the quality of care which Dr Fannin delivers to her patients.
KERRY FINLAY Following the National Review of Asthma Deaths report in 2014, Kerry Finlay from Cuan Family Practice in Portaferry undertook a review of patients prescribed inhaled corticosteroids in combination with long-acting beta2 agonists. The findings of the review - which is an ongoing project - were then shared with other nurses, practice pharmacists, GPs and local community pharmacists. The work of Kerry and her team gained national recognition last year when it was singled out and included in the latest Asthma UK report as an example of how to improve practice.
TOP100 Dr FitzGerald started Randox in 1982 in a converted ‘Hen House’ at the back of his parent’s house in Crumlin, Co. Antrim. Since then the company has grown to over 1300 staff worldwide including 300 R&D scientists, with customers in over 145 countries. Dr FitzGerald was awarded the Commander of the Order of the British Empire (CBE) in 2011. He has gained many other accolades in his career to date; named a Fellow of the Royal Academy of Engineering (FREng) and Innovation Founder of the Year 2013 from the Northern Ireland Science Park, to name a few.
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Kate Fleck, Northern Ireland Director at Arthritis Care, is responsible for all of the charity’s work in NI. Kate represents Arthritis Care on a number of voluntary and statutory bodies to campaign for improved care and services for people living with the condition. She is also responsible for delivering Arthritis Care’s NI business plan and building the relationships and networks needed to provide sustainability in the activities which it provides for people with arthritis.
Company Haemoband Surgical. The small Belfast-based company have supplied to the medical marketplace for over 10 years, generating sales of over 380,000 units. Customer service is key to the company with feedback being generated into improved design. They continuously work closely with their Bangorbased manufacturers Denroy Plastics Ltd. to create a product made, not only for users, but by them.
TOP100 In 2015, Anne Friel, Head of Pharmacy and Medicines Management at the Western Trust, received a special recognition award at the highlyesteemed annual Guild of Healthcare Pharmacists conference, collecting the Silver Medal award accolade for ‘Outstanding Contribution to Pharmacy’. Anne has been recognised for a variety of projects including developing pharmacy services in the Western Trust and Craigavon Area Hospital and developing new roles for pharmacists to support the safe and appropriate use of medicines.
Gordons Chemists was founded by Neil and Robert Gordon in 1980 in Donaghadee. Today around 800 persons are employed: at their Head Office (Banbridge), in more than 50 pharmacies across Northern Ireland, and in 9 pharmacies in Scotland. Caring for patients’ need through offering a full range of pharmacy services and delivering high class customer care have been the cornerstones of the business. Gordons Chemists also has a strong retail presence stocking a wide range of health and beauty products. The business also supports several local charities.
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As Chief Executive of CPNI, Gerard represents the interests of community pharmacy contractors in Northern Ireland. His role is to liaise and negotiate with the Department of Health, Social Services & Public Safety, the Health & Social Care Board and other Agencies as required in relation to services, payments and terms of service and related Health & Social Care matters. Prior to joining CPNI, he held the post of Superintendent Pharmacist of Northern Pharmacies Ltd and is a past Chairman of the Pharmaceutical Contractors Committee.
Michael Guerin registered as a pharmacist in 1987 and acquired his first pharmacy in 1988. Since then, the business has continued to grow and today MediCare operates 54 busy high volume retail pharmacies which are located in some of the most socially deprived areas of Northern Ireland. Employing over 600 staff, including 70 pharmacists, MediCare is the biggest indigenous pharmacy group in Northern Ireland.
TOP100 Small Things. Big Difference - For nearly 200 years, DENTSPLY has been partnering with the dental profession and investing in research and development to launch market leading products including WaveOne GOLD, CeramX and Cavitron® to name a few. It is our belief that the small things we do when we develop dental products can make a big difference to your working day in practice and to the exacting care which you provide to your patients.
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With more than fourteen years’ experience as Pharmacy Manager at McMullan’s Pharmacy in Belfast, John Hamill has attained many attributes for his dedication to improving healthcare in his local community, his pharmacy management ability and his service development within primary care. In independent prescriber in respiratory care, John has been most recently involved in education or healthcare professionals within respiratory care settings including patient review process, inhaler technique and device training.
PETER HAMILTON PathXL is an IT company specialising in the development of web-based, digital pathology software to support the medical profession in the fight against cancer. With a focus on the oncology sector, PathXL provide expertise in cancer tumour analysis, and supporting pathologists globally in finding new treatments. Users of the software span Pharmaceutical companies, CRO’s, Diagnostic labs, Hospitals and Universities. PathXL are fortunate to have a client list of globally renowned cancer institutions including Mayo Clinic, Cleveland Clinic, UCLA, Cancer Research Cambridge, and many more.
SIMON HAMILTON Simon Hamilton replaced former Health Minister, Jim Wells in May 2015. For the previous two years, Simon had been NI’s Finance Minister and had a wide range of responsibilities including budget setting and managing public finances, civil law reform and the rating system. A graduate of Queen’s University in Belfast, Simon began his career as an auditor with an accountancy firm in Belfast and was employed as a DUP Policy Officer in their Party Headquarters from 2003 until his election to the Northern Ireland Assembly in 2007.
TOP100 Dr Harper has worked for the South Eastern Trust as a Consultant Physician and Endocrinologist from 1999. An experienced clinician with a particular interest in harnessing information and communication technologies to successfully enhance clinical care services, Dr Harper has helped develop innovative patient monitoring systems to enhance the care of hospital inpatients and to improve patient safety. He is a champion for effective ICT developments within healthcarebeinginvolvedinmajorsystemdeployments and in testing hardware and software solutions.
Dr Harper, who previously worked as a GP in Belfast for fifteen years, was appointed in April 2010 to the newly established post of Director of Integrated Care at the Health and Social Care Board. He is responsible for the Board’s management of GP, Dental, Pharmaceutical and Optometric Services, and for the development of integrated care. His ambition is to promote and develop integration in the delivery of health and social care, particularly for older people and those with long-term conditions.
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PETER HARRISON Building on over 160 years of innovations and 43,000 employees worldwide we are one of the world’s largest suppliers of technology to the healthcare industry and a leader in medical imaging, laboratory diagnostics, and clinical IT. The healthcare market is in transition. Successful healthcare providers drive consolidation, an increasingly “industrial” logic of healthcare delivery, and a shift from treating illness to managing health. In these times of change, Siemens Healthcare aspires to become the trusted partner of healthcare providers worldwide - the partner that you can rely on to help drive their clinical excellence, operational efficiency, and profitability.
SHEELAGH HILLAN A registered pharmacist for nearly 30 years, Dr Sheelagh Hillan served on the original Northern Health and Social Services Board and later on the Homefirst Community Trust. In her role as a member of the Board of Prison Visitors for Maghaberry Prison, she campaigned for proper pharmaceutical services throughout the Northern Ireland Prison System. She has been Chair or President of all the major pharmaceutical bodies, and has represented NI pharmacy at PGEU Pharmaceutical Group of the European Union and on the Council for Healthcare Regulatory Excellence.
TOP100 Killian Johnston is not only the owner of H Sweeny Chemist in Londonderry, but is also the current President of the Ulster Chemists Association. Killian is heavily involved in community outreach work, holding smoking cessation clinics around the city, in addition to various Building Community Pharmacy Partnership projects. He’s also now Clinical Pharmacist Lead for the North Western Integrated Care Partnership.
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At present, Frank directs the UKCRC Centre of Excellence for Public Health Research (NI), and is Deputy Director for the Centre for Public Health in Queen’s University, Belfast (QUB). As Programme Director for Masters in Public Health at QUB, he coordinates and delivers the ‘Populations’ elements of the Concepts in People and Populations, while his work also comprises serving on the Phase Two Teaching Committee for the medical undergraduate curriculum and the School Teaching and Learning Committee, and chairing the Phase One and Two Quality Assurance Committee.
Professor Mark Lawler is Chair in Translational Cancer Genomics and newly appointed Dean of Education, Faculty of Medicine, Health and Life Sciences, QUB. Mark has an international reputation in cancer research and its translation to 21st century cancer control with more than 160 peer review publications, significant research funding and numerous national/international awards. He has high profile recognition in the global community, with leadership roles in the European Alliance for Personalised Medicine, the European Cancer Concord and the Global Alliance for Genomics and Health.
Born in Belfast, Jim’s extensive experience includes taking up the post of Head of Information Services Unit, and later, positions as Head of Finance and Head of the PFI Unit. Before retiring from the NI Civil Service in October 2012 he developed the department’s Quality 2020 Strategy launched in 2011, and since November 2012 has served as a Non-Executive Director on the NI Ambulance Service Trust Board. Jim is also an Associate Fellow of the British Psychological Society, as well as a volunteer member of the St Vincent de Paul charity.
TOP100 With more than 20 years’ experience in community pharmacy, Dr Maguire is recognised as a pioneer in the development of pharmacy services in the UK and beyond. A Past President of the Pharmaceutical Society of Northern Ireland, Dr Maguire was also the Director of the N Centre for Postgraduate Pharmaceutical Education and Training (NICPPET) from 1997 to 2002. In the early 1990s he developed the PAS smoking programme, which is now used throughout the UK, the Republic of Ireland and internationally.
Tommy Maguire is Kerr’s Regional Manager for Ireland, helping clients to achieve the best possible clinical outcomes for their patients. With the Irish economy showing signs of recovery, now is the time to work toward restoring confidence within the dental profession. Tommy recognises that this is easier said than done, and is ideally placed to help you overcome any professional worries or challenges.
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TOP 100 MICHAEL MARTIN
With over 25 yearsâ€™ experience in the IT business, mostly in Health, I donâ€™t think I have seen more challenging times than those facing the health service today. But challenge brings opportunities and paraphrasing the Health Minister we need to innovate to deliver more for less. I believe the work we are doing with the new regional Medicines Optimisation Innovation Centre(MOIC) will help deliver some of this innovation. I relish the challenge.
Since December 2014, Dr Michael McBride has combined his role as Chief Medical Officer (CMO) for Northern Ireland with that of Chief Executive at the Belfast Health Trust. His specialist interest in HIV/ AIDS suggested early on in his career that he was not afraid of working in a challenging and ever-changing field. Indeed, Dr McBride has been at the forefront of medicine in Northern Ireland for two decades, both as an accomplished physician and a highly respected government advisor.
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ALAN McCARTNEY As GSK and through our heritage companies, we have a 150-year legacy of helping transform the health, lives and futures of millions of people around the world. One great example is in the field of oral health. As many as one in three people suffer from sensitive teeth, impacting their quality of life. Using our leadership in tooth sensitivity, we developed our Novamin technology creating Sensodyne Repair & Protect: which is the first everyday, fluoride toothpaste that both repairs and protects sensitive teeth.
KATE McCAMMON Kate has been working for Otsuka Pharmaceuticals on our CNS portfolio since May 2013 as a Regional Account Director, covering the whole of Northern Ireland. She has a long history in the mental health therapy area having previously worked for Lundbeck in a variety of roles for a number of years. She is passionate about ensuring patients in Northern Ireland have access to the best and most appropriate therapies by delivering high quality education and working closely with the NHS.
TOP100 Dr Keith McCollum, who is based at Willowbank Surgery in Keady, is an award-winning GP with a particular interest in quality improvement. In 2012, Dr McCollum redesigned the surgery’s diabetes care pathway with the aim of improving both efficiency and outcomes. The approach, using a web-based pathway a diabetic review score and a “diabetes nudge chart” designed by Dr McCollum, succeeded and, as a result, enhanced the practice’s ‘customer focus’ and demonstrated improved care. Dr McCollum currently works for the HSC Safety Forum as a Primary Care Lead for Quality Improvement.
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VINCENT McGOVERN A sessional General Practitioner in Belfast, with a particular interest in respiratory medicine, Dr Vincent McGovern also holds three part-time clinical assistantships, one in adult chest medicine at Belfast City Hospital, one in paediatric asthma at the Royal Belfast Hospital for Sick Children and one in A&E.
GERRY McKENNA Gerry McKenna is Senior Lecturer / Consultant in Restorative Dentistry in Queens University Belfast. A native of Northern Ireland, he completed his PhD and specialist training in Cork before joining QUB in 2014. Gerry is an active clinical researcher and member of the Centre for Public Health. He is president of the European College of Gerodontology and a member of the EU Platform for Better Oral Health. Gerry is a fellow of the Royal College of Surgeons, Edinburgh and the college’s dental advisor for Northern Ireland.
TOP100 Professor Hugh McKenna CBE is a mental health and general nurse and is currently deputy Vice Chancellor for Research at Ulster University. With more than 250 publications and £7 million in grants to his name, Prof. McKenna also chaired the UK Research Excellence Framework panel for nursing, allied health professions, pharmacy and dentistry. He chaired the Hong Kong Accreditation Panel for Health Sciences and the Swedish Health Sciences Research Council and is currently visiting Prof. at the Universities of Texas, Moribor, Sydney, and Trinity College Dublin and Head of the Visiting Committee at the Chinese University of Hong Kong.
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Professor James McLaughlin is currently the Director of the Engineering Research Institute (ERI) and Director of NIBEC. A Fellow of the Institute of Physics and the Irish Academy of Engineering, he was recently awarded an OBE for his services to Research and Economic Devleopment in Northern Ireland. He is also a Senior Distinguished Fellow of the University. James’ current research interests address and he has attracted over £41m of funding to establish research that has led to the establishment of NIBEC, NICAM, NanotecNI and BEST.
ALBERT McNEILL Dr McNeill graduated from QUB and trained in general medicine and cardiology within Northern Ireland. He was a British Heart Foundation, British Dutch Research Fellow in the Thorax Centre, Rotterdam where he published on stress echocardiography and developed the Dobutamine/Atropine stress echo protocol. He was appointed Consultant Cardiologist in Altnagelvin Hospital, Londonderry in 1992 and, in his role as Lead Clinician for Cardiology, he has managed the development of primary percutaneous coronary intervention (PPCI) on the Altnagelvin site and is currently working to establish cross border PCI for Donegal patients.
IAN MENOWN Dr Ian Menown is a Consultant Cardiologist and Director of Interventional Cardiology at the Craigavon Cardiac Centre; current President of the Irish Atherosclerosis Society and Honorary Senior Lecturer at Queen’s University Belfast. He obtained a Postgraduate Doctorate of Medicine, the Purce Medal and JD Williams prize for his research in Improving Early Detection of Acute Coronary Syndromes and has been elected to Fellowship of the Royal College of Physicians, Edinburgh. Dr Menown also serves as Interventional Editor-in-chief of Editorial Board of Interventional Cardiology, Future Cardiology and Biomarkers in Medicine.
TOP100 As Project Manager: Medicines Optimisation in Older People at both the Western and Northern Health and Social Trusts, Dr Miller’s work revolves around improving the care provision for older people. Last year, she was a member of the Western Trust’s winning team at the prestigious National Royal Pharmaceutical Society’s Pharmaceutical Care Awards.
Recently appointed as a Professor of Personalised Medicine at Ulster, Professor Tara Moore is actively involved in teaching within the University and was awarded a National Teaching Fellowship by the Higher Education Academy for her role in developing online PgDip and MSC courses in Cataract and Refractive Surgery for various eyecare specialists. She was also recently awarded Hononary Fellowship of the Royal College of Physicians Faculty of Forensic and Legal Medicine for her role in developing online courses for medical legal experts worldwide.
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HEATHER MOORHEAD Heather Moorhead was appointed as the Director of the NI Confederation for Health and Social Care (NICON) in May 2010, having previously served as the Chief Executive of the Northern Ireland Local Government Association (NILGA) since its establishment, representing the interests of local government. Prior to this, she was an active member of the Chartered Institute of Environmental Health, and was the first female chair of the NI Centre from 1992 – 1994. Heather’s key interests lie in the areas of public health, reinvigorated local democracy and sustainable development.
JIM MORROW Dr Jim Morrow, Consultant Neurologist Out Patient Department Royal Victoria Hospital, was nominated as a result of his dedication to epilepsy services within Northern Ireland and the rest of the UK. He set up the UK Epilepsy & Pregnancy Register, which is internationally renowned and has also established a joint epilepsy obstetric clinic at the Royal Jubilee Maternity Service to help improve the care of pregnant women with epilepsy and to ensure professionals looking after them are better informed and aware of current best practice.
TOP100 BF Mulholland Ltd is a full service Dental Dealer established in 1969, providing over 14,000 lines of Consumables, Equipment Sales and Engineering Support to the Dental Profession and other businesses throughout Ireland and further afield. Holding a degree in Actuary at UCD, Mark worked within the finance sector for a couple of years in Dublin. For further information on BF Mulholland Ltd, please feel free to visit our newly launched website: www.bfmulholland.com
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Norbrook is a leading global provider of veterinary pharmaceuticals and I am delighted to be charged, alongside a very able team, with taking the company through its next phase of development. Animal health is a new sector for me so my first year here is a time for learning and listening. I hope to use my experience across a range of different sectors together with the knowledge I am gathering from my colleagues in Norbrook to work, as One Team, to deliver for our Customers.
EOGHAN O’BRIEN Having been established in 1960 by the late Colm O’Brien, Eoghan took over the reins of Bannside Pharmacy in 1993, and after purchasing the adjacent property a few years later, carried out extensive renovations in 1998, doubling the size of the premises. It was as a result of experiencing eczema from early childhood and finding conventional treatment of little benefit, that underlined his mission to discover types of treatment that could help others. Eoghan and his team are also supportive of the integration of natural, holistic and homeopathic treatments.
JOHN O’KELLY Dr John O’Kelly is a partner with Aberfoyle Medical Practice, Derry, and has been a principal in General Practice for the past 18 years. He is the current Chair of the RCGPNI Quality Committee, a member of the RCGPNI Executive Committee and has represented Northern Ireland Council at the College’s UK Council. John has a background in respiratory health, having chaired the Western Area Respiratory Group and been a member of the Northern Ireland Regional Respiratory Forum.
TOP100 In Northern Ireland Microsoft are working to help health organisations provide the best patient care possible while controlling costs. One of our key areas of focus is clinical mobility – we are empowering healthcare organizations to enable health professionals to spend less time juggling multiple devices and more time caring for their patients, as complete systems can be accessed from any one of our many clinical-grade devices. We are providing care teams with fast, easy ways to communicate, collaborate, and improve productivity.
Now Medical Advisor at the Health and Social Care Board, Dr Edward O’Neill working daytime and out-of-hours GP sessions. He was previously a Primary Care Director with the NI Cancer Network. He has broad academic and teaching experience, as a Clinical Skills Teacher and Research Fellow at Queen’s University Belfast, Postgraduate Tutor at the Northern Ireland Medical and Dental Training Agency; and served as Chair of the RCGP(NI) Education Committee 2004/5. Dr O’Neill has served in professional representative roles over many years, at both national and regional level, for the BMA and RCGP; and founded the NISDA, in 2002.
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GEORGE O’NEILL Dr George O’Neill from Springfield Surgery in Belfast has been at the forefront of significant medical initiatives in Northern Ireland for more than 40 years. George was a lead GP in the first wave of the Fundholding Scheme, and the West Belfast Total Purchasing Pilot owed much of its success to his efforts while, as Chairman of the Belfast Local Commissioning group from 2008-2013, he successfully steered the complex 17-member board and management team to achieve many positive strategic outcomes and comprehensive commissioning plans.
JOE O’SULLIVAN Professor of Radiation Oncology at Queen’s, Professor O’Sullivan works as a clinical academic consultant oncologist at the Northern Ireland Cancer Centre at Belfast City Hospital. He is one of two Clinical Co-Directors of the first regional Movember Centre of Excellence, a partnership between Queen’s and the University of Manchester, which is funded by Prostate Cancer UK and the Movember Foundation. Five million pounds will be invested in the Centre over a five-year period to improve outcomes for men with advanced prostate cancer.
TOP100 Professor Peter Passmore, Professor of Ageing and Geriatric Medicine at Queen’s University Belfast, established the Memory Clinic at Belfast City Hospital in 1993. Professor Passmore has a long-standing interest in the clinical management of dementia and in translationalresearchrelatedtodementia.Hehasbeen Chair of the British Geriatric Society SIG for Cerebral Ageing and Mental Health, advisor to PENTAG on the last NICE Guidance on Drugs for Dementia and Member of the NI Dementia Strategy Group.
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CHRYS QUARMBY Almus is one of the fastest-growing and most innovative ranges of generic medicines in Europe. The first international generic brand to tailor its pack design to meet the needs of both patients and pharmacists, Almus’ medicines are produced through partnership with the world’s leading generics manufacturers, to provide high quality medicines, with a focus on cost efficiency. There are more than 350 products in the Almus range. For more information, visit: www.almus.co.uk or call 0800 032 057
JOHN RAINEY The Bangor based manufacturing firm showed commitment to medical manufacturing in Northern Ireland by investing £3 million into a new factory ‘clean room’ in 2015. The space allows devices to be assembled, free of contamination. Established in providing products such as heart monitor casings, Denroy will now diversify its maufacturing range, such as the new Haemoband Plus, launched in 2016. The original haemorrhoid ligation device has been updated to use latex-free bands, a transparent nozzle and a unique trigger ‘step line’, providing more reliable and cost effective usage and has improved patient outcomes.
TOP100 At Southern Cross Dental, we lead the way in providing high quality dental products and services to dental industry professionals. We have been working with the dental profession for over a decade. Our history has given us the experience and industry knowledge required to understand what you need to manage your practice in the long term: reliable, high quality products and services that help you give your patients the best possible results. Our comprehensive range of products includes fixed and removable prosthodontics, all-ceramic restorations, implants, occlusal appliances and anti-snoring devices.
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Eugene Reid is a science graduate with a number of years’ experience in Further Education and over 20 Years’ experience in the Pharmaceutical Industry. Eugene has worked in direct sales for a number of pharmaceutical companies in various therapeutic areas, including Dermatology, Rheumatology, Cardiovascular, Diabetes and Psychiatry. This has involved working in different geographies including Republic of Ireland and Scotland.
Mark is the Senior Director of Cardiac Services, part of the SISK Healthcare Group, and has been working in the Healthcare industry for over 25 years. He has a wide spectrum of experience managing 70 people locally within Ireland who operate across a wide range of disciplines from Technical, Sales, Clinical Application Specialists, Logistics and Clinical IT. Mark joined the Company in 2002. Cardiac Services have been putting Service at the heart of healthcare since 1969 and are a leading supplier of Medical diagnostics and therapeutic equipment throughout Ireland and the UK.
Caring for Life, at Fannin provide the medical devices, medicines and diagnostic products that help healthcare professionals and patients across the island of Ireland and the UK manage illnesses and restore health. We deliver more than simply the mechanics of treatment, we seek to be the best service provider of Medical Devices, medicines and services to the healthcare sector. With the heritage of care giving dating back to 1829, we have the track record to support our claims. We deliver confidence in our ability and with the backing of DCC, one of Ireland largest Plc’s we have the financial strength to sustain and develop our business which is underpinned by our dedicated workforce. David Rodgers, Sales and Marketing Director at Fannin NI Limited. we
I have represented Rosemont Pharmaceuticals as a business executive in Northern Ireland for the past 23 years. I have obviously seen lots of changes in that time, not least the attitude to medication management in swallowing difficulties. It has been a personal goal to promote best practice for this condition; ensuring patients receive the appropriate formulation for their disability. I have invested many hours delivering education to a wide range of Healthcare professionals in Northern Ireland with this objective in mind.
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AD TO COME
Dr Eddie Rooney is Chief Executive at the Public Health Agency, which was established in 2009 to protect and improve health and social wellbeing and reduce health inequalities. Prior to his joining the PHA, Dr Rooney served as Equality Director at the Office for the First Minister and Deputy First Minister and as Deputy Secretary at the Department of Education from 2004–2008.
O4 Research, founded in 2008, is a successful Clinical Research Organisation (CRO) headquartered in Belfast and operational across Ireland, UK and Europe. Working with both national and global Sponsors, we pursue innovation in clinical trial delivery with a focus on Phases II-IV research. We operate in a highly regulated, competitive industry which places a huge emphasis on the patient’s safety and interests. A cornerstone of our mission is to challenge the status quo and seek to optimise every aspect of the clinical trial process. We believe this provides the best opportunity to conduct safe and thorough studies on schedule and within budget.
TOP100 Consilient have had a presence in Northern Ireland for 10 years now. We have seen business grow significantly on our “bedrock” generic business and also the more recent Branded products - Oral Contraceptives range now the largest in the UK and the growing Invita D3 “bone health” portfolio. Our Business development team continue to identify other “niche products” to complete our bespoke portfolio. Consilient 1st to market generic strategy will continue into 2016 and beyond and we will be adding to our Women’s Health and Bone Health ranges in 2016. I take this opportunity to thank all our customers for their continued support.
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Professor Scott is currently Head of Pharmacy and Medicines Management in the Northern Health and Social Care Trust and is based at the Pharmacy and Medicines Management Centre, Antrim Area Hospital. In 1994, he established the first academic practice unit in the province in conjunction with Queens University and, since then, has published numerous full papers and made numerous conference presentations worldwide. In 2015, Professor Scott became the Director of the new regional Medicines Optimisation Innovation Centre (MOIC) based in the NHSCT.
CHERITH SEMPLE Cherith Semple, a Macmillan Head and Neck Clinical Nurse Specialist at the Ulster Hospital, Dundonald, was recently named as Northern Ireland Nurse of the Year. Cherith scooped the top award at an event organised by the Royal College of Nursing NI after impressing judges with a series of initiatives to enhance aftercare for people with head and neck cancer. Cherith’s research helped patients to develop skills and confidence for self-surveillance, and using iPad technology patients can share their concerns in real-time at the follow-up clinic.
SIMON SHAWE DMI are the leading supplier of equipment, consumables and service to dentists across all of Ireland. DMI have recently invested in a ‘Sate-ofthe-Art’ showroom and training facilities at their Northern Ireland office to provide educational events for all people in the dental industry and to experience latest technologies such as 3D X-Ray machines and CADCAM milling along with a range of dental chairs and cabinetry.
TOP100 Currently Mike Shields is Professor of Child Health at Queen’s University Belfast and Consultant Paediatrician at the Royal Belfast Hospital for Sick Children. He chairs the N Ireland Paediatric Respiratory and Allergy Network and recently has become President of the Ulster Paediatric Society and Chairman to the Medical Staff of the Royal Belfast Hospital for Sick Children. Until recently he co-chaired the British Thoracic Society Asthma Guidelines Pharmacology section.
Our vision is a world where people are healthier and live better. Our purpose is to make a difference by giving people innovative solutions for healthier lives and happier homes. We are constantly evolving our global portfolio of consumer health brands. These are brands with a purpose, supported by relevant medical facts and scientific based evidence. At RB we know that the home is the centre of family life and in turn this is at the centre of our vision for healthier lives and happier homes.
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Founded by Professor Suzanne Saffie-Siebert, SiSaf was conceived as an innovative drug delivery company specialising in the design and formulation of semiconductor delivery systems for a wide range of medical, nutrient and skin care applications. SISAF has developed a unique nanoparticle silicon based platform that has very broad formulation applications. The nanoparticles dissolve to Orthosilicic acid, the natural form of silicon absorbed from food. Orthosilicic acid has a positive safety and toxicological profile – it’s literally edible!
Janice spent several years in the independent sector as Director of Nursing of a large nursing home group before moving to the Northern Health and Social Services Board as a registration and inspection officer. Whilst in this position, she was seconded to the DHSSPS to oversee implementation of the recommendations of the UKCC’s Fitness to Practice report. Janice joined the Department fulltime in 2002 to take up the post of Nursing Officer within the Nursing and Midwifery Advisory Group. She was appointed Director of the RCN in Northern Ireland in May 2009.
TOP100 Karen Smyth is Chief Executive of Clear Pharmacy, a retail community pharmacy chain, which boasts 31 outlets. Karen has over 30 years’ experience across the pharmacy sector in various roles. Clear Pharmacy is part of the Clear group of companies, which includes an independent pharmacy chain, private day nurseries, dental surgeries and a healthcare distribution company.
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Dr Alan Stout is Chairperson and GP Lead of the East Belfast ICP. A GP principal in a practice in East Belfast for the past twelve years, he is an active member of the British Medical Association, and is currently deputy chair of the Northern Ireland General Practice Committee. Over the years he has been involved in various aspects of service development and innovation through roles with the Belfast Local Commissioning Group, Primary Care Partnerships and now the East Belfast ICP.
SURESH THARMA Dr Suresh Tharma FRCOG is a Consultant Obstetrician and Gynaecologist who co-founded the 3fivetwo Group 12 years ago. Comprising its flagship private hospital, Kingsbridge Belfast and its sister hospital, Kingsbridge Sligo, it is the largest private healthcare company in Northern Ireland and the only one straddling both sides of the border. “I started 3fivetwo with a vision to move private healthcare provision up a notch in Northern Ireland and to provide the population with a wide choice of world leading services on their doorstep”. I am particularly proud of the waiting list work which the 3fivetwo Group does in partnership with the NHS.
LORNA SWEENEY Boehringer Ingelheim has always remained true to its character as an independent family-owned company. Our vision drives us forward. It helps to foster value through innovation in our company and to look to the future with constantly renewed commitment and ambition. Today we operate with 146 affiliated companies and more than 47,000 employees worldwide. With a track record developed over 125 years, we are dedicated to improving the outlook for healthier lives. www.boehringer-ingelheim.co.uk
TOP100 As Chief Pharmaceutical Officer at the Department of Health, Social Services and Public Safety, Dr Mark Timoney is responsible for providing specialist advice on medicines and pharmaceutical issues to the Health Minister, health department and wider health service and for the development of policy relating to medicines optimisation and pharmacy.
Serving the UK Oncology community since 1995, with operations based at the Innovation Centre in Belfast, CIS Oncology Ltd is a trusted supplier of chemotherapy prescribing and management software to public and private healthcare providers. As the most chosen system across the NHS, CIS’s ChemoCare product now supports over 125 adult chemotherapy treatment centres and the majority of paediatric oncology centres throughout the UK. For further information, please visit our website www. cis-healthcare.com or contact us on 02895 600830
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COLIN WARWICK I’ve worked for MSD in Northern Ireland for over 12 years, but our company has been delivering innovative medicines worldwide for over a century. I’m really proud to be part of our heritage as well as being part of a team that is driven by a desire to save and improve lives long into the future though our medicines and services. Our team in Northern Ireland is continuing on this journey; working in partnership with the NHS and ultimately to help bring about better health outcomes in key areas like diabetes.
VALERIE WATTS As Chief Executive of the Health and Social Care Board, Valerie Watts has been instrumental in leading on major system wide reform, providing strategic leadership to enhance care against the backdrop of increasing demand and challenging finances. Valerie came to the Board from Aberdeen City Council where she was Chief Executive. Prior to that she was Chief Executive of Derry City Council, where she was instrumental in securing the UK City of Culture for 2013 and developing a strategic economic masterplan.
TOP100 Heather Weir’s appointment as Chief Executive of Northern Ireland Hospice followed her fifteenplus years working in hospice and palliative care, and experience operating in partnership across voluntary and statutory sectors. Heather first joined the hospice in 1999, and has undertaken numerous clinical management roles over the years, in addition to her contribution to Marie Curie Cancer Care in which she was the Divisional General Manager for Northern Ireland. Heather has also worked with Northern Ireland Cancer Area Network, where she supported reform and modernisation of palliative care in Northern Ireland.
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Dr Wiggam is the Belfast Trust Directorate’s Clinical Director and lead consultant for stroke. Two years ago, he was instrumental – alongside Ward Manager Sister Karen Davison - in the successful merger of the two stroke wards (Belfast City Hospital and Royal Victoria Hospital) in a new Stroke Unit on the RVH site. Dr Wiggam worked with colleagues across systems in A&E, Neuroradiology and the NI Ambulance Service in order to set up a robust performance management system for the stroke thrombolysis service.
HeartSine Technologies, a pioneer of innovative automated external defibrillators (AEDs) for public access, advances the deployment of lifesaving defibrillation therapy for the treatment of sudden cardiac arrest in non-traditional areas of care. The HeartSine samaritan PAD is recognized around the world for its lifesaving technology. HeartSine was acquired by emergency medical response company Physio-Control in September 2015, making one of the largest defibrillator companies in the world with a long history of innovation across the globe.
Roche is a pioneer and leader in diabetes care. For over 40 years, Roche has been committed to delivering products that meet the needs of people with diabetes as well as their healthcare professionals. Monitoring systems with software for storing and analysing data, unique all-in-one blood glucose systems and state-of-the-art insulin pumps are key parts of Rocheâ€™s diabetes care portfolio. These features not only help glycemic control for many users, but also offer greater convenience and quality of life.
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With a career spanning over 25 years’ in the Dental industry, Helen’s experience includes working as a Dental Nurse, in both general practice and community services. Moving into the sales area in 2011, and currently working as Territory Manager, Scotland and NI for Coltene. Helen has a passion for customer service; showcasing products and up-skilling staff through “lunch and learn” events and providing after sales care. Helen’s technical background, coupled with her previous experience of owning her own beauty business, ensures she is vitally aware of the need to source and provide quality products and support.
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Professor Young is Professor of Medicine and Director of the Centre for Public Health, one of four research centres within the School of Medicine, Dentistry and Biomedical Sciences at Queen’s University Belfast. Established in 2008, the Centre’s key areas of research are epidemiology and public health; cancer epidemiology and health services; genetic epidemiology; and nutrition, and Professor Young’s particular aim is to impact on people’s lives on a global level, not just in Northern Ireland.
Permanent gloss - in next to no time! When it comes to ‘fillers’ in restorative dentistry, it’s obviously vital to use a material that’s not only easy to process, aesthetic and long lasting, but which will offer excellent blending properties and no complications. While ‘traditional’ filling materials such as gold, porcelain and silver amalgam have increasingly been replaced by materials known as composite resin fillings, when it comes to dental fillers there’s now a fantastic ‘new kid on the block’! The specially developed BRILLIANT EverGlow from Coltène represents an entirely new quality of composite. Suitable for both anterior and posterior restorations, this state-of-the art NIHR / 2016 / 74
composite offers the right mix of simple and practical handling, excellent blend-in properties and long-lasting brilliance. Due to BRILLIANT EverGlow’s intelligent composition with special fillers, the sub-micron hybrid universal composite offers an exceptionally uniform and smooth surface. Polishing becomes a more or less minor issue and dentists can achieve highly aesthetic results in next to no time. In addition, the versatile filling material excels thanks to its extremely durable gloss stability. When it comes to shading, BRILLIANT EverGlow also comprises a total of seven universal and two transparent shades and, thanks to the special blending
properties, the shades integrate extremely harmoniously into the existing dental arch. Naturally with fillers, consistency is also vitally important, so it’s good to know that BRILLIANT EverGlow provides excellent handling for dentists, allowing it to be easily applied into cavities of all classes. Due to its good wetting capacity, it also offers excellent adhesion to bonded tooth surfaces without sticking to the instruments. When it comes to fillers, BRILLIANT EverGlow is a material that meets the demand without compromise. But don’t just take our word for it! Just listen to the professionals.... ‘I was massively impressed with Coltène Brilliant Everglow’s
performance on so many levels. It does not stick to your instruments and this, as well as its obedience to packing movements of the operator, ensure it will reliably adapt to the cavity form. Thereafter you have the aesthetics which are stunning. It doesn’t demand a complex finishing protocol and you will achieve a smooth glassy, natural end result. BRILLIANT EverGlow has excellent shade adaptation and I cannot recommend it enough to the armamentarium of any dentist.’ Dr Nalin Karunaratne, BDS, BSc (Hons), AKC, MJDF, RCS (Eng), MFDS, RCPSG. ‘The polish and gloss persistence of this material are groundbreaking.’ Dr Monik Vasan, BChD, MFGDP (UK), MSc
Bringing benefits to all Fifty years ago this year, the Commonwealth Foundation was established. One of its main aims was the formation of Commonwealth Professional Associations and a short five years later, the Commonwealth Pharmacists Association (CPA) came into being. NIHR takes a closer look….
The CPA is an organisation which was set up to, among other objectives, effect close links between members of the profession in Commonwealth countries and facilitate personal contacts between pharmacists and students. In the years since its creation, much of CPA’s work has involved advocating the profession and the role of the pharmacist in particular, to governments and health bureaucracies. Building capacity and strengthening health infrastructures and professional associations has been the focus of workshops, collaborative projects, training courses and travel fellowships. Since its formation, CPA organisational membership has grown to over forty national professional associations. Personal membership has been
promoted over recent years and approximately 600 registered pharmacists from throughout the Commonwealth contribute their time and effort to advancing the Association’s work. ‘There’s no doubt that the CPA is an organisation that benefits many countries,’ says its President, Portadown pharmacist, Raymond Anderson. ‘Obviously a country like Northern Ireland can learn from other countries such as Canada and Australia, which are perhaps more advanced technologically and research wise, but we need to share our best practice with underdeveloped countries, particularly those in Africa. I recently returned from a People’s Forum in Malta, which was held during the Heads of
Government Meeting, and there was no doubt that doctors and pharmacists wanted a meeting on sustainable health. By working together we are stronger in assessing how to translate health requirements from high level to ground level. ‘Recently, the former NI Chief Pharmaceutical Officer, Dr Norman Morrow, has been heavily in working with us, particularly on governance issues and on a new constitution. Thanks to Norman’s work, we hope to take the Association to the next level by assessing where we can do the most good. We will also shortly be appointing a pharmacist on a parttime basis, who will be working two and a half days a week in supporting Norman in his work.’
Dr Morrow has recently returned from a visit to?? where he The CPA is an organisation which was set up to, among other objectives, effect close links between members of the profession in Commonwealth countries and facilitate personal contacts between pharmacists and students. In the years since its creation, much of CPA’s work has involved advocating the profession and the role of the pharmacist in particular, to governments and health bureaucracies. Building capacity and strengthening health infrastructures and professional associations has been the focus of workshops, collaborative projects, training courses and travel fellowships.
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HERE’S ONE EXAMPLE OF THE GOOD WORK THAT CPA DOES...
’Africa cares: no woman should die while giving life’ By Lorraine Osman, Vice President, Commonwealth Pharmacists Association
Every year, nearly 300,000 women die in pregnancy or childbirth. Nearly two thirds of these die in sub-Saharan Africa, where a woman has a one in 38 lifetime risk of maternal death. By comparison, women living in developed regions have a one in 3700 lifetime risk. Maternal deaths are highest in countries where women are unlikely to be assisted by a skilled healthcare professional. It is unlikely that pharmacists can single-handedly improve the infrastructure and ensure access to a skilled attendant at every birth. There are, however, a number of interventions that have been identified as contributing to maternal health. To some extent, pharmacists may undervalue their contribution, because so much of what they do in their everyday practice is critical to health outcomes in all their patients, including pregnant women and children.
Transfer of knowledge:
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not. Many pharmacists have direct contact with patients and can use all opportunities to inform and educate women on their health choices.
Women must be educated on contraception. If appropriate and permitted, pharmacists may supply contraceptive options, including emergency contraception. In May 2015, WHO reported that only one out of every four African women who wants to delay or prevent conception has access to contraceptives.
Vitamins and nutritional substances:
The importance of folic acid and iron supplementation during pregnancy must be stressed. The pharmacist can educate and supply these supplements.
Alcohol and nicotine cessation: Foetal alcohol syndrome is particularly prevalent in South Africa. Studies have shown that in rural areas of the Western Cape, poverty, low educational levels and unplanned pregnancies are characteristic of women
with a high risk of alcohol exposure during pregnancy. Community pharmacists in particular can counsel pregnant women on alcohol and smoking cessation, as can pharmacists working in facilities that offer services to pregnant women.
All medicines dispensed or sold by pharmacists must be screened for teratogenic effects so that pregnant women can be appropriately advised.
HIV infection: It is
critical that the pharmacists should stress the importance of adhering to antiretroviral regimens in order to reduce mother-to-child transmission.
Malaria: Because malaria in pregnant women can lead to low-birth weight infants with associated increased risk of child mortality, it is particularly important for pharmacists in Africa to encourage the use of preventative measures and early treatment.
Development of post-partum depression in African women may be due to unique stressors, such as traditional value systems and customs, as well as unsatisfactory antenatal care and support. Pharmacists must be alert to the risk and refer the women if necessary. In his foreword to the Millennium Goals Report 20215, the Secretary General of the United Nations, Ban Ki-Moon said that ‘too many women continue to die during pregnancy or from childbirth-related complications. Progress tends to bypass women and those who are lowest on the economic ladder or are disadvantaged because of their age, disability or ethnicity. Disparities between rural and urban areas remain pronounced. It is likely that the post-2015 Sustainable Development Goals will continue to place great emphasis on the health of mothers, neonates and children, and it is clear that pharmacists can and must contribute to their successful implementation.’
Come On Arlene…At This Moment…You Mean Everything! When I initially sat down to write a review of last year, I was working on the basis that little, if anything, had really happened in NI healthcare over the previous twelve months. What had initially started out as a promising year had effectively dissolved into the usual NI healthcare scene which has more shades of grey than E L James and has been run for too many years by little grey suits who think that charisma is the 25th of December! I wasn’t alone in my frustration. Those, for example, who heard Health and Social Care Board’s Chief Executive, Valerie Watts, speak at the NICON conference in April, witnessed her tone of total frustration at the lack of movement and pace in NI healthcare at the NICON conference in April. And could you blame her? We’d run out of TYC acronym jokes and it seemed that every time something major was put into action, it was either dropped (care home closure) or had stalled. NI healthcare had effectively started to resemble the old WWII Italian tank joke: five gears: one for forward, four for reverse. To make matters worse, we’d also been through two Health Ministers in close succession. To misquote Oscar Wilde, to lose one was a misfortune, to lose two was plain carelessness, and bookies had started taking bets on which lasted longer…an NI Health Minister or a wine gum! The ‘window of opportunity’ that had been opened by Compton’s Transforming Your Care document had turned into an ‘escape route’ 78 / NIHR / 2016
which, to be honest, had left so little room for manoeuvre that the only person who could have safely escaped was Cheryl FernandezVersini. But then something bizarre happened in NI healthcare. Enter stage left one Mr Simon Hamilton MLA…. Far-from-simple Simon certainly came in with a bang…Within a short space of time this extremely clever and astute guy had certainly made his presence felt…. Having held the caretaker role for a few months, he seemed to have quickly assessed what needed done and - strangely for NI healthcare moved quickly to make it happen. In November, while Valerie Watts’ review of workforce planning for HSCB was busy behind the scene, Simon Hamilton carried out the quickest workforce review seen here for years and axed the entire Board…practically overnight! He followed this up with the creation of an expert panel made up not only of NI professionals with proven track records
in ‘getting things done’, but augmented by international luminaries who could show NI healthcare a thing or two! Wow! (There is one point on which Hamilton and I disagreed...his assertion that he recognised the talents of the HSCB people and wanted to disperse this talent throughout NI healthcare. Hmmmm….I’ve spent six years in this role trying to deal with this humungous body, and I’ve lost count of the number of times I’ve asked for the ‘best person to speak to’ regarding a particular issue. ‘Emmmm….’ has come the response on more than one occasion. Five, six emails later I’d still be waiting. Then, eventually, back would come a ‘quote’ from someone, which would often resemble notes I used to leave out for the milkman – though not as long or as interesting. Some were so dry I didn’t know whether to attribute them to the HSCB or Dulux. I hope that Simon Hamilton will be proactive in flushing out those who have certainly been barriers to innovation and that those, who ARE willing to effect change, will be given the opportunity to
prove their mettle. Meanwhile, as Linenhall Street’s main employer undergoes the ‘workforce review of all time’, I look forward to the story of its demise hitting the silver screen – ‘Northern Ireland’s Health and Social Care Board: A Few Good Men’.) Anyway, back to the positive.... As Hamilton swung into action and NI healthcare’s head started to spin, there was another positive development in January with the appointment of the ‘get things moving’ Arlene Foster as First Minister. So, as this New Year begins, I have to admit that I’m a lot more positive about the year ahead in NI healthcare than I was in October. With Foster’s proactive attitude and Hamilton’s brainpower, the future for all of us is looking a little more rosy. Let’s hope that, for the sake of NI healthcare - and regardless of your politics - Foster returns to her post in May and that Hamilton gets another tour-alour-aye-ay and isn’t forced to do a midnight runner!
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NORTHERN IRELAND HEALTHCARE AWARDS Thursday 25th February 2016 Europa Hotel, Belfast
If you would like to book a table or would like further information, please contact our Events Manager: bridget. email@example.com or call Bridget on: 028 9077 5500
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