ITK February/March 2014 - Edition 34 by Gold Cross Products & Services

ISSUE #34 : FEBRUARY / MARCH 2014

P r a c t i c a l I n f o r m at i o n f o r T o d a y ’ s C o m m u n i t y P h a r m a c i s t

• APP 2014 • Business Profile • Building loyalty through compounding

A pregnancy supplement specifically formulated for mums in Australia

• CPD Osteoarthritis • Dehydration • Mystery Shopping • Product Spotlight

A pregnancy supplement specifically formulated for mums in Australia

Specially developed for mothers and babies in Australia, Blackmores Pregnancy & Breastfeeding Gold provides a balance of essential nutrients as recommended by current evidence and Australian guidelines, including NHMRC1,2, RANZCOG3 and ANZBMS4. In addition to folate5 and iodine3,5 the new and improved formulation delivers lowconstipation iron, vitamin D34,6 (1000 IU), and omega-3 fatty acids2 supporting the health of both mother and baby in a smaller, easy to swallow capsule. For a healthy start in pregnancy and beyond, recommend Blackmores Pregnancy & Breastfeeding Gold - Australiaâ&#x20AC;&#x2122;s most trusted brand.*

*Australiaâ&#x20AC;&#x2122;s most trusted Vitamin and supplement brand as voted by Australians in the 2013 Readers Digest Most Trusted Survey

REFERENCES: 1. NHMRC Public Statement: Iodine supplementation for pregnant and breastfeeding women. NHMRC, 2010. 2. NHMRC. Nutrient Reference Values for Australia and New Zealand Including Recommended Dietary Intakes. Fats, Total Fats and Fatty acids 2006. 3. The Royal Australian and New Zealand College of Obstetricians and Gynaecologists, 2013. Vitamin and mineral supplementation in pregnancy, college statement. 4. Paxton G. et. al. Vitamin D and health in pregnancy, infants, children and adolescents in Australia and New Zealand: a position statement. MJA 2013;198(3):1-8. 5. Guidelines for preventive activities in general practice, 8th edn. East Melbourne: Royal Australian College of General Practitioners, 2012. 6. Perampalam S. Vitamin D status and its predictive factors in pregnancy in 2 Australian populations. Aust N Z J Obstet Gynaecol. 2011;51(4):353-9.

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CONTENTS PROFFESSIONAL REVIEW 18 Dehydration and the use of oral rehydration therapy

SPECIAL FEATURES 14 CPD – Osteoarthritis 30 Nutrients key during pregnancy

for Australian Women 32 A little bit of relief

OTHER ARTICLES

HAPPY NEW YEAR

22 Category Review – Cramps in elite sportspeople 34 The Mystery Shopping Program

BY SEAN TUNNY Editor, Gold Cross Products & Services Pty Ltd

On behalf of the entire team at Gold Cross, Happy New Year and we wish you every success in 2014. As this edition of ITK is being delivered to Pharmacy throughout Australia, it is only a few short weeks to APP 2014. We have our APP feature this edition and look forward to welcoming everyone to the Gold Coast from 16 March for one of Australia’s biggest Pharmacy events on the annual calendar. At the time of writing, Victoria and Adelaide are in the grip of extreme levels of heat not recorded since 1908 in some parts. The real and direct threat to property in Western Australia and community throughout Australia due to fire has also affected community and rural pharmacies in many areas. This edition of ITK has a Business Profile from Flowsell and MIMS, CPD article on Osteoarthritis coinciding with “Arthritis Awareness Week” in March, along with our regular features. The support of our partners throughout 2013 was tremendous, and we extend a sincere thank you to everyone involved in ITK—it is greatly appreciated. It is also pleasing to receive so many positive comments regarding the editorial and features in each edition from pharmacy, thank you for your support. Happy New Year and we look forward to seeing you all at APP 2014. Best Regards, Sean Tunny Editor

GUILD NEWS 04 Training towards leadership 36 Guildcare – Tackling Adherence

BUSINESS PROFILE

20 FlowSell 26 MIMS

DOWN TO BUSINESS 28 Building loyalty through compounding 38 What will 2014 bring to you?

REGULARS 40 What’s new and Company news 44 Product Spotlight 46 Health Calendar 47 60 Seconds Interview 47 Classifieds

PLEASE USE THIS PUBLICATION TO KEEP YOUR PHARMACY IN THE KNOW.

Editor: Sean Tunny 0457 029 052 sean.tunny@goldx.com.au

PROUDLY AUDITED BY:

DESIGN: Megan Hibberd 0408 452 133 www.artbymegan.com.au PRINT & DISTRIBUTION: APN Print 1300 134 628 www.apnprint.com.au PUBLISHED BY: Gold Cross Products & Services. PO Box 505 Spring Hill Qld 4004. Contact Candice Radford Email: Candice.radford@goldx.com.au In The Know is produced for the information of Australian Pharmacists. The presence of the logo of the Pharmacy Guild does not constitue endorsement of a product. The Pharmacy Guild of Australia accepts no responsibility for claims made by advertisers. Opinions and views expressed in articles do not necessarily reflect those of Gold Cross.

Your first choice of digital medicines knowledge itâ&#x20AC;&#x2122;s simple Delivered your way Desktop or Internet M MIMS Australia, 2nd Floor, 1 Chandos Street, St Leonards NSW 2065, Locked Bag 3000, St Leonards NSW 1590 Phone: (02) 9902 7700, Facsimile: (02) 9902 7771, www.mims.com.au ACN 050 695 157, ABN 68 050 695 157

NEWS FROM THE GUILD PRESIDENT

News from the Guild President Training towards leadership George Tambassis National President of The Pharmacy Guild of Australia

There are so many great people working in community pharmacies, and I believe we need to do more to promote and celebrate the achievement of excellence in our field.

That’s why I am a big supporter of competitions such as the Quality Care Pharmacy Program’s Pharmacy of the Year, and also the Pharmacy Assistant of the Year. The pharmacy assistant competition, affectionately known as PATY, is especially worthwhile and I encourage pharmacy assistants to get involved as it’s a great opportunity to develop invaluable skills, and network with industry leaders and stakeholders. As the first point of contact in pharmacies, pharmacy assistants are the true frontline of our industry, and first impressions are crucial to successful ongoing relationships. This is why I believe training is vital; to build important skills and provide valuable advice to patients. Now more than ever, there is an important opportunity for pharmacy assistants to get involved with systemised pharmacy programs such as GuildCare, and I encourage them

to receive appropriate training to develop these vital skills within our evolving business. The GuildCare suite of programs is designed to assist pharmacists and pharmacy assistants in the easy delivery of professional services and support, including medication management programs, and compliance and adherence programs. Through the electronic recording and delivery of these services, this software aims to help pharmacists ensure that patients are getting the maximum benefits from their medications. Pharmacy assistants can utilise various programs within GuildCare to guide patients to take the right medicines, at the right time, over the appropriate period, which boosts patient compliance to their medicines and adherence to their treatment over time. This may be an intervention by the pharmacy assistant (with advice from a pharmacist), a discussion around a patient’s selfadministration of their medications, assistance

“I believe training is vital; to build important skills and provide valuable advice to patients.”

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 34 : FEBRUARY / MARCH 2014

to patients by offering dose administration aids, or the recording of interactions with other health care professionals. In my experience as a pharmacist, I have witnessed GuildCare provide a platform to building ongoing relationships between customers and pharmacy assistants. Assigning customers to a program brings the opportunity for recurring visits to the pharmacy and customer loyalty, which is important for health outcomes and also vital for a successful business. This highlights potential opportunities for pharmacy assistants to help patients with their medication: from education, to staying on their medication, to finding better health management alternatives. Pharmacy assistants and interns who are already familiar with GuildCare should keep up to date with new programs launched. It’s important that they get an early grasp of the technicalities within these software platforms, so I encourage them to get involved with training. I believe the ultimate aim is to stay ahead in this ever-changing industry so it’s important to continually advance programs, electronic recording systems and service delivery. The ultimate aim for a pharmacy assistant is to continually provide the public with services, value and advice they will not get elsewhere, so training is vital to keep ahead and standout within this evolving industry.

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Exhibitor Name A.P.E Distribution Abbott Australasia Actavis Pty Ltd Actegy Health Adnohr Marketing / Studex Aust AFT Pharmaceuticals Airssential Home Health Care Alphapharm

Stand F3 215 - 217 35 - 40 160 & 161 220 201 288 75, 76, 83, 84 & F4 F2 67 & 74 277 259 51 - 54 101 - 106 123 & 124 23, 24, 27 & 28 25 & 26 1-4 18 & 19 308 255 239 204 & 213 279 177 256 230 264 & 265 193 & 194 234 248 78 & 79 238 261 113

Ambra Corporation Pty Ltd American Express Amneal Pharmaceuticals Ansell Healthcare API Apotex Aptimal + Karicare Aspen Australia Aspen Nutritionals AstraZeneca Aurobindo Aussie Soles Australian College of Pharmacy Baby Tooth Land Bayer Betaglucare Bindweld Bio Living Baby & Beauty Bioceuticals BioRevive Blackmores Ltd Bug Off Head Lice System Care Pharmaceuticals CDC Systems Cheeki Chemist POS Direct P/L Clinical Genomics BowelScreen Australia

Exhibitor Name ClockOn Australia Colgate Palmolive Corum Health Services Cosmetiques De France CostSave Covidien Designs to You Diabetes Queensland - NDSS Discount Drug Stores Dose Innovations Doward International Dr Reddy’s East Coast Distributors (Aust) P/L Ego Pharmaceuticals Erskine Oral Care eRx Script Exchange Essentials in-a-box Ethical Nutrients Eye of Horus Flordis FlowSell Fred IT Group Galderma Australia Generic Health GlaxoSmithKline Gold Cross Products & Services Good Price Pharmacy Gordochom Solution Guild Insurance & GuildSuper Guild Pharmacy Academy GuildLink HARTMANN Havenhall Pty Ltd Healthpoint Heritage Brands of Brands RMJ Hydralyte Hydrozole (GSK) IMS Health

Stand 156 128 - 131 266 & 267 237 278 281 & 282 275 296 228 & 229 58 - 65 114 & 115 126 & 127 F17 121 & 122 303 117 & 118 290 241 & 242 F1 85 & 86 233 120 & 125 138 & 139 262 68 - 73 42 47 & 48 292 57 & 66 306 144 & 147 44 & 45 F13 - F15 224 & 225 192 & 197 293 & 294 F10 - F12 11 & 12

Exhibitor Name iNova Pharmaceuticals A Valeant Company Instigo Intellipharm Pty Ltd IsoWhey J.A. Davey Pty Ltd JDL Strategies Johnson & Johnson Pacific JR Pharmacy Kimberly Clark knowITall Loyalty Systems La Roche-Posay Le Desire Link Healthcare Pty Ltd Lively Living L’Oreal Consumer Division Love Pharmacy Making Life Easy Mater Mothers’ Hospitals McPherson’s Consumer Products md Briefcase MEDA MedCheck Controlled Drug Register Medical Vita Diet Medication Automated Systems (Aus) Pty Ltd Medici Capital Pty Ltd Meditec Pty Ltd Methsof Mountaintop Systems MPS Australia MSD Australia MSI Taylor Pharmacy Services MTS Musashi NAPSA Neilmed Pharmaceuticals

Stand 198, 199, 202 & 203 155 82 235 298 - 301 289 107 - 112 188 172 & 181 13 208 & 209 219 77 195 284 - 287 F16 7 207 270 & 271 180 227 223

Exhibitor Name Nipro Australia No More Sweat Norgine Novartis Consumer Health NPS MedicineWise OAPL Optica Life Accessories Ltd Optimum Nutrition & BSN PDL Paper-Pak PCCA Australia Pty Ltd Perrigo Australia Pfizer Pharmaceutical Society of Australia Pharmacy Board of Australia Pharmacy Club Pharmacy Group Solutions Pharmacy News Pharmalink (Atkins and Rafftery’s Garden) Pharmalink (Evolution Health, Lifespace and Elmore Oil) Pharmalink (Melcare, Nuk, Sebamed, Quck Beverage and 1Cal) Philips Home Healthcare Solutions Planet Health Pop Impact Powrgard Sports + Medical Probiotec Ranbaxy Australia Raven’s Recruitment Reckitt Benckiser Retail Pharmacy Magazine Retail Vitality RipSnore Roche Diagnostics Australia Pty Ltd

214 263 8 272 & 273 221 159 9 & 10 162 - 165 46 80 & 81 196 297 226

Stand 205 & 206 240 182 243 & 244 178 249 252 185 5&6 43 211 & 212 302 29 - 34 260 254 200 186 & 187 307 173 174 175 189 268 & 269 309 & 310 190 14 & 15 183 & 184 232 166 - 171 304 & 305 F7 F9 140 - 143

Exhibitor Name Rocktape Rollex Medical Refrigeration RSM Bird Cameron Sandoz Sanofi Consumer Healthcare SCA Hygiene - TENA + Libra Scholl Orthaheel Sheralven Australia Pty Ltd Shop for Shops Shop Supplies Sigma Company Simple Retail Pty Ltd Simuolive Australia Sliquid Organics SmarterPharm Smith + Nephew Souvenaid StirlingFildes Swisse Symbion Pty Ltd Tepe Oral Hygiene Products Terry White Management The Pharmaceutical Locum Company The Pharmacy Guild of Australia

Stand 295 253 116 & 119 132 - 137 49, 50, 55, 56 236 & 245 218 231 257 191 87 - 92 250 & 251 246 & 247 179 154 & 157 16 & 17 176 158 150 - 153 93, 94, 99 & 100 276 145, 146, 148 & 149 291 21, 22 & 41 20

The Pharmacy Guild of Australia, Guild Training Think National 258 ToLife Technologies Pty Ltd 280 Tony Ferguson Weightloss Program 222 Visa F5 Webstercare 274 & 283 Willach Pharmacy Solutions 95 - 98

Correct as at 16 December 2013

185 186 187 NORTH WEST FOYER

F2 F3

61 62

79 80

60 63

78 81

59 64

18 19 20

25 26

31 32

37 38

24 27

30 33

36 39

23 28

29 34

35 40

I EX T

12 11 10

256 257

278 279

295

301

182

175 178

207 210

239 242

255 258

277 280

294

302

174 179

206 211

238 243

254 259

276 281

293

303

173 180

205 212

237 244

253 260

275 282

292

138 139

304

172 181

204 213

236 245

252 261

274 283

291

305

160 161

306

96 97

58 65

77 82 76 83

95 98 94 99

57 66

75 84

93 100

109 110

122123

134 135

146 149

108 111

121 124

133 136

145 148

155 158

167 170

199 202

231 234

247 250

269 272

289

107 112

120 125

132 137

144 147

154 157

166 171

198 203

230 235

246 251

268 273

288

163 164

197 196 195

229 228 227

267 266 265

287 286

162 165

192 193 194

224 225 226

262 263 264

284 285

156 159

168 169

200 201

232 233

248 249

270 271

290

CAFE

52 53

70 71

89 90

104 105

117 118

129 130

141 142

151 152

51 54

69 72

88 91

103 106

116 119

128 131

140 143

150 153

50 55

68 73

87 92

49 56

67 74

102

EXIT

126 127

EXIT

188 189 190 191

EXIT

ATM

EXHIBITION FOYER FOYER C

F15 F13 F14

F8 F7

REGISTRATION

F9 F10 F11 F12

220 221 222 223

LIFTS

307 308 309

101

SOUTH EAST FOYER

240 241

EXIT

113 114 115

EX IT

J I H G F E D C

SOUTH FOYER

208 209

85 86 EXPONET C.S.

300 176 177

FRED NET INTERNET

296 297 298 299

183

IT EX

47 48

T XI

214 215 216 217 218 219

184

ESCALATOR

ATM

F16

F17

EXIT

310

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Osteoarthritis

“There are no disease modifying drugs for OA, so treatment of OA relies on symptom control. Treatment includes both pharmacological and non-pharmacological therapy.”

BY Margaret Robinson B.Pharm.Hons, Dip Comp Sci – AM Pharmacy Guild of Australia

Osteoarthritis (OA) is the most common form of arthritis. There appear to be several contributing factors which may cause a joint to develop OA. These include being in an older age group, being male, and having a genetic predisposition. There is also low grade inflammation and this may be why OA responds to anti-inflammatory drugs. However, the inflammation of the joint is less than with rheumatoid arthritis patients.

Epidemiology Approximately 60–80% of people older than 55 years have radiographic evidence of OA. Many of these patients will experience pain and disability. Men have a higher prevalence and incidence of OA than women before the age of 50. It is thought that oestrogen gives some protection against the development of OA.

Treatment There are no disease modifying drugs for OA, so treatment of OA relies on symptom control. Treatment includes both pharmacological and non-pharmacological therapy. Non-pharmacological therapy includes:

•• •• •• ••

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 34 : FEBRUARY / MARCH 2014

Weight loss Physical exercise Joint protection and energy conservation Assistive devices for walking

CONTINUING PROFESSIONAL DEVELOPMENT

“Approximately 60–80% of people older than 55 years have radiographic evidence of OA. Many of these patients will experience pain and disability.”

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 34 : FEBRUARY / MARCH 2014

CONTINUING PROFESSIONAL DEVELOPMENT

“Exercises are likely to be most effective if they train muscles for the activities a person performs daily.”

Treatment of osteoarthritis Paracetamol For treating the pain of osteoarthritis of the knee, trials showed that nonsteroidal anti-inflammatory drugs (NSAIDs) and cyclooxygenase-2 (COX-2) inhibitors are more efficacious than paracetamol. However, the superiority of NSAIDs over paracetamol (at doses of 4 g per day) is modest. In one large trial, the average reduction in pain, on a scale of 0 to 100, was 21 in patients treated with NSAIDs and 13 in those given paracetamol. Thus, given the toxicity of the NSAIDs and the modest benefits reported in clinical trials, paracetamol is still recommended as first line therapy.

NSAIDs and COX-2 inhibitors Advantages of NSAIDs include: relief of both pain and inflammation, rapid onset of action, improved quality of life, availability in several chemical classes (important in allergic reactions and intolerance), and variability of dosing regimens. Disadvantages include interpatient variability in response, uncertain effect on disease progression, GI toxicity, renal toxicity, CNS toxicity, bleeding effects and more recently cardiovascular adverse effects associated with the use of COX-2 inhibitors. The most significant disadvantage is the GI toxicity. There are approximately 200,000 hospitalisations a year related to NSAIDassociated GI bleeding and ulceration. The prevalence of ulceration is estimated at 10%–20%, and the incidence of ulcers/ ulcer complications is 2%–4% per year. One of the major problems with GI toxicity is that most patients with complications have no warnings or prodromal symptoms. Risk factors associated with serious GI complications from NSAIDs, include history of peptic ulcer disease, upper GI bleeding, or GI-related hospitalisation; older age; NSAID dose; and the concurrent use of prednisone. A history of previous treatmentrelated GI side effects and a history of cardiovascular disease are also serious risk factors. Low doses of anti-inflammatory

medications (e.g. 1200 mg of ibuprofen per day) are less efficacious, but better tolerated than high doses (e.g. 2400 mg of ibuprofen per day). One strategy to try and circumvent the GI toxicity of the NSAIDs is to use COX-2 inhibitors, but recent reports of cardiovascular adverse events has cast a cloud about their use especially in the at-risk group of elderly patients who are the most at-risk of suffering with osteoporosis and cardiovascular problems.

Glucosamine and chondroitin sulfate A clinical study involving the combination of glucosamine and chondroitin showed significant improvement in the management of joint pain in the knee. The response rate was 52% compared with a 28% response rate in the placebo group. Most trials have found little toxicity with this combination, usually no more than placebo. However, some trials have questioned the effectiveness of glucosamine and chondroitin. The Glucosamine Chondroitin Arthritis Intervention Trial evaluated the efficacy of glucosamine and chondroitin given alone and in combination over 6 months. The initial analysis showed that neither supplement alone or in combination was efficacious. However, analysis of the subgroup classified as having moderate to severe pain demonstrated that the combination therapy significantly decreased osteoarthritic pain. The researchers cited the fact that the high response to placebo (60%) may have limited the ability of the study to detect the benefits of treatment in milder pain. Treatment with chondroitin was associated with a significant decrease in joint swelling and effusions. The study also pointed out that there is wide variation between the content listed on the label of products available, underlining the necessity to use quality products. There is some evidence to suggest longer-term treatment with glucosamine and chondroitin over a two to three year period is associated with disease modification and a reduction in the progression of the disease.

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 34 : FEBRUARY / MARCH 2014

Injections of hyaluronic acid Injections of hyaluronic acid into the knee joint have shown inconsistent efficacy in clinical trials. Two meta-analyses done on clinical trials of hyaluronic acid injections reported statistically significant, but limited efficacy.

Corticosteroid injections In randomised trials, intra-articular corticosteroid injections have relieved pain more effectively than placebo for one to three weeks on average, after which their comparative efficacy wanes. However, data are lacking about the optimal number or frequency of corticosteroid injections.

Opiates Opiate analgesic agents are more efficacious than placebo in controlling pain, but side effects and dependence are concerns.

Topical therapies Topical compounds such as capsaicin and topical NSAIDs have been modestly better than placebo in reducing the pain of osteoarthritis.

CONTINUING PROFESSIONAL DEVELOPMENT

ASSESSMENT QUESTIONS Question 1

Question 4

Who in the following would be most at risk of suffering with osteoarthritis:

A truck driver that you have known for years comes into the pharmacy wanting something for his knee pain. He has been a road construction worker in his time and you know he took up truck driving to stay off his feet. He says his knees are “shot”. He is 55 years old, overweight, has hypertension which is under control with tablets. He does not want to go to the doctor yet. Your advice could include:

a. A 40 year old male who is a former rugby front row forward with a BMI of 24 (normal range) b. A 50 year old female who is a former swimmer and who has a BMI of 22 (healthy weight) with high blood pressure c. A 25 year old female who is a current swimmer and who has a BMI of 23 (healthy weight d. A 50 year old male who is a former rugby front row forward with a BMI of 26 (overweight)

Question 2 Which of the following statements is TRUE: a. Physical exercise can be beneficial for patients with osteoarthritis b. About 10% of people aged over 55 years will have radiographic evidence of osteoarthritis c. Paracetamol is first-line choice for treatment of osteoarthritis because osteoarthritis is a non-inflammatory condition and paracetamol has no anti-inflammatory properties

Question 3 Glucosamine in combination with chondroitin when used in osteoarthritis has been found in clinical trials done thus far to be: a. Significantly effective but only after 2-3 years of constant use b. Not effective as single therapy but effective when used in combination for mild to moderate pain c. Difficult to assess efficacy in practice because many products have differing strengths and quality d. When used in combination consistently reduce inflammation and joint effusions

ANSWERS:

Too little attention is paid to nonpharmacologic treatments. In patients with osteoarthritis of the knee, weakness of the quadriceps muscles is caused by disuse and by inhibition of muscle contraction in the presence of adjacent capsular swelling. The severity of pain is directly correlated with the degree of muscle weakness. Exercises are likely to be most effective if they train muscles for the activities a person performs daily. Range-of-motion exercises, which do not strengthen muscles, and isometric exercises, which strengthen muscles, but not through a range of motion, are unlikely to be effective. Low-impact aerobic exercise is also effective in lessening pain. In one trial, the combination of exercise and modest weight loss (mean, 4.6 kg)— but not weight loss alone — reduced pain and improved physical function in patients with osteoarthritis.

Question 1 – d / Question 2 – a / Question 3 – c / Question 4 – b / Question 5 – a

Exercise

d. The most significant disadvantage of using NSAIDs in osteoarthritis is their long-term cardiotoxicity

a. He would be best to go and discuss his pain relief with his doctor given he has hypertension and possibly other conditions associated with being overweight such as diabetes b. He could try paracetamol at 4G daily for a period to see if he gets pain relief. He should also try to lose some weight and do some physical exercise even though his profession is largely sedentary because mild weight loss and some exercise have been shown to be effective in pain relief for osteoarthritis c. He should try NSAIDs either topical or oral because they have been shown to be more effective for osteoarthritis than paracetamol d. Because of his hypertension, he should not take paracetamol or NSAIDs as they have been shown to have adverse cardiac effects. He would be best to undergo a series of corticosteroid knee injections for more long-lasting relief

Question 5 One of the concerns regarding NSAIDs for use in osteoarthritis is that: a. A risk factor for GI toxicity of NSAIDs is older age – which is already the group which is more likely to develop osteoarthritis as first line therapy b. One of the prodromal symptoms of NSAID GI toxicity is abdominal pain – a symptom that could stop patients being compliant with their medication, hence paracetamol is preferred c. While NSAIDs are longer acting than paracetamol and can be dosed at once daily depending on the particular NSAID, they are not as effective as paracetamol in osteoarthritis d. Slow onset of analgesic and anti-inflammatory action

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 34 : FEBRUARY / MARCH 2014

Professional review

Dehydration and the use of Oral Rehydration Therapy

Melissa Antonel

Dehydration or hypovolemia occurs when more fluid is lost than is taken in, leading to low cardiac output, decreased tissue perfusion and basically the body cannot carry out its normal functions.

B.Pharm

Every day our body loses fluid and electrolytes via urine, sweat, saliva, and in stools which are usually replaced with a healthy diet. The body is made up of approximately 60% of water and losing 2% of our body weight rapidly can show signs of dehydration. Clinical hydration status can be indicated by two different ways: osmolality the serum range of an adult being 280–300 mOsmol/kg H2O and the other is urine volume which also measures kidney function as well with a normal range from 0.6–2.5 L/24 hours among healthy adults.1 Common causes of dehydration include intense diarrhea, vomiting, fever, excessive sweating and increased urination. Not drinking enough water during hot weather or exercise may also cause dehydration. Alcohol, caffeine and certain medications including: diuretics, antihistamines, blood pressure medications and some psychiatric drugs can lead to dehydration. Anyone may become dehydrated, but young children, older adults and people with chronic illnesses are most at risk. Following is the table from the Australian Pharmaceutical Formulary on dehydration in children.1

“The body is made up of approximately 60% of water and losing 2% of our body weight rapidly can show signs of dehydration.” GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 34 : FEBRUARY / MARCH 2014

Dehydration in Children: Features and Treatment

Professional review

Degree of dehydration (% loss of bodyweight)

Clinical Features

Treatment

No or minimal dehydration (less than 4% loss of body weight)

•• History of diarrhea or vomiting •• Increase fluids by giving small amounts frequently. In non-dehydrated children, with adequate oral intake

•• No clinical signs of dehydration

•• Pinch test: skin fold retracts immediately

sweet drinks (e.g. carbonated beverages, fruit juices) diluted at least 1:4 with water can be used to maintain hydration. Avoid undiluted soft drinks, sports drinks, Lucozade, cordials and fruit juices.

•• Continue normal dietary intake; foods high in fat and simple sugars should be avoided.

•• Breastfeeding should be continued normally with extra fluids being provided between feeds.

•• Formula-fed infants should continue their normal intake and not be stopped for more than 12–24 hours. It is not necessary to dilute infant formula, and lactosefree or lactose-reduced formulas are usually unnecessary. Supplement with oral rehydration therapy if necessary.

•• Although there is some evidence that a lactose-free diet might reduce the duration of diarrhea in children with acute gastroenteritis, it is not routinely recommended that children avoid lactose-containing foods (e.g. dairy products). Mild to moderate (4–9% loss of body weight)

•• History of diarrhea and or vomiting with inadequate oral intake

•• Two or all of: – Restless or irritable – Sunken eyes – Thirsty and drinks eagerly

•• Rehydrate with oral rehydration solution in frequent small volumes to replace the fluid loss within about 4 to 8 hours: - <10 kg 60–120 ml for each diarrhoeal stool or vomiting episode - >10 kg 120–240 ml for each diarrhoeal stool or vomiting episode.

•• Most children with concomitant vomiting can still be successfully rehydrated with oral rehydration solution (5 ml given every 5 minutes, gradually increasing).

•• Soft drinks, cordial, fruit juice, sports and energy drinks have a low sodium and potassium content, are high in sugar and have high osmolarity. They can exacerbate diarrhea and dehydration and cause electrolyte disturbances. Their use is not recommended in children with dehydration.

•• Continue breast or bottle feeding and, if necessary, supplement with oral rehydration solution.

•• Gradually reintroduce an age-appropriate diet after 4–6 hours of rehydration. Solid food should be withheld for no more than 24 hours. Severe (>9% loss of body weight)

•• •• •• •• ••

•• Referral for hospital admission is necessary for immediate intravenous rehydration.

Two or more of: Abnormally sleepy or lethargic Sunken eyes Drinking poorly or not at all Pinch test: skin fold visible for > 2 seconds

•• Additionally signs can include: – Circulatory collapse (e.g. weak, rapid pulse, cool or blue extremities, hypotension) – Rapid breathing – Sunken anterior fontanelle

The only effective treatment for mild to moderate dehydration is oral rehydration salts providing fluid, electrolytes and glucose replacement initially to rehydrate and then to maintain hydration.2 Oral rehydration solutions have four main constitutes: electrolytes (sodium chloride and or potassium chloride), a bicarbonate source to correct or prevent metabolic acidosis (sodium bicarbonate or sodium citrate), water to replace fluid losses and a carbohydrate source to maximise absorption of fluid and electrolytes for example glucose, although cereal-based formulations may also be used especially for cholera infections.3 It is recommended by WHO for a rehydration solution to contain 60–75mmol/L of sodium and 75–90mmol/L

of glucose.3 The rehydration dosage for an adult is 200–400ml of oral rehydration solution for every loose bowel motion.3 Water and salt continue to be absorbed by active sodium-glucose coupled transport across the gastrointestinal epithelium driven by the sodium electrochemical gradient even in the presence of severe diarrhea.4 The preservation of this facilitated co-transport of glucose and sodium is the basis of oral rehydration therapy. References 1. Sansom LN, ed. Australian pharmaceutical formulary and handbook. 22nd edn. Canberra: Pharmaceutical Society of Australia, 2012 [cited 2013 December 2] 2. Rossi S. Australian Medicines Handbook [monograph online]. Adelaide, Australian Medicines

Handbook Pty Ltd; 2012 [cited 2013 December 2] 3. Micromedex®2.0. Oral Rehydration Solutions [Internet]. 2013 [cited 2013 December 2]. Avaliable from: https://www-micromedexsolutions-com. cknservices.dotsec.com/micromedex2/librarian/ ND_T/evidencexpert/ND_PR/evidencexpert/ CS/10724F/ND_AppProduct/evidencexpert/ DUPLICATIONSHIELDSYNC/2519D2/ND_PG/ evidencexpert/ND_B/evidencexpert/ND_P/ evidencexpert/PFActionId/evidencexpert. IntermediateToDocumentLink?docId=3277-r&conten tSetId=30&title=Oral+Rehydration+Solutions&servi cesTitle=Oral+Rehydration+Solutions 4. Duggan C, Fontaine O, Pierce NF, Glass RI, Mahalanabis D, Alam NH, Bhan MK, Santosham M. Scientific Rationale for a Change in the Composition of Oral Rehydration Solution . JAMA. 2004 June 2;291(21): 2628-2631.doi:10.1001/ jama.291.21.2628. [cited 2013 December 2]. Available from: https://jama-jamanetwork-com. cknservices.dotsec.com/article.aspx?articleid=1988 26&resultClick=24

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 34 : FEBRUARY / MARCH 2014

BUSINESS PROFILE

“FlowSell designs remain simple and are not over-engineered. To this end, we can make them more affordable for pharmacies.”

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 34 : FEBRUARY / MARCH 2014

BUSINESS PROFILE

FlowSell BY SEAN TUNNY Editor, Gold Cross Products & Services Pty Ltd

A company that is unique in the storage and dispensing industry is FlowSell. It is Australianowned and has been in business since 1998. In particular, over the past five years FlowSell has invested in extensive research and development in order to develop an innovative range of products for pharmacy dispensary and the front of shop.

In this edition of ITK, we had the pleasure of speaking with John Leahy, owner of FlowSell, to invite him to outline a little more about the business he has created.

Editor: John, can you outline a little about how you became associated with the pharmaceutical industry? John: My first serious job in the profession was as a Product Manager for Parke Davis in the OTC Division. After a number of progressive roles, I developed technology that led to the EverSlim product that was sold nationally through pharmacies when high fibre was in fashion in the seventies. My love affair with pharmacy has never waned.

Editor: What led to your involvement with shelving fixtures? John: I have always had a fascination with innovation and, after EverSlim was sold, I was asked to develop a shelf to gravity-feed products. This gave birth to the patented FlowShelf. This shelf had no base. Nylon mouldings formed both the base of the shelf along with the dividers. Products gravity fed on special nylon Dividers that were able to be moved further apart to accommodate larger products. This led to the development of the Dispensary FlowShelf which led to the completion of hundreds of projects in pharmacies and hospitals.

FlowSell designs remain simple and are not over-engineered. To this end, we can make them more affordable for pharmacies. A good example of this is the use of the Dispensary Support TrayShelf in cabinet shells. For a moderate investment, a pharmacy can have the most ergonomic dispensary for fast movers by placing the Dispensary Support TrayShelf on Support Pins in an open-backed cabinet behind the dispensing bench. Dispensary items can be quickly loaded into the system at the rear at the same time as a pharmacist is dispensing gravity-fed items from the front. Our satisfied customers are testimony that you do not have to be high-cost to be efficient in dispensing.

Editor: Can you outline a little of the products that have been developed through technology? John: We do not sell automated dispensaries, but when it comes to all other forms of dispensary products our quality and performance is second to none. Our metal fabrication meets ISO standards. The TrayShelf afforded us the opportunity to produce, not just fixed shelves for cabinet shells, but also for cupboards and walls on wall stripping or support pins. Using quality German drawer runners the TrayShelf can now be made as a PullOut TrayShelf for wall units, double-sided gondolas and wall stripping. We also have two robust drawer cabinet systems. The DualDrawer Cabinet can be used

as a multi-drawer system for slow movers as a free-standing cabinet or under a bench. It has drawers divided longitudinally into two compartments with dividers separating ethical products within each compartment. The FlowDrawer Cabinet is a single compartment drawer that gravity feeds ethicals laterally towards a clear acrylic shelf front. More recently we have introduced a range of fixtures for the front of shop. These are all quality Wall Bays, Island Gondolas with heavyduty Brackets and Flat Wire Shelves. We also provide the accessory items, like Mounting Strips and Front Risers to clip Product Dividers in order to give pharmacists better shelf management even on flat shelves.

Editor: What are your specific goals and objectives for FlowSell in 2014? John: We know we can only grow as long as we continue to pioneer new innovative products that set the benchmark for dispensing medications and merchandising retail products. We understand that current circumstances are putting pressure on pharmacy profits and that capital items must remain affordable. Every week around Australia, with our network of partner companies, we are installing a merchandising system somewhere in Australia. As the Australian supplier of quality products at competitive prices, our mission is to better service pharmacy so we can grow together.

Editor: How do you continue to maintain the drive to innovate? John: The last five years have probably been our most productive in terms of innovation. Our philosophy is to innovate, not to imitate. So we have recently developed a TrayShelf that uses a new FastFit Divider system that is used across all products in our pharmacy range.

For orders and customer service T: (03) 9708 2276 1/13 Network Dr,

www.flowsell.com.au

Carrum Downs VIC 3201

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 34 : FEBRUARY / MARCH 2014

Category Review

Cramps in Elite Sportspeople BY SEAN TUNNY Editor, Gold Cross Products & Services Pty Ltd

A common condition that impacts sportsmen and women to varying degrees is cramping. The precise definition of a cramp is a “painful involuntary contraction of a skeletal muscle or muscles, typically caused by fatigue or strain”. For those of us that have suffered a cramp, although often harmless and typically affecting pregnant women, people over 60, those on certain medications and sportspeople, they are certainly not pleasant for those impacted. Dylan Cooper has over 12 years of mountain bike racing experience at the highest level; from cross country and short track racing to team and endurance events. After winning the Junior National Championships and National Series, and representing Australia at the World Championships twice as a junior, Dylan became ill and had 6 years off his bike. Since making a comeback, he’s raced for Australia 5 times as an elite athlete, won many National XC races, coveted Australian National XC and Short Track Series on two occasions, while also winning the Japan National Series. With an array of World Cup and World Championship races, Dylan has vast experience and is now racing in the endurance scene in Australia. In 2012, he proudly won the National XCM (Marathon) Series.

“There have been countless races where I’ve been set for the win, only to have a cramp end my chances.”

I recently had the opportunity to chat with Dylan, as an elite cross country (XC) and endurance mountain bike rider, who has experienced cramping to varying degrees throughout his sporting career.

Editor: Congratulations on your successful career to date Dylan. As Pharmacists reading this interview, they are well versed in the physiological condition referred to as a cramp. As an elite sportsman, how have you been impacted by cramps? Dylan: Thank you. Cramps are the bane of my racing life. There have been countless races where I’ve been set for the win, only to have a cramp end my chances. This traditionally occurs very abruptly of course. Other failures in preparation and fitness impact results, but are normally more subtle, perhaps moving me back a few positions in a race. But cramps are so crippling that merely getting to the finish line becomes a challenge. I’ve tried every method under the sun to keep them at bay and have realised that I need to be quite precise in how I manage myself to avoid cramping.

Editor: In an endurance sport such as cycling, specifically mountain biking, the aerobic and anaerobic energy systems are frequently called on. Exercise associated muscle cramps often affect only those muscles being used extensively for the specific sport, in your case the legs in cycling, namely the calves, quadriceps and hamstrings. Has this been your experience?

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Dylan: Those three muscle groups are definitely the ones that cramp before any others. And, of course, once one group begins to cramp, the overcompensation effect means the others soon follow. The nature of mountain biking – riding position, terrain, distance, and intensity – makes it very difficult for riders to maintain form and spread the workload of those muscle groups evenly.

Editor: What precautions and/or preparations do you make to your training, diet, nutrition, hydration and program in general to minimise the chance of cramps? Dylan: Preparation is vitally important for minimising the chance of cramping. Whether I’m fit or not, or if it’s hot or cold, hydration is the number one factor. Simply drinking water or cheaper generic sports/energy drinks does nothing to help my level of cramping. In my experience, a high quality, easily absorbed sports electrolyte drink containing the right balance of salts, magnesium, potassium and other key ingredients is the only effective hydration source that works. Training and general conditioning is the next main factor. Not only fitness gained from training in general, but ‘race fitness’ which comes from riding at the same intensity, for the same distance, using the same muscle groups as you would for your goal race. I can ride 1000 km per week, but if that doesn’t involve regular ‘race simulations’ I’ll still suffer cramps in racing. Those ‘race simulations’ include eating and drinking what I would in my goal race, in order to allow the body to adapt to absorbing those nutrients when needed.

Category Review

Editor: During an event, despite your best intentions, you may develop a cramp. Research indicates it is more likely to be towards the end of an event when fatigued. How do you address this during the heat of battle?

“I’ve managed to win races where I’ve cramped in the middle of the race, but rehydrated and rested my muscles enough to restore my chances.”

Dylan: That’s so true. I can always predict the point at which I’m going to cramp in a race. Simply based on how hard I’ve been training and how much I’ve been racing leading up to that race. Once cramps hit, the first thing I focus on is hydration. If my system is lacking electrolytes I’ll quickly prioritise drinking while also reducing riding intensity if possible. Riders are often tempted to stop pedalling, but I find that makes things worse. The best method I find is to maintain a smooth and consistent cadence (rate of pedal revolution), increasing blood flow and stretching out the main muscle groups. I’ve managed to win races where I’ve cramped in the middle of the race, but rehydrated and rested my muscles enough to restore my chances.

Editor: One of the theories over a sustained period has been the correlation between water and salt lost through sweating and in turn electrolyte depletion and dehydration. From a physiological perspective, do you know why some athletes are more susceptible to cramps than others who may rarely or never suffer from the condition? Dylan: To be honest it’s still a mystery to me, but I do believe I’m genetically predisposed to cramps. Incidentally, my father and two brothers suffer the same issues. However, another theory I have is my family have all been brought up to push ourselves beyond our fitness level at certain races. That mental ability to push your body beyond its level of conditioning at that particular point in time does have its consequences I am sure. The only way to minimise those consequences is to be stringent and precise with riding technique, nutrition, hydration, and overall preparation in general.

Editor: Do you think there is enough education and knowledge on this condition? Dylan: I think more research needs to be done on this area in order to pinpoint the exact causes of cramping, even if those causes vary for different people in different situations. I’d really like to see a fool-proof hydration and nutrition formula that pushes aside all the wives tales and becomes a reliable method for combating those dreaded cramps. GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 34 : FEBRUARY / MARCH 2014

Category Review

Arthritis and Fish Oils BY SEAN TUNNY Editor, Gold Cross Products & Services Pty Ltd

“Arthritis can affect people from all backgrounds, ages and lifestyles.”

There are over 100 forms of arthritis and each type of arthritis affects a person and their joints in different ways. Some forms of arthritis can also involve other parts of the body, such as the eyes.

The most common forms of arthritis are:

•• •• •• ••

osteoarthritis rheumatoid arthritis gout ankylosing spondylitis.

In Australia nearly one in five people has arthritis. Anyone can get arthritis, including children and young people. Many people think arthritis is a normal part of getting older. This is not true. In fact two out of every three people with arthritis are between 15 and 60 years old. Arthritis can affect people from all backgrounds, ages and lifestyles. Arthritis affects people in different ways but the most common symptoms are:

•• •• •• •• ••

pain stiffness or reduced movement of a joint swelling in a joint redness and warmth in a joint general symptoms, such as tiredness, weight loss or feeling unwell.

Many types of arthritis can be easily and effectively controlled by modern treatment. Early diagnosis and the right treatment can ease symptoms and may even prevent damage to the joints. Research has led to great improvements in this area. The Arthritis Foundation provides information about arthritis and its treatment, including information about complementary therapies for people with Arthritis. The current reliable evidence from studies of complementary therapies shows that Fish Oils (Omega 3) can help to control

or ease symptoms for some forms of Arthritis. And more specifically that certain types of omega-3 fats can reduce inflammation from arthritis. This may help to relieve joint pain and stiffness in a similar way to non-steroidal anti-inflammatory drugs. Omega-3 fats have NOT been studied in all forms of arthritis but current research suggests omega-3 fats are helpful for people with inflammatory arthritis, such as rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis. There is also evidence that fish oils may help control symptoms of osteoarthritis and lupus (systemic lupus erythematosus). Long-term intake of fish oil has been shown to reduce the reliance on NSAIDs in some cases of arthritis. This can help decrease the risk of side effects from these medicines. Fish oils can also help reduce the risk of heart disease and heart attack. There is some evidence that they may also play a role in preventing and treating depression. Eating foods rich in omega-3 fats may help you to achieve benefits for your heart and general health. However it is unlikely that you can obtain enough omega-3 fats from your diet to reduce inflammation without fish oil supplements. Research suggests the dose needed to reduce inflammation is 2.7 grams of omega-3 (EPA plus DHA) daily. This dose usually requires approximately either:

•• nine to 14 standard 1000mg fish oil capsules or five to seven capsules of a fish oil concentrate per day, or •• 15mL of bottled fish oil or five to seven mL of concentrated bottled fish oil per day.

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Recent studies suggest that daily fish oil supplements which provide omega-3 (containing a minimum of 180mg EPA plus 120mg DHA) may also be useful for osteoarthritis. Different brands of capsules vary in the amount of omega-3 fats they contain so it is worthwhile to compare brands. One should check the label to see the amount of omega-3 contained in each capsule (it may be listed as a total omega-3 or as EPA and DHA, which are two forms of omega-3). Bottled fish oil is generally the most convenient and least expensive way to take the dose needed to reduce inflammation. Capsules are preferred by some people and are more portable when travelling. For a noticeable improvement in arthritis symptoms the patient would need to take fish oil supplements regularly at the recommended arthritis dose for two to three months and if there is no change by then, the supplements are probably not effective for their specific arthritis. A person with Arthritis should always let their doctor and pharmacist know if they are taking any treatments, including fish oils and other natural medicines and should not stop any current treatments without first discussing it with their doctor. Your local Arthritis Office has information, education and support for people with arthritis Helpline 1800 011 041 www.arthritisaustralia.com.au The information in this article is based on an information sheet on fish oils prepared by Arthritis Australia. It is provided for information purposes only and should not be used in place of medical advice.

Serious Sports Nutrition: An Opportunity for Serious Growth

• Prevent and relieve muscular cramps, aches, pains and spasms • Rapidly replaces fluid and electrolytes • Highly absorbable magnesium diglycinate (Meta Mag®) • Easily absorbed carbs for quick energy

Rapidly absorbed for optimum results Endura Rehydration can help improve stamina, rapidly replace fluid and electrolytes, relieve muscular aches and help in the prevention of muscular cramps and spasms. This formula may help with reducing muscle recovery time after intense physical exercise so your customers can achieve optimum results. The Endura Sports Nutrition range provides comprehensive formulas to assist the performance of your sporting customers. With over 11 million* people in Australia participating in physical recreation activity, the Sports Nutrition category provides a great opportunity for growth in Pharmacies as more and more people get serious about their chosen sport. Only available in Pharmacies, Health Food stores and Sports Specialty stores.

DELICIOUS FLAVOURS

Lemon Lime

Orange

Raspberry

Pineapple

Always read the label. Use only as directed. If symptoms persist consult your healthcare professional. * www.abs.gov.au – Australian Bureau of Statistics 2013

TRAIN

HARDER

RACE

FASTER

RECOVER

QUICKER

www.endura.com.au END4242 - 11/13

BUSINESS PROFILE

“Our focus remains firmly on delivering the right information in the right manner for our extensive and varied customer base.”

BY SEAN TUNNY Editor, Gold Cross Products & Services Pty Ltd

MIMS Australia has been publishing medicines information since 1963 and is a leading supplier of trusted, quality, independent medicine information to Australian healthcare professionals.

MIMS is known for its high level of editorial integrity and independence. We recently had the pleasure to speak with Siobhan Murphy, the Country Manager for MIMS Australia, about the company and gain a little more insight into their overall service offering, and direction for the future.

Editor: Can you tell us a little about how MIMS began? Siobhan: In November 2013, we celebrated the 50th birthday of MIMS in Australia. Given the scope of changes in healthcare, medicines development, healthcare funding and computerisation, to be still present and relevant half a century later is a considerable achievement. In November 1963 the first MIMS was published. Mailed each month, MIMS (Monthly Index of Medical Specialties) provided a unique service to doctors and hospitals in Australia, providing prescribers with an abbreviated version of the detailed PI to allow them to make prescribing decisions quickly and efficiently. It was a novel concept at the time – while there were other sources of medicines information available, they tended to be lengthy, complex monographs and many of them were international. For the Australian prescriber, GP and specialist, there was a definite need for quick, convenient, abbreviated information about available medicines.

Editor: From handheld devices to integrating databases into clinical software applications, can you outline some more about MIMS product offering

range along with positioning profile to client’s various needs? Siobhan: Use and access to computers in the healthcare environment accelerated during the 1990s, and MIMS was faced with the challenge of adapting to the new technology and remaining relevant to the needs of the user. The initial version of what was to become eMIMS was launched in 1992 as MIMS on Disk. Originally published as a series of 10 3.5 inch floppy disks, this somewhat unwieldy product was quickly redesigned in the mid to late 1990s in a CD format to become the original version of the current eMIMS. At the same time, the NSW Health department was establishing its health information portal, CIAP, and this provided the impetus for the development of MIMS Online, while GPs were starting to use the first clinical script writing programmes. Key to the usefulness of these programmes was an integratable database of medicines information which interfaced seamlessly with the prescription writing and patient record modules. The MIMS database ably filled this role and was adopted as the reference module of choice by most software developers. Over time, this has expanded to the point where we currently support over 70 clinical application providers supporting GPs, pharmacy, hospitals, ambulance service and others. The growth in the number of formats for MIMS was matched by growth in the range of information produced and in its client base. No longer was MIMS a print product mainly for GPs, and no longer was MIMS only a provider of PIs. By the turn of the century, MIMS was publishing a range of products for GPs, pharmacists, hospitals and specialists.

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Information had moved from being mostly print, to being more structured around digital requirements. Working closely with overseas colleagues, we created the global drug database, a common data structure across the MIMS products internationally. We had also learnt from our users of the need for evidencebased decision support products, so the first version of an independent drug-drug and drugallergy interaction programme was developed and made available to subscribers. In many ways, the shape of the MIMS business today was cast by the events in the late 1990s. Currently, the MIMS digital product range includes: iMIMS, MIMS Mobile, eMIMS, MIMS Online & MIMS Integrated. We continue to print both the MIMS Abbreviated & Annual—MIMS also publishes the IVS for Veterinarians.

Editor: With the ongoing and often rapid advances in information delivery, how does MIMS stay abreast of this? Siobhan: Our subscribers range from state health departments to universities and research institutions, including pharmacists, GPs, specialists and nurses. In response to the changing needs of our audience, our products now encompass a range of information. The core of the database is the PI and CMI, but this is supplemented by other information that provides value in context, for example: pregnancy information, use in sport, gluten and lactose status. MIMS has a dedicated IT team locally in Sydney, and also in Singapore that ensures we deliver the MIMS content in ways that

BUSINESS PROFILE

meet our users’ needs. Maintaining contact with our end users to engage them in product development through conferences, surveys and focus groups also provides MIMS with direct end user feedback.

is the confidence our end users have in the MIMS brand, delivering trusted, quality and independent medicines information. MIMS takes pride in listening to our end users and working to deliver products that meet their needs.

A recent example of delivering on our customers’ wishes is the redevelopment of the much loved eMIMS CD product, and our focus on developing for both mobile technology and integrated data in the acute care environment.

In 2014 we will continue to build on the foundations that have been established over the past 50 years. We continue to see high quality, relevant, independent editorial as of the utmost importance. Over the past 18 months we have collaborated with the University of Sydney, through its partner IMgateway, to deliver the first Australian evidence-based drug-herb and drug-food interactions tool in eMIMS and with the Society of Hospital Pharmacists to deliver their database of medicines that should not be crushed (“Don’t rush to crush”) to many hospitals through the MIMS Online product. The NPS Radar report is available through many MIMS products and we have incorporated the TGA’s adverse event reporting form, to aid with the efficient and timely collection of information around the safe use of medicines. We have mapped MIMS to the AMT and deliver this regularly to our partner vendors as a service.

Editor: Can you tell us a little bit about your partnership with pharmacy in Australia? Siobhan: The team at MMS has a close relationship with pharmacy both within the community and the acute care markets. We partner with the Pharmacy Guild, the Pharmaceutical Society of Australia and Monash University to supply free access to eMIMS for interns and students. Our sponsorship of the Intern of the Year Award in NSW and Victoria have proved very successful and this year we plan to roll this program out to other States for the first time.

Editor: MIMS recently celebrated their 50th birthday in Australia. Given the frequency, scope and volume of changes in medicines development, healthcare funding and computerisation, to be a driving force after such a period is a considerable achievement. What do you believe are the key elements behind the continued growth and success of MIMS? Siobhan: The key element to the success of MIMS over the last 50 years in Australia

An experienced IT team and developers have ensured that MIMS is able to stay up to date with an eye on the future with how we deliver MIMS.

Editor: What are the specific goals and objectives for the MIMS business in 2014 and beyond? How do you hope to achieve these? Siobhan: Over the past 50 years, MIMS’ success has been based on the simple premise of meeting the needs of healthcare professionals with convenient, reliable, high quality, independent information. Be it PI, CMI, interactions or any other of our modules, we have not strayed from these core values nor do we intend to do so in the future. Our focus remains firmly on delivering the right information in the right manner for our extensive and varied customer base. The new eMIMS which is recommended text for 3 different areas of content and usage will demand attention this year. Helping the change to a new version of this much loved product is important so we are developing training modules with CPD points for pharmacists. We intend to have a presence at all the major conferences and will use the opportunity to talk to our users and ensure we are “on track” to meet the evolving needs of this group of customers.

For orders and customer service Client Services

www.mims.com.au

T: 1800 800 629

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 34 : FEBRUARY / MARCH 2014

DOWN TO BUSINESS

Building loyalty through

Compounding Peter Saccasan FACP FCA CTA Director of Pharmacy Services, RSM Bird Cameron Chartered Accountants

With dispensary profits being attacked, pharmacy owners are looking for improvements to their business model to restore and maintain the business profits on the bottom line. Whilst script volume continues to be steady for most, it needs a good increase in script volume to replace lost GP$ from PBS reform.

There continues to be the compelling need to build a health offer that extends the range of services and products available to your customers. This entrenches the pharmacist’s position with the customer as the number one point of reference for all things health. One of the services making a comeback is that of compounding. Remember those pharmacology skills that were taught at university but then no longer used because our drugs come ready to go? In this day of iPhone, Youi car insurance, Myspace, iiNet, and personal bankers, designer drugs – and I mean tailored medicines of the legal variety – are certainly not out of place and no longer a surprising option to the consumer. Medicines-by-design can be an attractive offer to consumers and provide a supporting role to the individual diagnosis made by their medical practitioner. With the plethora of specialists that consumers can be assessed by today, the market for specific strength / dosage / directed / balanced medicines is ever present.

As with all services, compounding can be approached in many ways—big and small. There are those who go all out, with a designated lab upstairs taking up half a floor above the pharmacy, down to those who put a piece of granite next to the dispensary sink and call that the compounding area. But those who have approached this service with some care and detail are reaping good rewards. How does compounding fit in? If you go about creating specialty, you can actually draw customers to your pharmacy from outside of your normal draw area. These are customers who ordinarily may not even know your pharmacy exists. However, because of your focus on a niche and your marketing, these customers who don’t live in the area, but need the medicine you compound will visit or contact your pharmacy to obtain their medicine. This drives a high-margin service which will assist your business’s bottom line. In addition, these are customers to whom you have the opportunity of increasing the

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basket size and upselling on items relevant to their particular need, not to mention possibly increasing sales of general pharmacy items they may pick up when they are in your pharmacy. Alternatively, you may not have a strong compounding niche but do provide those general compounding scripts which your existing customers may be obtaining from elsewhere. This helps anchor your existing customers with you and increases the gross profit you are obtaining from those customers. Compounding places you effectively in the position of being the manufacturer, so the gross margin and contribution to the pharmacy is healthy. And with the range of issues facing pharmacy owners now, this is one service that can make a difference. How do pharmacy owners move into compounding? You can start small and work your way into the market. One way is to investigate the PCCA approach – Professional Compounding Chemists of Australia. They provide tailored training, establishment processes, product and ongoing support.

DOWN TO BUSINESS

“Compounding places you effectively in the position of being the manufacturer, so the gross margin and contribution to the pharmacy is healthy.” This can be a one-stop shop for owners to investigate and implement this service. A compounding service is only fully leveraged if you then make your store talk and provide products which are complementary to the drugs being dispensed. Just as many owners are taking steps now to link the dispensary to the front of store to leverage dispensary sales—drugs coming out of the compounding lab should be channelled the same way. What products are complementary to the drugs I am compounding and illnesses I am treating?

with. This will also assist in ensuring that you merchandise your store to take advantage of the customers you will seek to attract to this service. Compounding actually puts you in the position of knowing the type of customer you will attract and deal with. This may not always be said for the general customers you attract to your pharmacy.

Ultimately, to build the compounding business, your potential customers need to know you are in the business in the first place. If you are going to lay out the investment to set up the business, it makes sense that you have a business plan which includes a business development and marketing plan that will help the business to grow—again, PCCA can provide assistance with this. By carefully approaching this market, you can properly understand the customer you are targeting and dealing

As with any new venture, you should ensure you measure the outcome of your investment of time and resources. Gross profit on dispensary scripts is a good measure to start with. Other key inputs to the service include technician and pharmacist wages, as well as any direct marketing and associated costs. As the service grows, you should be sure to measure the returns after all direct costs, including additional labour that is directed to the service, direct material

costs, fit-out costs and marketing costs. You should also keep track of the basket size of sales to compounding customers and ensure that your staff are maximising the sale opportunity. If compounding is approached in the right manner, it can be a huge boon to your pharmacy business. Not only can you grow and develop sales in higher margin medicines, but you can create demand for related products, enhance the pharmacy’s positioning as a health provider and further entrench this image in the minds of your customers. With space being a fixed cost, the more GP$, including dollars from both sales and services, that you can generate, the better outcome you will achieve on the bottom line of your pharmacy. Compounding is one area that can make a healthy contribution to this.

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TRAINING AND EDUCATION

Nutrients key during pregnancy for Australian Women BY SEAN TUNNY Editor, Gold Cross Products & Services Pty Ltd

While the importance of nutrition and supplements are well documented, we recently had the opportunity to speak with Associate Professor Lesley Braun, Director of the Blackmores Institute regarding key nutrients for mother and child during Pregnancy. Editor: Why is it important for expecting mothers in Australia to consider a supplement? Lesley: Research has shown that many Australians do not receive adequate nutrients from their diet alone. The Australian Food and Nutrition Report (2012) highlighted that more than 9 in 10 people aged 16 and over do not consume sufficient serves of vegetables, and about 50% do not consume sufficient serves of fruit. Many Australian women are therefore not meeting the recommended daily intake (RDI) of key nutrients for a healthy pregnancy. And a supplement that reflects current Australian recommendations for pregnancy should be considered by expecting mothers to ensure sufficient nutrient intake and a healthy pregnancy. It is critical that a pregnant woman understands the significant influence that nutrition has on the health outcomes for her baby, not only for their immediate but also long term health. For example iodine deficiency during pregnancy and breastfeeding has a negative effect on the brain and nervous system of unborn children and infants, in particular reduced intelligence. This has led to the NHMRC recommending that all women considering pregnancy, or who are pregnant or breastfeeding take an iodine supplement of 150 mcg/day. Vegetarian and vegan women should also supplement with vitamin B12. There is also emerging research on the importance of probiotics intake in pregnancy having beneficial effects in atopic conditions such as eczema.

Overall, supplements specially formulated for preconception needs are a means of improving a woman’s overall nutritional status to support healthy conception and foetal development, and are particularly important where the diet is inadequate.

Editor: What should a pharmacist consider when recommending a pregnancy supplement? Lesley: Pharmacists are in a key position to be able to guide customers to supplements that best meet their needs based on Australian recommendations and provide information on other important considerations such as a healthy well-balanced diet including fresh fruits and vegetables, avoiding alcohol and smoking, and being mindful that fish may contain high levels of mercury. Any co-morbidities and other individual requirements should also be considered and incorporated into the woman’s health management plan. Women need to understand the significance of good nutrition during pregnancy and take a supplement as required. Current Australian recommendations and research into nutrient requirements during pregnancy for Australian women should be considered by pharmacists and used as a guide for dosage. For example, it is recommended women in Australia take a daily supplement with 500 mcg of folate at least one month prior to conception and in the first trimester to reduce the risk of having a baby with neural tube defects. As mentioned, a daily supplement of 150 mcg/ day of iodine is also essential. The pharmacists should also consider the role of probiotics.

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A woman’s iron levels should also be assessed during this period, with an iron supplement only recommended when a deficiency has been clearly demonstrated. It is worth noting that iron requirements in pregnancy do increase, with the RDI set at 27mg/day, so encouraging women to eat a diet rich in iron is of benefit. Other nutritional factors to consider are adequate zinc, vitamin D, and Omega-3 fatty acids.

Editor: Ongoing research into nutrient deficiencies during pregnancy in Australia suggest that Australian mums are at risk of low levels of key essential nutrients including iodine, iron, folate and vitamin D. What specifically occurs during pregnancy that causes such a risk in these nutrients? Lesley: Nutritional demands of many essential nutrients are increased during pregnancy and breastfeeding due to alterations in the mother’s tissues and metabolism, and the mother supporting healthy foetal and infant growth. Breastfeeding also increases demand as nutrients are lost through the breast milk. A variety of nutrients are needed for healthy conception and for the very early stages of foetal development. It’s important to note that the overall nutritional status of the mother at the time of conception and during the first trimester is critical to the short and long term health outcomes of her baby. Diet alone may not provide sufficient nutrition to meet these nutritional demands, in particular iodine and folic acid.

TRAINING AND EDUCATION Iodine is of critical importance during pregnancy for the healthy development of the brain and nervous system. During pregnancy the thyroid is particularly active, producing about 50% more thyroid hormones than usual. To produce enough thyroid hormones to support the mother and foetus, the mother needs to increase her iodine intake. And in Australia we are seeing an increase in the prevalence of iodine deficiency. This is frightening as event mild iodine deficiency is associated with clinical sequelae.

Editor: Some would argue and perceive that if a little is good then a lot more must better. When considering supplements, this is not necessarily sound advice. Can you please outline a little more? Lesley: Yes, more of something is not always better and this is certainly true when it comes to supplementation during pregnancy. As the nutritional status of the mother is critical to the health of her and her baby it is integral pharmacist recommend a supplement that takes into account her specific diet, climate and lifestyle. With this in mind it is important that pharmacists look to recommend pregnant

women in Australia supplements that have been formulated with the Australian guidelines of key nutrients for pregnant women in mind. A pharmacist is best prescribing a supplement that provides the recommended base line of nutrients to complement their diet and that then enables a woman to take additional supplementation when required. For example not all pregnant women need additional iron supplementation. But a woman diagnosed with iron-deficiency (anemia) will need to supplement. Unnecessary supplementation of iron can cause excess iron build up in the body leading to negative gastric symptoms and in the absence of appropriate storage or chelation, can readily participate in the formation of toxic free-radicals, inducing oxidative stress and apoptosis. Long-term excessive iron intake can result in negative health effects for both mother and baby.

Editor: An iron supplement during pregnancy may cause constipation as a direct side effect. How and why does this occur and what may Health Care Professionals advise customers to reduce such side effects?

Lesley: As mentioned it is important to establish need prior to iron supplementation, so check this with your customer in the first instance. If your customer has been recommended an iron consider the dose, the form and when it’s being taken. It is well documented that some iron supplements can cause gastrointestinal disturbances such as nausea, diarrhea, constipation, heartburn and upper gastric discomfort. These negative effects are most commonly linked to high doses of iron supplementation with the severity and frequency influenced by the amount of elemental iron released in the stomach. The upper limit set by NHMRC for iron in pregnancy is 45mg/day. It is interesting to note that research is indicating iron deficiency anemia may be effectively managed with intermittent low dose iron. Pharmacists may also wish to recommend supplements containing low-constipation forms of iron such as ferrous bisglycinate which has been demonstrated in pregnancy to be associated with fewer side effects and superior absorption to ferrous sulphate. To reduce the likelihood of constipation it is suggested women should take iron supplements with food.

Every manager knows the importance of meeting labour cost budgets, keeping accurate attendance records and maintaining compliant payroll. ClockOn Australia invites you attend a complimentary webinar at which you can learn more about the latest in Rostering, Attendance and Payroll systems for Pharmacy.

ClockOn Rostering, Attendance & Payroll Webinars will be held monthly at 11am (AEDT)

• Feb 4th • March 11th • April 8th • May 6th • June 3rd For more information contact ClockOn Australia on 02 4344 9444 or email: sales@clockon.com.au

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MYSTERY SHOPPING

The Mystery Shopping Program – Why is it so important?

HELEN STRACHAN

Shenee McCormack

Pharmacy Practice Officer The Pharmacy Guild of Australia, Queensland Branch.

QCPP Pharmacy Liaison Officer

Why do we get mystery shopped in pharmacy? It’s a great question and it’s important for all pharmacy staff to have an awareness of the underlying principles of the program.

Quality Care Pharmacy Program (QCPP) accredited pharmacies saw the introduction of the mystery shopping program in 2002. The program was designed to ascertain how well protocol questioning was used during the sales of pharmacy and pharmacist-only scheduled medicines.

the schedules as they were? Two separate OTC schedules are undeniably beneficial to the health system and to the Australian public. The system alleviates pressure on Medicare and other services, as well as provides increased access and convenience to patients needing these medicines.

Primarily the program assists pharmacies with improving their performance and training staff; however, in the past it has allowed the industry to demonstrate the value pharmacy adds to the provision of over-the-counter medicines. In 2010, The National Coordinating Committee on Therapeutic Goods (NCCTG) requested information from the Guild to justify the continuation of the pharmacy and pharmacist-only scheduling. The collated mystery shopping program results from the beginning of the program assisted with the NCCTG recommending continuation of the schedules. But why was it important to retain

In our continuously evolving industry it is important that pharmacies review how well staff interact with patients, gather information before the medicine is supplied and ensure that the patient understands how to use it for their relevant condition.

How does mystery shopping work? A Standard Maintenance Assessment (SMA) is where a mystery shopper will visit the pharmacy and an audio recording of the interaction takes place. Once the visit is complete a Pharmacy Liaison Officer from

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the Guild will then discuss the outcome in person with the proprietor or manager. Once the visit is complete the report and audio-recording are submitted to the Australian College of Pharmacy where an independent pharmacist ensures the on-site scoring of the interaction is correct. Following this review process a feedback letter is sent to the pharmacy with a final score as well as valuable information on how your pharmacy compares with others. This information provides the opportunity to review what the store did well and what areas require attention. It’s important for staff to know how they are performing. Sometimes it’s not until you see a report that you realise which products and conditions staff need further training on. It happens often enough that staff will be ‘on the ball’ when they know a mystery shop is due as the pharmacy has received a letter notifying them a random

MYSTERY SHOPPING

“In our continuously evolving industry it is important that pharmacies review how well staff interact with patients, gather information before the medicine is supplied and ensure that the patient understands how to use it for their relevant condition.”

assessment will be taking place in the near future. Imagine what the service levels would be like if we treated every customer as if they were a mystery shopper!

Scenarios There are 3 main types of requests used during a SMA. 1. Symptom Based Request: This is where the mystery shopper presents with a set of symptoms e.g. “Could I have something for sneezing and a runny nose?” 2. Direct Product Request: This request could be for either a pharmacy or pharmacistonly product. The mystery shopper will ask directly for the product by name e.g. “Could I please have a box of aspirin?” 3. Blended Request: In a blended request, the mystery shopper asks for a product by name and follows up with a question about that particular product e.g.

“I am having trouble sleeping and a friend recommended Dozile, is that any good?”

Adhering to Protocols As in any industry there are policies, procedures and guidelines to follow and pharmacy is definitely no exception to that. What-Stop-Go, Ask Assess Advise or Career are some protocols which are designed to assist staff to ask the right questions, gather information, select the right product and provide accurate advice. Asking these questions will also determine whether the customer needs to be referred onto the pharmacist.

Want to know more? In addition to the SMA, which happens under the rules of QCPP at least once a year for accredited pharmacies, the Pharmacy Guild of Australia Queensland Branch offers an additional Mystery Shopping Evaluation Service

to Guild Members. This service is an accurate, reliable and inexpensive way to monitor quality control and customer service standards in your pharmacy. We work with pharmacy owners to develop scenarios in the areas of their business which they want to examine.

For more information about this additional service contact the Queensland Branch on (07) 3831 3788.

Where can I find more about training on the supply of pharmacy and pharmacist-only medicines? Easy – just go to http:// www.qcpp.com/resources/trainingrequirements#refresher

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GUILDCARE

“Who is better equipped to assist patients with adherence than a pharmacist, whom patients see on average four times more than their doctor?”

Tackling Adherence BY ROMA CECERE General Manager – Strategic Business Performance, GuildCare

“Drugs don’t work in patients who don’t take them”, quote by C. Everett Koop, MD — could not be more to the point. The question is – What can Pharmacists do to assist patients with compliance to their prescribed medication regime? Our answer is – Who is better equipped to assist patients with adherence than a pharmacist, whom patients see on average four times more than their doctor? Through GuildCare, pharmacists can easily identify patients who are non-adherent, and who qualify for several sponsored and generic Compliance and New to Therapy programs. GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 34 : FEBRUARY / MARCH 2014

GUILDCARE

Why is adherence so important? Patients who struggle to use medication appropriately may limit a drug’s effectiveness, and as a result experience poor health outcomes and raise overall healthcare costs. In addition, with an ageing population, we know it is highly likely that there will be a growing number of people diagnosed with chronic diseases, and ensuring patients take medication as prescribed will be important to achieve effective treatment outcomes.

What can we learn from global trends? In the USA, pharmacies are repositioning as health and wellness centres, with a focus on professional services. Pharmacists deliver comprehensive medication reviews when conducting a Medication Therapy Management (MTM) program, which to some degree is similar to Australia’s MedsCheck Services program. MTM is a service or group of services with an objective to optimise therapeutic outcomes for individual patients. The UK’s New Medicines Service (NMS) is another great example of pharmacists assisting patients with adherence. This service is designed to increase patient adherence to newly prescribed medications for their chronic conditions, which in turn will lead to better engagement with their treatment and greater health outcomes. Medicines Use

Review (MUR), similar to Australia’s MedsCheck Services, helps patients understand their therapy and the importance of maintaining adherence to a prescribed medication regime.

Where is Australia heading? MedsCheck services were launched in July 2012, as part of the 5th Community Pharmacy Agreement under Medication Management. GuildCare’s MedsCheck Services program has proven to be popular amongst pharmacists. To date, over 80% of Australian GuildCare pharmacies are subscribed to MedsCheck Services. The objective of the service is to provide an in-pharmacy review of a consumer’s medicines, focusing on education and self-management aiming to enhance quality use of medicines.

How can GuildCare assist? Apart from MedsCheck Services, GuildCare provides pharmacists with many Patient Support Programs that are beneficial to patients who are newly initiated to a medication or who are non-adherent to a prescribed medication regime. In 2013, GuildCare redesigned all New to Therapy and Compliance programs from the Mirixa platform onto our user-friendly GuildCare platform. Patient Support Programs are molecule specific, and are designed to address the specific issues known to hinder adherence

to that particular medication – whether that be patient understanding of the medication, using a device correctly, forgetfulness, side effects etc. Patient Support Programs can be branded or generic, and vary in content and structure for each molecule based on the issue they are aiming to address. Additionally, within GuildCare’s New to Therapy and Compliance programs we now have the ability to offer follow-up options. These options include SMS Prescription Reminders and/or a GuildCare Pharmacist Follow Up phone call. Not all programs have both options available – again, it depends on the molecule and barriers to adherence being addressed. All follow-up options are provided on behalf of your pharmacy, aiming to maintain patient loyalty by continuing to support your patient once they leave your pharmacy.

What’s next? GuildCare continues to expand its range of Patient Support Programs, with Compliance and New to Therapy in the pipeline.

If you would like to know how we can assist you in implementing these programs within your pharmacy, please email us at support@guildcare.com.au.

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RETAIL FOCUS

“One thing I realised very early on is that you can’t be everything to everyone and it is unsustainable to achieve the best terms with every supplier.”

What Will 2014 Bring to You? BY SIMON HAMBRECHT Director of Pharmacy Essentials

Welcome to the New Year! I hope that you all had a wonderful Christmas – trading wise as well as personally. Following on from last year’s series on developing your own retail strategy, this year I will guide you in going to the next level of analysis. Throughout the next 5 editions I will be outlining to you 5 strategies to better analyse the performance of your businesses.

Let’s get started! Before we do though, I would like to thank those of you who contacted me last year wanting more information on building your retail strategies. I hope the information helped you in achieving strong sales over the Christmas period.

With each edition in 2014 I will cover the following topics: 1. The Importance of Accountability and Follow-Up 2. Improving Performance Retail Sales Through the Dispensary 3. The Need for Stock Budgets 4. Measuring Wages Performance Against Sales 5. The Use of Appraisals to get the Best From Your Team

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I have come across pharmacies in my travels that operationally are very savvy with clear cut processes to carry out various tasks throughout their businesses, yet they are still experiencing issues throughout the business. The main reason these businesses continue to have ongoing issues, irrespective of whether or not there are documented processes in place, is due to a low level of staff accountability and follow-up from their management.

We all have a Retail Manager or Pharmacy Manager in place (most of the time); however, have you ever stopped to train them in effective management processes. It is difficult to ask these key personnel to instill a high level of accountability throughout their teams. If we don’t train these people properly and give them the correct tools from the outset, then to implement a culture of high accountability throughout your business is doomed from the start. One of the simplest ways to increase the level accountability throughout your team starts from the moment we delegate a task to a Team Member. We need to ensure there is a clear instruction given to the Team Member. To do this, the person issuing the task needs to: 1. Detail what the task is – talk the team member through the task and outline what the expectation is. 2. Demonstrate the task to the team member – show them what is required and how to complete the task. 3. Set the time frame for the task to be completed – this should be a reasonable length of time and take into consideration anything which may have an impact on this time frame. You need to allow for the

time it may take to serve customers, any team member breaks and peak trading periods. 4. Check the team member understands the task – ask them to repeat back your expectation. 5. “Touch base” with them – throughout the task, follow-up to see how they are progressing with the task. This will allow you to monitor progress as well as correct the team member if the task isn’t being completed the correct way. I’m sure you will agree there’s nothing worse than a team member taking a lot of time to complete the task only to later find out it was completed incorrectly. 6. Sign off the task – once completed, review the task with the team member and give any feedback you may have to them. This process will create the culture throughout your business of high accountability. You want them to know that every action will be critiqued and praise given where necessary. So what happens when a task isn’t completed to the desired standard? When giving feedback to the team member, be honest, and let them know the areas they have failed to meet the required standard. Ask the team member what their interpretation

of the task is so you can understand their perspective and then ask them to carry out the task again to the desired standard. When completed, review the completed task again and ensure it has been completed to the desired standard. If the task still isn’t completed in a satisfactory standard, make a note of it as it will need to be addressed in the team member’s next appraisal (more on this later in the year). By following this process consistently with every team member you will create a culture throughout the business of high accountability, therefore increasing the overall performance of your business. When next on the sales floor, take the time to observe how your team interacts. How are tasks being delegated to the team? Are they being completed in a realistic time frame and are completed tasks being followed up? Remember, accountability needs to occur at all levels throughout the business! If you would like to know more about how culture of accountability can have a positive impact on your business, feel free to contact me at simon@pharmacyessentials.com.au.

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WHAT’s NEW & company news

Ethical Nutrients Ethical Nutrients is proud to announce the addition of three new products to our evidence-based range; Inner Health Immune Booster for Adults, Allergy Control, and Extra C Zingles. There is also an exciting upgrade to one of our most popular products; Bone Builder with Vitamin D Powder is now a delicious chocolate flavour and is dairy and lactose free. >> www.ethicalnutrients.com.au

INNER HEALTH IMMUNE BOOSTER FOR ADULTS (NEW) – FOR ADULTS WHO GET SICK OFTEN

“By applying cutting-edge analytics and proprietary application suites hosted on the IMS One intelligent cloud, the company connects more than 10 petabytes of complex healthcare data”

IMS Health IMS Health is the world’s leading information, services and technology company dedicated to making healthcare perform better. By applying cutting-edge analytics and proprietary application suites hosted on the IMS One intelligent cloud, the company connects more than 10 petabytes of complex healthcare data on diseases, treatments, costs and outcomes to enable our clients to run their operations more efficiently. Drawing on information from 100,000 suppliers and on insights from more than 45+ billion healthcare transactions processed annually, IMS Health’s 9,000+ expert resources drive results for over 5,000 healthcare clients globally. Customers include pharmaceutical, medical device and consumer health manufacturers and distributors, providers, payers, government agencies, policymakers, researchers and the financial community.

Immune Booster for Adults contains two clinically trialled strains that have been shown to reduce the incidence and severity of the common cold. When taken daily Immune Booster for Adults may help reduce the number of sick days due to colds, and also reduce the incidence of acquiring more than one cold episode. This product is recommended for adults who get sick often for a duration of 12 weeks, after which they can take Inner Health Plus ongoing to maintain a normal healthy immune system.

ALLERGY CONTROL (NEW) – CLINICALLY SHOWN TO REDUCE THE INCIDENCE AND SEVERITY OF ALLERGIES Australia has one of the highest prevalence rates of allergies in the world, with up to 20% of the population affected by allergic rhinitis/hay fever. Allergy Control contains the exclusive probiotic strain Lactobacillus paracasei (LP-33TM) which is clinically trialled in allergic rhinitis and may assist with reducing allergic sensitivity and relieving the symptoms including a blocked, itchy runny nose; sneezing; itchy and watery eyes; puffy and sore eyes, and an itchy throat.

EXTRA C ZINGLES (NEW) – DELICIOUS ORANGE FRUIT TINGLE FLAVOUR CHEWABLE VITAMIN C Extra C Zingles are a great tasting, chewable, buffered vitamin C supplement which contains 1000 mg of ascorbic acid and includes zinc to assist a healthy immune system. Featuring a convenient break bar to separate adult and child doses, this will be a supplement that everyone in the family will want to take. Extra C Zingles are gentle on the stomach and teeth, and may reduce the severity and duration of colds, relieve the symptoms of colds and flu as well as treat and prevent vitamin C nutritional deficiencies.

Trust in IMS Health for the expert provision, management and analysis of healthcare information. >> www.imshealth.com

PLACE YOUR NEWS You are welcome to submit your latest product launch, company news, information and/or updates of other pertinent information 200 words or less for positioning in this section of ITK. Please forward all content to Candice Radford on E-mail: Candice.radford@goldx.com.au

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WHAT’s NEW & company news

MAKING FRIENDS WITH FEVER Understanding the benefits of fever in children and dispelling the common myths Pharmacists and pharmacy assistants play an important role in educating parents about fever in children, according to Dr Tatiana Lowe, emergency physician at Manly Hospital, Sydney. “As healthcare professionals, we need to treat the discomfort of a child’s fever not the fever itself. Parents need to understand that fever is a normal physiologic response and it’s more important that they monitor their child’s pain symptoms such as crying or screaming, irritability or changes in their sleeping patterns.” “Pharmacists need to gently remind parents that if their child has a fever less than 39.50C, it’s unlikely they are experiencing too much discomfort at all.”

“Pharmacists need to gently remind parents that if their child has a fever less than 39.50C, it’s unlikely they are experiencing too much discomfort at all.”

Healthcare professionals and parents who prefer using medicines to treat young, unwell children with fever are advised to try ibuprofen first2. Ibuprofen has been proven to achieve faster and more prolonged fever relief in the first four hours compared to paracetamol. Nurofen for Children is the #1 Children’s Analgesic brand3, and relieves many types of children’s and babies discomfort, including discomfort caused by fever, and lasts for up to 8 hours4. Specifically formulated for children from 3 months to 12 years, Nurofen for Children is sugar-free and contains ibuprofen to rapidly tackle the symptoms of pain and fever within 15 minutes4. Red flags to look out for include age of 3 months or younger, headaches and vomiting, seizures, any history of immunosuppression, and importantly, when a parent insists that their child is sick.

>> For more information, please contact Ashley Coote at Health Haus Communications on (02) 8353 5767 or ashley.coote@healthhaus.net.au REFERENCES: 1. T. A. Mace, L. Zhong, C. Kilpatrick, E. Zynda, C.-T. Lee, M. Capitano, H. Minderman, E. A. Repasky. Differentiation of CD8+ T cells into effector cells is enhanced by physiological range hyperthermia. Journal of Leukocyte Biology, 2011; vol. 90, no. 5, pp. 951-962 DOI: 10.1189/jlb.0511229 2. Hay, A et al. Paracetamol plus ibuprofen for treatment of fever in children (PITCH): randomised controlled trial. BMJ 2008; 337: a1302. 3. MAT (value) 17/11/13 4. NFC Parents Guide. 2011.

Paper-Pak Do you need an environmentally friendly carry bag that is strong, easy to fill, looks great and meets increasing legislation around plastic bags? Paper-Pak, a leading manufacturer of paper bags can meet all of those requirements with the introduction of a new Paper Carry Bag that is Pharmacy Guild branded for your use. Paper-Pak have been supplying The Pharmacy Guild with satchel, foil and prescription bags for many years and are proud to now bring you, the new Ask Your Pharmacist branded Paper Carry Bag. The Carry Bag has strong handles that tuck inside of the bag for easy storage; it holds up to 10kg of weight and sits nicely on your countertop for filling. More importantly it is Australian made, 100% recyclable, refillable and re-usable.

Paper-Pak will be available at the APP Exhibition to provide you with further information, samples and guide you through our online ordering option. So, stop by stand #43 at the APP Conference and Exhibition to find out more about the Carry Bag and enter the competition. Alternatively, you can view the bags online at www.paper-pak.net. To find The Pharmacy Guild products on our website, go to products > customer specific > Pharmacy Guild and enter username ‘Pharmacy’ with password ‘Guild’. >> www.paper-pak.net Australia Free Call 1800 088 258

Paper is our world; and by purchasing a carton of the Carry Bags and telling us what material the Bags are made from, you can enter the draw to win flights and two nights’ accommodation for two in Hamilton Island. Enter by visiting Paper-Pak at stand #43 at the APP Conference and Exhibition where full Terms and Conditions of entry are available.

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WHAT’s NEW & company news

Nature’s Own announces new partnership with Channel Nine’s The Block Nature’s Own has announced a new partnership with Channel Nine’s ‘The Block’, hitting television screens on Monday, 27 January 2014. Luke Fitzgerald, Director of Sanofi Consumer Healthcare the makers of Nature’s Own said the partnership marked an exciting start to 2014 for the brand. “Last year we challenged Bear Grylls to unlock the science behind our products by using his knowledge of nature alone,” he said. “This year we are continuing our relationship with Bear and we are upping the ante. In 2014 we will challenge contestants and viewers of The Block to use our expertise to unlock better health for themselves.

NEUTROGENA® ANNOUNCES THE LAUNCH OF THEIR NEW PORE REFINING RANGE NEUTOROGENA®, a leader in premium skincare for the last 40 years, has announced the launch of the PORE REFINING® Skincare range. Pores are an essential element of healthy functioning skin. They enable the release of oils from the sebaceous glands up to the skin to help remove dead skin cells. But, over time pores can stretch making them look more noticeable, contributing to uneven texture and skin aging. Dermatologist expert Dr Diane Thiboutot comments: “Pores can appear larger and more noticeable when they become clogged with dirt, oil and dead skin cells making an effective cleansing and exfoliation regimen essential to help keep pores clean and minimise their appearance.” The NEUTOROGENA® PORE REFINING® is clinically-proven to visibly tighten and shrink the appearance of pores to half their size! To help women manage the look and appearance of enlarged pores, all three products are designed to harness the benefits of effective alpha and beta hydroxys. The Beta hydroxys (Salicylic Acid) penetrate deep into the skin to remove the dirt, oil and makeup that can clog and enlarge pores. The Alpha hydroxys (Glycolic Acid) then sweep away dead surface skin and smooth over rough, uneven patches to tighten large pores. Glycolic acid is an effective ingredient which is often used in dermatologist grade facial peels. Now it is available in a NEUTROGENA® cleanser.

•• NEUTROGENA® PORE REFINING® DAILY CLEANSER 198ml •• NEUTROGENA® PORE REFINING® EXFOLIATING CLEANSER 198ml

“One lucky viewer will also have a chance to win a once in a lifetime, $20 000 holiday. “The Block is one of the highest rating programs in the country. It’s loved by millions of Australian’s and we are proud to be working with both contestants and the broader Block team.” In addition to in-program support and a best in class digital program, Nature’s Own will also be providing pharmacy specific support for the duration of the campaign. “Nature’s Own understands the important role that pharmacies play by providing health information and support to our consumers,” Luke said. “Throughout our partnership with The Block, Nature’s Own will also be providing pharmacy specific point of sale including wobblers and die-cuts. Sanofi representatives will provide pharmacies with more information.” The Block airs nationally on Channel Nine at 7.30pm from Monday 27 January 2014.

Dissolved Vs Dispersed – New Study Compares 1% Hydrocortisone Cream Formulations A recent publication comparing two different formulations of hydrocortisone in the Australasian Journal of Dermatology has found that a cream containing 1% dissolved hydrocortisone exhibits greater vasoconstrictor activity than a cream containing 1% dispersed hydrocortisone . The DermAid 1% dissolved hydrocortisone cream, was found to be statistically more potent than the 1% dispersed hydrocortisone cream of another brand.

•• NEUTROGENA® PORE REFINING® TONER 250ml

The publication also describes the moisturising capacity and safety of DermAid 1% dissolved hydrocortisone cream.

All three products are non-comedogenic, dermatologist tested and won’t over dry skin. Available in stores from March 2014.

Moisturising capacity was also shown to increase by 23% following a single application of DermAid 1% dissolved hydrocortisone cream, compared to no treatment.

“An effective cleansing and exfoliation regimen is essential to help keep pores clean and minimise their appearance.”

No adverse reactions of any kind were observed during the vasoconstrictor and moisturising studies. Repeat Insult Patch Testing was used to evaluate the skin suitability of the Dermaid 1% cream formulation for both normal and sensitive skin, and concluded that Dermaid 1% cream was non-irritating and non-sensitising. The studies were sponsored by Ego Pharmaceuticals and published by Dr Kerryn Greive (PhD) and Dr Tanya Barnes (PhD) (both employed by Ego Pharmaceuticals). Read the full article here: http://onlinelibrary. wiley.com/doi/10.1111/ajd.12128/full 1. Greive, K. A. and Barnes, T. M. (2013), Increased bioavailability of hydrocortisone dissolved in a cream base. Australasian Journal of Dermatology. doi: 10.1111/ ajd.12128

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 34 : FEBRUARY / MARCH 2014

Take your career further with Pharmacy Assistant Training. Whether you are a new or experienced pharmacy assistant we have a solution that will develop your career in pharmacy.

Contact your state branch of The Pharmacy Guild of Australia for more information: NSW & ACT: 02 9467 7130 or training@nsw.guild.org.au VIC: 03 9810 9988 or training@vic.guild.org.au QLD: 07 3831 3788 or admin.training@qldquild.org.au

TAS: 03 6220 2955 or tastraining@guild.org.au SA & NT: 08 8304 8388 or trainingsa@guild.org.au WA: 08 9429 4100 or training@wa.guild.org.au

PRODUCT SPOTLIGHT

Aromatherapy & skin therapy in a bottle Lavender, chamomile and ylang-ylang are scents known to promote relaxation. The AVEENO® Stress Relief range has incorporated these essences into formulations rich in natural colloidal oatmeal so your body is moisturised, cared for and relaxed – calming the body and the mind. STRESS RELIEF MOISTURISING LOTION – Fast-absorbing, non-greasy and is clinically proven to moisturise for a full 24 hours STRESS RELIEF BODY WASH – The creamy formulation gently lathers to cleanse, help hydrate and soothe dry skin, leaving it feeling softer and smoother all day long. Soap free, dye free and gentle enough to use on sensitive skin. ® Trade Mark Johnson & Johnson 2156/11

>> www.Aveeno.com

MOOV Head Lice Defence Spray MOOV Head Lice Defence Spray is a low irritant formulation, free from synthetic pesticides, fragrance and DEET. The light non-greasy formula is a daily leave in spray that conditions hair whilst simultaneously delivering effective protection against head lice throughout the school day. Also recommend alongside MOOV Head Lice Treatment products, to help prevent re-infestation. MOOV Head Lice Defence Spray 120ml – RRP $12.95

Nature’s Own Joint Enhance + Krill Helps keep you moving Helps increase joint mobility and flexibility with NEW Nature’s Own™ Joint Enhance plus Krill. A triple combination of Glucosamine and Chondroitin with the added benefits of Krill for the temporary relief of arthritic pain. Always read the label. Use only as directed. If symptoms persist contact your healthcare professional. CHC43143-06/13

>> www.naturesown.com.au

>> www.moov.com.au

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 34 : FEBRUARY / MARCH 2014

BOOST LITTLE IMMUNE SYSTEMS For children who get sick often, recommend Inner Health Immune Booster for Kids. This probiotic formula contains the exclusive and extensively researched strains Lactobacillus acidophilus (NCFM®) and Bifidobacterium lactis (Bi-07), which are clinically shown to reduce the frequency and severity of cold and flu symptoms. Always read the label. Use only as directed. If symptoms persist consult your healthcare professional >> www.innerhealth.com.au

PRODUCT SPOTLIGHT

Hydralyte The NEW Hydralyte lemonade flavour tastes great... and what’s more; kids think of Ice Blocks as a treat, not medicine! Like all Hydralyte Electrolyte products - the NEW, COLOUR FREE Lemonade Ice Blocks are suitable for the entire family including infants, pregnant and breastfeeding mothers. Hydralyte Ice Blocks are a great way to replace fluid and electrolytes lost due to vomitting, diarrhoea, fever, heavy sweating (exercise & heat) and may also be given to those experiencing low food and fluid intake. This can be common with morning sickness, nausea and teething children.

Co-Senna – effective relief from constipation Constipation is a common problem and affects most people at some time in their lives. Co-Senna delivers effective relief of constipation with dual action. Co-Senna tablets contain both a stool softener (docusate sodium) and a stimulant laxative (senna) for gentle, overnight relief of constipation. Each tablet of Co-Senna contains docusate sodium 50mg and total sennosides 8mg. Co-Senna is now available in bottles of 30’s (RRP $ 4.72) & 90’s (RRP $ 7.86) so recommend Co-Senna to your customers. Co-Senna is RPBS listed. Contact your Clear Sales representative on 1800 640 043 for special deals.

>> www.hydralyte.com

>> www.petrus.com.au

Cenovis Joint Repair Krill Oil + Glucosamine Cenovis Joint Repair Krill Oil + Glucosamine joint support formula combines two key ingredients in one capsule for temporary relief of arthritic pain. It may help improve joint function and mobility by temporarily reducing stiffness and inflammation caused by arthritis. It may help maintain joint cartilage health and may help reduce further damage. Krill Oil is a potent antioxidant. Always read the label. Use only as directed. If symptoms persist, see your healthcare professional. CHC42779 – 09/12

>> www.cenovis.com.au

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 34 : FEBRUARY / MARCH 2014

HEALTH CALENDAR

HEALTH CALENDAR February–March 2014

CPD by the SEA NSW Convention 21 – 23 February CPD by the SEA is on track to once again deliver Pharmacy Owners, Managers, Pharmacists and Interns an engaging, informative and practical Education Program for the fourth consecutive year in 2014.

DonateLife Week 2014

>> www.cbdbythesea.com.au

Sunday 23 February to Sunday 2 March

Blackmores Institute Symposium 28 February – 1 March Australian Technology Park, Sydney.

DonateLife Week is a key part of the Australian Government’s national reform agenda to increase organ and tissue donation and transplantation outcomes. >> www.donatelife.gov.au/resources/ donatelife-week-2014

>> www.blackmoresinstitute.org

Purple Day for Epilepsy 2nd BioCeuticals Reserach Symposium 11 – 12 April Unravelling 21st Century Epidemics. Sofitel Sydney Wentworth. >> www.bioceuticals.com.au/education/ event/2nd-BioCeuticals-ResearchSymposium

March 26 Purple Day is a grassroots effort dedicated to increasing awareness about epilepsy worldwide. On 26 March each year people from around the globe wear purple to spread the word about epilepsy. >> www.epilepsyaustralia.net/Purple_Day/ Purple_Day.aspx

65km for Cystic Fibrosis

The MS Melbourne Cycle

Saturday 22nd March 2014

Sunday 23 February

Royal Park and Princes Park. All proceeds will be directed to research at the Murdoch Children’s to improve the lives of those living with cystic fibrosis.

The MS Melbourne Cycle is staged by MS Australia solely to raise vital funds to support over 23,000 Australians living with multiple sclerosis, an unpredictable and debilitating disease.

>> www.65kmforcf.com.au

>> register.msmelbournecycle.org.au/2014MS-Melbourne-Cycle/register

Ovarian Cancer Awareness Month February is Ovarian Cancer Awareness Month Raising awareness of ovarian cancer and recognising women, their families and friends affected by ovarian cancer. >> www.ovariancancer.net.au/awareness/ ovarian-cancer-awareness-month

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Arthritis Awareness Week 2014 Sunday 23 March to Saturday 29 March Each Arthritis State and Territory will be posting individual activities during this time on their website. >> www.arthritisaustralia.com.au/index.php/ what-s-on.html

60 SECONDS WITH

60 SECONDS WITH... Melissa Antonel Pharmacist Mount Sheridan Pharmacy, Cairns QLD I decided to become a pharmacist because... I enjoy working with people in the community and improving their health outcomes. The science of the human body and how behaviours, food, medicines and the environment affect us interests me. Also I like the challenge to continually learn, gain knowledge and keep up-to-date as the Pharmacist’s role in the Australian healthcare model is expanding. I have been working as a pharmacist for... 8 years after graduating from James Cook University in Townsville. What I like best about my job is... motivating and recommending health solutions to patients and then them coming back to say it worked or thank you which is very rewarding. My favourite hobby is... There are heaps! I love being outdoors; traveling, dining at restaurants, shopping

and spending time with friends and family. I also really like swimming, bike riding, hiking and finding the best chocolate to eat! My best getaway ever was... Climbing Mount Everest to base camp in the Himalayas in Nepal was an amazing experience! How I keep myself updated to the market news... By reading pharmacy magazines for example ITK and Australian Pharmacist. I attended the PAC conference in Brisbane this year and also undertook the primary course held by the Australasian College of Nutritional and Environmental Medicine in November. Over the next 3 years in pharmacy, I predict... Challenges for the industry on many levels. As a profession we need to keep healthcare front of mind and what is in the best interest for the patient.

CLASSIFIEDS FOR SALE Da Vinci Teeth Whitening System. Includes fully adjustable blue light whitening accelerator lamp and reclinable white vinyl client chair/bed. Valued brand new at almost $6000: All offers considered. Pick up only. 1 X Humira Pre-filled Syringe 40mg (Not the Pen) Exp: 08/2014 (never been used) - $1300

Contact: James at Doc’s Mega Save Chemist Newcastle. Ph: 02 4926 3300, Email: newcastle@megasavechemist.com

Contact: Ken at Berry and French Pharmacy, Muswellbrook. Ph: 02 65431080, Email: berryandfrench@maxnet.net.au (Can deliver in Hunter Valley//Newcastle area) 1x Avonex 30mcg/0.5mL prefilled syringe Exp: 10/14 - $900 Delivery included - Perth metro only Vfend 200mg x 56 tabs Exp: 04/16 - $2300 Contact: Lee, Branxton Pharmacy, Branxton, NSW. Ph: (02) 4938 1156, Email: branxtonpharmacy@gmail.com

Contact: Chad at Doubleview Chemmart. Ph: 9446 2050, Email: admin@doubleviewchemmart.com.au

Votrient 400mg tabs 60 in carton – Exp: 06/2015 6 x Predsol® retention enemas (7x100mL per pack) Exp: 10/2014 $38.00 each

Wholesale list price $4597 – Selling for $3800.

Contact: Andrew, Claisebrook Cove Pharmacy, Perth. Ph: 08 9325 5247, Email: claisebrookcovepharmacy@iinet.net.au

Contact: Steve McPhee, Ettalong Pharmacy. Ph: 02 43413338, Email: stphmcph@gmail.com

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 34 : FEBRUARY / MARCH 2014

CLASSIFIEDS (cont)

FOR SALE

2 x temizole 100mg 5 capsules Exp: 12/14 - $290 each 1 x temizole 140mg 5 capsules Exp: 12/14 - $390 Contact: Jack at Georges Hall Pharmacy NSW, Ph: (02) 9727 2497 1 x Nippon Denso scanner BHT 8000D for LOTS dispensing system $500 in good working condition. Contact: Jim Gow, Ph: 041 996 7805, Email: jimgow@gowgroup.com Fremantle WA

Stalevo 50/12.5/500 Exp 05/14 - $200 for 200 Renagel 800mg Exp 01/15 - $280

1 x Tarceva 150mg(30) Exp: 8/2015 - $2500 ONO (Cost $3233) Contact: Zoran - Terry White Chemist Gladstone Park, Ph: 03 9338 1033, Email: twcgp@frednet.com.au

1x Avandia 4mg QTY 28 Exp: 05/14 - $20.00 2x Fluanxol Depot 40mg/2mL x5amps Exp: 06/14; 08/15 - $20.00 each

Invega sustenna 100mg Exp 04/15 - $300 Strattera 40mg Exp 05/14 - $100 for 56

1x Sinemet CR 200/50mg QTY 100 Exp: 07/14 - $25.00 1x Propecia 1mg QTY 28 Exp: 05/15 - $50.00

All prices included freight.

4x Pentasa Enema 1g/100mL QTY 7 Exp: 05/15 - $50.00 each

Contact Steve : Tel: 0431316090, Email: management@hendersonpharmacy.com.au

3x Predsol Enema 20mg/100mL QTY 7 Exp: 06/14 - $20.00 each ALL PRICES INCLUDE DELIVERY Contact: Monique, Wesley Pharmacy, Auchenflower QLD. Ph: 07 3371 1754, Email: frontshop@wesleypharmacy.com.au

Pharmacy For Sale Only $400,000 A rare opportunity to purchase a part-time pharmacy in a supportive rural community. Currently operating 20 hours/week. Plenty of scope to incorporate professional services. Will suit a sole pharmacist seeking a quieter pace.

Cover Girl & Ulta 3 (Excellent condition, wholesale value $5000). Selling for only $2500

All inquiries Email: jeparit.pharmacy@frednet.com.au Omnaris nasal spray x2 - Exp 08/2014 50% off List Price Enbrel 25mg x2 - Exp 01/2015 15% off List price 1 x Sensipar 60mg x 28 Exp: 09/15 - Cost $550 (List price $638.34) Contact: Zarina or Lara at Nashville Pharmacy, Brighton. Ph: 07 3269 3228, Email: brighton@guardianpharm.net

Avandamet 2/1000 x3 - Exp 08/2014 20% off List Price Contact: Paul Drake-Brockman, Yanchep Pharmacy. Ph: 08 9561 2888, Email: yancheppharmacy@bigpond.com

2 x Baraclude 1mg Exp: 08/2014 - $500 each

PLACE YOUR FREE CLASSIFIED ADVERT

1 x Diflucan 100mg Exp: 08/2016 - $30 Contact: Chris Ph: (07) 40 382 111, Email: smithfield@alivepharmacy.com.au

If you would like to place your free classified ad, forward any items for sale to Candice. Email: Candice.radford@goldx.com.au

BROUGHT TO YOU BY:

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 34 : FEBRUARY / MARCH 2014

Not All Probiotics Are Th e Same The

Have your customers recently taken antibiotics?

Do your customers suffer from gas or bloating?

WHY RECOMMEND INNER HEALTH PLUS?

Want to improve general wellbeing?

Want to maintain healthy digestion and immunity?

Have you recommended Inner Health Plus today?

Not all probiotics do the same thing and itâ&#x20AC;&#x2122;s not just the number of good bacteria that counts. Recommend probiotics with scientifically researched and validated strains such as Inner Health Plus, and help restore your customers digestive balance and improve their general wellbeing.

Find out the full benefits, visit: www.ethicalnutrients.com.au Always read the label. Use only as directed.

IHP2882 - 01/14

Inner Health Plus is an exclusive probiotic, developed by the probiotic experts. It contains the exclusive and extensively researched strain Lactobacillus acidophilus (NCFMÂŽ) and Bifidobacterium lactis (Bi-07).