IPN February Issue 2017

February 2017 Volume 9  Issue 2

THE INDEPENDENT VOICE OF PHARMACY

In this issue: NEWS: Pharmacy crime on the rise Page 5

PROFILE: Innovations for Pharmacy in Epilepsy Care Page 9

REPORT: Survey identifies key shopping trends Page 18

Abbreviated Prescribing Informa�on

*Comparing to Standard ibuprofen Visuals are for illustra�on purposes only. Nurofen also works on other parts of the body and is indicated for other aches and pains.

Nurofen Express 200mg Tablets Nurofen Express Maximum Strength 400mg Tablets Refer to Summary of Product Characteris�cs for full informa�on Ac�ve ingredient: Ibuprofen (as sodium dihydrate). Pharmaceu�cal Form: Coated tablet - white to off-white, bioconvex, round, sugar coated tablet with an iden�fying logo in black (for 200mg tablet) and red (for 400mg tablet) on one face.

Indica�ons: an�-inflammatory, analgesic and an�pyre�c for short-term management of mild to moderate pain such as is associated with headache, dental pain, fever, period pain, muscular strain, backache, and for the management of the symptoms of head colds and influenza. Dosage & Administra�on: For oral administra�on. Short term use only. Adults and children over 12 years: Nurofen Express 200mg Tablets: 1-2 tablets every four hours with a maximum of 6 tablets in a 24 hours, i.e. maximum dose of 1200mg in a 24 hour period. Nurofen Express Maximum Strength 400mg Tablets; ONLY 1 TABLET PER DOSE. 1 tablet every four hours with a maximum of 3 tablets in a 24 hours, i.e. maximum dose of 1200mg in a 24 hour period. Max dura�on of treatment 3 days. If the symptoms worsen you should consult a doctor. If in adolescents this medicinal product is required for more than 3 days or if symptoms worsen a doctor should be consulted. Not suitable for children under 12 years of age without medical advice. Use NSAIDs with cau�on in the elderly and at the lowest dose of shortest period due to higher risk of adverse drug reac�ons (ADRs). Discon�nue if no benefit is seen or intolerance occurs.

Contraindica�ons: History of gastrointes�nal bleeding or perfora�on related to previous NSAIDs therapy. Ac�ve or history of recurrent pep�c ulcer/haemorrhage (two or more dis�nct episodes of proven ulcera�on or bleeding) or other gastrointes�nal disorder. Pa�ents with a known history of hypersensi�vity reac�ons (e.g. asthma, bronchospasm, rhini�s, angioedema or ur�caria) in response to ibuprofen (the ac�ve substance) or any of the excipients, acetylsalicylic acid (aspirin) or other non-steroidal an�-inflammatory drugs (NSAIDs). Use in children under 12 years of age. Pa�ents with severe hepa�c failure, severe renal failure or severe heart failure. Pa�ents with rare hereditary problems of fructose intolerance, glucose-galactose malabsorp�on or sucrase-isomaltase insufficiency should not take this medicine. During the last trimester of pregnancy. Warnings and Precau�ons: Undesirable effects may be minimised by using the minimum effec�ve dose for the shortest dura�on necessary to control symptoms. The elderly have an increased frequency of adverse reac�ons to NSAIDs especially gastrointes�nal bleeding and perfora�on which may be fatal. Prolonged use of NSAIDs in the elderly is not recommended. Use with concomitant NSAIDs, including cyclooxygenase-2 selec�ve inhibitors, should be avoided. Increased risk of asep�c meningi�s with Systemic lupus erythematosus and mixed connec�ve �ssue disease.

NSAIDs should be given with care to pa�ents with a history of gastrointes�nal disease (ulcera�ve coli�s, Crohn’s disease) as their condi�on may be exacerbated. GI bleeding, ulcera�on or perfora�on, which can be fatal, has been reported with all NSAIDs at any �me during treatment, with or without any warning symptoms or a previous history of serious GI events. The risk of GI bleeding, ulcera�on or perfora�on is higher with increasing NSAID doses, in pa�ents with a history of ulcer, par�cularly if complicated with haemorrhage or perfora�on, and in the elderly. These pa�ents should commence treatment on the lowest dose available. Combina�on therapy with protec�ve agents (e.g. misoprostol or proton pump inhibitors) should be considered for these pa�ents, and also for pa�ents requiring concomitant low dose aspirin, or other drugs likely to increase gastrointes�nal risk. Pa�ents with a history of GI toxicity, par�cularly when elderly, should report any unusual abdominal symptoms (especially GI bleeding) par�cularly in the ini�al stages of treatment. When GI bleeding or ulcera�on occurs in pa�ents receiving Nurofen Express Tablets, the treatment should be withdrawn. Cau�on should be advised in pa�ents receiving concomitant medica�ons which could increase the risk of ulcera�on or bleeding, such as oral cor�costeroids, an�coagulants such as warfarin, selec�ve serotonin reuptake inhibitors or an�-platelet agents such as aspirin. Cau�on (discussion with doctor or pharmacist) is required prior to treatment in pa�ents with a history of controlled or uncontrolled hypertension, conges�ve heart failure, cardiac oedema, established ischaemic heart disease, peripheral arterial disease and/or cerebrovascular disease. Similar considera�on should be made before ini�a�ng longer-term treatment of pa�ents with risk factors for cardiovascular events (e.g. hypertension, hyperlipidaemia, diabetes mellitus and smoking). Prolonged use of any type of painkiller for headaches can make them worse. If this situa�on is experienced or suspected, medical advice should be obtained and treatment should be discon�nued. The diagnosis of 'Medica�on Overuse Headache should be suspected in pa�ents who have frequent or daily headaches despite (or because of) the regular use of headache medica�ons. Clinical trial and epidemiological data suggest that use of ibuprofen, par�cularly at high doses (2400mg daily) and in long term treatment may be associated with a small increased risk of arterial thrombo�c events (for example myocardial infarc�on or stroke). Overall, epidemiological studies do not suggest that low dose ibuprofen (e.g. < 1200mg daily) is associated with an increased risk of myocardial infarc�on. Serious skin reac�ons, some of them fatal, including Exfolia�ve Derma��s, Stevens-Johnson syndrome and Toxic Epidermal Necrolysis, have been reported very rarely in associa�on with the use of NSAIDs. Pa�ents appear to be at highest risk of these reac�ons early in the course of therapy, the onset of the reac�on occurring in the majority of cases within the first month of treatment. Nurofen Express Tablets should be discon�nued at the first appearance of skin rash, mucosal lesions, or any other sign of hypersensi�vity. Renal impairment as renal func�on may deteriorate. Hepa�c dysfunc�on. Pa�ents with bronchospasm or SLE should consult their doctor before taking this medicine. Bronchospasm may be precipitated in pa�ents suffering from or with a previous history of bronchial asthma or allergic disease. There is some evidence that drugs which inhibit cyclo-oxygenase/prostaglandin synthesis may cause impairment of female fer�lity by an effect on ovula�on. This is reversible on withdrawal of treatment. As NSAIDs can interfere with platelet func�on, they should be used with cau�on in pa�ents with intracranial haemorrhage and bleeding diathesis. If you are pregnant, elderly or have asthma or are receiving regular medical treatment please consult your doctor before taking this medica�on. Each tablet contains an average of 24.6mg (200mg) or 49.2mg (400mg) of sodium.

This should be considered in pa�ents whose overall intake of sodium must be markedly restricted. There is a risk of renal impairment in dehydrated adolescents. Interac�on with other medicinal products and other forms of interac�on: known to interact with the following (please see SPC for full details): Cor�costeroids, An�-coagulants, An�-platelet agents and SSRIs , An�-hypertensive (ACE inhibitors and Angiotensin II Antagonists) , Diure�cs, Cardiac glycosides, Lithium, Methotrexate, Ciclosporin, Other NSAIDs including cyclooxygenase-2 selec�ve inhibitors, Aminoglycosides, Probenecid, Oral hypoglycaemic agents, Zidovudine, Mifepristone, Tacrolimus, Quinolone an�bio�cs and low dose aspirin. Fer�lity, Pregnancy and Lacta�on: Ibuprofen is not recommended during the first six months of pregnancy and is contraindicated in the last trimester of pregnancy. Ibuprofen and its metabolites can pass in very small concentra�ons into the breast milk. No harmful effects to infants are known, so it is not necessary to interrupt breast-feeding for short-term treatment with the recommended dose for mild to moderate pain and fever. Side Effects: Haematopoie�c disorders (anaemia, leucopenia, thrombocytopenia, pancytopenia, agranulocytosis) are very rare - first signs are fever, sore throat, superficial mouth ulcers, flu-like symptoms, severe exhaus�on, nose and skin bleeding, and bruising. Hypersensi�vity reac�ons consis�ng of ur�caria and pruritus (uncommon), severe hypersensi�vity reac�ons including tongue and laryngeal swelling, dyspnoea, tachycardia, hypotension (anaphylaxis, angioedema or severe shock) are very rare. Aggravated asthma, bronchospasm.

Respiratory tract reac�vity comprising asthma or dyspnoea. Headache, dizziness. Asep�c meningi�s (very rare). Impaired hearing (uncommon). Cardiac failure, oedema, hypertension (very rare). Abdominal pain, nausea and dyspepsia (uncommon) Diarrhoea, flatulence, cons�pa�on and vomi�ng (rare). Pep�c ulcers, perfora�on or gastrointes�nal haemorrhage, malaena, haematemesis, some�mes fatal, par�cularly in the elderly, ulcera�ve stoma��s, gastri�s, exacerba�on of coli�s and Crohn’s disease (very rare). Liver disorders, especially in long-term treatment (very rare). Severe forms of skin reac�ons such as bullous reac�ons including Stevens-Johnson Syndrome, erythema mul�forme and toxic epidermal necrolysis can occur (very rare). Acute renal failure, papillary necrosis, especially in long-term use associated with increased serum urea and oedema (very rare), decreased haemoglobin levels and decreased urea clearance (very rare). Name and Address of Marke�ng Authorisa�on Holder: Recki� Benckiser Ireland Ltd, Citywest Business campus, Dublin 24, Ireland. PA Number: PA 979/32/10 and PA 979/32/11 For full prescribing informa�on, please consult the SPC which is available on www.medicines.ie. For product queries, please call (01) 630 5429 or contact the MAH above.

Legal Category: Retail Sales through Pharmacy only. Date of prepara�on: May 2016.

Nurofen Express 200mg Tablet. Nurofen Express Maximum Strength 400mg Tablet.

Contaings ibuprofen (as sodium dihydrate). For adults and children over 12. ALWAYS READ THE LABEL. Date of prepara�on: Januray 2017. IRL/N/0117/0002

FEATURE: Sexual Health in Pharmacy Page 25

CPD: Specialised Nutrition in Children Page 35

AWARDS: OTC and Pharmacy Retail Product Awards Page 39

FIND THE RIGHT CRAVING RELIEF FOR YOUR CUSTOMERS

MAH: McNeil Healthcare (Ireland) Ltd., Airton Road, Tallaght, Dublin 24.

Full prescribing information available upon request. Products not subject to medical prescription.

IRE/NI/17-2335

Contents Page 4: Lloyds join operations with United Drug Page 6: Launch of Change your Health Direction 2017

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Page 9: Epilepsy Ireland launches new Model of Care Page 12: Vaccination advice in wake of flu crisis Pharmacy win Training Bursary

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Page 39: OTC and Retail Pharmacy Product Awards 2017 PUBLISHER IPN Communications Ireland Ltd. Clifton House, Lower Fitzwilliam Street Dublin 2 00353 (01) 6690562

EDITOR - Kelly Jo Eastwood kjeastwood@hotmail.com

43

EDITORIAL DEPARTMENT editorial@ipnirishpharmacynews.ie

ADVERTISING MANAGER Nicola McGarvey nicola@ipnirishpharmacynews.ie SALES AND MARKETING Aisling Twomey aisling@ipnirishpharmacynews.ie CONTRIBUTORS Deirdre O’Donnell | Amy Oates Rachel Dungan | Mena Eskander Marie Therese Burke DESIGN DIRECTOR Ian Stoddart Design

Regulars

We’ve got a packed issue to continue momentum as we progress through the early stages of 2017. Our top story this month is the announcement that Lloyds have joined operations with United Drug, which has prompted concern from a number of independent pharmacists as to the implications for the market. We are monitoring this story closely as more details emerge, and will have further coverage in forthcoming issues this year.

Also included this month are details of a new report which has suggested that Ireland will need the equivalent of three ‘Beaumont-sized’ hospitals to cope with an increase in the population over the next ten years; and a report from the IPU which finds that three out of four pharmacists are experiencing crime.

On page nine we look at the HSE’s new Model of Care regarding epilepsy, and the role for pharmacists outlined therein. On page 17 we provide advice to pharmacists dealing with patients who are showing symptoms of the winter vomiting bug, which crippled the health service towards the end of last year.

The people at Visualise have compiled an interesting survey concerning the habits of pharmacy shoppers featured on page 18, which should be of interest to pharmacists who want to maximise footfall.

On page 30 we look at smoking cessation, in ‘New Year – Old Habits: Stubbing out Smoking’, and discuss some of the options and products for pharmacists helping their customers quit.

MANAGING DIRECTOR Natalie Maginnis n-maginnis@btconnect.com

COMMERCIAL MANAGER Barry Maguire Barry@ipnirishpharmacynews.ie

Journalist: Paulie Doyle

Turn to page 5 for more details.

Page 14: Marrons

ACCOUNTS Jon Dickinson accounts@ipncommunication.com

Foreword

Irish Pharmacy IRISH News is circulated PHARMACY to all independent, NEWS multiple and hospital pharmacist, government officials and departments, pharmacy managers, manufactures and wholesalers.

Buyers of pharmacy groups and healthcare outlets.

Circulation is free to all pharmacists subscription rate for Irish Pharmacy News ¤60 plus vat per year.

All rights reserved by Irish Pharmacy News.

All material published in Irish Pharmacy News is copyright and no part of this magazine may be reproduced, stored in a retrieval system of transmitted in any form without written permission.

IPN Communications Ltd. have taken every care in compiling the magazine to ensure that it is correct at the time of going to press, however the publishers assume no responsibility for any effects from omissions or errors.

Feature: Childhood Type 2 Diabetes

36

Save

Elsewhere we take a look at a predicted rise in the Type 2 Diabetes in children, and new research regarding children’s health and eating habits. Turn to page 32.

The time has also come for you to nominate your contemporaries (or yourself!) for The Irish Pharmacy Awards.

Now in their sixth year, the awards showcase excellence in Pharmacy practice and innovation.

When we created the Awards, it was to provide a platform for pharmacists like you, who invest their heart and soul into their daily practice. The Irish Pharmacy Awards recognises the dedication, innovation and professional excellence of pharmacists.

Why not take the time to nominate your colleagues, friends and peer’s contribution to Pharmacy this year by nominating them for an award? Turn over to page 39 for why your Pharmacy should enter the Irish Pharmacy Awards.

Feature: Sexual Health

25

Feature: Male Health

65

CPD: Specialised Nutrition

39

Product Profiles

78

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News Concerns voiced as LloydsPharmacy news brief and United Drug join operations PHARMACISTS ENCOURAGED ON STARTING PAS Having published the Pharmacy Assessment System in October 2016, the Pharmaceutical Society of Ireland (PSI) is encouraging all pharmacies to commence using this new self-assessment and quality management tool from the start of this year.

The Pharmacy Assessment System contains six sections that look to assess or audit key areas of a Pharmacy’s practice.

From January, the PSI has been reminding pharmacies, led by their supervising pharmacist, to begin using the Assessment System to review their Pharmacy’s practice, to consider what is being done well and any areas for improvement in relation to their compliance and assuring patient care.

Pharmacies should have the first cycle of the Assessment completed by the end of June 2017.

To help pharmacies get started, the PSI has circulated a suggested completion schedule, starting with section one to consider management and supervision arrangements in the Pharmacy, then a review of procedures relating to sale and supply of non-prescription medicines. The Assessment can be completed using the documentation sent to all pharmacies or by downloading the electronic editable versions from the PSI website.

The PSI will also be sending monthly email alerts to all supervising pharmacists and pharmacies reminding them of the section of the Assessment for completion.

From February, PSI inspectors will begin visiting pharmacies to check that the Assessment is being completed and to answer any questions on it. This will be a short visit - not an inspectionthat will focus on assisting with understanding the Pharmacy Assessment System.

In addition, following the six well attended information events in October and November, the PSI will host further meetings in different locations this Spring. The Assessment forms part of the revised PSI routine inspection policy for pharmacies, and in time PSI inspectors will seek to verify it is being completed during an inspection of the Pharmacy.

4

Ireland’s LloydsPharmacy will join operations with the country’s largest wholesaler, United Drug, it has been revealed to Irish Pharmacy News, prompting concern from independent pharmacists that a small group of companies may acquire a market monopoly.

Both companies are owned by McKesson Corporation, but have been operating separately until now.

LloydsPharmacy is Ireland’s largest Pharmacy group, and employs just under 1,000 people nationwide, in 94 stores.

McKesson is the majority shareholder of Celesio AG, the owner of the LloydsPharmacy retail chain in Ireland.

In the third quarter of last year, McKesson claimed revenues of $50.1 billion, up 5% yearover-year, and in early January also announced it would buy privately held CoverMyMeds for approximately $1.1 billion.

Speaking to Irish Pharmacy News anonymously, a sample of fifteen randomly selected independent pharmacists expressed concern that they may have to purchase drugs from their direct competitor.

Of those surveyed, 100% said they thought the move was bad for the market and independent pharmacy in particular; over twothirds said that they would like to see another wholesaler on the

Irish market; and over half said that, if they were customers, they would reconsider buying their stock from United Drug following the move.

Commenting on the announcement, a spokesperson for LloydsPharmacy said, “We have combined our operations into one organisation that will be led by Paul Reilly as Managing Director, Ireland. We believe this represents real opportunities for growth for our combined businesses, manufacturers, and our expanding number of community pharmacy partners.

“We are advancing a detailed development plan which has an emphasis on enhancing our offering right across our customer network, informed by feedback at community level and innovative measures we are seeing internationally. Alongside this, we continue to operate as usual with each of our customers, maintaining our excellent service levels and offering.”

More on this story as it develops in the next issue of Irish Pharmacy News.

Two pharmacists face inquiry over distribution of Enbrel Two pharmacists have faced a fitness to practice inquiry, relating to the supplying of a double dose of a powerful drug to a minor, it has been reported in the national press.

Both Ana Eusebio and Patrick Staunton, from Staunton’s Pharmacy Ltd, Link Pharmacy, on Hopkins Rd, Castlebar, Co Mayo faced allegations of professional misconduct and poor professional performance, in a hearing at the Pharmaceutical Society of Ireland.

Enbrel to be taken twice weekly, when his prescriptions were half this dose.

Superintendent pharmacist Patrick Staunton is also accused of failing

to take adequate steps to ensure the health and wellbeing of Patient A after he found out about the matter on November 21, 2012.

Supervising pharmacist Ms Eusebio was accused of supplying Enbrel to a man, who was a minor at the time, a total of 12 times between 2011 and 2012.

Enbrel is used to treat rheumatoid arthritis and other chronic autoimmune conditions, and is often taken in the form of an injection.

Ms Eusebio is accused of failing to take adequate steps upon discovering the error on September 17, 2012.

Ms Eusebio allegedly supplied the man with directions for 50mg of

The drug has serious potential side-effects

News Ireland will need ‘three new hospitals in news brief the next ten years’ Research commissioned by the Irish Life Group has suggested that Ireland will need more beds, equivalent to the size of three Beaumont Hospitals, to deal with a forecasted increase in the population in the next decade.

According to an industry analysis published by Deloitte, the profits on investment in drug research and development (R&D) attained by the pharmaceutical industry fell to 3.7% in 2016 — the lowest figure in the past six years.

Ireland’s population of over 65s, Irish Life estimates, will grow by 200,000 over the next ten years.

Commenting on the research, Jim Dowdall, Managing Director, Irish Life Health, said, “The current model for funding the public and private health system is not sustainable. If we are to create a sustainable health system to support an ageing population, we require a different vision for the future.”

Mr Dowdall proposed three areas which should be addressed: a strategic vision incorporating the public and private system; a focus on costs and changes to the funding model, and ensuring a sustainable community rated market.

The Irish Healthcare system is currently having problems dealing with current numbers. In December, a record number of patients, over 600 on a number of days, were recorded as being on trolleys in hospitals.

Last year, the PSI’s ‘Future in Pharmacy report said that community Pharmacy and the expertise of pharmacists could

The research indicated ‘three Beaumont sized’ hospitals would be needed be better used to alleviate some of the pressure currently on Irish hospitals.

In the UK late last year, the NHS made a similar suggestion, urging patients to think ‘Pharmacy or GP first’, as it says that Accident and Emergency services were ‘extremely busy’ during Christmas and New Year.

Commenting on the Irish Life research, IPU President Daragh Connolly said, “In the UK, the Royal College of General Practice and the College of Emergency Medicine has previously estimated

that one in seven GP consultations and one in 12 A&E attendances could have been dealt with by a visit to a Pharmacy.

“The public too is fully supportive of an extended role for pharmacists. Independent market research conducted by Behaviour and Attitudes on behalf of the Irish Pharmacy Union found that 92% of the public are in favour of pharmacies providing a minor ailment scheme, and 94% favour pharmacies providing services to improve patient adherence to medicines.”

Three out of four pharmacies experiencing crime - IPU Three out of four pharmacies, or 77%, have experienced some form of crime – including shoplifting, robbery and raids – a survey from The Irish Pharmacy Union (IPU) has revealed.

According to ‘The Irish Pharmacy Union (IPU) Crime Survey 2016’, 78% of those who experienced crime experienced two or more incidents, with 23% describing the incident as ‘violent’.

The research also found that 92% of pharmacies who were victims of crime experienced shoplifting, 19% experienced robbery, 15% fraud and 6% experienced a raid.

Only 71% reported the case to the Gardaí, and two thirds were happy that their case was dealt with effectively/adequately. One-third of pharmacists (33%) who decided not to report a crime did so because they felt the perpetrator would not be charged. 37% of pharmacists who experienced

PHARMACEUTICAL R&D PROFITS DOWN TO 3.7%

crim had no confidence in the Garda response.

most effective for reducing crime going forward.

In one in five cases in which a robbery or raid took place, the perpetrators had a weapon. A knife was used in 81% of these cases, while a gun was used in 18%.

Commenting on the findings, IPU President Daragh Connolly said, “It is not an exaggeration to say that crime against pharmacies has reached crisis levels. The appalling level of crime should send out a strong message to the authorities that unless immediate action is taken, criminals will continue to see retail businesses, including pharmacies, as an easy target.

Cosmetics and fake tan were the most likely items to be shoplifted from pharmacies, the survey found. In one in five cases (21%), cash was taken. In 12% of cases, over-the-counter drugs were taken, and controlled drugs taken in 9% of cases.

Respondents to the survey said that more visible policing (93%), faster Garda response (88%) and tougher sentencing (86%) were the methods they believed would be

“The belief that criminals will not be charged and the revolving door scenario in our Courts for the few that are charged, is giving the impression to thieves that their criminal activities will go unpunished.

Diary Date: The Future Health Summit - Citywest Convention Centre, Dublin - May 24-25th, 2017 - 15 Summits, 3,000 delegates, 160 Speakers. Visit www.futurehealthsummit.com

The study found that predictable peak sales per new product have dropped by 11.4% year on year since 2010 to reach an average US$394m.

The findings, published in Deloitte’s report ‘Measuring the profit from pharmaceutical innovation 2016: Balancing the R&D equation’, are based on its 2016 analysis of the R&D spend by the global top 12 research-based life science companies: Amgen, AstraZeneca, BristolMyers Squibb, Eli Lilly, GlaxoSmithKline, Johnson & Johnson, Merck & Co, Novartis, Pfizer, Roche, Sanofi and Takeda.

The report reveals that the companies have launched 233 products over the past six years and developed another 376 to reach late stage pipelines, with a total sales estimate of US$1,697bn.

During 2016, the costs of bringing a new drug from discovery to launch have alleviated — from US$1,576m in 2015 to US$1,539m in 2016 — but peak sales per product have continued to fall.

Colin Terry, Consulting Partner for European life sciences R&D at Deloitte, says the continuing fall in projected return is a “real issue” for the global industry: “As costs per product remain high, sales projections decline, and given it now takes the industry over 14 years to launch a drug, real questions must be elevated about output and revenues on innovation.”

He says drug price is the “most publicized challenge, with political and public scrutiny on the topic intensifying.” The mainstream of companies are struggling to attain historical highest sales in spite of continuing to launch many new products. They are also progressively looking for revenues from treatments in smaller patient groups.”

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News news brief LLOYDSPHARMACY LAUNCH ‘CHANGE YOUR HEALTH DIRECTION 2017’ LloydsPharmacy have launched a free eight-week healthy living programme to help people improve the health of their customers following the Christmas period.

The pharmacy chain says it “aim(s) to support customers’ healthy living ambitions for 2017.

The programme is flexible and convenient for customers with many stores having late night and weekend opening hours.”

LloydsPharmacy customers will have access to an eightweek ‘health transformation’ programme, in which in-store health coaches provide free weekly advice and support for participants in the privacy of the pharmacy’s care rooms.

Weight loss and smoking cessation programmes will be devised specifically for the participants following an initial ‘health check’ of their blood pressure and body mass index (BMI), and a discussion about their individual health goals.

Participants then have regular check-ins with their local LloydsPharmacy coach to track progress and review their personal programme if needed. At the end of the eight weeks, customers receive a full report on their progress and recommended next steps to further sustain their lifestyle for the long term.

This year, LloydsPharmacy have teamed up with nutritionist, The Healthonist, who will be sharing a variety of easy to make healthy recipes to keep participants on track. These recipes will be available on LloydsPharmacy’s blog and social media channels.

Now in its third year, since the start of the programme in 2015, LloydsPharmacy colleagues have coached their customers to lose a combined total of over 6,168lbs.

Commenting on the initiative, LloydsPharmacy’s Managing Director Goretti Brady said: “With obesity a major health concern in Ireland, particularly among our younger generation, LloydsPharmacy is committed to providing healthcare and wellbeing advice to all customers so they can take positive steps for a healthier lifestyle.”

6

Local scholars talk connecting research The third SPHeRE (Structured Population and Health-services research Education) Network Conference took place in RDS on January 12th in RCSI, bringing together over 180 researchers, policy-makers and practitioners under the theme of “Supporting solutions: Connecting Research, Policy and Practice.”

The initiative aims to provide excellent education and training programme that delivers a sufficient quantity of high-quality population health and heath service researchers, qualified at various academic levels for both academic and non-academic settings. Among this year’s attendees, and some of the SPHeRE scholars, were a number of students from the UCC School of Pharmacy.

Speaking to Irish Pharmacy News, pharmacist and SPHeRE scholar Kieran Walsh, said, “The point of SPHeRE is to build a tangible, multi-disciplinary network. There are people from across the medical spectrum involved. The variety of voices and areas of expertise is greatly beneficial.”

Kieren is currently doing his PhD on rationalising anti-psychotic prescribing in dementia.

Key note speakers included Professor Mike Kelly from the University of Cambridge; Professor Ella Arensman, and Director of Research at the National Suicide Research Foundation.

Opening the conference, SPHeRE Programme Director Professor Steve Thomas welcomed delegates and added that the next academic year is a milestone year for the Programme. “Ten years ago next October, our colleagues and

SPHeRE Network 3rd Annual Conference: Ms Michelle O’Driscoll, Ms Aoife McGillicuddy, Ms Aoife Fleming and Mr David O’Riordan School of Pharmacy UCC - Photo by David Coleman alumni in RCSI, Trinity College, Dublin and University College Cork launched the first structured PhD programme in health services research in Ireland,” he said.

“SPHeRE continues to build on its success, has expanded to incorporate population health research topics, now encompasses all universities in Ireland, and continues to grow as a network connecting research, policy and practice.”

Funded by the Health Research Board (HRB), the SPHeRE Programme is a national level programme involving three core

institutions (RCSI, TCD and UCC) and five partner universities (UCD, NUI Galway, Maynooth University, DCU, University of Limerick).

The SPHeRE Programme provides a key national infrastructure to support health research in Ireland through its unique and innovative PhD programme; an expanding SPHeRE Network of more than 900 members across research, practice and policy; as well as a forthcoming jointly-awarded online Diploma in Population Health & Health Services Research to be delivered online by RCSI, TCD and UCC.

OptiBac Probiotics to use Wholefoods as distributor OptiBac Probiotics will now use the company Wholefoods as a distributor, it has been announced.

The move comes after OptiBac had used the company Pharmed as distributor for eight years.

All of their point of sale material will also be available from Wholefoods, OptiBac have said, and Wholefoods’ team of Sales Representatives will be representing the brand at store and key account level.

Wholefood also offering its sales team, who have history, and

expertise in probiotics, to offer companies a chance to increase sales. In addition, OptiBac Probiotics will also be expanding their sales team in Ireland to offer training to pharmacies across the country.

“OptiBac Probiotics have worked closely with Pharmed Limited for the past eight years, and have been very grateful for the work they have done in helping to

establish the OptiBac Probiotics brand,” the company said in a statement.

“However, the company now feel that it’s time to work with a specialist within the natural products industry and are delighted to announce that as from January 1st 2017 their new and exclusive distribution partner is Wholefoods,” it added.

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uality • Choice • Value • Service

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‘Key innovations for pharmacists’ in new Epilepsy Model of Care Several changes and suggestions regarding the role pharmacists can play in caring for people with epilepsy have been included in the HSE National Clinical Programme for Epilepsy’s new Model of Care.

Dr Colin Doherty, Consultant Neurologist and HSE Epilepsy Lead

The Model of Care was launched in December of 2016, and sets out a vision for the transformation of epilepsy care in Ireland to provide the best patient centred care for all people with epilepsy in the right place, at the right time, sharing the best available information.

It is a blueprint for how Epilepsy services will be developed and continuously improved nationally.

The Epilepsy Programme, it says, has three core aims: - To improve access to expert care and information - To improve the quality of care across the healthcare spectrum from prevention, through to managed primary care to complex surgical care for difficult epilepsy - To improve value conscious care by shifting care where possible from expensive hospital cased care to the community.

“We anticipate with changing demographics, service requirements and new advances in the treatment of the disease that a peer review process may see the need for development of a new vision for service beyond that,” said Dr Colin P

Doherty, MD National Clinical Lead for the National Clinical Programme for Epilepsy, discussing the new model.

“For now, this document carries the hope for the most important standardisation in epilepsy care in the history of the state but it is only words on a page and it is up to us all to implement and sustain its ideas,” he added.

Key Innovations The key innovations of the Clinical Programme for Epilepsy include: - The creation of a cohort of registered advanced nurse practitioners (RANPs) to compliment the current medical expertise to help in the chronic disease management of epilepsy and to integrate it with care in the community.

This will provide timely access, intelligent support to general practitioners, and outreach clinics in the community. It is anticipated that these services will reduce admissions and length of stay in acute hospitals, both of which are key performance indicators for the National Clinical Programme for Epilepsy.

- The development of the Epilepsy Electronic Patient Record. More than 6,500 patients are now registered on Epilepsy EPR. 12 modules of functionality have been developed to support delivery of epilepsy services. The Epilepsy EPR has also been identified as a demonstrator project for the Individual Health Identifier through the Office of CIO and is leading out on the development of precision medicine and personalised care through a patient portal within the EPR. - The development and implementation in two sites of the Acute Seizure Integrated Care Pathway (ICP). An audit of the use of the ICP in one hospital demonstrated a reduction in the admission rate from 45.9% when ICP wasn’t used, to 28.7% where it was used.

Implementation While several of the recommendations within the Model of Care are currently being addressed, its full implementation will see significant changes in the way epilepsy care is delivered across the country. It will place community and hospital staff working together to support persons with Epilepsy in a care setting appropriate to them and their needs.

These care settings are grouped as follows: 1. Local level - this includes the patient’s GP, Primary Care Health and social care professionals and nurses, Community Rehabilitation Teams, the nearest Acute General Hospital and support provided by Epilepsy Ireland, the national advocacy service for people with epilepsy.

2. Group Epilepsy/Neurology Services - the hospitals with an epilepsy service (existing or proposed) collaborate

to function as a Group Neurology Service, operating as a Clinical Network in each of the six Hospital Groups.

These group centres will support hospitals within the group and Primary Care professionals in the management of patients with epilepsy in a planned and coordinated way.

3. National Tertiary Centres - in addition to the two neuroscience centres, Beaumont Hospital and Cork University Hospital, tertiary centres can be further developed across the service. Tertiary centres will generally have teams with sub specialism in some of the low volume / high complexity conditions within epilepsy.

Pharmacy The report includes several key innovations for pharmacists in both a primary and secondary care setting.

The chronic nature of epilepsy, the report notes, and the drugs employed in the treatment of epilepsy means that there is a need for access to Pharmacy services.

These services can provide on-going support, advice and guidance for both healthcare professionals involved in their care and for the patients themselves with regard to their medical management.

Pharmacy in Primary Care The following services can be easily implemented at this level in a relatively efficient budget neutral process: Medication Usage reviews (MUR’s): whereby the pharmacist’s consults with the patient, and on the basis of an assessment of the patient’s understanding of their medication use, formulate a mutually agreed plan to optimise the patient adherence to their treatment programme.

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Profile With the patient’s consent this process allows the pharmacist to make recommendations to the prescriber to enhance patient adherence/concordance.

As patient adherence is critical in Epilepsy care community Pharmacy is ideally positioned to support the patient.

Compliance Aids/Monitoring: Most Pharmacy practices offer some access to compliance aids for patients who have difficulty with complicated treatment regimens, in collaboration with their GP Compliance aids such as Monitored Dosing Systems (MDS) – commonly referred to as “Blister packs” are also used to physically check the patient’s adherence to the treatment regimen.

Drug Information Service: As part of the current Community Pharmacy Contract 1996 (CPC) the pharmacist is obliged under Clause 9 to conduct a full clinical review of the patient’s medication profile on each occasion a prescription is presented.

This level of holistic assessment is especially critical when it comes to managing hospital discharge prescriptions.

The pharmacist will review any departmental discharge prescription in light of other co-existing treatment regimens – and work with the local GP and/or the Secondary care medical team to ensure that any new treatment is appropriate relative to potential for Drug Interactions and Side Effect profile. Each Pharmacy has access to comprehensive Drug Information packages as standard practice.

It is important to highlight the position of community pharmacies in terms of managing the patient transition between interfaces. Community Pharmacy practice records provide the most up to date record of medications dispensed to the patient in the community – anecdotally the Pharmacy PMR has been shown to be more accurate than the Primary Care GP record.

Pharmacy in Secondary care At present, where clinical Pharmacy services are available in secondary care, pharmacists advise the specialist team on medication related issues on an individual patient basis, in

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response to specific queries and in the development of evidence-based guidance for the medical management of patients with epilepsy The clinical pharmacy service aims to ensure continuity of care between healthcare settings in medication-related issues Where available, Pharmacy Medicines Information services provide quality, evidence based information to support all healthcare professionals with medication-related queries about the care of patient with epilepsy eg: review of new drug treatments, development of patient information about AEDs, advice on therapeutic drug monitoring. This service may be particularly beneficial to the new Advanced Nurse Practitioner and Nurse Prescribers in regard to medication related issues.

Pharmacists can also provide pharmaceutical input into integrated care pathways, protocols involving drug therapy, medication management, patient education, and review of patient compliance. The integration and continuity of pharmaceutical care is an important consideration in medication safety management.

The roles and responsibilities of clinical pharmacists have been outlined in the Report of the National Clinical Programme for Acute Medicine 2010 and will be the same for the care of patients with epilepsy.

Considerations for Special groups in Primary and Secondary Care within Pharmacy Women of child bearing age, pregnant and nursing mothers There are important pharmaceutical care considerations in this group due to the potential teratogenic nature of many AEDs and the challenges in managing AED therapy in pregnancy and lactation.

There are also clinically significant drug-drug interactions between the AEDs and some contraceptive agents which can be problematic for the management of both indications Community Pharmacy can form a critical support structure to manage the patient throughout maternity care.

While several of the recommendations within the Model of Care are currently being addressed, its full implementation will see significant changes in the way epilepsy care is delivered across the country.

Older People The Pharmaceutical Care of these groups is significant in terms of polypharmacy and the complex nature of regimens used in the treatment of Epilepsy.

Factors such as altered drug handling, the risk of drug-drug interactions and drug-disease interactions due to other comorbidities require significant Pharmacy input.

The clinical Pharmacist has an important part to play in highlighting drug-related problems and liaising with epilepsy specialists in the care of this patient population.

Paediatrics Review by a clinical pharmacist with reference to dose

calculation and formulation, therapeutic drug monitoring, interactions and administration via enteral feeding tubes is essential in this patient group.

Any procurement issues around unlicensed and specially manufactured extemporaneous preparations may also be addressed and communicated to primary care services.

Intellectual disability Clinical pharmacists are available to identify the pharmaceutical care needs of individual people and to support enquires from the community in the medication – related management of these individuals.

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News Vaccinations recommended by pharmacists in face of flu increase As health authorities reporting an increase in influenza cases and influenza-like illness, pharmacists in the Irish Pharmacy Union have reminded members of the public that it is not too late to get the flu vaccination. They have also advised people, particularly those in at-risk categories, to get vaccinated.

Reports from January found that levels of influenza and respiratory illness almost doubled across the country.

There were 341 cases of confirmed flu in the last two weeks of 2016, with a total of 270 hospitalisations.

In the first week of January 2017, seven people died of the illness. All the patients who died were aged 60 or over.

The HSE has previously warned that flu could potentially be responsible for up to 1,000 deaths if Ireland has a severe winter.

Research has also shown that the flu vaccine cuts the risk of death from influenza for elderly patients and reduces the chance of hospitalisation.

Of the recorded cases of flu during this period, fifteen patients were placed in critical care units. Most of these were aged over 65. Two cases of children contracting the illness were recorded.

The flu virus can be passed on by coughing or sneezing and can be spread from 1-2 days before you develop symptoms and for up to a week after symptoms develop.

Flu symptoms, particularly fever and muscle aches, tend to come on suddenly, whereas a cold usually starts gradually with symptoms of a sore throat and a blocked or runny nose.

At-risk patients include persons with Down syndrome; those who are immunosuppressed due to

disease or treatment, including those with missing or nonfunctioning spleens; persons aged 65 years and older; persons who are aged 18-64 with a chronic illness requiring regular follow up (e.g. chronic respiratory disease including chronic obstructive pulmonary disease, cystic fibrosis, moderate or severe asthma, chronic heart disease including acute coronary syndrome, chronic renal disease, and other illnesses).

Also at risk are the morbidly obese, healthcare workers such as doctors and nurses, pregnant women, residents of nursing homes and other long-stay institutions, and people with regular contact with pigs, poultry or water fowl.

According to the Health Protection Surveillance Centre, the average uptake of the flu vaccine amongst healthcare workers was 28%, a 6% increase from the same time 12 moths previously.

In January, it was reported that in response to the crisis, McCabe’s Pharmacy had slashed cost of its flu vaccinations by 50% in a bid to encourage people to get them.

In a statement, Paul Candon, CEO of McCabe’s said, “This is a critical time for the health service and we believe we can make a positive impact by offering the vaccine to all patients for the market leading price of ¤10 (down from the standard price of ¤19.50).”

Last month I considered scenarios of potential futures for today’s IPC Independent Pharmacist Contractor. We seem to be moving inexorably toward chain uniformity, however retaining values and individualism isn’t just wishful thinking but a market differentiator.

Long established family-run businesses will not easily forfeit autonomy in a blind rush to conformity but can, and should, pick those aspects that can be integrated whilst maintaining their diversity and personality.

It can be time well spent with staff and family to brainstorm the vocabulary of a business and service vision and mission statement. Without getting too anally ‘marketing speak’ , distilling the service ethos in a few words can be a rewarding and affirming exercise for all.

Years ago the IPU studied the diversity of IPC and defined types by  Rural, Suburban, High Street or Shopping Centre  High or Low GMS, and  High or Low Retail Further subdivisions are possible, but its striking how diverse neighbouring stores can be.

All businesses are different

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but good ones have common characteristics of skilled people, flexibility and work ethic - to name but a few.

There are only two main line wholesalers now - United Drug and Uniphar.

Uniphar present themselves as the champions and natural home of IPC, but the reality for those share holders of long memory does not add up.

The acquisitions of Boileau and Boyd made sense but the IPOS scheme was an unmitigated disaster for which accountability and contrition did not occur.

More recently a new Board has turned the indebted ship around and its currently being primped and primed for a possible stock market launch in 2018.

My broker friend likened the process rather callously to “putting lipstick on a pig”.

The likely beneficiaries of this will be the Board but the largesse and shared values may not extend equally to the IPC.

United Drug started life in the late 1940’s in the West of Ireland as a co-operative of IPC. It’s been quite a journey via pension companies and resales to the global giant McKesson. The vertical integration for the in-house Lloyds group should pay dividends for them.

So where should the loyalties of the IPC lye in a modern cut throat world of retail competition and a two-horse low-margin wholesale monopoly? Or indeed does it really matter if supply and price are right?

As ever in life, the choice is a personal one based on the integrity of the individuals on the ground and their history of delivering on promises. You can trust your instincts but seek your proof in paperwork.

There’s basically three current models being presented to the IPC sector: 1. A wholly committed and disciplined Franchise model

2. A branded symbol group with some conformity and autonomy 3. Remain visually independent and avail of buying group discounts Having moved between the latter two options, conformity has substantial costs but limited upside into the medium term.

It also depends on the maturity scale and scope of the business.

Some IPC’s feel overwhelmed, isolated and under resourced and skilled so a security blanket covering HR , Regulatory Affairs, SOP’s and Marketing can be attractive. For mini chains this may seem like a rear view mirror exercise, a list of past goal posts and boxes ticked.

So it’s horses for courses. You pay your money and you take your pick. The only certainty is ever hastening change and the fact that society and patients will need IPC despite big corporate hype.

Bayer is a global life science company managed by 3 divisions; Pharmaceuticals, Consumer Health and Crop Science. In all areas of our business, we invent, develop and market new molecules which influence the biochemical processes in living organisms. We are based in Leverkusen, Germany.

Bayer has been in Ireland for more than 45 years and employs over 100 people.

Our Pharmaceutical division provides quality medicines for diagnosing, combating and preventing disease in Irish patients. We are involved in researching new pathways, new molecules and new technologies in areas with a high level of unmet medical need, such as cancer therapy, cardiovascular and blood disorders, as well as gynaecology and ophthalmology.

Our Consumer Health division produces non-prescription medicines

and dietary supplements with brands including Berocca and Alka Seltzer.

Our Crop Science division supports the agricultural industry, offering a broad range of innovative products for improving plant health, along with high-value seed products and also includes Animal Health, which focusses primarily on treating infectious diseases and repelling parasites.

Life Science Company

News Marrons’ Pharmacy wins Actavis news brief Training & Mentoring Bursary SAM MCCAULEY’S TO PARTNER WITH MARIE KEATING For the months of February, March and April Sam McCauley Chemists are partnering with The Marie Keating Foundation to raise money for the charity and increase awareness of the symptoms of cancer.

As part of their fundraising efforts, collection boxes will be in all Sam McCauley stores and special events will also be held.

In addition, the Marie Keating Foundation will be visiting several Sam McCauley stores with mobile units, where customers can speak to a nurse in confidence about any concerns and undergo testing for carbon monoxide levels.

Please check your local store for visit dates.

The NCRI’s Cancer projections for Ireland 2015 – 2040 estimates that the incidence of cancer in Ireland is expected to double by 2040.

Cancers are expected to be those of the skin – both melanoma and non-melanoma – in both sexes, are projected to be the biggest increase.

Breast cancer is the most common malignant tumour diagnosed in Irish women, with 2,883 cases diagnosed each year on average during 20112013, representing almost one third of all major malignancies diagnosed in women.

The latest trends report just published by the National Cancer Registry shows that the chances of a woman developing malignant breast cancer before her 75th birthday currently stands at about one in 10.

Marrons’ Pharmacy Clane, Co Kildare has been named as the winner of the Actavis Academy Training & Mentoring Bursary.

The family-run Pharmacy will receive a ¤5,000 training bursary and a two-day business mentoring workshop with Irish entrepreneur and presenter of Newstalk’s Down-to-Business show, Bobby Kerr. The Actavis Academy Training & Mentoring Bursary is supported by the Irish Pharmacy Union.

Marron’s Pharmacy has been serving the people of Clane for 60 years and is well recognised for its contribution to the health of the community.

By receiving the Actavis Academy Training and Mentoring Bursary the team at Marron’s plan to develop their skills so they can provide a community Pharmacy triage service for patients with common ailments such as sore throats and urinary tract infections so that they can be referred to their GP or to their appropriate hospital for secondary care treatment.

Speaking about the Bursary announcement, Tony Hynds, Managing Director, Actavis Ireland said, “We are delighted to award this new Bursary to

Pictured here are Marguerite Tierney, Product Manager, Actavis Ireland and Desmond Marron and his grandson Jonathon Morrissey of Marron’s Pharmacy - Photo: Alan Rowlette Marron’s Pharmacy – a fantastic example of the ever-expanding role of pharmacists in Ireland. We received some excellent entries showcasing the desire for training across a range of disciplines so pharmacies can continue to evolve and provide excellent customer service.

“To help pharmacists reach their training goals and become leaner, faster and stronger, Actavis will provide further opportunities like this through the Actavis Academy in 2017.”

Actavis provides Irish pharmacists with long-term sustainable value across a broad product portfolio.

On Wednesday Jan 11th the PharmaConex team met with some of the 2017 Pharmacy Interns to discuss all options available to them before and after registration.

Kept busy with helpful training and thesis discussions, the 2017 Pharmacy Interns had a busy week in the RCSI, Dublin.

But while the interns have a few challenging and busy months ahead of becoming registered Pharmacists, they are on the home stretch and so close to seeing the benefits of years of hard work.

“At PharmaConex we believe it is never too early to consider your career,” PharmaConex said in a statement.

Norabeth Hogan, head of communications and marketing at PharmaConex, said, “It’s always great to meet interns early on in their pharmacy careers, and a lot of them were delighted to discover that they would be able to work in a community pharmacy setting as a technician, in addition to working elsewhere.

Lung cancer incidence is rising more rapidly in females than in males, and by 2040 the rate is projected to increase by 136% in females and 52% in males.

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Entries were judged by Mary O’Meara, Head of Regulatory Affairs, Actavis Ireland, Bobby Kerr, Irish entrepreneur and businessman and presenter of Newstalk’s Down to Business show and Daragh Connolly, President, Irish Pharmacy Union.

PharmaConex meet with 2017 Pharmacy Interns ahead of busy week

The incidence rate increased significantly between 1994 and 2013, by c.1.5% annually. The trend has been influenced somewhat by the introduction of screening (BreastCheck programme) from 2000 onwards.

Cancers of the colon and rectum are projected to increase largely in line with demographic change, by 120% - 130% between 2010 and 2014.

This is based on taking a partnership approach with pharmacists with value, choice, service and support central to the company’s offering, and initiative builds on the comprehensive training and business development programmes which Actavis already has in place to support partner pharmacies across the country.

PharmaConex met the interns to discuss their options over food and drinks

“We wanted them to know that PharmaConex is here for them.”

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PHARMACY

Wednesday

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GROWTH SEMINAR

March 2017

Citywest Hotel, Dublin

Get ready to grow your pharmacy business Speakers

Stuart Fitzgerald Director, Fitzgerald Power

Michael Hussey

Davy Corporate Finance

David Fitzsimons

CEO, Retail Excellence Ireland

Barbara Kenny Partner, William Fry

Daragh Connolly President, Irish Pharmacy Union

Mark Stafford

CEO, Stafford Group

Ramona Nicholas

MD, Cara Pharmacy Group

#PharmacyGrowth To register your interest email seminar@fitzgeraldpower.ie or call 051 870152

Available at all leading pharmacies

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The Number 1 Selling Rehydration Treatment1 Dioralyte rehydrates faster and more effectively than water PLACE AN ORDER WITH YOUR SANOFI REPRESENTATIVE Padhraic Speight Tel: 086 0456 817 Munster

Colm Moran Tel: 086 0470 989 Midlands, North West

PRESCIBING INFORMATION DIORALYTE™ NATURAL, BLACKCURRANT AND CITRUS, POWDER FOR ORAL SOLUTION Presentation: Sachet containing the active ingredients Sodium Chloride 0.47g, Potassium Chloride 0.30g, Glucose 3.56g and Disodium Hydrogen Citrate 0.53g. Indications: Oral correction of fluid and electrolyte loss and the management of watery diarrhoea in infants, children and adults. Dosage and Administration: Each sachet should be reconstituted in 200ml (approximately 7 fluid ounces) of fresh drinking water. For infants where fresh drinking water is unavailable the water should be freshly boiled and cooled. The solution should be made up immediately before use. If refrigerated, the solution may be stored for up to 24 hours, otherwise any solution remaining an hour after reconstitution should be discarded. The solution must not be boiled after reconstitution. Daily intake may be based on a volume of 150ml/kg body weight for infants and 20-40 mg/kg body weight for adults and children. A reasonable approximation is: Infants – One to one and a half times the usual feed volume. For infants under 12 months, use only under medical advice. Children – One sachet after every loose motion. Adults (including elderly) – One or two sachets after every loose motion. More may be required initially to ensure early and full volume repletion. Contraindications: None known. Warnings and Precautions: The solution must not be reconstituted except with water at the volume stated. Solutions of greater concentration may result in hypernatraemia.

Those of greater dilution may result in inadequate replacement. If there is no improvement within 24-36 hours, consult the physician. If nausea and vomiting are present with the diarrhoea, small but frequent amounts of dioralyte should be drunk at first. No specific precautions are necessary in the elderly. However, caution is required in cases of severe Reference: 1. IMS Health OTC Market Overview, Data on file IE.OTC.14.02.03(1), January 2016 Date of Preparation: March 2016 SAIE.DIO.16.02.0021

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renal or hepatic impairment or other conditions where the normal electrolyte balance may be disturbed. Pregnancy and Lactation: Dioralyte is not contra-indicated in pregnancy or lactation. Interactions and Adverse Effects: None stated. Overdose: In the event of significant overdose, serum electrolytes should be evaluated as soon as possible, correct any abnormalities and monitor levels until return to normal, especially in the very young and in cases of severe hepatic or renal failure. Precautions for Storage: Do not store above 25°C. The reconstituted solution should be used immediately but may be stored for up to 24 hours in a refrigerator at 2-8°C. Marketing Authorisation Holder: Sanofi Ireland Ltd., Citywest Business Campus, Dublin 24. Marketing Authorisation No. PA 540/98/1 (Blackcurrant), PA 540/98/2 (Citrus), PA 540/99/1 (Natural) Legal Category: P Further information: Available from Sanofi Ireland Ltd., Citywest Business Campus, Dublin 24 or contact IEmedinfo@sanofi.com. Please refer to Summary of Product Characteristics which can be found on IPHA at http://www.medicines.ie/ before prescribing. Date of Preparation: January 2016 Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via HPRA Pharmacovigilance, Earlsfort Terrace, IRL - Dublin 2; Tel: +353 1 6764971; Fax: +353 1 6762517. Website: www.hpra.ie; E-mail: medsafety@hpra.ie. Suspected adverse events can also be reported to Sanofi Ireland Ltd. directly by emailing IEPharmacovigilance@Sanofi.com or calling 01 403 5600.

News Advice to give on Winter Norovirus Norovirus, better known as the winter vomiting bug, is currently the most common stomach bug in Ireland, affecting people of all ages. drinking slowly — small sips every few minutes.)

Oral rehydration therapy may be recommended to reduce the risks of dehydration. The summary of product characteristics for Dioralyte suggests the following quantities for fluid and electrolyte loss in diarrhoea: • One to one and a half times the usual 24-hour feed volume in infants up to two years The virus, which is highly contagious, causes vomiting and diarrhoea.

Norovirus can be unpleasant to experience, but it’s not generally dangerous and most people make a full recovery within a couple of days, without having to see their GP or other healthcare professional.

Noroviruses are a group of viruses that are the most common cause of Gastroenteritis in Ireland. They are also known as small round structured viruses (SRSV) or Norwalk-like viruses.

Between 10,000 and 20,000 people per week in Ireland can catch norovirus in a peak period.

It is also referred to as the ‘winter vomiting bug’ because the illness is more common in winter.

However, the virus can be caught at any time of the year.

Although the commonly used term for norovirus is ‘winter vomiting bug’, diarrhoea is also a feature. The first sign of infection is usually sudden nausea, which may be followed by forceful (projectile) vomiting and watery diarrhoea. Other symptoms include abdominal cramps, headache, fever and aching muscles.

Diagnosis can be confirmed by stool sample, but this is unnecessary in most cases. The infection is not usually dangerous and symptoms tend to clear up after a couple of days.

Norovirus is highly contagious.

People who think they have norovirus should be advised to stay at home rather than visit their GP, to help prevent spreading the infection, although those with co-morbidities or who still have symptoms after a few days should contact their GP.

A painkiller can be recommended to alleviate any fever or aches.

Paracetamol is probably a better choice than ibuprofen or aspirin in this case, to avoid adverse effects on the gastrointestinal tract.

Key points • Typical signs of norovirus infection are sudden nausea, followed by forceful vomiting or watery diarrhoea, or both.

Symptoms tend to last a couple of days. Use of antiemetics and antidiarrhoeals is discouraged.

• The main danger of infection is dehydration and oral rehydration sachets may be recommended, particularly for at-risk groups.

• Those infected should stay away from work or school for 48 hours after the last attack of vomiting or diarrhoea.

Dehyrdation The main risk of norovirus infection is dehydration, particularly if symptoms are severe.

Children under five years of age are considered at increased risk of dehydration if they pass six or more diarrhoeal stools in 24 hours or if they vomit three times or more in 24 hours. Babies under six months old are at particularly high risk. Dehydration in adults is more likely in old people.

The symptoms of dehydration initially include passing little urine, dark urine, a dry mouth and lips, weakness, lethargy and irritability.

Patients should be advised to drink plenty of fluids (more than they would normally), avoiding fizzy drinks and fruit juices, which can worsen diarrhoea. Adults will require at least 200ml after each bout of diarrhoea or vomiting.

(After vomiting it is recommended to wait five to 10 minutes before

• 200ml after every loose motion in children over two • 200–400ml (ie, one or two sachets) after every loose motion in adults An oral syringe may be helpful for administering fluids slowly to children. Home-made salt or sugar drinks should be avoided.

Eat or fast?

It is not necessary to avoid eating and current advice is to eat small light meals if able. Fasting in children and babies is not considered appropriate unless a child is clinically dehydrated and being treated for dehydration.

Children should be encouraged to eat where possible but may have a reduced appetite. Getting enough fluid is most important.

Breastfed babies should continue to be breastfed and bottle-fed babies should be given normal strength feeds.

Other helpful advice Norovirus is typically spread by the faecal-oral route. It can be caught by eating contaminated food or touching contaminated objects.

To prevent its transmission, towels should not be shared and hands should be washed and dried after going to the toilet, vomiting or changing nappies and before preparing food or eating. Toilet seats, flush handles and taps can be disinfected with household bleach. People with norovirus should stay away from school or work until at least 48 hours after the last bout of diarrhoea and vomiting. They should also not visit hospitals during this time.

A person can be infected with norovirus several times because the virus is always changing and immunity is probably genotype specific. Research into a norovirus vaccine is ongoing.

news brief CAREPLUS PHARMACY OPEN PEARSE STREET STORE CarePlus Pharmacy has opened their 28th store on Pearse Street, Dublin.

Welcoming the progression to CarePlus was owner Tomas Conefrey, whose Pharmacy has served the area for over 50 years. Mr Conefrey feels that the rebranding of his Pharmacy will offer his loyal customers a better service which has always been the core focus of this family business.

With a new and improved consultation room, Tomas says he can help his customers and patients with baby weighing, blood pressure measuring, skin advice and flu vaccines as well as a wider range of infant care and beauty brands.

Commenting on the rebrand, Tomas said, “I felt it was time for us to move forward and ensure we were providing our customers with a modern but welcoming Pharmacy, and CarePlus delivered on this in every way. They not only changed the layout of the store, they introduced new brands that will appeal more to customers.

“Already our locals are really positive about the new store look and they love the brightness of the refit and how easy it is to find what they need. CarePlus is focused on operational retail excellence and as I want to ensure Conefrey’s is here for another 50 years, I felt going with CarePlus was the best decision for me, my team and my business”.

CarePlus Pharmacy CEO, John Carroll, added, “We are adding to our CarePlus portfolio of pharmacies each month and we are very active in our recruitment process.

We are dedicated to working with our community-based Pharmacy partners to provide a professional, personal experience in a friendly environment. The newly rebranded pharmacies will serve local customers and provide them with the very best in health care, wellbeing and beauty needs.”

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Survey

Visualise study identifies key Pharmacy Shopping Types A study commissioned by Shopper Marketing Specialists Visualise has identified the habits of Pharmacy shoppers, as well as a potential 38-million-euro opportunity for pharmacists nationwide.

The online survey, which engaged with over 1,000 pharma shoppers, took place in August of 2016, and was taken with the intent of helping pharmacists consider how to better engage the Pharmacy shopper.

The study found that 64% of respondents agreed the Pharmacy channel plays a leading role when shopping for new or different products; that a good customer experience – basics, convenience and staff – was likely to make them return, and that instore- ‘the experience while waiting’ and additional services would also help ensure their repeated custom.

62% of those surveyed spent five or more minutes in a Pharmacy, with in-store digital screens being a key component for receiving in-Pharmacy messages.

Commenting on the study, Eoghan Phelan of Visualise said, “The retail Pharmacy market is in the midst of a period of considerable change, and it is more important than ever for pharmacists to build effective shopper experience and engagement strategies. In order to build these strategies, it’s integral for pharmacists to understand both the different types of shopper who visit their store, as well as their respective behaviours in store. With 45% of Pharmacy shoppers only buying for their primary mission there is significant opportunity for growth through more effective shopper engagement in store.”

Pharma Shopper Types The study identified four types of shopper who visit the Pharmacy.

The lowest percentage of these were ‘relief seeker’ shoppers, people whose primary mission was to purchase OTC medicines, at 19%.

27% of shoppers were ‘prescription only’ shoppers,

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people ‘who come in for their prescription and leave without purchasing any additional items.’

‘Health and Beauty Explorers’, people whose primary mission was for front of shop products were 25%. The last category, ‘Household providers’, people who primarily come for their prescription, but also purchase from other categories, were 29% of respondents.

Shopping Habits The study found that four out of five people visit a Pharmacy at least once a month. Just under one in five (19%) of shoppers visit their Pharmacy once or more a week, while 27% visit slightly less than that, at two or three times a month.

35% of shoppers visit once a month, while the remaining 19% frequented a chemist less than that.

Just over half of people visiting their Pharmacy did so with the primary objective of filling out a prescription (56%), with just under another fifth (19%) looking primarily for nonprescription medicines. 12% or shoppers were primarily looking for toiletries/cosmetics, and 9% were primarily looking for healthcare products.

Time spent in store The considerable amount of time spent in-store by Pharmacy shoppers, presents an excellent opportunity to engage with shoppers.

‘Relief seekers’ spent about four minutes in the shop, ‘prescription only’ shoppers spent 12 minutes. ‘Household providers’ spent 15 minutes, while ‘Health and beauty explorers’ spent the most time, 23 minutes in total.

In total, 37% of Pharmacy shoppers spent up to ten minutes in store, while 28% spent up to five minutes. 18%

spent up to 15 minutes, while 12% spent over 15 minutes.

Factors for selecting a Pharmacy Convenience, staff relationships and expertise were key influencing factors when choosing a Pharmacy.

Convenience was the most important factor for 26% of shoppers when they selected their Pharmacy, while a good relationship with staff was integral for 18% respondents.

Price was a major factor for 18%, while expertise was key for 16%. Customer service was the most important factor for 8%, and range of products for 6%.

Potential improvements for pharmacists. The in-store environment What do you think could improve the in-store environment in the Pharmacy you visit most often?

Two key points to jump out of this section were a demand for

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Survey to customers, yielded some interesting results, as well as a number of opportunities for pharmacists.

51% said their Pharmacy provided a consultation room, while 44% said it provided flu vaccines. 42% said their Pharmacy offered blood pressure screening, and 34% said emergency contraception.

26% noted cholesterol screening, followed by 26% of people saying travel vaccinations, and another 18% saying food intolerance testing.

In-Pharmacy communication and advertising When it came to influencing shoppers purchase decisions, the in-store environment proved to be crucial with 44% of people stating that in-Pharmacy advertising was the most influential method of advertising in determining what brand to purchase. 37% said they were most influenced by TV advertising, while 25% selected online advertising as the most influential.

something to engage shoppers in-store and an opportunity to increase focus on additional health services and advice.

29% said more in-store competitions/events would help improve their in-Pharmacy experience, while 25% noted consultation rooms 24% as key to a better customer experience.

Free wifi was desired by

22% of people, while easier to find products and entertainment while waiting were wished for by 21% and 17% of people respectively.

Perceived services What services does the Pharmacy you visit provide?

When looking closer at some of the in-store advertising methods used by Pharmacies and their suppliers, in-store digital screens ranked as the leading medium of communication for a range of different communication objectives, including providing health information, informing customers of relevant products and of additional services on offer in the Pharmacy.

Anyone looking for more information on the ‘Shopper Nation - Focus on Pharmacy’ study, should contact Visualise General Manager Eoghan Phelan at eoghan@visualise.ie

The perceived services of the Pharmacies, according

About Visualise:

Putting shoppers at the core of everything we do, Visualise have been pioneering shopper marketing in Ireland for over a decade. Locally owned and independent, we combine expert strategic and creative thinking with strong retail relationships and an unrivalled excellence in execution to offer our clients a 360° service from insight to implementation.

Our local expertise is supported and informed by global insight and strategy through our partnership with engage. We offer an extensive range of training, insight, planning and evaluation tools, proven to deliver results and drive business growth.

news brief CAREPLUS TO PARTNER WITH LUCY WOLFE CarePlus Pharmacy have announced a partnership with renowned infant sleep consultant, Lucy Wolfe, who will travel the country with the 35 strong Irish pharmacy chain this year hosting free mother and baby workshops, and offering expert advice on how to help your little one sleep through the night.

The roadshow commenced in 2016 in Mullingar and Limerick, with over 100 parents in attendance, focussing on all-important tips for building healthy sleeping habits with children. Following on from the success of these events, CarePlus have scheduled seven more events for 2017 with the next event taking place on the 22nd of February in the Middleton Park Hotel, Cork.

Attendance is free and registration takes place via the pharmacies or through social media, but early sign up is advised to avoid disappointment.

Commenting on the partnership, Lucy Wolfe, Infant Sleep Consultant said, “I’m thrilled to be partnering up with CarePlus Pharmacy to inform parents on good sleep practices with their little ones. Nobody plans to have a sleep problem, but habits can become easily engrained and spiral quickly out of control and you can find yourself sleep deprived, desperate and not too sure what to do.

Sue O’Grady, Head of Marketing for CarePlus Pharmacy said, “We are delighted to have Lucy on board for this roadshow.

We will also have our own CarePlus baby experts at each event to answer all baby related questions our customers may have. Supporting parents and their babies is an integral part of our ethos at CarePlus Pharmacy…. This partnership shows our commitment to providing a best in class service to our customers, and we look forward to working with Lucy over the coming year.”

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Advertorial

e-prescribing, National Phase 1 The McLernons e-prescribing initiative in Mallow has been chosen by the HSE’s eHealth Ireland as the model for a national roll out.

One of two original pilots, the development team at McLernons worked closely with Carl Beame of GP prescribing system CompleteGP to ensure a seamless, safe and effective method of e-prescribing.

Keith McLernon, MD of McLernons, said, “We were delighted to be invited to participate in the original pilot in Mallow last year, which was run under the auspices of the Health Innovation Hub in Cork. After a successful initial phase, the pilot was extended to include one of the larger pharmacy groups to test our software against the group’s own internal protocols.”

“We supported the participating pharmacies with one-on-one training, educational evenings and one of our trainers was dedicated to the initiative, providing help and reassurance on the ‘phone and in person.”

“At the end of the initial pilot the pharmacists and GPs recognised how e-prescribing has been proven to beneficial to their own ways of working and also helped their patients, and the project has grown from strength to strength, and we are currently in Phase 1 of the national roll out.”

How it works The data on each prescription for each individual item is automatically coded in the GP surgery and sent to a central computer server, accompanied

by a unique code or ‘unlock’ key.

The prescription is fully encrypted during the transmission and storage on the central server.

When the prescription is printed, the printer also produces this unique key on the prescription form in a single line barcode. The data is sent to the cloud, and the prescription (which is still the legal document) is given to the patient or their carer. At all times, control over the prescription remains with the patient, and nothing happens until they present the ‘script in the pharmacy of their choice. Only at this point is the prescription barcode scanned and the code allows the information to be retrieved from the cloud, and is then dispensed from the McLernons MPS dispensing system.

The ‘new look’ prescription has the barcode as well as the list of prescription items for the patient, and is now just a single document and not the multi-part document of before. GP surgeries can now get rid of their old dot matrix printers, and reducing the need to print multiple copies is much better for the environment as well as more time-efficient.

Keith added, “McLernons, working with CompleteGP, the Health Innovation Hub, eHealth Ireland and Healthlink (the national message broker), have delivered a standardised transportation mechanism and supporting infrastructure for the safe electronic transportation of a prescription from a GP’s prescribing site to the pharmacy’s dispensary.”

View from the pharmacy Peter Weedle, who owns two community pharmacies in Mallow, was closely involved in the project from the very early days of the ‘back of an envelope’ discussions with McLernons and CompleteGP. He commented, “I am an enthusiastic early adopter of technology and have for a long time been one of the test sites for McLernons as they developed their MPS dispensing system.”

The new-look, single sheet, barcoded GMS ‘script

22

“Anything which improves patient safety and streamlines the work

The McLernons’ MPS dispensing system with the new barcoded GMS prescription flow in the pharmacy has my approval, and I am delighted with the success of the initial pilot and its subsequent endorsement by eHealth Ireland and the HSE as Phase 1 of the national roll out.”

“Simply scanning the barcode allows the pharmacist to view the electronic version of the script, which is ‘tagged’ to the pharmacy automatically, eliminating the time-consuming keying in of the information and removing the possibility of errors in transcription of this important drug information.

Pharmacists have patient safety at

the centre of everything that we do, and this is a great example where technology is helping us to deliver increasing levels of pharmaceutical care to our patients, accurately and effectively.”

“My customers are delighted with the new system, showing a real interest in how it works and the benefits that it brings, and the fact that I do not have to return the paper ‘script to the PCRS in order to get reimbursed is most welcome!”

information between the GP surgery and the pharmacy. We are indebted to Prof Peter Weedle who led the way in testing the software for us over a number of months, his professional colleagues in the Mallow area and to the support given by Niall Sinnott and Richard Corbridge of eHealth Ireland.

“With the launch of our Medi Marshal mobile app, which offers the patient a new way to manage their medicine and give them access to their full medicine history, as well as a quick and easy way to order their family’s medication, with notifications when

the medicines are ready to be collected from the pharmacy.”

“This will be rolled out across Ireland this year, allowing our customers to offer yet another way to help their patients, increasing customer loyalty and strengthening the bond between their pharmacy and their patients.”

“At McLernons we pride ourselves on constantly innovating and finding new ways to help our customers care for their patients and grow their business and we are particularly proud of this Irish first.”

Peter Weedle with the GMS barcoded prescription in his Townview pharmacy

Advantages E-prescribing offers a number of benefits to both patients and pharmacists. Accuracy of dispensing is improved and, by being able to plan their workload, pharmacists can use their time more efficiently, freeing up more time to counsel patients when they arrive to collect their medication”.

Already several thousand prescriptions have been issued digitally, with about half of these dispensed by the pharmacies enabled to participate.

Richard Corbridge, Chief Officer of eHealth Ireland, said, “Moving to a digital prescription is a key step in the eHealth Ireland agenda.

What is being done here will prove the concepts of a digital prescription service that meets the requirements of the recently published HIQA standards and delivers a level of patient safety through information never before seen in these types of solutions.

The innovation that has been enabled here is a shining example of how the health service across Ireland is starting to embrace the concepts of an eHealth fabric. The eHealth Ireland team are excited to see the outcomes of this pilot and work with the suppliers involved to consider the next steps for this delivery.”

related areas such as the Individual Health Identifier and an Electronic Health Record and we are closely involved in finding ways to ensure that the needs and concerns of community pharmacists are raised and addressed in the development of these initiatives.”

The future Keith concluded, “We are delighted to yet again be at the forefront of development of cutting edge technology for our community pharmacy customers. McLernons worked closely with Carl Beame of Complete GP to ensure a seamless transfer of patient and prescription

Dr David Molony gives Conor Coughlan the first barcoded GMS prescription

What next?

McLernons’ collaboration with eHealth Ireland and the involvement of Healthlink is highly significant in that it opens up a great many other opportunities for closer electronic working between primary healthcare professionals and, in future, between community pharmacy and the acute hospital sector.

Keith added, “eHealth Ireland have made significant progress in

Tim O’Brien, McLernons, Niall Sinnott, Office of the CIO, HSE, Peter Weedle, pharmacist, Carl Beame, CompleteGP and Brian Markey, Office of the CIO, HSE

23

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Feature

Sexual Health & the Irish Pharmacy Written by Deidre O’Donnell Sexual health can be defined as appreciable sexual functioning or attitudes to sex on the part of an individual. Other areas of sexual health inevitably focus on the prevention of the negative consequences of sexual contact, such as sexually transmitted diseases. Pharmacy is a profession that can offer sexual health-related help and assistance, depending on the situation and the needs of the customer. On the other hand, there are factors that may affect the range of services and advice that Irish pharmacists are prepared to offer in some cases. These include how relevant products are perceived by customers, doctors and pharmacists. advising on the availability of these kits, and of the potential benefits of screening. However, unless a customer is willing to discuss any worries relating to their potential or actual infection status, there is little a pharmacist can do to help. If the customer is diagnosed with an STI, the treatment options available from their pharmacy may depend on a consultation with a GP or other health professional (e.g. staff in a sexual health clinic) and on any prescription they receive as a result.

Prophylactics Products that help to prevent or avoid potentially negative sexual consequences may be most familiar, popular and in demand. These, of course, include condoms. Condoms (referred to as ‘contraceptive sheaths’ in the Irish statute books) are sold over the counter in pharmacies.

Their sale is restricted to people who are over seventeen years old and/or married (in line with the latest amendment to the Family Planning Act of 1979. In addition, condoms are only to be sold by those licensed by relevant health authorities. This piece of legislation appears to miss the important point that condoms function not only to prevent pregnancy but also to reduce the risk of transmitting a sexually-transmitted infection (STI) from one partner to another. The recent Irish Study of Sexual Health and Relationships, published in 2006 as a result of collaboration between the Crisis Pregnancy Agency and the Department of Health and Children, also acknowledge an inextricable link between pregnancy use and protection against STI contraction in the intended use of condoms.

Condoms are regarded as having a high level of efficacy and success in pregnancy and/or STI control.

However, they can fail. Despite the popular preconception of condom ‘breakage’, their success is also likely to be affected by other factors. Studies conducted at the RCSI on condom use in Irish subjects indicate that they tend to include avoiding their use altogether, or putting it off until a late stage in a sexual encounter.

This research indicates that alcohol, especially if combined with specific partner types (e.g. recently-encountered or ‘casual’ partners), can also significantly increase the failure to use a condom.

STIs, Screening & the Pharmacy If a customer knows or suspects that a condom has failed (as outlined above), they can access services at their local pharmacy to find out if this has happened and/ or what the consequences may be. These (obviously) include the

Other Options in Contraception

A typical sexual health section in a regional Boots store.

sale of pregnancy tests and similar products. However, customers can also access STI screening and detection services at some Irish pharmacies. Screening for common STIs is offered by companies such as Let’s Get Checked. They provide simple kits that a customer may use themselves to extract and store a sample. The sample is then sent to a reputable laboratory to be tested for a range of STI types that are prominent in Ireland. These include chlamydia, gonorrhoea, HIV, herpes simplex and hepatitis.

A customer can request screening for a combination of these in accordance with their preferences.

Let’s Get Checked also offer a separate test for HPV, aimed at the detection of cervical cancer risks. Alternatively, a doctor or pharmacist may recommend screening if an individual approaches them with complaints or queries about relevant symptoms.

Over the counter screening services are available in approximately 1000 pharmacies across the country. The role of the pharmacist in terms of STI screening, therefore, is mainly on

Pregnancy is another common result of condom failure that affects female partners. In these cases, there are other options that may be used instead of (or in combination with) condoms to reduce the chances of an unintended pregnancy. Hormonal contraception is a popular solution among pharmacists, health professionals and customers, due to their familiarity and the frequency with which doctors tend to recommend them to patients. There are a number of contraceptive product types available for women in Ireland today. Prominent examples of these include long-acting removable (or reversible) contraceptives (LARCs) such as intra-uterine devices, subdermal implants, injectable contraceptives and oral contraceptive pills. The use of oral contraceptives in particular has been a consistently popular method for Irish customers over the last ten years.

Public health research has found that younger, single women with higher incomes tend to be more likely to use oral contraceptives in preference to LARCs, compared to their older, more likely to be married, less solvent counterparts. This has been found to be due at least in part to negative perceptions of LARCs, their safety and efficacy.

Moreover, there is evidence that these preconceptions may have been picked up from healthcare professionals. Additionally, some studies indicate that healthcare professionals are unfamiliar with LARC administration techniques

and have little motivation (e.g. in terms of institutional compensation schemes) to recommend them to patients.

On the other hand, LARCs may be more effective in terms of pregnancy planning compared to oral contraceptives. However, this may be related to factors such as ‘user error’, i.e. the failure of a patient to adhere to a dose-regiment of these pills for a day or more. Similarly, negative conceptions or attitudes concerning potential unwanted side-effects of ‘the pill’ also affect the uptake of, and adherence to, this treatment. A recent study including over 1500 Irish women between the ages of 18 and 45 found that 37% of these respondents agreed with the following statement: ‘[oral contraceptive treatments] have dangerous side-effects, and that this was the most powerful predictor of poor adherence in women taking this treatment.

Other studies have found that there are also different perceptions concerning oral contraceptives in Ireland among pharmacists.

A study on the perspectives of pharmacists, their clients and health professionals was recently conducted by a team from NUI Galway, the RCSI and QUB (among others from the UK).

It found that the pharmacists interviewed perceived adherence to oral contraceptives on the part of their clients as ‘good’. However, this may have been affected by similar observations that the same customers did not discuss any concerns about missing doses or other mistakes with these pills in their pharmacies. The pharmacists also believed that they were in a position to offer interventions, such as advice differing from that of a GP, based on an improved understanding of a customer’s individual circumstances. However, most pharmacists restricted their assistance regarding contraception to information-giving (e.g. offering material such as leaflets, which are also available at a GP’s surgery) and dispensing. So what prevents pharmacists from offering more complete help and advice?

25

Feature their administration for healthcare professionals involved in family planning. There may be a need for improved education on the benefits and risks of hormonal contraceptives for both patients and doctors. These issues aside, it appears that it is possible to access and effective range of sexual health-related services and assistance available in the Irish pharmacy today. However, larger shops and/or chain shops may be in a better position to offer them.

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Full Service Provision at the Pharmacy Current legislation surrounding the availability of contraception in Ireland requires a pharmacist to offer ‘comprehensive’ services in this area. This includes dispensing some medications (e.g. the emergency (or ‘morning-after’) contraceptive pill) and other services concerning relevant areas of health, such as blood pressure monitoring. However, the pharmacists in the study as above perceived themselves as hampered in their ability to fulfil this role. This was related to

issues such as resources; e.g. one pharmacist running a shop alone may not have the time or staff numbers necessary to provide these services. Research indicates that pharmacists may also perceive restrictions in terms of dispensation in the absence of a GP’s prescription. Some pharmacists may feel unable to render comprehensive advice as they lacked access to a customer’s medical history or family medical history. In addition, while some pharmacists feel they are prepared to offer contraception-related services and advice, they may

also believe that the same should remain between a customer and their doctor.

This represents a potential problem in situations that involve discussing the risks of oral contraceptives with customers. These risks include the increased likelihood of venous thromboembolism (VTE), found by some studies to be increased as a result of newer oral contraceptive use (in comparison to non-use of these drugs)6. This risk has been particularly linked to the fourth-generation synthetic drug drospirenone, although a recent review of these studies found no difference in the VTE risks associated with it compared to those associated with other oral formulations containing different progestins. However, these studies may not have taken other factors that also affect the risk of VTE (e.g. genetics, typical daily activity rates or obesity) into account when assessing the role of these oral contraceptives in its development.

On the other hand, this does not change the prevailing message that oral contraceptives are not suitable for some women. Despite this, pharmacists may feel unable to educate customers on these and other relevant risks due to the issues as outlined above.

Final Thoughts

Educational material on STIs alongside other leaflets in an Irish pharmacy

26

Pharmacists in Ireland may mainly address the sexual healthrelated needs and queries of their clients through informationgiving and filling prescriptions as applicable. As a result, the nature of pharmacy help and advice on this subject may be determined by what a healthcare professional has recommended to a patient. When these needs concern contraception, doctors may recommend or dispense oral contraceptives, as this is often the most familiar and popular solution.

It seems that the uptake of other contraceptives, on the other hand, is affected by a number of factors. These may include improved access to, or possibly more incentives to, training in

HIV Ireland (formerly Dublin AIDS Alliance) recently published the 2nd edition of Living with HIV in Ireland: a Self-Help Guide.

Addressing the practical and psychosocial needs of people living with HIV, the 138 page guide was devised with the assistance of 58 people living with HIV who determined the content, clarity, tone, and design of the book. Recent additions to the guide include sections on the Criminalisation of HIV Transmission and the Irish Human rights and Equality Commission, as well as updates on Moving or returning to Ireland, Housing and Mortgages, Foreign Country Entry Polices, Health and Travel Insurance, and Tattooing and Body Modification.

The guide is available on HIV Ireland’s website www.hivireland.ie Sources 1. Government of Ireland/Oireachtas na hEireann. Health (Family Planning) (Amendment) Act, 1992. Department of Health and Children. Dublin: Government of Ireland; 1992.

2. Cousins G, Layte R, Ingham R, McGee H. Sexual risk-taking at home and on holidays: the importance of context for the late application of condoms. Sexual health.

2013;10(5):414-418.

3. Cousins G, McGee H, Layte R. Suppression effects of partner type on the alcohol-risky sex relationship in young Irish adults. Journal of studies on alcohol and drugs.

2010;71(3):357-365.

4. Molloy GJ, Sweeney LA, Byrne M, et al. Prescription contraception use: a cross-sectional population study of psychosocial determinants. BMJ open. 2015;5(8):e007794.

5. Sweeney L-A, Molloy GJ, Byrne M, et al. A Qualitative Study of Prescription Contraception Use: The Perspectives of Users, General Practitioners and Pharmacists. PLoS ONE. 2015;10(12):e0144074.

6. Sehovic N, Smith KP. Risk of venous thromboembolism with drospirenone in combined oral contraceptive products. The Annals of pharmacotherapy. 2010;44(5):898903.

7. letsgetchecked.com 8. http://hse.ie/eng/health/az/

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ellaOne® is the most effective emergency contraceptive pill1

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exécution

Further information available from: HRA Pharma, Haines House, 21 John Street, Bloomsbury, WC1N 2BF, London.

Freephone: 1800 812 984. Email: med.info.ie@hra-pharma.com

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

ÉTAPE / STEP :

01

DATE :

13 / 03 / 14

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

*unprotected sexual intercourse

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

Date of preparation: March 2016

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ARTWORK FILE Please make sure to check the artwork with the Over Preview is on.

Trapping, overprint colours, colour adjustments, must be processed in photoengra Barcods must be checked by the Printer.

A Printer Approval is required before the final printi

Awards The Irish Pharmacy

2017

Why entering Awards can be good FOR YOUR PHARMACY Awards are one of the most powerful and cost-effective marketing tools. Winning a prestigious Irish Pharmacy Award has been proven to help your Pharmacy business to stand out from the crowd, send a positive message to your existing customers and attract new business.

We have compiled the top ten reasons why your Pharmacy should be involved in the 2017 Irish Pharmacy Awards.

1. Benchmarking The application process for entering an Award can often force you to evaluate your business from a different perspective. You will need to make sure that you stand out from the competition, whether through innovation, diversity, growth, customer service, investment in people and/or strategic thinking.

2. Free Marketing Awards can often be an overlooked tool in your marketing toolbox. Simply being shortlisted can improve brand awareness and promote your Pharmacy to new customers.

You can maximize PR exposure, update your marketing materials and window displays with awards branding.

3. Increased Credibility An Award win, shortlisting or nomination, can act as a third party endorsement for your Pharmacy. A win or finalist placing can give a seal of approval to your activities and is a sign of quality for your customers, making you

stand out from other local pharmacies and will give positive signals to customers and suppliers.

4. Employee Motivation Awards recognise the hard work and achievements of your employees so being shortlisted for one can help boost staff morale and improve motivation. Employees will be focused on what is great about the company they work for and can feel proud to be a part of it.

5. Attract Talent Being part of an Awards process can attract the talent you need to help push your business forward and/or into new directions.

6. Raise your Pharmacy Profile Being part of an Awards process can also significantly raise your company profile and gain you respect from your peers. In addition, being nominated for an Award can help identify your business as an ‘expert’ within a specific category.

Part of the Clinigen Group

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7. Impress Potential Investors If you aim to grow your business, recognition gained from the Awards can help impress potential investors.

8. Network with fellow Pharmacy leaders, Manufacturers and Suppliers Attending the Awards dinner and subsequent events gives you the opportunity to network with other Pharmacy leaders and professionals. Networking at this high level will enhance your business.

9. Free to Enter Put simply, you shouldn’t have to pay to highlight your successes. Your business resources are important. Awards shouldn’t be an expensive process.

10. Trophy and Finalist Certificate Successful finalists and winners are awarded an impressive trophy and certificate which can be displayed within the Pharmacy, instilling pride.

Award Categories RB Nurofen for Children Baby Health Pharmacy of the Year 2017

Quintiles IMS Superintendent Pharmacist of the Year 2017

IDIS Young Pharmacist of the Year 2017

Business Development (Chain) Award

Pharmacist of the Year 2017

Professional Contribution Award

McLernons Innovation & Service Development (Independent) Award

Johnson & Johnson Community Pharmacy Team of the Year

MSD Innovation & Service Development (Chain) Award

RSM Community Pharmacy Technician of the Year 2017

Unilever OTC Retailer of the Year 2017

Bank of Ireland Community Contribution Award

Business Development (Independent) Award

People’s Pharmacist

KRKA Counter Assistant of Year 2017

IPN Pharmacy Representative of the Year

Please contact Aisling Twomey directly for Awards applications: Email: aisling@ipnirishpharmacynews.ie | Office: 00353 (01) 6690562 | Mobile: 00 44 7935 986484

What the Winners say Winning one of these Awards can significantly raise your company profile within Ireland and gain you respect from your peers. A number of our winners have shared their experiences with us and have outlined how winning an Irish Pharmacy Award has improved business performance, motivated staff and attracted new customers.

WINNERS OF THE BUSINESS DEVELOPMENT (CHAIN) AWARD 2016 & UNILEVER OTC RETAILER OF THE YEAR 2016 - OONAGH O’HAGAN, MEAGHERS PHARMACY GROUP, DUBLIN Oonagh O’Hagan, Managing Director of Meaghers Pharmacy Group says, “Team work plays a massive role in the ongoing businesses development strategy at Meaghers Pharmacy Group. We put a huge amount of work into the continuous development of our business strategy and this win has been absolutely a joint effort by every single member of our team.

“We would like to thank KRKA and Unilever for their investments into the Awards. They are showing their support for excellence in their Pharmacy sector and highlighted their commitment to providing an outstanding service to consumers.

“Winning these Awards has created a really positive feeling across the entire company. It has been brilliant for the team; to know that they all played a part in it, and it has created a really good feeling in our stores.

Customers will always notice and remark on a positive atmosphere and all our team and indeed our customers are very proud of our achievement.”

WINNER - ACTAVIS BUSINESS DEVELOPMENT (INDEPENDENT) AWARD 2016 - MS CLIONA FINN, FOXFORD PHARMACY, CO MAYO Ms Finn explained that winning the award has paid dividends for the pharmacy and the response from local people has given the pharmacy team a boost.

“It was an amazing night and one that we won’t forget. It meant so much to our Pharmacy team to achieve this recognition from our peers for the hard work we put in each day. The support of this Award by Actavis has also served to validate the work done by the team at Foxford Pharmacy.

“The response to the Award has been overwhelming. The number of customers we have had coming into the store congratulating us has been really great. I think it gives a lot of people an insight into all the work that goes on behind the scenes. We’ve had a lot of people saying that they didn’t realise what goes on behind the counter. The recognition from the Award has led to an increased number of customers visiting the Pharmacy, with many eager to congratulate the Award-winning team.”

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Feature

New Year – Old Habits Stubbing out the smoking January is a very popular time of the year for people to attempt quitting smoking. The health benefits from kicking the habit cannot be understated; on average, smokers lose ten years of their life from their nicotine addiction.

Up to 65000 people die every year from tobacco related illnesses according to the HSE, and if they continue to smoke, one in every two smokers will die of a tobacco related disease.

Government Initiatives Currently, the government is discussing further initiatives to encourage Irish people not to smoke. Among these are new prices measures.

In January, Minister for Health Promotion, Marcella Corcoran Kennedy TD, said that price measures where important it comes to encouraging behavioural change in relation to tobacco use, alcohol and unhealthy diets.

The Minister was speaking as she opened the University of Liverpool Conference ‘Taxation and Other Economic Incentives as Health-Promoting Tools: A Focus on Tobacco, Alcohol and Unhealthy Diets’.

Minister Kennedy said, “When it comes to health promotion and encouraging behavioural change in relation to tobacco, alcohol and unhealthy diets what we need is a whole of government and a whole of society approach. This is crucial if we are to be successful in stemming the tide of NCDs and their impact on our populations.”

The Minister pointed out that tobacco use is one area where the importance of economic incentives can be clearly seen. The 2015 Healthy Ireland Survey found that 23% of adults 15 years or older are current smokers. Almost 6000 of our population die annually from tobacco related disease and tobacco use has been estimated to cost Irish society a total of ¤10.7 billion annually in healthcare, productivity and other costs.

Regional & National Support The HSE has also launched Quit.ie, which is a service for smokers who wish to kick the habit, providing information, support, and motivation.

Launched in June of 2011, Quit. ie is compiled of a team of HSE staff, who ‘will chat, ask questions, throw out some advice and tips that have worked for us, and we will get advice from some experts in Smoking Cessation who work

30

full time helping people to quit.’ It offers a Freephone, an email, and if you are so inclined, you can tweet to them @HSEQuitTeam.

The Benefits The health benefits do start right away when a person stops smoking and the following benefits to smoking cessation should spur customers on to achieve their goal: • Within 20 minutes’ circulation will improve, and the patient’s heart rate and blood pressure will get lower. A patient is immediately less likely to have a heart attack.

• Within eight hours the carbon monoxide level in the blood will drop and the oxygen level will go up.

• Within 24 – 48 hours all the carbon monoxide in the body will have left • Within a few days the sense of smell and taste will start to improve • After 72 hours breathing will improve and energy levels will increase

• Within two or three months lung capacity can increase by up to 30% OTC Treatments There are also several products available for pharmacists to sell to people who want to kick the habit. If you are a pharmacist, here are some of products available to sell over the counter to people trying to rid themselves of nicotine addiction.

Patch A nicotine patch is a small square, usually placed on the arm, which slowly releases nicotine into a person’s system throughout the day. A high strength patch is advised for heavy smokers, while a medium strength one will suffice for others.

Lozenges A lozenge is appropriate for patients who smoke less than 20 cigarretes a day, while a higher strength one is appropriate for smokers who consume more than 20.

Lozenges can be taken every one to two hours.

Gum Nicotine gum may also be helpful for people who are currently trying to kick the habit.

Patients on less than 20 cigarettes a day should have a single, lower strength (2mg) piece of gum whenever they get a craving.

Lasting for a about 30 minutes, the gum should be chewed until the taste becomes strong and then placed between the cheek and gum. People smoking more than 20 cigarettes per day or those who require more than 15 pieces of the 2mg gum should use the stronger (4mg) strength.

Inhalation cartridges These can be used when the urge to smoke occurs and are generally ideal for patients who feel that they would miss the hand to mouth action of smoking.

No more than 12 of the 10mg or 6 of the 15mg inhalators should be used per day. An inhalation cartridge last 40 minutes of intense use. However, these should be used in caution with patients with COPD or chronic throat disease.

Feature Concerned calls in Childhood Type 2 Diabetes Education and health eating initiatives key, say experts Medical experts are calling for the government to address the problem of childhood obesity, in order to prevent a spike in the number of cases of children living with Type 2 diabetes.

Type 2 diabetes is most common in people over the age of 40 who are overweight. However, in the past two decades, a number of cases of the illness in children have been reported.

It is not known precisely how many children are currently living with the condition, but some estimates have the number at around ten to fifteen children.

Speaking to Irish Pharmacy News, Dr Anna Clarke, Health Promotion and Research Manager at the charity Diabetes Ireland, said that while Type 2 diabetes is still a rarity in children, the numbers will increase unless preventative measures are taken.

“One of the risk factors is carrying excess weight,” she said. “So, we need to address this before it becomes an issue in Ireland. This is already a problem in England, America, Asia, because, children of a non-Caucasian background are genetically more pre-disposed to developing type 2. There’s a genetic factor as well.”

“We need to address this issue from the cradle,” Dr Clarke added.

“Healthy eating and regular physical activity are absolutely vital if we are to prevent children from developing this illness. The importance of healthy eating and exercise cannot be understated.

That’s why Diabetes Ireland go into schools, promoting physical exercise and educating children in this regard.”

According to the Irish Heart Foundation, two out of five Irish Adults (18 years and over) are overweight 39%, and one in four - 25% (24% of men; 26% of women) are obese.

In addition, being overweight or obese is now the most common childhood disorder in Europe for children. One in ten 5-12 year olds is overweight and a further one in ten is obese.

Between 1990 and 2000 the prevalence of obesity increased by 67% overall, up 1.25 fold in women (from 13%) and up 2.5 fold in men (from 8%). In total, 22% of 5-12 year olds are overweight or obese.

New Research New research has shown that that 46% of adults rarely or never check the sugar content of their food, despite

32

82% ‘regularly’ consuming confectionery and over a third (37%) eating it at least daily.

Women and under-25s were found to be the most likely to snack on sugary food.

The LloydsPharmacy commissioned research, conducted by Amárach Research among 1,000 Irish people over the age of 16, is part of the pharmacy’s national campaign to highlight the risk of developing Type 2 diabetes.

Only 14% of parents are aware of their children’s recommended daily sugar intake, despite 47% claiming to monitor their children’s sugar levels.

The research revealed only 44% of Irish men claim to know the difference between Type 1 and Type 2 diabetes, compared to 64% of women.

Irish men rank first in Europe for the highest body mass index (BMI), while Irish women rank third, according to a 2016 study published by medical journal, The Lancet.

GP and leading healthcare expert Dr Nina Byrnes described the findings as a “shocking

snapshot of the diabetes challenge faced by the Irish public, healthcare professionals and policymakers.”

“The findings of LloydsPharmacy’s research are shocking, yet they attest to what I and many other Irish GPs encounter on a regular basis,” she said.

“With sugar consumption on the rise, and obesity and Type 2 diabetes along with it, there is an urgent need to educate the public on the dangers of an unhealthy lifestyle, particularly children and especially secondary school pupils. Teenagers are at a point in life where they have greater autonomy and more power over their nutrition, and it’s important that they learn early on in life what constitutes healthy eating and what does not.

“Type 2 diabetes is a chronic condition that requires lifelong management. If we do not tackle the root causes now, beyond the personal health and welfare of hundreds of thousands of people with diabetes, an epidemic will create huge problems for our health service, both in terms of

MAKE THE SWITCH TO BYDUREON® PEN

Out with the old

In with the improved

Instead of Bydureon Injection (Single-Dose Tray), prescribe BYDUREON® Pen for your patients with type 2 diabetes BYDUREON® Pen offers your type 2 diabetes patients: ✔ sustained Hba1c reductions3 ✔ low hypoglycaemia risk*4 ✔ convenient administration ✔ sustained secondary benefit +1,2 of weight loss + BYDUREON is not indicated for the management of weight loss, and weight change was a secondary endpoint in clinical trials. * Increased risk of hypoglycaemia when Bydureon is added to sulphonylurea. Consider reduction in dose of sulphonylurea to reduce the risk of hypoglycaemia.

Adverse events should be reported directly to: HPRA Pharmacovigilance, Earlsfort Terrace, Dublin 2. Tel: +353 1 6764971 Fax: +353 1 6762517 Website: www.hpra.ie Email: medsafety@hpra.ie.

Adverse events should also be reported to AstraZeneca Medical Information on 1800 800 899.

References: 1. Buse JB, Drucker DJ, Taylor K, et al. Exenatide once weekly produces sustained glycaemic control and weight loss over 52 weeks. Diab Care 2010;33:1255–61. 2. Drucker DJ, Buse JB, Taylor K, et al. Exenatide once weekly versus twice daily for the treatment of type 2 diabetes: a randomised, open-label, non-inferiority study. Lancet. 2008;372(9645):1240-1250 3. Klein EJ, Henry RR, Malloy J, et al. DURATION-1 extension: efficacy and tolerability of exenatide once weekly over 6 years in patients with type 2 diabetes mellitus. Poster presented at the 50th Annual Meeting of the European Association for the Study of Diabetes; September 15-19, 2014; Vienna, Austria. 4. BYDUREON® Summary of Product Characteristics available at www.medicines.ie.

Approval ID: 1019258.011 Date of preparation: November 2016

BYDUREON® (exenatide) 2MG POWDER AND SOLVENT FOR PROLONGED-RELEASE SUSPENSION FOR INJECTION PRESCRIBING INFORMATION Consult Summary of Product Characteristics (SmPC) before prescribing.

Use: Treatment of type 2 diabetes mellitus in combination with metformin, sulphonylurea, thiazolidinedione, or combinations of metformin and sulphonylurea or metformin and thiazolidinedione, in adults who have not achieved adequate glycaemic control on maximally tolerated doses of these oral therapies. Presentation: Powder and solvent for prolonged-release suspension for injection containing 2mg exenatide. Dosage and administration: Adults: The recommended dose is 2mg exenatide once weekly, on the same day each week, at any time of day, with or without meals. Administer as subcutaneous injection in the thigh, abdomen, or back of the upper arm immediately after suspension of powder in the solvent. If dose is missed, administer as soon as practical, then resume once weekly dosing schedule. Two injections should not be given on the same day. Prolonged-release exenatide is for selfadministration, appropriate training is recommended. Patients switching from immediate-release to prolonged-release exenatide may experience transient elevations in blood glucose concentrations, which generally improve within first two weeks after therapy initiation. When prolonged-release exenatide is added to existing metformin and/or thiazolidinedione, the current dose of these oral therapies can be continued. Increased risk of hypoglycaemia when prolonged-release exenatide is added to sulphonylurea. Consider reduction in dose of sulphonylurea to reduce the risk of hypoglycaemia. Blood glucose self-monitoring may be necessary to adjust the dose of sulphonylurea. If a different glucose-lowering treatment is started after the discontinuation of prolonged-release exenatide, consideration should be given to the prolonged release of the product. Elderly: No dose adjustment required. >75 years: Very limited clinical experience. Consideration should be given to the patient’s renal function. Renal or hepatic impairment: No dose adjustment required for patients with mild renal impairment (creatinine clearance 50-80 ml/min) or hepatic impairment. Very limited experience in moderate renal impairment (creatinine clearance 30 50ml/min). Not recommended in patients with moderate renal impairment, severe renal impairment (creatinine clearance <30 ml/min) or end-stage renal disease. Children and adolescents: <18 years old: Safety and efficacy not established. Contraindications: Hypersensitivity to the active substance or to any of the excipients. Warnings and precautions: Not to be used in patients with type 1 diabetes mellitus or for diabetic ketoacidosis. Must not be administered by intravenous or intramuscular injection. Renal impairment: Uncommon events of altered renal function with exenatide, including increase serum creatinine, renal impairment, worsened chronic renal failure and acute renal failure, sometimes requiring haemodialysis. Some occurred in patients experiencing events that may affect hydration and/or receiving medicinal products known to affect renal function/hydration status, including angiotensin converting enzyme inhibitors, angiotensin-II antagonists, non-steroidal anti-inflammatory medicinal products and diuretics. Reversibility observed with supportive treatment and discontinuation of potentially causative medicinal products, including exenatide. Severe gastrointestinal disease: Not recommended. Acute pancreatitis: Use of GLP-1 receptor agonists has been associated with a risk of developing acute pancreatitis. Spontaneously reported events of acute pancreatitis. Resolution of pancreatitis has been observed with supportive treatment, but very rare cases of necrotising or haemorrhagic pancreatitis and/or death have been reported. Inform patients of the characteristic symptom of acute pancreatitis: persistent, severe abdominal pain. If pancreatitis suspected, discontinue use; if acute pancreatitis is confirmed, prolonged-release exenatide should not be restarted. Caution should be exercised in patients with a history of pancreatitis. Concomitant medicinal products: Concurrent use of prolonged-release exenatide with insulin, meglitinides, alpha-glucosidase inhibitors, dipeptidyl peptidase-4 inhibitors or other GLP-1 receptor agonists have not been studied. The concurrent use of prolonged-release and immediate-release exenatide has not been studied and is not recommended. Weight loss: Rapid weight loss at a rate of >1.5kg per week has been reported with exenatide, which may have harmful consequences. Monitor for signs and symptoms of cholelithiasis. Discontinuation of treatment: The effect of Bydureon may continue as plasma levels of exenatide decline over 10 weeks. Choice of other medicinal products and dose selection should be considered accordingly until exenatide levels decline. Drug interactions: No dose adjustment required for medicinal products sensitive to delayed gastric emptying. Warfarin and cumarol derivatives: Increased INR (International normalised ratio) spontaneously reported during concomitant use of warfarin and prolonged-release exenatide. INR should be monitored during initiation of prolonged-release exenatide. HMG CoA reductase inhibitors: Concomitant use with exenatide was not associated with consistent changes in lipid profiles. Lipid profiles should be monitored as appropriate. Pregnancy and lactation: Women of childbearing potential should use contraception during treatment with prolonged-release exenatide. Discontinue at least 3 months before trying to get pregnant.

Avoid use during pregnancy and breast-feeding. Undesirable Effects: Consult SmPC for full list of side effects. Very common (≥1/10): Hypoglycaemia (with sulphonylurea), diarrhoea, nausea. Common (≥1/100 to <1/10): Decreased appetite, dizziness, headache, vomiting, abdominal distention, abdominal pain, dyspepsia, constipation, flatulence, gastroesophageal reflux disease, pruritus and/or urticaria, injection site pruritus, fatigue, injection site erythema, asthenia. Uncommon (≥ 1/1000 to < 1/100): Dehydration, somnolence, intestinal obstruction, eructation, altered renal function (including acute renal failure, worsened chronic renal failure, renal impairment, increased serum creatinine), injection site rash. Rare (≥1/10,000 to <1/1000): Anaphylactic reaction. Frequency not known: Acute pancreatitis, angioneurotic oedema, macular and papular rash, injection site abscesses and cellulitis. INR ratio increased with concomitant warfarin use (some reports associated with bleeding). Patients may develop anti-exenatide antibodies following treatment with prolonged-release exenatide. These patients tend to have more injection site reactions (e.g. skin redness, itching). Small subcutaneous injection site nodules observed very frequently, consistent with the known properties of PLGA polymer microsphere formulations. Legal category: POM. Marketing authorisation number: EU/1/11/696/001 (single dose kit) and EU/1/11/696/003 (pre-filled pen). Further product information available on request from: Freephone 1800 800 899 or contact AstraZeneca UK Limited, Horizon Place, 600 Capability Green, Luton, Bedfordshire, LU1 3LU, United Kingdom. Bydureon is a trade mark of the AstraZeneca group of companies Date of API preparation: 03/2016.

Feature cost to the taxpayer and hospital infrastructure.”

Ahead of the campaign, LloydsPharmacy invited Diabetes Ireland to further enhance colleagues’ expertise on diabetes and develop additional skills within its pharmacies to support those at risk and living with diabetes. In total, 144 colleagues in 82 stores nationwide received advanced training from Diabetes Ireland.

Joanne Kissane, Superintendent Pharmacist at LloydsPharmacy, added, “The increase in Type 2 diabetes in Ireland is a major health concern, but one that is largely preventable. However, our research shows that many people are still confused about core issues like daily sugar intake for their children, the sugar content in fizzy drinks and alcohol, and the dangers of diabetes.

“It is vital that consumers are educated on the adverse effects of sugar and the benefits of a healthy lifestyle and diet. According to the HSE, many Type 2 diabetes cases can be prevented by following four healthy lifestyle recommendations: regular exercise, not smoking, limited alcohol consumption, and eating a healthy balanced diet, especially the recommended daily amounts of fruits and vegetables.”

Overview Information from Diabetes Ireland has the total number of people living with diabetes in Ireland estimated at 225,840.

The International Diabetes Federation Diabetes Atlas (2013) estimate that there are 207,490 people with diabetes in Ireland in the 20 – 79 age group (prevalence of 6.5% in the population) which is in line with previous estimates that by 2020 there would be 233,000 people with the condition, and by 2030 there would be 278,850 people with the condition.

Type 1 Diabetes The prevalence of Type 1 diabetes is on the rise and is typically diagnosed in childhood.

People with Type 1 account for approximately 14,000 – 16,000 of the total diabetes population in Ireland i.e. 10-15% of the population of people living with diabetes.

34

It is estimated there are 2,750 people under 16 years of age living with Type 1 diabetes (based on the Irish Paediatric Diabetes Audit 2012) results and other young adults under 20 years attending transition clinics).

Type 2 Diabetes According to the Healthy Ireland survey, 854,165 adults over 40 in the Republic of Ireland are at increased risk of developing (or have) Type 2 diabetes. More alarmingly, there are a further 304,382 in the 30 – 39 year age group that are overweight and not taking the weekly 150 minutes recommended physical activity, leaving them at an increased risk of chronic ill-health.

This means that there are 1,158,547 adults in Ireland that need to consider making changes to their daily behaviours in terms of eating healthily and being more active.

It is estimated that there are over 15,600 people over 80 years of age living with Type 2 diabetes based on the TILDA study which showed a prevalence of 11.9% in the over 75 age group. The International Diabetes Federation’s (2012) estimates that by 2030 there will be 278,850 people with the condition (prevalence of 7.5% in the population).

Pre-diabetes A VHI Healthcare Screening Projects tested 30,000 people for Type 2 diabetes between 2009 and 2013 the findings were published in PLOS ONE (Public Library of Science).

VHI Healthcare’s findings demonstrated that 17% of participants (nearly 5,000 people) had abnormal initial fasting blood sugar levels, 1.8% had undiagnosed diabetes and 10% had confirmed pre-diabetes.

Abnormal blood sugar levels, prediabetes and diabetes were more common in men than in women with men 2-3 times more likely to have abnormal blood sugar levels and undiagnosed diabetes The study also found that the risk of having undiagnosed diabetes increased by 89% for every 5 KG / m2 increase in body mass index which demonstrates the importance of modifiable lifestyle factors in preventing diabetes.

The Slan 2007 study reported of the prevalence estimate of prediabetes (high risk of developing diabetes) in participants over 45 years was 19.8% which would imply there are 338,956 people in the over 45 age group at high risk of developing diabetes in Ireland in the next five years. In reality, given rising obesity levels in younger age groups, the figure is more likely 450,000.

Economic Cost of Diabetes to Ireland The economic burden of diabetes on the Irish health care system is becoming a major challenge for the government and the HSE. Professor J. Nolan’s seminal CODEIRE study is still the most accurate estimate of costs.

The CODEIRE study was an international accredited study and examined the cost of treating type 2 diabetes in Ireland during NovDec 1999, and suggested that 10% of the national health budget was being consumed treating the condition (49% on hospitalization for complications and wages; 42% on drug costs; 8-9% on ambulatory care and attending non-diabetes specialists for diabetes related complications).

Preventing Type 2 Diabetes There is great potential to prevent Type 2 diabetes in high-risk individuals by lifestyle intervention. There is sufficient evidence based on several clinical trials such as American Diabetes Prevention Programme8 and The Finish Prevention Study9, supporting this. These studies had a strong focus on increased physical activity and dietary modification as well as weight reduction among high risk participants.

The Diabetes Prevention Program Outcomes Study showed in their follow-up of participants at 10 years (from the initial randomization to lifestyle intervention or no action), that Type 2 diabetes incidence in the group with lifestyle changes was reduced by 34% compared with the control group8.

The Finish Diabetes Study was more intensive with participants offered intensive lifestyle support (dietary intake, physical activity, smoking and alcohol intake) with some participants also getting oral hypoglyceamic agents and showed that addressing all the

diabetes risk factors could reduce Type 2 diabetes by 80%.

Thus, in order to reduce the risk of developing Type 2 diabetes, it is recommended that all people have a healthy balanced diet, take regular physical activity and attain a weight appropriate to their height.

You are more at risk of getting Type 2 diabetes if you are: • Over 40 years of age • Have a parent or brother/ sister with diabetes • Had diabetes during a pregnancy • Are overweight for your height • Do not take 30 minutes of physical activity daily • Have high blood pressure • Have high cholesterol

And/or recognise any of these symptoms: • Blurred vision • Fatigue, lack of energy • Extreme thirst • Frequent trips to the bathroom (urination) especially at night • Rapid and unexplained weight gain or loss • Frequent infections • Numbness, pain or tingling in your hands or feet

More information The Diabetes Ireland Conference and Exhibition (DICE) 2017, will take place on Friday March 24th, at 8.30am, in the Croke Park Conference Centre, Hogan Stand.

For more information about diabetes, visit the Diabetes Ireland website: https://www.diabetes.ie

CPD 75: SPECIALISED NUTRITION FOR CHILDREN Biography - Amy Louise Oates. I qualified from the Robert Gordon University Aberdeen with a Master in Phamacy in 2011. I then undertook my pre-registration year with Gordons Chemists in Edinburgh. After registration I moved back home, where I am now working for Johnstons Pharmacy in Longford Town, Lanesborough and Ballygar, Co. Galway. I also recently completed a Cardiology in Clinical Pharmacy Practice module with Trinity College Dublin.

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

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

3. PLAN - If I have identified a knowledge gap

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

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

Have I identified further learning needs?

CHILDREN’S NUTRITION

GENETIC CHANGES

Community pharmacists frequently come in to contact with new parents presenting prescriptions for specific nutritional needs or their new-borns. It can be a very difficult and stressful time for parents, and they often look to their pharmacist for support and advice. As pharmacists it is important that we can help these parents in the best possible way. It could be by advising appropriate OTC remedies to alleviate their baby’s symptoms, or by noticing alarm symptoms that should warrant seeing their doctor. Other parents may need assistance on getting their prescriptions covered under schemes such as the Drug Payment Scheme and Long Term Illness. For most parents, a lot of the concerns are ensuring they are able to get the nutritional products required by their babies and children, and that they have enough knowledge and information to help them with their symptoms.

Mutations in the PAH gene is the cause of phenylketonuria. The PAH gene is responsible for providing the instructions for making the enzyme phenylalanine hydroxylase. This enzyme works to convert the amino acid phenylalanine to other important compounds in the body. If gene mutations reduce phenylalanine hydroxylase activity, then phenylalanine from the diet is not effectively processed. Excessive amounts of phenylalanine can cause brain damage as nerve cells in the brain are particularly sensitive to phenylalanine levels.

Both parents must pass on a defective version of the PAH gene for their child to inherit the disorder. If just one parents passes on the altered gene, the child won’t have any symptoms, but they will be a carrier of the gene.

Phenylketonuria (PKU) is a rare genetic condition that causes an amino acid called phenylalanine to build up in the body. Amino acids are the building blocks of protein, it is found in all proteins and in some artificial sweeteners. The enzyme phenylalanine hydroxylase coverts phenylalanine into tyrosine, which the body needs to create neurotransmitters such as adrenaline, noradrenaline and dopamine. This rare metabolic disorder affects the metabolism of foods containing protein. PKU is treated by restricting the natural protein in the diet and replacing them with synthetic amino acids and low protein foods available on prescription. These low protein foods provide the energy, bulk and variety needed in the diet.

Disclaimer: All material published in CPD and the Pharmacy is copyright and no part of this can be used within any other publication without the permission of the publishers and author.

5. WHAT NEXT - At this time you may like to record your learning for future use or assessment. Follow the 4 previous steps, log and record your findings.

Specialised Nutrition for Children

PHENYLKETONUIRA

Published by IPN. Copies can be downloaded from www.irishpharmacytraining.ie

SYMPTOMS PKU symptoms range from mild to severe, with the most severe form of the disease known as classic PKU. Infants with classic PKU may appear normal for their first few months, but if not treated the following symptoms can develop: • Delayed mental and social skills • Smaller head size than normal • Hyperactivity • Jerking movements of the arms or legs • Mental disability • Seizures • Skin rashes • Tremors If PKU is left untreated, or food containing phenylalanine is eaten, the breath, skin, ear

60 Second Summary Community pharmacists are ideally placed to help new parents of infants with specific dietary and nutritional requirements.

Some conditions mean infants need to obtain foods on prescription and can’t be purchased from local supermarkets.

Phenylketonuria is a rare metabolic disorder affecting metabolism of foods containing protein. Children with classic PKU need to adapt a strict diet eliminating protein and certain artificial sweeteners from their diet.

Pre-term babies require specialised formulas and fortifiers to provide sufficient essential nutrients and to promote appropriate weight gain and growth. A high percentage of infants and children suffer from gastroesophageal reflux, which is a normal “spitting up” after feeding.

In some cases this can become gastoresophageal reflux disease, causing significant problems such as irritation of the oesophagus, failure to grow and asthma. Infants with these signs and symptoms usually require treatment.

CPD 75: SPECIALISED NUTRITION FOR CHILDREN When the baby is old enough to eat solids, foods high in protein need to be avoided.

These include: • Eggs • Cheese • Milk • Nuts • Beans • Chicken • Beef • Pork • Fish The artificial sweetener aspartame or aspartame-acesulfmame-k are not permitted in the PKU diet Theses sweeteners are also known as E951/ E962.

wax and urine may have a musty odor due the buildup of phenylalanine substances in the body. Phenylalanine also plays a role in the production of melanin in the body. This is the pigment responsible for skin and hair colour. Children with PKU will often have lighter skin, hair and eyes than brothers or sisters who don’t have PKU. A less severe form of PKU is called variant PKU or non-PKU hyperphenlyalaninemia.

This condition is characterised by too much phenylalanine in the body. Infants with this form of PKU may have only mild symptoms but they will need to follow a special diet to prevent intellectual disabilities.

DIAGNOSIS If PKU isn’t diagnosed at birth and treatment started immediately the disorder will cause irreversible brain damage and intellectual disabilities in the first few months of life, behavioural problems and seizures in older

children. Newborns are routinely screened for PKU in hospital.

TREATMENT Diet is the main way to treat PKU, a special diet that limits foods containing phenylalanine.

A specialist infant formula must be used (Anamix Infant) in the dietary management of proven PKU, in infants from birth to 12 months and as a supplementary feed up to 3 years.

Breastfeeding an infant with PKU is not contraindicated as was previously believed. Human milk has relatively low levels of phenylalanine when compared with cow’s milk formulas. Total or partial breastfeeding should be encouraged in the PKU infant. These infants should have their phenylalanine blood levels monitored regularly.

Children with PKU will require regular prescriptions for low protein foodstuffs.

Without these foods the treatment of PKU and the dietary management would not be successful. In Ireland, all children with PKU are entitled to the Long Term Illness card which allows them to be supplied with their low protein foods and prescribed synthetic protein/ amino acid supplements without cost. All children with PKU require an amino acid supplement to replace the high protein foods that need to be avoided. If the child does not have a constant supply of their amino acid supplement, their phenylalanine levels will rise as they will become catabolic.

If this continues, over time the child’s growth and development with be affected. *metabolic.ie there are several different types of amino acid supplement, which are prescribed according to age and suitability.

Once the child is established on one type they usually don’t change it for several years.

HOW CAN PHARMACISTS HELP? • If there are supply issues with any of the low-protein foods or amino acid supplement, contact the manufacturers

CPD 75: SPECIALISED NUTRITION FOR CHILDREN directly as they often have sufficient stock of their own.

• Some supplies can be ordered in advance for products that are required every month.

• Many low protein foods are Gluten free, but Gluten free products are not necessarily low protein. Take care with gluten free products which appear similar to low protein foods. Gluten free products often have protein added in the form of egg, milk or soya which will result in too high of a protein level for patients with PKU. NUTRITIONAL SUPPORT IN PREMATURE BABIES Prospects for premature babies have improved significantly over the past 30 years, with babies born as early as 24weeks gestation now with a 50% chance of survival. (paper) This achievement has come about due to many advances such as in the management of respiratory failure and in other aspects of obstetric and neonatal intensive care. With these advances nutritional support has increased in importance, as early interventions are now known to have implications for health that extend beyond childhood. The aim of optimum nutrition is to allow adequate growth with fulfilment of both genetic growth and developmental potential.

When in hospital, premature babies are often fed both human milk with and added human milk fortifier and a preterm formula.

The feeding of both milks often generates a slower rate of growth compared to that achieved by the fetus in utero. On discharge, ongoing growth monitoring must be an essential component of clinical followup. Babies who are sent home below the expected weight for post-conceptional age are at an increased risk of long-term growth failure. If these babies are fed on human milk, it should be supplemented with a fortifier to provide an adequate nutrient supply. If formula fed, the babies should receive a special post-discharge formula with high contents of protein minerals and trace elements. This post-discharge formula should be given until a post-conceptional age of 40 weeks, and even until about 12 weeks post-term.

At discharge, infants can be divided into four different groups: 1) Infants with a birth weight and a body weight at discharge, appropriate for postconcepional age . Appropriately grown.

2) Infants born at an appropriate weigh for gestational age but with a discharge weight below the reference growth chart 3) Infants born small for gestational age, with a discharge weight still below the reference growth chart

4) Infants born small for gestational age, but now with a discharge weight appropriate for post-conceptional age, having shown early postnatal catch up growth.

initial treatment wold be fortified breast milk or a low birthweight formula such as SMA® Gold Prem 1 until at least 6months corrected age.

Premature babies will have their preterm formula commenced on discharge from hospital. These specific formulae are prescribed for babies born before 34 weeks gestation, weighing less than 2 kg at birth. They are not to be used to promote weight gain in babies other than those born prematurely. The specific formula should be discontinued at 6 months corrected age.

Some babies with significant weight gain can stop the formula before this.

GASTROESOPHAGEAL REFLUX IN INFANTS

Nutriprem 2 powder (Cow and Gate) Use up to 6 month corrected age .

Gold Prem 1, SMA Gold Prem 2 (SMA) Use up to 6 month corrected age.

Nutriprem Breast Milk Fortifier (Cow & Gate) - This is a breastmilk supplement for low birthweight babies fed breastmilk, particularly those having a very low birthweight (<1500g) and pre-term babies, before suckling has been established. It can be added to a mother’s own expressed breastmilk, or to donor breastmilk.

SMA High Energy - a milk based formula for the dietary management of babies with medically determined high energy requirements. It can be used to enhance growth catch up in pre-term babies up to 18months of age. In preterm babies, the

Gastroesophageal reflux (GER) is when food backs up or refluxes from a baby’s stomach.

It is the medical term for “spitting up”. In infants, at the lower end of the oesophagus where it joins the stomach, the ring of muscle known as the lower oesophageal sphincter (LES) is not fully mature. When the LES does not close completely, the contents of the stomach can flow backwards.

Reflux commonly occurs in healthy infants, with most between birth and three months spitting up at least once a day.

Uncomplicated reflux does not usually bother the infant, has a low risk of longterm complications and does not require treatment.

Signs and symptoms that may indicate conditions such as Gastroesophageal Reflux disease (GERD) include: • Refusing to eat • Frequent crying • Arching the back and neck as if in pain • Projectile vomiting • Spitting up blood

CPD 75: SPECIALISED NUTRITION FOR CHILDREN MEDICATION When the above lifestyle changes and treatment have not improved the infants symptoms, there are medication available that may be prescribed.

PROTON PUMP INHIBITORS

• Not gaining weight • Chronic cough Reflux becomes GERD when acid in the reflux causes significant problems such as irritation of the oesophagus, failure to grow and asthma. Infants with these signs and symptoms usually require treatment.

COMPLICATIONS OF GER Some children develop complications from GER. The constant reflux of stomach acid can lead to: • breathing problems (if the stomach contents enter the trachea, lungs, or nose) • redness and irritation in the esophagus, a condition called esophagitis • bleeding in the esophagus • scar tissue in the esophagus, which can make swallowing difficult Because these complications can make eating painful, GER can interfere with proper nutrition.

after a feed. It is essential to avoid overfeeding and to stop feeding when the infant seems to lose interest.

COW’S MILK-FREE DIET A high percentage of infants with gastroesphageal reflux have a tolerance to cow’s milk protein, and some also to soy protein. In infants who are breasted, mothers need to eliminate all milk and soy products from their own diet. If the infants reflux symptoms improve after a three-week trial, the mother should continue the restricted diet. The diet can be continued until the infant is ages one, and by that stage they should be able to tolerate cow’s milk without difficulty. Infants who are formula-fed should receive a hypoallergenic formula free from cow or soy proteins. Again, a three week trial will determine if symptoms improve and should be continue.

E.G: NEOCATE LCP

• Upright positioning after feeds

Neocate LCP is used to treat the symptoms of Cows’ milk allergy and other food protein intolerances. Neocate LCP provides all the nutrition your baby needs to grow. It differs from other baby formulas in that it is based on amino acids, the building blocks of protein. These amino acids in Neocate LCP make it easier to digest and should alleviate the symptoms of infant reflux.

• Cow’s milk-free diet

THICKENED FEEDS

• Thickened feeds

Adding thickener to expressed breast milk or formulas can help to reduce the frequency of acid reflux.

TREATMENT The first steps of treatment usually involve lifestyle changes: • Avoiding overfeeding

INFANT POSITIONING Lying flat most of the time is a main factor that contributes to infant reflux and can’t be avoided. It can be of some benefit however if infants can be kept upright (held on an adults shoulder) and calm for about 30 minutes

E.G: GAVISCON INFANT SACHETS They work to reduce reflux by thickening the contents of the stomach, making it more difficult to relax the oesophagus.

PPI’s such as omeprazole and lansoprazole have been best studied for use in infants.

Omeprazole in the form of Losec MUPS can be dispersed in water and administered with an oral syringe for very young infants, or can be added to pureed fruit or yogurt for older infants. The MUPS are made of small pellets in an enteric coating, and these pellets do not completely dissolve. It is important not to crush the pellets. Omeprazole is also available in a suspension form from ULM wholesalers such as Medisource. Depending on how the suspension is made up, it can have a short shelf-life. If made with sodium bicarbonate the shelf life could be only 10-14 days, or if made with cellulose gel, the shelf life could be 45 day if stored in a refrigerator. PPIs are very effective for treating gastroesophageal reflux in infants and have a good safety profile. Discontinuing PPIs abruptly can cause the stomach to build up acid and so the dose should be weaned when stopping treatment. As infants metabolise PPIs more rapidly than adults, more frequent doses may be required and possible higher does for their weight.

H-2 BLOCKERS H2 receptor antagonists include Zantac.

They work to suppress stomach acid production, are more effective than antacids but not as effective as the PPIs. Infants can develop a tolerance to Zantac very quickly, and can happen in as little as one week.

H2 Blockers can be given in conjunction with PPIs, however they should not be administered at the same time. Four hours should be left between administrations as the H2 blocker can prevent the PPI from working.

For most infants with acid reflux the symptoms will cease by one year of age and are unlikely to carry symptoms into adulthood.

TIPS FOR PHARMACISTS • Confirm if the infant has medical card eligibility for specialised formulas and feeds and make sure it is reimbursable on the GMS scheme.

• If the infant does not have medical card eligibility, get the parents to complete DPS form. Most claims need to be accompanied by a valid prescription and invoices for the claim amount.

• Keep a small stock of formula product.

It’s important to have stock in case of emergency, but not full supply as infants can be stopped or changed on to different formulas.

Awards The OTC and Pharmacy Retail

Product Awards 2017 Following on from a successful launch in 2015, IPN are proud to showcase the finalists for the 3rd Annual OTC and Retail Pharmacy Awards.

According to reports, The OTC market in Ireland is worth more than half a billion in annual revenue with commentators estimating year on year sales growth of approximately 15%. Despite the global financial crisis surrounding Brexit, sales of OTC medicines have continued to rise, spurred by a swathe of recent innovation, greater promotion of self-care and increased access through expanding channels of distribution.

Consistently the OTC market is now a key source of business expansion and competitive edge.

These awards act as a celebration and showcase of product innovation, marketing and value to its customers. Recognising the achievements of leading manufacturers and distributors in bringing new products and services to Ireland’s retail pharmacies. The entries received represent those leading the way in innovation.

Categories are as follows;  Best Pharmacy Only Product  Most Innovative Product  Best New Product Launch Large Budget  Best New Product Launch Small Budget

 Best In-Store Promotion  Best Product Marketing Initiative  Best Product Training  Best Irish Pharmacy Brand  Best Natural Product  Best Natural VMS Product  Best Skincare Product  Best Beauty Product  Best Men’s Product  Best Women’s Product  Best Women’s Intimate Health Product  Best Children’s Product

The judges will draw on their own extensive experience and the material submitted to assess each product. The products entered are discussed and evaluated in detail, using a scoring system, to decide the winning entries. The expert panel represent the most knowledgeable decision makers in Ireland’s retail pharmacy, which will ensure that these awards represent a true mark of excellence.

Find out more about our expert judging panel in the next issue of Irish Pharmacy where the judging day will be covered in detail.

Judging will be based on: Impact

of the product on shelf Impact of the product on consumer Product innovation Brand loyalty Performance in the market Product training and differentiation from market competitors The winners are announced at the annual ceremony and dinner in Radisson Blu, Golden Lane on the 2nd March 2017. The Winner of each category will be announced at the ceremony and showcased in April issue of IPN. Tickets are available for the Awards and please contact Aisling Twomey at aisling@ipnirishpharmacynews.ie

 Best Baby Product  Best Hair and Scalp Product  Best Cough, Cold & Flu Product  Best Pain Relief Product  Best GI Product  Best VMS Product  Best Allergy Product  Best Travel Product IPN have selected a panel of 40 expert judges from across the country. Our judging panel includes independent retail pharmacy owners, OTC buyers from pharmacy chains, symbol groups, co-operatives and buying groups.

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The OTC & Pharmacy Retail Product Awards Solpadeine Best Pharmacy Only Product Voltarol Range Voltarol Emulgel is a topical gel that provides topical relief for pain and inflammation of muscles and joints.

Voltarol gel creates a reservoir of diclofenac when applied regularly according to instructions, which gives the skin a source of the active ingredient throughout the day for lasting relief of pain and inflammation. Unlike products that work by just heating or cooling the skin, Voltarol Emulgel contains an anti-inflammatory drug (NSAID) called diclofenac which targets pain at its source.

Solpadeine, Ireland’s number 1* pharmacy only pain relief brand, is a highly respected brand in the OTC oral analgesic market, with extensive heritage in pharmacy.

Solpadeine offers a range of different formats to provide fast and effective pain relief to patients for acute moderate pain when paracetamol, aspirin or ibuprofen alone are not enough. * Source: IMS MAT Dec 2016 Volume Sales

Uriage Keratosane 30 Uriage Keratosane 30 is cream gel for callused skin. This high tolerance cream gel is a complete treatment that helps restore the skin’s smooth, soothed and soft appearance, without areas of roughness.

Its concentration of Urea produces a powerful keratolytic action on rough or very thick skin areas of the body. It’s ideal for body, elbows or scalp. This product has 30% Urea, the highest available in Ireland and is especially effective against the thickening of skin caused by psoriasis. Uriage is one of the leading dermo-cosmetic brands on the international market.

Nurofen for Children Nurofen for Children have been supporting parents for 18 years by providing effective relief for children suffering from pain, fever and cold and influenza. Our ibuprofen based liquid medicine provides relief for children. It starts to work in just 15 minutes and lasts for up to 8 hours for fever.

Being there for parents when their children are unwell is at the heart of everything we do, which is why we developed a non-drip syringe which was specifically designed so parents can give medicine to their little one without having to worry about accuracy of dosing or spilling.

Nurofen for Children Orange or Strawberry 100mg/5ml contains ibuprofen. Suitable from 3 months and weighing over 5kg. Always read the label.

HYLO Fresh HYLO Fresh provides relief for mild eye irritation - it is perfect for busy people who use screens, tablets & phones throughout the day or work in an office environment It includes a natural tear lubricant (0.03% Sodium Hyaluronate) & a natural plant extract shown to relieve redness of the eye (Euphrasia) 100% Preservative Free, HYLO-FRESH® is safe, easily tolerated and highly effective and can be used for 6months after opening HYLO-FRESH® is delivered via the patented COMOD system. One pump supplies a precise dose every time, providing great value for money.

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Bronchostop® Identifying the right treatment for a specific cough is known to be a daily hassle for pharmacists. Introducing Bronchostop. With its unique mixture of ingredients it can resolve this problem, it’s traditionally used to relieve any type of cough including chesty, dry, tickly, irritating coughs and catarrh, exclusively based on long standing use. Bronchostop: to relieve any cough.

Most Innovative Product

Mustela Stretch Marks Prevention OIl Mustella is the Skincare Expert and number 1 brand in Europe for Babies, Children and Mothers and has been for over 60 Years. Mustela Stretch Marks Prevention Oil nourishes the skin, improving the elasticity and leaving it feeling soft and silky. This dry and rich oil leaves the skin delicately scented. Specially formulated for expectant and new mothers, Stretch Marks Prevention Oil helps prevent the appearance of stretch marks thanks to its unique combination of active ingredients and ingredients of natural origin. It can also be used whilst breastfeeding.

Lupeol®, an ingredient of natural origin, extracted from lupine seeds, helps skin withstand stretching to prevent stretch marks.

Canetest Canestest is the first OTC self test for women to help them diagnose their vaginal infection. Canestest self test is the first of its kind to be launched in the world.

The test allows women diagnose their vaginal infection with a quick change of colour on the swab and is designed to be used in conjunction with the symptom guide on pack.

Scholl Ingrowing Toenail Strepsils Intensive Spray

New Scholl Ingrowing Toenail Treatment kit is an innovative treatment in a complete kit (nail clips, glue, cooling spray) that not only relieves the pain caused by the ingrowing toenail but also helps the nail to grow out straight to prevent future discomfort.

ALWAYS READ THE LABEL

1) An Aerosol Spray that provides a cooling relief to help soothe the affected area.

2) Toenail Straightening Clip allows the nail to grow out straight to prevent discomfort.

IRL/SC/0117/0001. Date of Preparation Jan 2017

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The OTC & Pharmacy Retail Product Awards Best Product Launch Large Budget Urostemol Urostemol® is a new range of traditional herbal medicinal products (THMPs) tailor-made for men and women used for the relief of LUTS related to an overactive bladder or bladder weakness, exclusively based upon long-standing use.

Voltarol 2% Was launched in July 2016 with two SKU size’s; 30g and 50g. Within a month it has reached a market share high of 49.1% in the topical pain category. It was well received by customers across the board and its launch was aided by excellent execution. It continued to perform throughout 2016, with continuous growth in sales and share.

All products contain a unique therapeutic pumpkin seed.

It has been used traditionally to relieve frequent and urgent urination related to an overactive bladder for more than 30 years, exclusively based upon long-standing use.

Urostemol® is traditionally used to relieve symptoms such as frequent urination, urgent urination and urinary leakage, exclusively based upon long-standing use.

SUDAPRO™ HEAD COLD Non-Drowsy Tablets Non-Drowsy Sudapro Head Cold is a new product launched in Ireland as an extension of Sudafed ® range. Each filmcoated tablet contains 200 mg Ibuprofen and 30 mg Pseudoephedrine hydrochloride and relieves trilogy of Head Cold symptoms: blocked nose, pressure & headache.

The product proposition is based on Consumer insight that 68% of cold occasions are categorised as a head cold.* The product was successfully launched in September 2016 with a 360o campaign worth ¤� million. The campaign included a TVC, Out of Home, Digital Support as well as Trade Press, Consumer Activation and In Store Visibility.

MAH: McNeil Healthcare (Ireland) ltd. Airton Road, Tallaght, Dublin 24, Ireland. Full prescribing information available upon request. Product not subject to medical prescription. *Source: Millward Brown – Brand Equity April 2015

Lysopadol

Strepsils Intensive Spray

Lysopadol is a pharmacy-only sore throat range containing the active ingredient ambroxol hydrochloride.

Its unique dual action relieves pain within minutes and reduces inflammation, providing lasting relief for up to 3 hours. Its anaesthetic effect means you can actually feel it working and Lysopadol has high consumer satisfaction in more than 93% of patients.

ALWAYS READ THE LABEL

Lysopadol is well tolerated with few side effects or interactions with other medicines, allowing pharmacy staff to recommend with confidence – especially alongside other cough and cold treatments.

The Spray and Mint lozenges are also essentially sugar free.

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Quinton Hypertonic Quinton Hypertonic is a full-spectrum mineral supplement containing 78 minerals and trace elements. The proportions are almost identical to those found in your body, but at three times the concentration. It is 100% natural and is harvested from within a huge vortex bloom of Phytoplankton in the Atlantic before being checked for purity and safety. Its stronger concentration makes it the ultimate support during physical, mental and emotional stress. Recommended for those who lead an active or stressful lifestyle.

Best Product Launch Small Budget bBold Smart Mousse bBold smart mousse has 3 simple steps, APPLY, SHOWER, DEVELOP. There is NO FAKE TAN SMELL, NO STICKINESS, NO TRANSFER ONTO SHEETS. Like all products within the bBold tanning range bBold smart mousse is a kind to skin formula.

It contains 100% natural organic DHA, natural erythrulose, Aloe Vera to tone protect and moisturise and Kahai Oil... this has 50% more vitamin E and twice as much vitamin F than Argon Oil. Calla Lily and Vanilla Orchid essence also provide a refreshing pleasant fragrance and it is paraben free and non toxic.

Mycosan Mycosan Fungal Nail is a complete treatment set, containing a unique serum in a user-friendly tube with brush (5ml), 10 nail files for single use and a treatment schedule. Mycosan is proven effective and active against fungi that cause fungal nail.

It is an easy and fast* solution: 92% of the users during a consumer study in 2011 saw in 2 weeks time an improvement of the nail surface.

Bronchostop

®

Identifying the right treatment for a specific cough is known to be a daily hassle for pharmacists. Introducing Bronchostop.

With its unique mixture of ingredients it can resolve this problem, it’s traditionally used to relieve any type of cough including chesty, dry, tickly, irritating coughs and catarrh, exclusively based on long standing use.

Bronchostop: to relieve any cough.

Best In-Store Promotion Menomin Introducing Cleanmarine® MenoMin - a clinically researched proprietary blend of omega 3 Krill Oil, plant extracts and key vitamins. Cleanmarine® MenoMin has been proven to help women cope with many of the physiological and psychological symptoms associated with perimenopause and beyond. In a recently published study results have shown a significant reduction in menopausal symptoms when taking two capsules for three consecutive months including a 77% reduction in Hot Flushes, one of the most unpleasant symptoms reported by women.

NiQuitin NiQuitin offers a range of products specifically designed to help customers beat both the underlying physical addiction and sudden cravings.

NiQuitin Patches, with unique Smart Control TM Technology, provide a rapid initial release of nicotine followed by a controlled and continued delivery of nicotine throughout the day, for 24-hour craving control. With nicotine in the adhesive, NiQuitin Patches release nicotine rapidly once the patch is applied. When worn for 24 hours, they help protect against morning cravings.1 Oral formats of NRT help relieve cue-provoked breakthrough cravings – the cravings which are brought on at specific times or in particular situations when someone would usually smoke. NiQuitin Mini Lozenges are our smallest NRT lozenge available; they can relieve cravings in 3 minutes**2. They packaged in a convenient pack for on the go cravings, in the familiar shape of a lighter. **Niquitin Mini 4mg Mint Lozenges 1 NiQuitin 21mg Clear Patch. Summary of Product Characteristics 2 Data on file and Durcan MJ et al. Efficacy of the nicotine lozenge in cue provoked cravings (poster). 66th Annual Meeting of College of Problems of Drug Dependence; San Juan, Puerto Rico, 2004

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The OTC & Pharmacy Retail Product Awards Best Product Marketing Initiative Flexiseq Flexiseq® is a topical gel that takes a fresh approach to treating osteoarthritis. This innovative treatment is designed to deliver lubricating ingredients to joints to help ease the pain and stiffness associated with osteoarthritis. Drug free and clinically proven Flexiseq has an excellent safety profile which is of great benefit to patients who cannot take anti-inflammatory medications due to their associated side effects.

Panadol Extra Soluble Panadol extra soluble has had a huge investment in its marketing campaign. TV, Radio, Print, Digital, 6 Sheet, Instore, Luas and Pharmascreens were all heavily invested in across the country. Over 220 sites of pharmascreens had Panadol extra soluble on loop, there were over 400 6 sheet sites with Panadol extra soluble and Panadol extra soluble had red and green line Luas domination during the November and December.

Flexiseq® is available over-the-counter from pharmacies nationwide from ¤17.95.

Best Product Training ellaOne® ellaOne® (Ulipristal Acetate) is the most effective emergency contraceptive pill1, helping women to avoid unintended pregnancy. ellaOne has been available from pharmacies without prescription since May 2015 and has quickly become Ireland’s market leading oral emergency contraceptive brand2.

For more information visit www.ellaOnepharmacists.ie

Perrigo This year Perrigo launched its national training seminars in the categories of Weight Management, NRT, Pain and Cough. The seminars attracted high attendance levels at each event. Sarah Whitehead, Perrigo’s trainer facilitated an educational and interactive evening, with support material and certificates provided to all attendees.

1. Glasier A et al. Lancet 2010; 375(9714): 555-62 2. IMS volume sales MAT Nov 2016

Deep Heat Deep Heat – Relief from Muscular Aches, Pains and Stiffness.

Topical pain relieving products are becoming increasingly popular as customers become more concerned about using oral painkillers, especially for long-term conditions such as arthritis. Topical painkillers are available over the counter in formats including creams, gels, sprays and patches and they can be effective and convenient way to help patients manage and treat pain. Deep Heat can be used for nagging back pain, painful, stiff or aching muscles. It should be used before exercise for the relief of muscular aches and pains.

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NiQuitin NiQuitin offers a range of products specifically designed to help customers beat both the underlying physical addiction and sudden cravings. NiQuitin Patches, with unique Smart Control TM Technology, provide a rapid initial release of nicotine followed by a controlled and continued delivery of nicotine throughout the day, for 24-hour craving control. With nicotine in the adhesive, NiQuitin Patches release nicotine rapidly once the patch is applied.

Best Irish Pharmacy Brand Elave Sensitive Skincare By using elave skincare combined therapy head to toe, we can protect the skin from a residue of medically researched skin sensitising chemicals. By using elave combined therapy essentials your skin is protected, hydrated and deeply moisturised. Dermatologically and paediatrician approved and made in Ireland.

pre-Conceive pre-Conceive is a clinically studied nutritional supplement shown to improve both the key fertility parameters in both men and women.

The Lead Researchers Conclusion stated, “pre-Conceive combined with nutritional advice improves the levels of key fertility and nutritional parameters.”

Dr. David Smallbone, M.B., Ch.B., L.R.C.P., M.R.C.S., M.F. Hom., F.C.O.H., former President of the Food & Health Section of the Royal Society of Medicine (UK), “In my opinion, Pillar Healthcare’s pre-Conceive product is the best available for a single dose material.”

Relactagel Relactagel® is a natural approach to the management of bacterial vaginosis through the regulation of vaginal pH. By regulating the vaginal pH, Relactagel® neutralises embarassing odour, relieves abnormal discharge and vaginal discomfort. The lactic acid in Relactagel® restores and maintains the natural acidity of the vagina thereby creating a suitable environment for good bacteria to flourish.

The glycogen content in Relactagel® provides nutrients for naturally occurring bacteria thereby further promoting the growth and rebalance of natural bacteria.

As well as relieving the symptoms of Bacterial Vaginosis, Relactagel® can be used to maintain the natural pH balance of the vagina, thereby preventing a recurrence in the long term.

Sunkiss “The latest tanning product to hit the high street is SUNKISS, a streak-free, beautifully scented self-tan which fades naturally without any patchy, uneven fading. Launching with a medium to dark shade in both a mousse and a mist, SUNKISS has been developed by Irish entrepreneur Janice O’ Sullivan specifically for the Irish Skin tone. SUNKISS Instant Self-Tanning Mist & Mousse are your easy step to an instant healthy glow, without any orange overtones. SUNKISS’ unique responsive formulation means adapts to every individual skin tone. Easy application and a lovely fresh scent were key to the final product design which Irish consumers can now enjoy. RRP: ¤12.99 - Available in Pharmacies Nationwide”

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The OTC & Pharmacy Retail Product Awards Best Natural Product

Durex Natural Intimate Gel This is 100% natural and designed to make those intimate moment feel smoother & naturally thrilling.

It is a gentle water-based formula that has no added fragrances or colours, is pH friendly and works with your body to moisturise your intimate areas for smoothness and comfort.

Elave Sensitive Baby Bath

duct

obiotic which cisionBiotic®. tudied in own to defend upsets. Alflorex -counter in

t Support

Contains pre-biotics to help maintain skin balance.

Allergan free formula enriched with organic aloe vera and organic camomile. Elave baby bath is a clinically tested extremely gentle cleanser enriched with organic camomile and organic aloe vera to protect and hydrate baby delicate skin. 99% of the total ingredients are from Natural origin. 20% of the total ingredients are from Organic farming. Natural and Organic Cosmetic certified by ECOCERT Greenlife according to ECOCERT standard.

Elave Sensitive Baby Bath is Paediatrician approved from Newborn.

que, antioxidant-rich formula containing curcumin, ginger and vitamin C designed specifically to relieve pain and inflammation.

Using a patented process, ZinCuflex achieves 100 x better absorption compared to ordinary curcumin, making it more bioavailable and effective. ZinCuflex offers quick pain relief in conditions such as arthritis, gout and sport injuries. RRP ¤19.99

Multi-Mam Multi-Mam Multi-Mam Compresses provide effective nipple care for breastfeeding mums. With it’s unique ingredient 2QRcomplex, it neutraliss harmful microorganisms naturally while supporting the natural healing process. A totally natural product for babies, it won the silver at the National Parenting Awards. It is the number one recommended product by midwives.

Multi-Mam Baby D

Best Baby Product

ummer uch of mmer as he best ut that’s on ual tan r Revived match

Mustela Barrier Cream “Mustela, the Skincare Expert and number 1 brand in Europe for Babies, Children and Mothers for over 60 Years has launched a new Vitamin Barrier Cream 1 2 3 which has been specially formulated to prevent, relieve and to repair irritations and redness such as nappy rash, with unequalled effectiveness and a unique combination of patented active natural ingredients.

Vitamin Barrier Cream 1 2 3 has clinical proven efficacy and has been tested in extreme conditions, so it can be used safely every day from birth.

Multi-Mam Compresses provide effective nipple care for breastfeeding mums. With it’s unique ingredient 2QR-complex, it neutraliss harmful micro-organisms naturally while D® healing is a vitamin D3 supplement supporting theBaby natural process. which is specially formulated for A totally natural product for babies, it infants between the ages of 0-12 won the silver at the National Parenting months.

Awards. It is the number one recommendedBaby product by midwives. with a unique oral D® comes

dosing syringe allowing Baby D® to be easily measured and accurately administered to infants, young children and adults on a daily basis. Baby D contains: No sugars, No flavourings, No preservatives, No artificial colours, Odourless and tasteless.

Best Skincare Product

Nelsons Teetha Teething Granules Nelsons Teetha Teething Granules are a product used IDC Regen Express within the homeopathic tradition for the symptomatic Multi-Benefit Integral Care with

Extensive clinical studies have proven technology for face, eyes and that the Vitamin Barrier Cream 1Regen-16 2 3 is the only change cream that actsneck. on allBeing a day and night care, it is designed the essential elements of the skin barrier for women seeking efficacy andaction results in their everyday life. and has overall a higher protection on the protection of the skin than any The #1 anti-aging face cream in competitor on the market.”

new Sensitive Spf um High Uva/Uvb

relief of teething pain and the symptoms associated with teething which are sore and tender gums, flushed cheeks and dribbling. Each 300mg of granules in a sachet contains the active ingredient of Chamomilla recutita (Chamomilla).

Quebec!*

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Spatone Ireland’s favourite iron supplement: Spatone is a naturally occurring iron-rich mineral water. The iron in Spatone is highly absorbable and gentle on the stomach.

Spatone has been scientifically shown to help prevent iron deficiency during pregnancy.

Suitable for Vegetarians - No artificial colours Gluten Free.

Best Natural VMS Product ZinCuFlex® ZinCuFlex® is a new health food supplement with proven benefits for joint health. Combining the power of Ginger, Curcumin and vitamin C, ZinCuflex® has been shown to support joint health. Curcumin and Ginger extract both offer anti-inflammatory benefits, however they work synergistically as they both reduce different inflammatory markers, thereby having a complete anti-inflammatory effect. Vitamin C plays an essential role as it is recognised as helping to contribute to normal collagen formation and function of bones and cartilage. ZinCuFlex® is ideal for anyone looking to ease joint discomfort, sports injuries or support bones or cartilage.

Quinton Isotonic Quinton Isotonic is a full-spectrum mineral supplement containing 78 minerals and trace elements. The composition is almost identical to the fluids in your body. It is 100% natural and is harvested from within a huge vortex bloom of Phytoplankton in the Atlantic before being checked for purity and safety. It is the ultimate solution for gently restoring and balancing normal cell and body function.

Recommended for everyone with no contra-indications to support a gentler pace of life.

Miss Fit Skinny Tea Miss Fit Skinny Tea is an expertly formulated blend of 10 natural, super ingredients that traditionally have been used to assist with weight reduction, increasing energy and improving skin.

Ingredients include, Hibiscus Jasmine, Lotus Leaf, Chamomile, Pu’Erh Leaf, Sencha Green Tea, Lemongrass, Rhubarb Root, Fennel, Garcinia, and Cambogia Extract.

Arko Royal Energing Complex Arkopharma’s Arko Royal Energing Complex contains a complex of stimulating, invigorating and energizing active ingredients for multiple and synergic actions: INVIGORATING: 1500mg of Ginseng, whose stimulating properties have been recognized for millenniums.

RECONSTITUTING: 500mg of Royal Jelly, ideal stimulant for all the family and sportsmen/women.

NATURAL DEFENSES STIMULATING: 100mg of Propolis, for its ideal properties in winter.

ENERGIZING: 200mg of Acerola (natural vitamin C), renowned for its tonic action.

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The OTC & Pharmacy Retail Product Awards Biofresh Best Skincare Product Suu Balm™ Suu Balm ™ - Ireland’s Proven First Rapid Itch Relieving Moisturising Cream. Eczema, psoriasis, and the ageing process affect a huge number of people with their hallmark symptoms – dryness and itch. Few, if any, are made to tackle itch quickly – a maddening sensation that invites scratching, leading to further skin damage. Suu BalmTM has been optimized for use on sensitive skin, and contains no parabens or other ingredients that might irritate.

It reduces itch intensity by up to 80%, breaking the itch-scratch cycle. Contains ceramides, which reduce water loss through the skin by repairing the skin barrier.

Uriage Bariederm CICA Cream “Uriage, one of the leading dermo-cosmetic brands on the international market has launched the Uriage Bariéderm Repairing CICA Cream, a first aid product that provides fast healing, immediate relief and prevents scarring for the entire range of cuts, perfect also for minor surgeries and procedures. Thermal Spring Water is the key ingredient unique to the Uriage dermatological skincare range and it is the basic ingredient in all of the Uriage product ranges. It is 52 times richer than any other Thermal Water available. In clinical studies, the Bariéderm Repairing CICA-Cream was found to decrease redness by 85% in 21 days, immediately relive pain and improve healing.

It is the perfect repairing cream for everyday minor skin ailments for the whole family.

The patented formula of our ACNE OUT series provides adequate care for skin prone to acne and oiliness, blackheads and enlarged pores. The active ingredient has powerful antibacterial action which eliminates the main cause of the condition - Propionibacterium acnes. The carton contains three tested products needed for daily cleansing, active care and gentle moisturizing of oily and acne-prone skin with amazing results. The unique formula of active ingredients destroys acne causing bacteria, leaving a clearer complexion in no time.

ACNE OUT is gentle on your skin, contains no harsh chemicals and no side effects. Proven products created by leading Dermatologists.

Retail Price ¤55.00

Eucerin The Eucerin Urea products for dry skin contain the natural moisturising factors (NMF) Urea and Lactate, which improve the moisture holding capacities of the skin. The end result is smooth, softened skin.

Suitable for extremely dry and rough hands or feet.

All the Eucerin Urea products for dry skin are dermatologically approved.

Revidox+ Revidox+ is a next generation anti-aging food supplement clinically proven to show visible results within 60 days!

Revidox+ contains a vital mix of antioxidants, minerals and vitamins that work in harmony to address the signs of ageing and enhance the integrity of the skin. This includes: Pomegranate extract: high antioxidant capacity and reduces breakouts and wrinkles Vitamin C: helps with the formation of healthy collagen in blood vessels, bones and skin Selenium: essential mineral for the body’s antioxidant defences and protects DNA from oxidative stress Vitamin B2: helps with the reduction of tiredness and fatigue Zinc: helps maintain healthy hair, skin and nails and regulates cognitive functions STILVID® - a 100% bio-active and patented form of Resveratrol, an antioxidant derived from the skin of grapes. Growing body of evidence show resveratrol’s health benefits in our entire body including our metabolism, cardiovascular system and cognition.

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IMEDEEN® IMEDEEN® supplements are specially designed for different ages and skincare needs, taking beauty routines to a higher level. Signs of skin ageing begin on the inside long before they’re visible on the surface.

Whether they are in their 30s, 40s, 50s or beyond, IMEDEEN skincare tablets work from within to help women look younger for longer by nourishing the deep layer of skin untouched by traditional creams and lotions.

Best Beauty Product

EYLURE 3 DIMENSIONAL LASHES

Perkies “Perkys Breast Lift Tape is a superior adhesive tape, used to enhance the breast by lifting them up and holding them in place. It only takes a couple of minutes to apply, and will last all night!

Each packets of Perkys Breast Lift Tape comes complete with 4 nipple covers and 4 Perky Breast Tape. Perkys does the same action as a bra, available in cup sizes A-C and D-F, so now any woman can have the freedom to wear the garment of their choice.”

Leading lash brand EYLURE introduces its patented range of lashes for a 3 DIMENSIONAL finish. Adding an entirely new collection to the Eylure lash range, 3 Dimensional is a new patented style of lashes - giving length, texture and volume all in one. Created with an offset band that not only makes a more flexible application but allows the lash to be tailored to your eye shape for a super comfy fit. This 3D effect lifts up the layered lash for a gorgeous fluttery look on the eye, making them perfect for day and night wear.

The unmissable lashes are available now in two styles – 111 and 119.

Eylure Brow Amplifier wins at the 2016 CEW Beauty Awa

The Eylure Brow Amplifier has been announced a winner at the very prestigious CEW Beau ‘Best New Make-up Product for Eyes – Mass’.

Eylure’s success at the awards indicate that brows continue to be seen as one of the most impo a finished make-up look.

The Brow Amplifier is a brow fibre gel that creates a long-lasting, intense colour whilst tami Available in Dark Brown, Mid Brown and Blonde this is a one-stop product for beautifully

Eylure Brow Amplifier The Eylure Brow Amplifier has been announced a winner at the very prestigious CEW Beauty Award for ‘Best New Make-up Product for Eyes – Mass’. Eylure’s success at the awards indicate that brows continue to be seen as one of the most important aspects of a finished make-up look. The Brow Amplifier is a brow fibre gel that creates a long-lasting, intense colour whilst taming the brows.

Available in Dark Brown, Mid Brown and Blonde this is a one-stop product for beautifully full brows.

The Eylure Brow Amplifier is available in Boots, Superdrug and online at www.eylure.com For further details please contact Charlotte James Cjames@originaladditions.co.uk / 0208573943 Norresa Perucho Nperucho@originaladditions.co.uk / 02087563457

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The OTC & Pharmacy Retail Product Awards Durex Intense Condom A condom that actually helps to make sex better for both!

Best Men’s Product

A transparent & lubricated natural latex condom with a stimulating ribs and dots texture, with Desirex gel for warming, cooling or tingling sensations to increase sensitivity in her intimate area.

Pre-Conceive In a landmark clinical study, pre-Conceive showed it can substantially improve male fertility. In men, pre-Conceive improved the overall sperm count, progressive and total motility and the shape and form of sperm cells. pre-Conceive also showed significant improvements in the sperm cell’s DNA integrity and quality, which is associated with infertility and miscarriage. pre-Conceive can provide a viable option for men who have been diagnosed as infertile or are struggling to conceive, especially when solutions are limited for male infertility.

For many men giving pleasure is more important than receiving it, these men get greater pleasure from seeing her so aroused.

This condom is designed to improve the sexual experience for both by helping her reach orgasm and for him the pleasure from seeing her so aroused.

Lynx Daily The new Lynx Daily Fragrances range will give men the tools to express and work their own unique, individual style and has been created by the best in the business using precious ingredients and innovative technologies. To create its new Daily Fragrances, Lynx partnered with one of the world’s leading fragrance designers – Ann Gottlieb – and two fragrance houses that are collectively responsible for creating iconic fragrances for fine fragrance brands including Tom Ford, Marc Jacobs and Calvin Klein.

Best Women’s Product Perkies “Perkys Breast Lift Tape is a superior adhesive tape, used to enhance the breast by lifting them up and holding them in place. It only takes a couple of minutes to apply, and will last all night!

Each packets of Perkys Breast Lift Tape comes complete with 4 nipple covers and 4 Perky Breast Tape. Perkys does the same action as a bra, available in cup sizes A-C and D-F, so now any woman can have the freedom to wear the garment of their choice.”

ellaOne® ellaOne® (Ulipristal Acetate) is the most effective emergency contraceptive pill1, helping women to avoid unintended pregnancy. ellaOne has been available from pharmacies without prescription since May 2015 and has quickly become Ireland’s market leading oral emergency contraceptive brand2. For more information visit www.ellaOnepharmacists.ie 1. Glasier A et al. Lancet 2010; 375(9714): 555-62 2. IMS volume sales MAT Nov 2016

Cleanmarine® MenoMin Introducing Cleanmarine® MenoMin - a clinically researched proprietary blend of omega 3 Krill Oil, plant extracts and key vitamins. Cleanmarine® MenoMin has been proven to help women cope with many of the physiological and psychological symptoms associated with perimenopause and beyond. In a recently published study results have shown a significant reduction in menopausal symptoms when taking two capsules for three consecutive months including a 77% reduction in Hot Flushes, one of the most unpleasant symptoms reported by women.

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Durex Intense Gel This is not a lube, this is a water-based clitoral gel boosted with unique arousal stimulation!

The clitoris is an important cluster of nerve endings, this makes it sensitive to stimulation. Intensify her moment!

Best Women’s Intimate Health Product

Durex Intense Gel, with Desirex™ stimulant, is designed for more intense orgasms! A few drops on the clitoris during foreplay and the special formula will bring sensual warming, cooling or tingling sensations that will increase the sensitivity of her intimate areas.

Intensify her big moment!

Canesbalance Canesbalance BV Gel is a triple benefit, 7-day treatment that relieves the symptoms of BV infections. In just 3 days you can start to see a difference - it helps to regulate the pH balance which effectively relieves unpleasant odour and abnormal discharge, restricts growth of bad bacteria and supports good bacteria (lactobacillus). It’s easy to use, with our handy and hygienic squeeze tubes.

8/10 woman in a consumer test reached orgasm.

IRL/DUX/0117/0002 Date of preparation Jan 2017

MULTI-GYN The Multi-Gyn range is formulated to treat and prevent vaginal itch, irritation, soreness and dryness experienced by many women.

Each product is a bio-active range helping restore vaginal health. The unique ingredient 2QR complex neutralises harmful organisms naturally.

The range includes ActiGel which treats and prevents recurring bacterial vaginosis (BV). The Department of Health state that BV is the most common cause of vaginal discharge. Up to 30% of women, including pregnant women, may be affected and that around 25% will have BV again within one month.

FloraPlus which treats early stage symptoms of thrush and recurring yeast problems. FloraPlus provides prebiotic stimulation of lactobacilli and can be used with Antimycotics.

LiquiGel for vaginal dryness, stimulating natural vagina moisture.

The product range optimise the vaginal pH and provides instant relief from itch and irritation.

Regelle Regelle® is a vaginal gel intended for the symptomatic relief of vaginal atrophy, dryness, itching, irritation and discomfort.

Regelle® is a fast acting hormone-free vaginal moisturiser designed to provide instant and long-lasting relief from the symptoms of menopausal and post-menopausal vaginal dryness. Regelle® can be used in conjunction with hormone replacement therapy (HRT) for the symptomatic relief of vaginal dryness but is not intended for use as a substitute for HRT. In addition, Regelle® has a pH which is compatible with a healthy vaginal environment

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The OTC & Pharmacy Retail Product Awards Best Children’s Product

Nurofen Soft Chew ALWAYS READ THE LABEL

Lyclear Head lice are a common problem, particularly among children of primary school age as they often play with their heads together – giving head lice the opportunity to climb across to the next head.

Lyclear has a full range of products to effectively treat head lice and to suit customers’ needs.

Lyclear Treatment Shampoo is clinically proven1, and treats the whole head in 10 minutes. The dual action formula suffocates and dehydrates head lice and eggs. Lyclear Treatment Spray is clinically proven2 and treats the whole head in 15min.

The treatment is easy to apply with no odour and no drips. Lyclear Treatment Sensitive is clinically proven to kill 100% of head lice when used as directed3. It is gentle to hair and skin and dermatologically tested.

The formula is non-greasy and washes out easily. Lyclear Head lice Repellent is scientifically proven to help protect for up to 24 hours4, and contains IR3535, a well-known insect repellent.

1. Ex vivo study 2010. 2. Ex vivo study 2010 / In vivo clinical study 2008.

3. Ex vivo Aug 2006 / In vivo Oct 2010.4. Omega Pharma Data on file.

Radox Kids Frozen Hand Wash This liquid handwash with thyme & tea tree washes away dirt and bacteria, so is perfect for keeping little hands clean every day.

Specially developed to be mild and caring to your child’s skin, this gentle formula keeps the skin feeling soft and protected.

So while your little princess is having fun getting clean, you can relax knowing their tender skin is cared for.

Calpol Calpol has over 35 years’ experience in Ireland, helping patients to care for their little ones when they are feeling unwell. CALPOL Infant suspension is specifically formulated for babies and infants from as young as 2 months. It has a pleasant strawberry flavour and will relieve pain (including teething pain), and feverishness without irritating the stomach. Further information available upon request from Johnson& Johnson (Ireland) ltd.

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Elave sensitive Shampoo Elave sensitive shampoo is an extremely gentle sulfate free shampoo suitable for all hair types including dry, damaged, coloured and heat processed hair.

The formula combined with conditioning polymers and natural glycerine cleanses and repairs hair providing immediate and lasting scalp comfort, leaving hair shiny, soft and easy to style.

Best Hair and Scalp Health Product

TONI & GUY Reconstruction Mask TONI&GUY Damage Repair Mask for reconstruction. This intense treatment for damaged hair deeply penetrates the hair fibres, giving a softer and smoother finish. Smooth onto wet hair, leave for 3-5 minutes to allow the formula to penetrate deep into the hair fibre, and rinse thoroughly. For best results pair with TONI&GUY Damage Repair Shampoo.

Bioxsine BIOXSINE, THE HERBAL SOLUTION FOR HAIR LOSS AND THINNING HAIR Bioxsine is scientifically proven to reduce hair loss.

Hair loss is common, up to 70% of men and 40% of women will experience hair loss during their lifetime. Hair loss can begin as early as aged 20.

Bioxsine contains the unique ingredient BioComplex B11 with minerals, vitamins, unsaturated fatty acids and flavonoids and, as Bioxsine is a topical products, the solution goes straight to the hair follicle where it is needed.

The Bioxsine range includes Shampoo and Serum for those experiencing moderate hair loss, Forte Shampoo and Spray maximum strength for those with significant hair loss. The Femina range is a Shampoo and Conditioner range with added ingredients to create extra shine and fullness.

Viviscal Hair Care System The Viviscal Hair Care System is a unique, dual-action hair care system that works on the outside and the inside.

Backed by 25 years of research, and 10 clinical trials, the award-winning supplements nourish from within to maintain healthy hair growth and are now the No1 selling hair growth supplement in the US. Meanwhile, the newly launched scientifically formulated Viviscal Gorgeous Growth Densifying range (which includes Viviscal Shampoo, Conditioner and Elixir) complements the hair growth benefits of the Viviscal supplements by conditioning from the outside. In a recent consumer research group 9 out of 10 women said their hair appeared thicker and fuller after one weeks use of the topical range.

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The OTC & Pharmacy Retail Product Awards Lysopadol

Best Cough, Cold and Flu Product BENYLIN® Day and Night Tablets BENYLIN® Day and Night tablets are the only day & night tablets for 24 hour cold and flu relief Each blue tablet contains 500mg paracetamol and 25mg diphenhydramine hydrochloride. Each white tablet contains 500mg paracetamol and 60mg pseudoephedrine hydrochloride.

Lysopadol is a pharmacy-only sore throat range containing the active ingredient ambroxol hydrochloride.

Its unique dual action relieves pain within minutes and reduces inflammation, providing lasting relief for up to 3 hours. Its anaesthetic effect means you can actually feel it working and Lysopadol has high consumer satisfaction in more than 93% of patients.

Lysopadol is well tolerated with few side effects or interactions with other medicines, allowing pharmacy staff to recommend with confidence – especially alongside other cough and cold treatments. The Spray and Mint lozenges are also essentially sugar free.

During the day the white tablet relieves fever and decongests the nose.

During the night the blue tablet helps relieve cold symptoms for a better night sleep.

Continued marketing, which includes a TVC has contributed to fantastic results, gaining the product +2% share points in the market since 2014 and Value Sales increase by +15% vs LY, and up 68% since 2014.* MAH: McNeil Healthcare (Ireland) ltd. Airton Road, Tallaght, Dublin 24, Ireland. Full prescribing information available upon request. Product not subject to medical prescription. *(IMS, MAT, November 2016).

Bronchostop Identifying the right treatment for a specific cough is known to be a daily hassle for pharmacists. Introducing Bronchostop. With its unique mixture of ingredients it can resolve this problem, it’s traditionally used to relieve any type of cough including chesty, dry, tickly, irritating coughs and catarrh, exclusively based on long standing use. Bronchostop: to relieve any cough.

Echinaforce® Echinacea tincture & tablets. Echinaforce® Echinacea drops (tincture) and tablets - herbal remedy for colds and flu.

Echinaforce® is a licensed traditional herbal remedy for colds and flu. It helps the body fight the symptoms of these infections by supporting the immune system, helping to maintain the body’s resistance.

Benefits and features of Echinaforce®: EchinaceaHelps fight the misery of colds and flu. Strengthens the immune system. Made from Echinacea purpurea. Fresh herb extract.

Nurofen Cold & Flu The highest value selling pharmacy Cold & Flu brand*. The dual action formula of Nurofen Cold & Flu provides non-drowsy relief from the symptoms of cold & flu. Combining the action of Nurofen with the decongestant pseudoephedrine, each tablet provides effective relief from aches and pains, headache, fever, blocked noses and sinuses and eases the pain of sore throats.

Supported on TV, on-line and in-store throughout the cold and flu season. Pharmacy only product. *IMS OTC Value sales MAT Dec ‘16 Nurofen Cold & Flu Film Coated Tablets contain 200mg ibuprofen and 30mg pseudoephrine. Always read the label.

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Solpadeine

Best Pain Relief Product

Ireland’s number 1* pharmacy only pain relief brand, is a highly respected brand in the OTC oral analgesic market, with extensive heritage in pharmacy.

Solpadeine offers a range of different formats to provide fast and effective pain relief to patients for acute moderate pain when paracetamol, aspirin or ibuprofen alone are not enough. * Source: IMS MAT Dec 2016 Volume Sales

Nurofen Express

Flexiseq Flexiseq® is a topical gel that takes a fresh approach to treating osteoarthritis. This innovative treatment is designed to deliver lubricating ingredients to joints to help ease the pain and stiffness associated with osteoarthritis. Drug free and clinically proven Flexiseq has an excellent safety profile which is of great benefit to patients who cannot take anti-inflammatory medications due to their associated side effects.

Nurofen Express contains a unique formula of sodium ibuprofen that gets to work twice as fast as standard ibuprofen, providing fast, effective relief from everyday pains such as headache, dental pain, period pain, backache, muscular pain, fever and cold & flu symptoms. The 400 mg single dose tablets are driving overall value sales* for the segment. Nurofen Express is supported throughout the year with strong TV and in store campaign. Pharmacy only product. *IMS OTC Value sales MAT Dec ‘16 Nurofen Express Tablets contain either 200mg or 400mg ibuprofen (as sodium dihydrate). Always read the label.

Date of preparation: Jan 2017 RL/NfC/0117/0002

Panadol Extra Soluble When you’re suffering from headaches, such as migraine headache, you want powerful relief.

Panadol Extra Soluble contains a second active ingredient, caffeine, that amplifies the analgesic effect of Paracetamol, giving up to 30% more pain relieving power when compared to standard paracetamol tablets. So, when you’ve got a headache you can count on Panadol Extra Soluble to deliver powerful, effective relief. And it’s gentle on your stomach, too. Panadol Extra Soluble is also effective in treating backache, rheumatic pains and muscle pains, period pains and toothache.

Diclac Relief 1% w/w Gel Diclac Relief 1% w/w Gel contains Diclofenac Sodium 10 mg. For the local symptomatic relief of pain and inflammation in: - trauma of the tendons, ligaments, muscles and joints, - e.g. due to sprains, strains and bruises.

- localised forms of soft tissue rheumatism.

Diclac Relief 1 % w/w Gel is available in 30 g, 50 g and 100 g tubes. Marketed by Rowex Ltd, Co. Cork. Always read the leaflet.

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The OTC & Pharmacy Retail Product Awards OptiBac ‘For those on antibiotics’ Best VMS Product Pharmaton “PHARMATON CAPSULES is a licensed medicine formulated for the relief of short periods of fatigue. It is clinically proven to relieve tiredness and restore vitality, and also enhances mental and physical performance.

Containing a special blend of vitamins and minerals, and the unique G115 ginseng extract, Pharmaton Capsules effectiveness is supported by over 30 clinical studies”

For people who are taking antibiotics (e.g. amoxicillin, penicillin, tetracycline, doxycycline), or who have recently finished an antibiotic course, the strains of natural bacteria in this supplement are especially selected for their suitability and safety. These two high quality strains of natural bacteria, Lactobacillus acidophilus Rosell-52 and Lactobacillus rhamnosusRosell-11, have been extremely well-researched, and are scientifically proven to survive to reach the gut alive, even during a course of antibiotics.

Miss Fit Skinny Tea “Miss Fit Skinny Tea is an expertly formulated blend of 10 natural, super ingredients that traditionally have been used to assist with weight reduction, increasing energy and improving skin. Ingredients include,Hibiscus Jasmine, Lotus Leaf, Chamomile, Pu’Erh Leaf, Sencha Green Tea, Lemongrass, Rhubarb Root, Fennel, Garcinia, and Cambogia Extract. Our Teatox helps you to eat clean, while developing habits and routines to help you along your healthy journey.”

Revive Active: Super food supplement Our product is Revive Active. A unique super supplement containing 26 active ingredients, all the RDA of Amino Acids, Vitamins and Minerals in one daily sachet. The product was recently re-formulated to include 5 trace minerals; molybdate 100µg, manganese 2mg, chromium 60µg, zinc 7.5mg and copper 200µg. In addition to the trace minerals the quantity of C0Q10 per sachet was increased by a further 50mg up to 150mg and the folic acid was replaced with a natural folate. This unique product supports energy, reduces fatigue, supports the immune system and heart, skin, hair and nails.

Best GI Product Nexium Control® Nexium Control has been one of the most successful OTC launches ever. In just over two years since launch, the product has established itself as the OTC PPI market leader and is second in the overall category with a 25% value market share for 2016. A high level of continuous marketing support including a new TV ad has driven the success of the brand together with an extensive pharmacy training programme which is available on request from Pfizer Consumer Healthcare representatives.

Full product details are available on medicines.ie

Gaviscon Extra Gaviscon Extra is specially formulated and contains sodium alginate and double the concentration of calcium carbonate compared with Gaviscon Original for acid neutralising effect. It not only neutralises acid but it also creates a physical barrier to soothe heartburn and ingestion fast.

Gaviscon Extra gets to work instantly; in a survey 90% of patients would use Gaviscon Extra again. It provides effective dual relief from heartburn and indigestion.

Essential information: Gaviscon Extra Chewable Tablets, Gaviscon Extra Oral Suspension Contains Sodium alginate, Sodium bicarbonate and Calcium carbonate. ALWAYS READ THE LABEL Zinc number: IRL/G-OTC/0117/0001

Alflorex Alflorex® is a probiotic, developed by an Irish company Alimentary Health (AH). It’s the only product in Ireland that contains the patented 35624® culture, a naturally occurring bacterial strain first discovered in Cork. The 35624® strain has been clinically tested in patients with Irritable Bowel Syndrome (IBS) and is proven to reduce digestive upsets including bloating, abdominal discomfort, passage of gas, diarrhoea and constipation. It’s now the No 1 gastroenterologist recommended probiotic in the US and many Irish patients have testified to the enormous improvement that taking alflorex every day has made to their lives. Alflorex® is available OTC from pharmacies nationwide. ¤32.95 for a one month’s supply.

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PrevalinTM Allergy PrevalinTM Allergy is a hay fever treatment with a unique formula that acts 5x faster than single active antihistamine hay fever tablets. PrevalinTM Allergy is a barrier treatment for hay fever that gets to work in just 3 minutes. PrevalinTM works by covering the nasal lining with a thixotropic micro-gel to block allergen contact; preventing and relieving the first signs of hay fever.

PrevalinTM Allergy Plus is a hay fever treatment which contains a formula with an anti-allergic therapeutic oil, which acts as a mast cell stabiliser to block the release of histamine, thereby reduce to allergens such as pollen.

As a result, sufferers can become less vulnerable to allergic reactions. PrevalinTM Allergy Plus gets to work in 3 minutes, which is 5x faster than single active anti histamine hay fever tablets and is drug and steroid free.

Prevalin Allergy, Prevalin Allergy Kids and Prevalin Allergy Plus are medical devices. Always read the leaflet.

Best Allergy Product

Clarityn Clarityn is the No 1 Global OTC Allergy Brand and is available in many markets so consumers do not have to worry about securing their preferred treatment while abroad. 2016 saw the development of a national radio campaign along with placement of attractive counter units that took into consideration space and accessibility of the brand given its medicine status. Along with the consumer support there was a drive to increase distribution of the 30â&#x20AC;&#x2122;s pack which many consumer were unaware of as an option to treat their allergies.

Cetriz Cetriz is available in packs of 7 and 30 film coated tablets. For the treatment and relief of allergy related symptoms of seasonal and perennial rhinitis and urticaria. Available from Teva Pharmaceuticals Ireland.

Available in retail pharmacies only. Contains cetirizine, always read the leaflet carefully.

Cetrine Allergy Cetrine Allergy by Rowex is Irelandâ&#x20AC;&#x2122;s favourite non drowsy, antihistamine product providing fast relief from hay fever allergy. The active ingredient is Cetirizine Dihydrochloride and currently available in 10 mg Tablets x 7 and 10 mg Tablets x 30 with one tablet per day providing 24 hour control.

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The OTC & Pharmacy Retail Product Awards Elave sensitive Sun SPF 30

Best Travel Product

Elave Sensitive Sun SPF 30 is a high daily UVA and UVB protection system that is EU complient and, if used as directed, prevents long term sun damage of the skin. If used at directd and with other sun protection measures, elave sensitive Sun SPF 30 decreases the risk of skin cancer and early skin ageing caused by the sun and absorbs 97% of UVB radiation that causes sunburn.

P20 Riemann P20 Once a Day Sun Protection SPF50 200ml (¤30.00) is a clear, quick drying spray that gives you 10 hours of reliable sun protection and with one application. Water resistant, even after frequent swimming, P20 offers superior long lasting sun protection. The non-greasy, light weight formula is quick and easy to apply. It offers broad spectrum photostable UVA and UVB protection. P20 is proven to work for up to 10 hours due to a very stable formulation. No added fragrance, colourants, parabens or preservatives.

O.R.S. Clinova’s innovative O.R.S soluble tablets are based on the standard oral rehydration salts formula containing a balanced combination of glucose, salts and electrolytes. The soluble tablets replenish water and salts and help maintain optimal fluid balance. O.R.S is Vegan, gluten and lactose free.

Ideal for travel and can be used by: Children who are dehydrated due to illness. People who lose excess fluid. Professional and recreational athletes. People who are dehydrated due to alcohol consumption.

People who work in hot climates.

Easilocks Hair Hero Easilocks Hair Hero – Professional 3 in 1 Hair Styler Easilocks Hair Hero is a revolutionary 3 in 1 Hair Styler with patented technology to straighten, wave and curl hair. Ceramic plates allow for even heat distribution, reducing styling time resulting in a smooth finish with zero pulling or breakage, it has: a burn proof rubber feature protecting fingers, an LCD digital screen for easy temperature control , it shuts off automatically for safety after 30 minutes, a 360 degree swivel tangle free cable cord, an ergonomic handle for comfort and a built-in power-plug adapter for travelling.

RRP ¤99.00

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Would you like to see your work in print in Ireland's leading pharmacy publication?

The Editorial team at IPN are keen to hear from individuals who may be interested in submitting original articles for publication in the magazine. Whether you are a Pharmacist, Specialist or Industry expert or Business mentor, we want to hear from you .

Your piece can be on a wide variety of topics that would be of developmental and educational value to the IPN readers, for example:

 Educational/CPD articles on a chosen therapeutic area  Case studies  Research/clinical trials  Category management  Business management advice  SOPs  Financial advice  Recruitment/HR  Security  Technology

All enquiries welcome to: editorial@ipnirishpharmacynews.ie or Telephone 01 6690562

NEW

Traditionally used to relive overactive bladder symptoms

urostemol.ie

The only remedy without prescription for relief of urgency and frequency of an over active bladder.

UROSTEMOL Men capsules (P) contain crushed pumpkin seeds, pumpkin seed oil and saw palmetto fruit extract. A traditional herbal medicinal product for use in the relief of lower urinary tract symptoms in men related to an overactive bladder or bladder weakness, such as urgency to urinate, urinary incontinence, frequent urination day and night, exclusively based upon long-standing use. Prior to treatment, other serious conditions should have been ruled out by a doctor. Adults aged 18 and over: One capsule three times a day. Not recommended for use by pregnant or breast-feeding women, or children and adolescents under 18 years. Contraindications: Known hypersensitivity to ingredients. Caution: Seek medical advice if symptoms worsen during use or persist after 4 weeks, or if fever, spasms, blood in the urine, urinary retention, painful urination or loin, abdominal or back pain occurs. Patients taking anticoagulant or antiplatelet medication, or patients due to undergo surgery. Rare hereditary intolerance to some sugars. Side effects: Mild gastrointestinal complaints - abdominal pain, dyspepsia, nausea/vomiting, stomach discomfort, dysphagia, oesophageal pain and diarrhoea. Allergic reactions – rash, urticaria, erythema, pruritus, oedema and anaphylactic shock. Nervous system disorders – headache. Intraoperative haemorrhage. TR1186/7/1. TR Holder: Chefaro Ireland Limited, First Floor, Block A, The Crescent Building, Northwood Office Park, Dublin 9, Ireland. RRP: 60s €23.00 120s €40.00 SPC:http://www.medicines.ie/medicine/16690/SPC

Feature

Self-Care is for guys too In practically every country on a global scale, men have shorter life expectancies than women. Ireland is no exception, with men living four years less than women on average. There are some physiological reasons for this difference.

One example, for instance, is that oestrogen protects women from developing various types of heart disease and helps to regulate cholesterol, as noted in a study conducted by Dr Giuseppe Rosano for the Cardiology Department of the Institute of San Raffaele in Rome.

Physiological differences, however, cannot adequately explain the extent of the life-expectancy gap, or why men have a higher mortality rate for virtually all comparable causes of death, so sociological and lifestyle differences between men and women must certainly be a factor.

A Brigham Young University study, for example, showed that people with strong social ties were half as likely to die as people with few social ties, positing that women tend to have stronger social networks than men.

It must also be noted that men are much less willing to access healthcare services than women.

Research in the UK conducted by the National Pharmacy Association (NPA) found that women on average visited their GP 33.3% more often than men. The statistics for pharmacies was even starker, with women visiting their local Pharmacy four and a half times as often as men.

“Men don’t, in fact, go anywhere near their doctors as much as they should do,” Gopa Mitra, former Director of Health Policy at PAGB, said in an interview with The Pharmaceutical Journal. “But the problem is men don’t like going to the Pharmacy either because they don’t see the Pharmacy as an environment that is particularly open to them. They think it is about nappies and perfumes.”

Encouragement The enormous gap between male and female Pharmacy attendance illustrates just how much more could be done to encourage male customers. Pharmacies could, for instance, try using posters to promote male specific products.

Currently, health promotion posters are almost exclusively aimed at women, and many men are not aware of the numerous products available.

Pharmacies should also make efforts to tie their promotion to prominent national campaigns,

exploit social media as a promotional tool when possible, and stock products related to sports and fitness (which are increasingly popular purchases for men).

As men are less likely to browse when shopping than women, a Pharmacy might find it beneficial to showcase male-specific products near the till, where they are much more likely to see them. As Chelmsford pharmacist Nemesh Patel told P3 Pharmacy in 2016 that, “Men are typically impulse buyers, so we stock male grooming products close to the counter, such as Lynx, Nivea and Gillette. You can reap the benefits in your retail growth margins.”

Men also respond better to literature and brochures, which can work as conversation starters for those reluctant to ask for advice. Meanwhile, having a command of facts and figures adds authority, and often helps to put nervous men at ease – ‘did you know that the five-year survival rate for prostate cancer in Ireland is now over 91%?’

Prostate cancer As it is mostly found in men over the age of 65, prostate

cancer is only going to increase in prevalence as our population ages. Presently, over 3,300 men in Ireland are diagnosed with the condition every year. It accounts for one fifth of all male cases of cancer, with the Irish Cancer Society noting that one in seven Irish men will suffer from the condition at some point in their lives.

At its early stage, prostate cancer may produce little or no symptoms. The most common symptoms to look out for, however, include: • An increase in urination frequency, especially at night • An inability to urinate • Erection problems • Weak flow, or a burning painful sensation • Erection problems or painful ejaculation • Blood in urine or semen.

If a customer relates a combination of these symptoms to their pharmacist, it is vital that they are referred to make an appointment with their GP in order to arrange a screening test and a blood test for

prostate-specific antigen (PSA).

It is in the area of lifestyle promotion that pharmacists can have the most impact when it comes to prevention and management of prostate issues, as outside of family history and age, the key risk factors for developing prostate cancer are a bad diet and an inactive lifestyle.

For example, a study conducted in 2014 for The World Cancer Research Fund found that a tenth of advanced prostate cancers could be prevented if men kept to a healthy weight.

The European Prospective Investigation of Cancer (EPIC) recommends a diet that is high in fibre and low in saturated fat, endorses cutting down on red and processed meats, and encourages eating fruit and vegetables.

Research has indicated that cruciferous vegetables such as Brussels sprouts, cabbage and cauliflower may lower the risk of developing cancers, with broccoli particularly beneficial regarding the prostate.

Dietary supplements which have been shown to have a protective or preventative effects vis-à-vis prostate cancer include plant sterols, zinc supplements and

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Feature Minoxidil treatment will fall out within two months of discontinuing the medicine.

Hair loss, meanwhile, can sometimes be an indicator of other conditions. Hypothyroidism and autoimmune thyroid disease, for instance, can cause loss of hair.

In such situations, it is important that the customer obtains an appointment with their GP. Other causes for hair loss include having too much vitamin A or a protein deficiency. Lifestyle and diet alterations can reverse the hair loss in such situations.

Mental Health

selenium. The patient’s GP should be consulted, however, before taking dietary supplements, to make sure they don’t interact badly with any current medication.

Cases of prostate cancer, meanwhile, tend to be much more severe for men who smoke than men who do not. An international paper conducted in the Medical University of Vienna in 2015 found that smokers and ex-smokers have a much higher risk of recurrence of prostate cancers, but that the negative impact will have been offset within a decade of quitting.

“Our study findings underline the importance of informing a prostate cancer patient about the negative effects of smoking,” said Shahrokh F. Shariat, Principal of the University Clinic of Urology at MedUni Vienna. “It is never too late to quit smoking. On the contrary: as our study shows, it makes sense to quit, even if you are already suffering from prostate cancer.”

Benign Prostatic Hyperplasia (BPH) It is normal for a man’s prostate to enlarge as he gets older, with half of all men presenting evidence for BPH by age 50, and 90% by age 90. While usually harmless, an enlarged prostate can obstruct the flow of urine by pressing against the urethra, sometimes leading to chronic or acute retention. It can also cause other complications such as bladder stones and cystitis (inflammation of the bladder).

If the customer’s symptoms are mild to moderate, the pharmacist

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should recommend a period of watchful waiting. If the condition worsens, then they should be referred to their GP, who will likely prescribe an Alpha Blocker such as Tamsulosin, which relaxes smooth muscle in the prostate, or a 5α-reductase inhibitor, which will inhibit the production of the prostate-enlarging hormone DHT. There are alterations to lifestyle that have been shown to slow down or address the symptoms of BPH including decreasing fluid intake before bed and reducing the consumption of caffeine and alcohol overall. It may also be recommended that customers avoid antihistamines, decongestants and opioids, which have been shown to exacerbate urinary retention symptoms.

Erection Problems Cancers are not the only condition with a strong link to tobacco consumption. Smokers, for instance, are twice as likely to develop erectile dysfunction (ED) as non-smokers (see article on page xxx of this issue for more information on smoking cessation).

Other causes for erection problems include obesity, high blood pressure, high cholesterol and diabetes. In such cases, pharmacists should promote lifestyle changes such as improving the patient’s diet, increasing their exercise and reducing their alcohol intake.

Increasingly, pharmacies are beginning to offer free ED assessments or run erectile dysfunction clinics so that customers can have private consultations. These sessions

may result in the patient being prescribed medication such as Viagra, Sildenafil, Cialis or Levitra.

If the issue is psychological, therapy might also be recommended for the patient.

Alternatively, vacuum pumps have been shown to be an effective treatment, regardless of the cause of the patient’s impotence.

Hair Loss The only medicine available without prescription for malepattern baldness is Minoxidil, which is a lotion that you have to rub on your scalp every day. The treatment is slow, as Minoxidil needs to be applied for at least four months before any noticeable effect is seen. It is also a treatment that must be continued by the customer in perpetuity, as any new hair that is grown during

While women are more than twice as likely to develop depression as men, they only have one quarter of the suicide rate. This is partially because women are much more likely to seek treatment and/or discuss their problems with others.

Over 75% of men will not seek help for a mental health problem, so it is much less probable that they will end up taking antidepressants, see a therapist or develop a coping strategy.

Symptoms that are more common among depressed men than depressed women include irritability, aggressive behaviour and a proclivity towards risktaking. It is also much more prevalent among shy men. A pharmacist is in an ideal position to help identify the signs, lend an ear and provide a safe place for a man to express their feelings, providing general direction and encouraging them to pursue further help.

The pharmacist may recommend that the patient write down their feelings in a journal, emphasising the importance of diet and exercise, and recommend certain dietary supplements such as Omega-3 and Vitamin B complex which can be beneficial for depression.

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Business and Management

CPD

Reflection

Evaluation

Planning

Action

This information may be used and collected each month as an ongoing comprehensive programme for management in Pharmacy. The modules are suitable for use by anyone working in community pharmacy wanting to improve their effectiveness as a successful leader and manager for their continuing professional development.

Why CPD? Continuing profession educational development (CPD) is a legal requirement for pharmacists. Journal-based educational programmes are an important means of keeping up to date with professional developments and from a significant element of your CPD

Astonishing Non-Adherence Facilitating Adherence in the Health Challenged Patient Written by Rachel Dungan MPSI ACC (adapted from an original article written by Dr Michael Arloski PCC) Understanding and responding to the individual needs of patients is crucial, not only to optimising the safe and rational use of medicines, but also to build customer loyalty.

According to leading health coaching expert Dr Michael Arloski, working with patients around adherence to medication and lifestyle prescriptions is the place where Prochaska’s “Readiness for Change”, Elizabeth Kubler-Ross’s “Stages of Grief”, and Maslow’s “Hierarchy of Needs” all intersect.

What we, as pharmacists often fail to understand is that when a patient has experienced a truly life changing event, like the onset or worsening of a health challenge, they feel a loss of control that threatens their safety. They experience grief at the loss of health, ability, or dreams, and often need to redefine their identity. It shakes them to the core.

As more pharmacists develop health, wellness and medical coaching skills and take the lead in more fully supporting patients to adhere to their medicines (e.g. through medication use reviews and new medicine schemes), we will face again and again what has stymied healthcare professionals for decades; the patient who has heard the diagnosis, has been given medical treatment, but has made virtually no changes to improve their health.

The person gets a diagnosis of a life-threatening or life altering disease, or is warned that lifethreatening consequences are imminent unless they take their medication as prescribed to manage their blood sugars, high cholesterol, high blood pressure, reduce the clot ability of their

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blood etc. They may even be told that additional lifestyle changes are absolutely essential to their continued survival - :a low-sodium diet for the hypertensive patient; lower stress levels for the post-heart attack patient; complete re-structuring of the diet of the newly diagnosed diabetes patient, or quitting smoking for the COPD patient.

1. Pre-contemplation (I can’t or I won’t)

We are encountering grief and loss

2. Contemplation (I might)

A loss is a loss. The loss of a loved one through death, the l oss of one’s health, or the loss of the dream held for how life would be, is all perceived as losses to be grieved.

Then, far too often, the pharmacist watches, as do family and friends, in total astonishment, as the patient makes none of these changes. When it comes to medication adherence, research shows that 33% of prescriptions are never filled (even once) (Tamblyn R 2014, Annals of Internal Medicine), and of those that do fill their prescriptions >50% discontinue their treatment within the first 6 months (Choudhry 2011, N Engl J Med).

This is a helpful way to understand where someone is at regarding their readiness to start and sustain adhering to their prescribed medicine. This single lens, however, is not enough. In the patient who astounds us with their level of non-adherence, we find we are encountering more than just lower levels of readiness.

So, when health challenges trigger the need for lifestyle behaviour changes (and taking a medication is a behaviour), what determines a person’s ability to make and sustain the needed changes in the quickest way possible?

Behavioural change experts have long tried to understand people’s adherence to recommendations for lifestyle improvement through the lens of Prochaska’s Readiness For Change model (Changing For Good, Prochaska, et.al. 1994).

In this model, Prochaska and his colleagues reminded us that change is a process, not an event and that people change when they are ready to, not before.

Furthermore, the change process is made up of six stages, not just ready or not ready.

3. Preparation ( I will) 4. Action (I am) 5. Maintenance ( I still am) 6. Termination (Adoption)

To help you understand a person’s reaction to a health challenge or diagnosis, and to help you respond more compassionately and effectively, put all of it in the perspective of the classic stages of grief. The work of Elizabeth KublerRoss and others have shown us that the grieving process is a multi-layered experience that affects us powerfully.

Business and Management

CPD

Kubler-Ross identified the 5 stages of grieving that are present for any significant loss: 1) Denial; 2) Anger; 3) Depression 4) Bargaining; 5) Acceptance.

When we see the astonishingly non-adherent patient, they are often experiencing this first stage of denial. They go into “diagnostic shock”, minimise the importance of the diagnosis or event, downplay its seriousness, and do all they can to return to “business as usual”.

Talking about their health challenge becomes a forbidden subject and the person may become defensive.

The experience of a “brush with death”, or an experience that reminds us of our mortality, can push us into survival mode.

No matter at what level we were getting our needs met on Abraham Maslow’s Hierarchy of Needs such an experience necessarily drives us down to the survival need level.

We feel profound threat to our “safety needs” and “physiological needs”, our very physical existence is threatened. Life becomes about the real basics of survival; the next breath, food, water, shelter.

It becomes about the basics of safety; feeling secure, going back to the familiar, whatever reassures us that we will be OK.

It is no wonder that patients going through such an experience may embrace the status quo, resist change and psychologically minimise the threat that they perceive. This brings up questions about the patient’s readiness to change: What needs to be considered to work effectively with health challenged patients (every patient seeking or collecting a medicine from a pharmacy has a health

challenge) is the intersection of these three widely accepted psychological theories. Once understood, a pharmacist can truly motivate their patient towards medication adherence and lasting lifestyle change.

Maslow’s theory of motivation contends that as people get their needs met at the lower levels of the Hierarchy of Needs Triangle, they naturally move on up to the higher levels. When we encounter

a patient who has just received a new diagnosis, experienced an exacerbation of their condition or started a new medication, do we acknowledge where they are at and do we help them get their needs met at that level? Or, do we demand immediate behavioural change just because the value and urgency of it is so great?

Our first job is to get curious and explore their perspective, their fears, their loss, their needs, to help them feel as if they have an ally, someone who supports them and has their best interests at heart, in other words, to build trust and rapport. This helps meet their safety needs and even some of their social needs.

We then need to check in with the person and see how they are doing at the survival level. Are they receiving the medical care they need? How do they know (feel reassured) that this is the case?

Is their living situation allowing them to cover the basics of shelter, food, and safety? Much of this comes down to how they perceive their health challenge affects the security of their way of making a living. Are they consumed with fear of losing their job, or having their business falter or fail? What is more frightening than to believe we are powerless? The threat to our very survival is there, and we believe we can do nothing to stop it. If our patient feels powerless to affect the course of their illness, it would seems pointless to make all the effort required to achieve lifestyle improvements or put up with the inconvenience or side

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Business and Management

CPD

effects of taking a medicine. What difference would it make anyway?

When we feel powerless we often don’t go to fight or flight, we freeze. The reflexive response to fear is contraction. Hear a sudden, loud noise and we instantly tense up and contract all our major muscle groups. When we are scared, we hold on. We reflexively hold on to what we have and to the way things are. Change seems even scarier than what frightened us to begin with. For our patient to “let go” and trust in the change process, their physiological and safety needs have to be met. If they doubt this they may give the appearance of compliance (collect their medications on time, tell you what they know you want to hear) but their follow-through is questionable.

Beyond the very basics of survival, we can help our patient to get their needs in the next two levels met: Social Needs (sense of belonging, love) and Self-Esteem Needs (self-esteem, self-worth, recognition, status).

This is where human connection plays a priceless role. When we are fearful, we tend to withdraw and isolate ourselves. This isolation is a real health risk and at this crucial time the presence and engagement of an extended support system can provide huge benefits.

Our patient will need the help of others in many practical ways, but they will fare far better if they are getting the emotional support that comes with getting their needs for belonging, acceptance and compassion met. We, the pharmacist, can provide a small but very significant part of this in being part of their trusted support structure, providing relevant information and perspectives and helping them to solve medication related problems as they arise.

Some of our best efforts may be to sign-post the patient we are working with to find, develop and expand sources of support in their lives. The nature of the support they receive from others is important as well. This patient needs understanding, empathy and support, not criticism, judgement and pressure to make lots of changes immediately.

We need to encourage our patient to ask for the support they need in the ways that they need to receive it. We all need to feel good about ourselves, to receive recognition and acceptance. When they are hit with a health challenge they may feel anything but good about themselves. Perhaps they are interpreting the illness as a

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weakness or personal failing. There may be embarrassment, guilt and/ or shame that they are no longer completely healthy. Their own “inner-critic” may be very harsh on them, filling their mind with self-critical thoughts that, again, cause them to do anything but take action for change. Helping the person to regain a sense of power and control in their life can also reclaim self-esteem. When we feel powerless to control events and circumstances in our lives we feel weak, vulnerable and impotent. When we discover what we CAN actually do through our own choices and behaviours to affect the course of our illness for the better, we feel empowered and regain confidence and strength.

Ten Ways to Effectively Engage with the Health Challenged Patient to Optimise Adherence When we encounter the person who is reluctant to adopt all the well intentioned medication and lifestyle prescriptions they have been prescribed, we need to respond to them in a 100% patient-centred way. In each step consider that their readiness for change will be determined in part by their stage of grief and where they fall in Maslow’s hierarchy of needs. How quickly they move through the change process will be. in part. determined by past experiences and in part by the support they have in the present to change. You are a part of that present support.

1) Meet them with compassion not judgement. Catch yourself quickly before you criticise their lack of adherence to the medication and lifestyle prescription they have been prescribed. Bite your tongue, and instead of TELLING them what they SHOULD be doing, and warning them, once again, of the dire consequences of non-adherence, respond with EMPATHY and LISTEN. 2) Seek first to understand their perspective. ASK them what it was like when they found out about their health challenge or experienced a health event.

Don’t jump to solutions or start problem solving. Really listen. Reflect their feelings.

Acknowledge what was real for them. Explore it with them and identify any fears that need to be talked about here.

3) Don’t push. Be patient and explore more. While it may feel like this person needs to take swift action with tremendous urgency, be patient. Readiness for change grows at a different rate for each step of the journey.

4) Be their ally. Help them feel that they are not facing this alone. This helps meet their needs for safety and belonging. Does the patient understand their health challenge? To what degree does the patient understand and buy into the medication and lifestyle changes suggested? Do they believe the treatment will positively impact their health?

5) Address survival first. Make sure they are getting the medical help they need.

Explore their fears about health, treatment side-effects, job, business, family and how it all will be impacted by their health challenge. Help them gain a sense of control and feel more safe and secure in all ways. Help them to see that they are not completely helpless and vulnerable, but that there are ways they can affect their situation.

6) Help them process the loss.

Talking through the grief is very powerful. Don’t be afraid to be with your patient as they process their feelings and give a voice to the part of them that is afraid. Accept their initial tendency to minimise but slowly help them feel safe enough to move through the other stages of grief.

7) Help them form a plan. Even if it is very basic, help them develop a plan to face their health challenge and create a “new normal”. What do they need to know? What skills do they need? What resources and support do they need?

How could they access these? Having a plan will give them both hope and a sense of purpose and direction, a map to find their way out of their current situation. It is something to hold on to.

10) Nothing succeeds like success. Help the healthchallenged person to take small steps to prepare for change and then experiment with actions when they are ready. Build on these easier successes and leave the tougher challenges for later after confidence has been built. Maslow reminds us that “growth forward customarily takes place in little steps, and each step forward is made possible by the feeling of being safe, of operating out into the unknown from a safe home port, of daring because retreat is possible.”. How better to set sail towards the unknown lands of change than with a pharmacist on your team as advocate and ally?

Rachel Dungan.is available for one-to-one personal, professional, and medical coaching, For further training options contact Rachel@racheldungan.com or phone/text 086 6025584 • LEAD Engagement Online Mastermind Programme, covering topics of Effective Communication, Demonstrating Empathy, Resolving Conflict & Motivating Others. https:// racheldungan.coachesconsole.com/ lead-online-programme-content-andcalendar-2016-2017.html • Medical Coaching Learning Community http://www.icfireland. org/medical-coaching-learningcommunity/ • Michael Arloski’s Health & Wellness Coach Training http://www.realbalance.com • Medical Coaching Institute’s Medical Coach Training http://www. medical-coaching-institute.com/

8) Encourage connection. If the basic survival needs feel met the person can reach out to others and will benefit from a sense of belonging. This may include patient support groups, family, friends, co-workers, members of their healthcare team etc.

9) Build self-esteem. Recognise, acknowledge and reinforce all progress. There is no failure, only feedback.

Encourage them to articulate positive learnings from their experiences, both positive and negative. Help them to grow greater self-efficacy because as THEY take charge of their health and their life, their selfesteem grows.

Rachel Dungan, The Pharmacist Coach

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Report

The Erring Human

By Mena Eskander - Head of Product & Innovation at Pharmapod In 2015, Irish pharmacies dispensed in excess of 100 million items. Research shows at least 1% of these may have involved a medication error.* Human error is inevitable. Quality is not.

“New script! She said she’ll be back in 5 minutes.” – You quickly nod in acknowledgement and your eyes cross over a quickly building trail of scripts as you turn back to the half-written prescription in front of you. You’re not absolutely certain what letters are contained in the scrawl on the next line but a familiar “1000mg QDS PRN” and experience with this doctor confidently allows you to proceed.

The dulcet tones of Nat King Cole crooning on the radio are rudely interrupted by the phone’s shrill ringtone. It’s the fifth time this hour and you hope it’s Tom’s clinic calling you back about his methadone dose before the clinic closes for the weekend. Time passes, the day ends and as you sign the daily audit form you

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wonder if you missed something in the last 11 or so hours of the sensory barrage that is your dispensary.

Does the above scene seem familiar? No matter how welldesigned a pharmacy may be, there are inevitable moments when your thoughts and the dispensary around you may seem a bit overwhelming with the many demands being placed on your focus. Research in the area has shown these distractions can be important causative factors in allowing errors to occur. The error rate in community pharmacies has been estimated to range from 1-24%*. This is not surprising considering the volume and complexity of the mental and

physical processes involved in dispensing that we must complete with little time and occasionally incomplete information. Our duty of care to our patients underlies our every action in practicing our profession and it would be grossly unfair to say that the majority of us have not reflected on this, as is our professional duty. Around the country, every day pharmacies make an effort to bolster their safeguards against errors – both in terms of their processes and of course, their personnel. The question is not so much are we concerned about quality and protecting our patients, veritably we are. Rather, the question is are our good intentions being correctly translated to quality in our pharmacies?

PSI inspection results from 2015 showed that almost 2 in 5 pharmacies do not keep adequate records of their dispensing errors. Over 3 in 10 did not keep adequate records of their staff’s compliance with pharmacy SOPs. These are recognised by the PSI to be essential components of a pharmacy’s quality management system and a key factor in ensuring a safe, quality service for our patients. In the UK, the Patient Safety Group headed by the Medication Safety Officers across the UK, recommend a process of blame-free reporting, learning, sharing, action and review with regard to medication errors. This is the ideal and many of you reading may think “Yes, I know this. But in my pharmacy…”. The same group

also surveyed pharmacy teams around the UK on their attitudes towards error reporting and learning from error. A lack of time, fear of repercussions and complex or unclear reporting processes were found to be major barriers in establishing a sound safety culture of reporting and shared learning.

A lack of feedback or apparent action following reporting an error is also off-putting, considering the time input required for reporting in a very time-poor environment.

Perhaps one, some or all of the reasons explain the PSI’s inspection findings.

Without serious overhaul to community pharmacy, well beyond the scope of this article, time will inevitably be a scarce commodity.

Our priority is always, quite rightly, the patient at the counter.

However, it is a false economy to omit a robust, clear and effective quality management system in an attempt to save time. Near misses and errors have potential to harm our patients and our pharmacies.

They also slow our teams down and create unnecessary work and confusion and can damage confidence, all of which can precipitate further errors. There is certainly value in making an

effort to establish and extract the maximum benefit from a clear but effective system for reporting and learning from medication errors. In the UK, the NHS recently announced plans to introduce a Quality Payments Scheme for pharmacy contractors, which will see pharmacies being reimbursed for meeting certain quality criteria including the recording, analysis and learning from error data. This signals a move away from itembased reimbursement towards a differentiated reimbursement model which takes into account a pharmacy’s commitment to provision of quality care. This is a very welcome development and is a model already in place in other European jurisdictions such as the Netherlands and countries like Ireland are likely to follow.

In the UK and Ireland over the course of most of 2016, aggregate data from the Pharmapod incident reporting and learning system shows that errors involving SALAD (Sound-Alike Look-Alike Drugs) were among the most common errors reported, with interruptions during dispensing and poor shelf separation of these drugs being frequently reported as contributory factors. Errors involving incorrect

strength selection in drugs such as metformin and both strength and form in PPIs were also common.

With more and more generic brands entering the market and therefore our dispensaries, it is important to be vigilant and ensure the entirety of the pharmacy team are familiar with the packaging of new branded generics with regard to dose form, strength and quantity.

Whether the pharmacy organisation you practice in is small, large, independent, franchised or a corporate group, there is value in openly acknowledging error and harnessing error data to its full potential as a director and driver of quality in your pharmacy. *National Medicines Information Centre.

Medication Errors. Dublin: St. James’ Hospital, 2001. Web. 1 Dec. 2016.

The Pharmapod system allows us to share our experiences of incidents and near misses so that we can look at every incident as an opportunity to improve our service. The system helps us to analyse the trends and the root causes of errors across our pharmacies. It has helped us develop a no blame culture in our company, keeping the focus on open communication, learning and improving patient safety.

Oonagh O’Hagan, Managing Director, Meagher’s Pharmacy Group, Community Pharmacist of the Year 2013

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Skincare Advice - Rosacea With Marie Therese Burke, Head of Training and Skincare expert with Graham Anthony Distribution

Addressing customer’s skin concerns is one of the most important areas in which the community pharmacist is ideally positioned to help. Good skin care advice can often address problems prior to patients visiting their GP and support self-care.

This month, Marie Therese looks at the 3. Papulopustular Rosacea which adds treatment of Rosacea. Rosacea is a chronic, bumps and pimple-like eruptions to inflammatory condition that by canleading be redness.

Some of the bumps at this stage Broughtskin to pharmacies distributor, Graham Anthony Distribution characterised by red patches on the face. can become infected with acne-causing It can affect anyone, and is mainly found bacteria.

This stage The in richest thermal water for is often what people adults between the ages of 30 and 60.

Marie and other are referring to when they say they have Eczema skin irritations Therese identifies four different stages of Acne Rosacea.

Xemose, from thermal water brand Uriage, is a line Rosacea: of new generation emollient for extreme and 4. Thecare fourth stage is Rhinophyma, which long-lasting cutaneous comfort. It is particularly 1. Facial Redness or Vasomotor Flushing is a swelling of the nose. If the condition suitable for people who suffer from eczema or other The first stage of Rosacea is where redness progresses, the nose will become swollen, skin irritations. appears on the face, appearing similar to a appear redder and bumpy which changes The-Xemose ideal range This to useswelling on your is because there sunburn. This is caused by flushing when range is theits shape. skin as the effects of the rangeof willscar-like last all excess blood rapidly flows through the isXemose formation tissue and the day, providing a nourishing and soothing feeling. skin’s blood vessels, which then need to sebaceous glands (which produce oil on Products from the Xemose range have a triple barrier enlarge in order to handle this flow.

After a the skin) get bigger. This fourth stage is action for long-lasting relief: Cerasterol 2F restores period of time facial skin can become very usually only found where Rosacea has and reinforces the skin barrier, the TLR2-Regul dry whilst the redness can become more been active for many years. regulates the innate immune barrier and Uriage noticeable.

Thermal Water re-balances the microbial barrier.

Marie Therese suggests: Uriage is one of the leading brands the international 2. Erythrosis or Couperose – In some cases using dermo-cosmetic active ingredients inon products that market and is now available exclusively in pharmacies nationwide. there will be a second stage, where are fragrance free, which will help to sooth, Thermal Water cannot be compared to others sold in Ireland as small permanent red vessels can Uriage appear moisturise, protect and treat Rosacea. very different. Uriage is; progressively on the face. This is it’s mainly THE RICHEST Thermal Water, with the highest concentration of Vitamin B protects skin from external irritants found on the cheekbones and the nose. minerals and trace elements. 52 x richer than other Thermal Water available. by fortifying the skin.

This is called “couperosis”

Vitamin C will strengthen the wall of d elicate vessels.

Uriage Xemose Lipid-Replenishing AntiIrritation Cream contains Cerasterol - 2F, which is great to use as it helps to restore and reinforce the skin barrier and soothe irritation.

Using Ginseng and Red Algae Extract will help to reinforce your blood vessels, whilst Uriage Roséliane Anti-Redness Cream helps fight against Kallikrein 5 Activity, which causes inflammation and vascular problems.

Uriage Roséliane Anti-Redness Cream uses its SK5R complex to provide a highly effective soothing action against Kallikrein 5 Activity Sooth, moisturise and protect your skin by using Uriage Thermal Water – a skincare water ideal for daily use on your face and body.

THE ONLY Thermal Water which can be use in mucous membranes.

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Voltarol® Emulgel® 2% w/w Gel

EXTRA STRENGTH

Voltarol® Emulgel® Extra Strength 2% w/w Gel for the relief of pain and inflammation. Contains diclofenac diethylammonium.

Always read the label / leaflet.

Diclofenac Diethylammonium Product Information: Please consult the Summary of Product Characteristics for full product information.

Voltarol Emulgel Extra Strength 2% w/w Gel (diclofenac). Indications: For the local symptomatic relief of pain and inflammation in trauma of tendons, ligaments, muscles and joints, localised forms of soft tissue rheumatism. Dosage: Adults and adolescents 14 years and over: 2g to 4g of gel, applied topically 2 times daily – morning and evening. It is recommended that treatment to be limited to 7 days. Patients should consult their doctor if the condition does not improve. Contraindications: Patients with or without chronic asthma in whom attacks of asthma, urticaria or acute rhinitis are precipitated by aspirin or other non-steroidal anti-inflammatory agents. Hypersensitivity to diclofenac, acetylsalicylic acid or other non-steroidal anti-inflammatory drugs. Hypersensitivity to any other ingredient of the gel. Use in third trimester of pregnancy, in children and adolescents aged less than 14 years is contraindicated. Warnings and Precautions: Caution with oral NSAIDs as may result in unwanted side effects. Avoid use with other products containing diclofenac. Apply only to intact, non-diseased skin and not to skin wounds or open injuries. It should not be used with occlusion. It should not be allowed to come into contact with the eyes or mucous membranes, and should never be taken by mouth. Application over extensive areas for prolonged periods or application in excess of recommended dosage may give rise to systemic effects.

These include gastrointestinal disturbances and bleeding, irritability, fluid retention, rash, hepatitis, renal dysfunction, anaphylaxis and rarely blood dyscrasias, bronchospasm and erythema multiforme.

Discontinue if rash develops. Use with caution in patients with a history of peptic ulcers, gastrointestinal bleeding, hepatic or renal insufficiency, or bleeding diathesis, or intestinal inflammation. Pregnancy and Lactation: The systemic concentration of diclofenac is lower after topical administration, compared to oral formulations. During the first and second trimester of pregnancy, diclofenac should not be given unless clearly necessary. Only use during lactation on the advice of a health professional. Diclofenac is contraindicated during the third trimester of pregnancy. Should not be applied on the breasts of nursing mothers, nor elsewhere on large areas of skin or for a prolonged period of time. Side effects: Very rare: rash pustular, hypersensitivity (including urticaria), angioedema, asthma, photosensitivity reaction. Rare: Dermatitis bullous. Common: Dermatitis (including contact dermatitis), rash, erythema, eczema, pruritus.

Overdose: The low systemic absorption of topical diclofenac renders overdosage extremely unlikely. MA Holder: GlaxoSmithKline Consumer Healthcare (Ireland) Limited, 12 Riverwalk, CityWest Business Campus, Dublin 24, Ireland. MA Number: PA 678/140/3. Legal Category: Pharmacy only. Text revised: October 2016. Further information available on request.

Trade marks are owned by or licensed to the GSK group of companies.

CHGBI/CHVOLT/0245/16