INNOVATION TECHNOLOGY HEALTHCARE PHARMACY Welsh
Review
SUMMER SPECIAL THE SEASON'S MAJOR HEALTH HAZARDS
BIOSIMILAR MEDICINES WHAT YOU NEED TO KNOW
WELSH PHARMACY AWARDS THE 2017 SHORTLIST IS REVEALED
MEET AND GREET HOW ONE LADY OVERHAULED THE PATIENT EXPERIENCE THE WORD ON THE STREET ISSUE HOMELESSNESS AND PHARMACISTS 33 - 2017
VISIT US AT WWW.WALESHEALTHCARE.COM 5688 QIPP advertorial in Northern Ireland Healthcare Review (NIH) v1.qxp_QIPP Zeroderma advertorial 18/01/2017 13:43 Page 1
wIdER CHoICE, GREATER SAvINGS FRom THE ZERodERmA RANGE WWW.WALESHEALTHCARE.COM
WPR WELCOME ISSUE 33 - 2017
MEDCOM www.waleshealthcare.com www.pharmacy-life.co.uk Sarah Nelson Editor
EDITOR [email protected] SARAH NELSON [email protected]
NATIONAL ACCOUNTS MANAGER CHRIS FLANNAGAN [email protected]
NATIONAL ACCOUNTS MANAGER (SPECIAL FEATURES) HANNA DEVON [email protected] EDITOR'S LETTER How much could you save ACCOUNTS MANAGER DONNA MARTIN [email protected] Welcome to the latest edition of Welsh Pharmacy EVENTS MANAGER Review! on emollient prescribing? BRIDGET MCCABE [email protected]
The Zeroderma emollient range offers MARKETING MANAGER A long-running joke among my friends services to offer them their own network Survey shows benefits of KELLY ROCK and family is how I must be ‘one of the of support. The health of the homeless a choice of four creams, one ointment, [email protected] ® 19% Zerodouble Emollient Gel cost saving unluckiest people ever’ – and, to be fair, is becoming increasingly magnified, one gel and two bath additives - per pack STUDIO MANAGER Results from a recent survey with over 300 members of DECLAN NUGENT I’ve gifted them a lot of ammunition to and this edition, we weigh up how you providing complete emollient therapy [email protected] ® make this claim. can help – via regular engagement and for moisturising, washing and bathing. the Psoriasis Association using Zerodouble emollient Gel showed that 97% liked the feel of Zerodouble Gel, 91% MANAGING DIRECTOR From my trains breaking down mid- medication delivery methods – and chat ADRIAN MAGINNIS All Zeroderma products are gentle on said it was as good as or better than their current emollient [email protected] journey, phones giving up on me mid- to those pharmacists who are already out the skin and do not contain the harmful and 84% wanted to continue using Zerodouble Gel. IF YOU WISH TO CONTACT US BY text, and restaurants running out of my there, playing their part (beginning on irritant sodium lauryl sulfate (SlS). TELEPHONE - 02890 999 441 preferred dishes mid-order, I’ve come to page 10). Zeroderm® ointment – convenient 37% almost expect these occurrences now. Elsewhere, check out this year’s Zeroderma products are similar in formulation cost saving Whilst every care has been taken in compiling this magazine to ensure that it is correct at In a way, it’s been character-building; summer special (beginning on page 26) to around 50% of emollients currently 3-in-1 emollient therapy per pack the time of going to press, the publishers assume no responsibility for any effects I now know to always plan ahead, expect – covering inhaler technique findings, prescribed by CCGs and offer cost savings SLS-free Zeroderm® Ointment provides a rich from errors or omissions. The opinions of contributors are not necessarily those of the the worst, and stock my handbag with an need-to-know allergy updates, and more 3-in-1 emollient for the management of eczema publisher. No part of this publication may be of up to 37%, with no compromise on reproduced, stored in a retrieval system, or and dry skin conditions. Zeroderm Ointment can transmitted in any form, or by any means, impressive array of essential items, that – and our tremendously talented 2017 patient care. Around 75% of formularies and mechanical, electronic, photocopying, recording be used as a skin cleanser, a bath additive and as a leave-on moisturiser. or otherwise without the prior permission of even Bear Grylls has sought me out for Welsh Pharmacy Awards finalists are prescribing guidelines already include at Medical Communications 2015 Ltd. All rights reserved. Data Protection - Please note, your advice. revealed (beginning on page 15). least one Zeroderma product. The ® mailing details and copies of any articles Having thought about it, though, That’s not all – we once again check ZeroAQS Cream – An SlS-free 24% supplied will be held on a database and may be Zeroderma emollient range is available on cost saving shared with associated companies. Sometimes ‘unlucky’ is a term we’ve been using in with the All Wales Medicines Strategy alternative to Aqueous Cream per pack your details may be obtained from, or made prescription and listed on NHS contract. available to, external companies for marketing far, far too loosely, and is in no way Group (page 46), and delve into the latest ZeroAQS® emollient cream is a cost effective purposes. If you do not wish your details to be used for this purpose, please write to: Database accurate. I’m in fact incredibly lucky – in nutrition (beginning on page 38). A CCG who recently started using the 2-in-1 moisturiser and soap substitute which does Manager, Medical Communications 2015 Ltd, 142-148 Albertbridge Road, Belfast, BT5 4GS. particularly due to the support network Zeroderma range commented: not contain sodium lauryl sulfate (SLS), fragrance Subscription: £120 a year or colour. The Medicines and Healthcare products Regulatory Agency (MHRA) I have around me which is sturdier than Happy reading! ‘Emollient prescribing has been a has directed that SLS-containing Aqueous Cream should carry a safety warning David and Victoria Beckham’s wardrobes useful area to address as part of stating that: ‘aqueous cream may cause skin irritation due to its sodium lauryl combined. Having them by my side sulfate (SLS) content,’ if used as a leave-on emollient. grants me the confidence to try new QIPP. The focus has been on optimising INNOVATION TECHNOLOGY HEALTHCARE PHARMACY things, grateful of the knowledge that patient care by offering emollient Welsh they’re always willing to help me pick up products that patients are happy to use. QIPP By changing from proprietary emollient brands the pieces (literally, as well as figuratively to the cost-effective Zeroderma emollient range, CREATED FOR PHARMACISTS Feedback from GPs has been positive Review CRAFTED BY YOU – I tend to drop things a lot). 1 and changes have been simple to ToolkIT the NHS could save over £13 million p.a. In Conversation with For those less lucky, and lacking a Health Secretary similar unit, members of the sector have implement. Patient care has not been A QIPP & emollients toolkit developed by Medicines Management Vaughan Gething compromised and changes to the teams contains everything needed to implement product changes been admirably branching out their product prescribed have been at practice level. To estimate your potential local savings and find out
CHAMPION CYCLIST ALEX DOWSETT acceptable to most patients.’ more please visit: www.qipp.trderma.co.uk THE SPOTLIGHT ON HAEMOPHILIA A MIRACLE DRUG? THE LATEST ON ME-CFS
2017 WELSH PHARMACY AWARDS Thornton & Ross, Linthwaite, GET YOUR APPLICATIONS IN NOW ISSUE Huddersfield HD7 5QH ISSUE
FIGHT THE FAKES 114 - 2017
32 - 2017 @MEDCOMwales Medical Communications Ltd THE BATTLE AGAINST COUNTERFEIT MEDICINES For FREE samples for patient evaluation please ROLLS ON 01484 842217 VISIT US AT WWW.WALESHEALTHCARE.COM www.trderma.co.uk email: [email protected] [email protected] 1 . P C A d a t , M r c h 2 0 6 WPR | May 2017 | 1 WWW.WALESHEALTHCARE.COM CONTENTS ISSUE 33 - 2017 7 NEW TO THE GAME What opportunities and challenges are biosimilar medicines bringing to the market? 9 SPECIAL COMMUNITY PHARMACY EVENT ANNOUNCED Key figureheads are coming together to discuss new challenges
»» p.26 10 WORD ON THE STREET How the sector is helping to reshape the health of the homeless 12 ADHD: THE PHARMACIST’S CHALLENGE A new perspective is lessening misdiagnoses of the condition 15 WELSH PHARMACY AWARDS »» p.44 »» p.15 Meet the 2017 finalists We make happy pharmacists 26 UNDER THE SUN The latest on the season’s health hazards – from That’s because more pharmacies than ever before in Wales are increasing allergies to inhaler technique findings their profits as members of the Cambrian Alliance Group. 36 WELCOME ABOARD Why join them? Community Pharmacy Wales has revealed its new Chairman We’re independent & impartial meaning we’re truly focused on your needs. 40 COELIAC DISEASE »» p.7 With over 1,200 members and an annual spending power of £0.5 billion The evolving role of the pharmacist in signposting we save you money on generics, PIs, OTCs & dressings. symptoms And we give you with the professional services & technology you need 44 WHAT’S IN A NAME? to grow your business including e-CASS - our price comparison, stock The social media campaign that’s personalising the face ordering tool that makes you money and saves you time. of healthcare 46 THE JURY IS OUT Contact us today and start making more money. The All Wales Medicines Strategy group on the e: [email protected] prevalence of antimicrobial resistance t: 0845 130 1187 »» p.46 w:2 | cambrianalliance.co.uk NIHR | April 2017 WPR | April 2017 | 3
Medcom Scot mag advert.indd 1 3/7/2017 2:25:24 PM WWW.WALESHEALTHCARE.COM WWW.WALESHEALTHCARE.COM
NEWS NEWS NEW STUDY been set aside for the protection The app, developed with Welsh of plants and wildlife, wildflower government funding, is targeted at SLEEPING PILLS TO IMPROVE meadows and a bee sanctuary. reducing pressure ulcers developing LINKED TO HIP DIABETES SELF- Sophie Howe, Future in the first place; but when they do Generations Commissioner, occur, it will help make the best use FRACTURES IN MANAGEMENT explained, ‘Projects like this are so of resources by allowing specialist important because as part of the staff to prioritise the most serious A small pilot study has found ELDERLY Future Generations Act it requires cases. that watching short health us to think about the connections Created by Morriston information films online, via a between our social wellbeing, our Hospital-based PUPIS, ABMU’s smartphone or tablet, can help Older people newly prescribed health, nature, our culture, and the multidisciplinary Pressure Ulcer patients with type 2 diabetes sleeping pills like benzodiazepines economy. Prevention and Intervention reduce their blood glucose level. and ‘Z-drugs’ have over double ‘This isn’t just a facility for Service, the prototype has been A series of short films were the odds of a hip fracture in the patients in hospital, this is a facility trialled, and additional work to ‘prescribed’ to people newly- first two weeks compared with for the whole community to get expand and further evaluate the diagnosed with type 2 diabetes, non-users, according to a new involved in through volunteering app will now be carried out. alongside standard treatments, study by researchers at Cardiff which will help people connect, PUPIS is hosted by the by a GP or practice nurse at two University and King’s College keep active and involved with Rehabilitation Engineering GP practices within Hywel Dda L to R Maria Battle, Sophie Howe, and Dr Rhys London. nature which will be beneficial Unit, part of the Department University Health Board (UHB) Dr Ben Carter, Cardiff Jones to their health and wellbeing. I for Medical Physics and Clinical and Abertawe Bro Morgannwg University’s School of Medicine really would urge everyone to see Engineering. UHB. and the Institute of Psychiatry, INNOVATIVE ORCHARD PROJECT this as their community orchard ABMU Principal Clinical They included titles, such L to R Head of Rehabilitation Engineering, Dr Psychology and Neuroscience, and contribute to it and help out Scientist, Dr Mark Bowtell, who as ‘What is diabetes?’; ‘What King’s College London, wherever you can.’ Lorna Tasker, Principal Clinical Scientist, Dr led the app project, and worked can I eat?’; ‘Diabetes and LAUNCHES AT HOSPITAL SITE explained, ‘While ‘Z-drugs’ Meanwhile, Dr Rhys Jones, who Mark Bowtell, and Rehabilitation Engineer, with Fujitsu software developers, weight’; ‘Looking after your are fast becoming the doctor’s was named the official ambassador explained, ‘The main aim was to feet’; ‘Stopping smoking’; and Kelly Jones, with the new app hypnotic prescription of A unique outdoor space Battle, Chair of Cardiff and Vale of Ein Berllan – Our Orchard, said, engage with patients and frontline ‘Medication and monitoring’. choice, there is no evidence that to enhance the health and University Health Board, and ‘I am delighted to get involved in staff in the community so they can After just three months, they are a safer alternative to wellbeing of patients and the Ecologist, Dr Rhys Jones, who is Our Orchard because we have an APP ENHANCES PRESSURE have specialist information at their routine tests showed a clinically benzodiazepines in relation to hip local community has launched at the official ambassador. opportunity to be able to create fingertips. significant improvement in fracture risk. University Hospital Llandough The site was created in line with the most wonderful, beautiful ‘There are illustrations staff can HbA1c – an established marker ULCER CARE ‘Our study shows that both (UHL). the vision of creating a unique oasis of calm and to help people to show patients to explain why they of diabetes control. In contrast, appear to significantly increase Ein Berllan – Our Orchard space which will become a legacy heal instead of using the land for An award-winning team at may eventually being available to are at risk and what can happen no reduction in HbA1c was the risk of hip fracture when was officially launched by Future for generations to come. This long- redevelopment and building. ‘ Morriston Hospital has created people at home with, or at risk of to their skin if they sit in a certain observed in the non-watchers. newly prescribed by doctors.’ Generations Commissioner, term project will be established an app that could transform the developing, pressure ulcers, as well way, for example, or don’t move for Study author Dr Sam Rice, The study of people aged over Sophie Howe, Mayor of Vale of in phases, and will include a semi- care of patients with a potentially as the health professionals caring a certain amount of time.’ Consultant Physician and Glamorgan, Stuart Egan, Maria natural planted area which has crippling condition – with it for them. 65 found that new users of these Endocrinologist at Prince Philip hypnotic medicines experienced Hospital, and Deputy Research FISHGUARD PHARMACY RECOGNISED FOR SUPPORTING CARERS PSORIASIS PATIENTS PARTICIPATE IN GROUND-BREAKING DRUG STUDY nearly two and a half times the and Development Director for fracture rate, when compared Hywel Dda UHB, commented, facilities, such as pharmacies, GP patients who are being treated at plaque psoriasis. with older people not taking ‘With patient self-management practices and hospitals focus on Betsi Cadwaladr University Health Ysbyty Gwynedd originally hypnotics. An estimated 53 per widely recognised as an and improve their carer awareness Board’s three acute hospitals are joined the study in 2011 and then cent increase in fracture risk was increasingly important treatment, and enhance the help and support taking part in the national study, in 2013 Research Officer Caroline identified in medium-term users it is encouraging to see that this they give carers. and the team at Ysbyty Gwynedd Mulvaney Jones joined the (15 to 30 days), as well as a 20 per low cost and scalable solution is Pennie Muir, Investors in Carers in Bangor, who recruited the project full-time to enhance the cent increased risk of hip fracture reaching many more patients than Regional Project Support Manager North Wales patients, has now recruitment process. in long-term users (greater than would otherwise be the case. for Hywel Dda University Health won an award from the British The research team, which 30 days). ‘Through further research, we Board, commented, ‘Pharmacies L to R Consultant Association of Dermatologists includes BCUHB Lead Dr Carter added, ‘Careful may even find that the success are busy places so it is good to see Dermatologist, Dr Biologic Interventions Register Dermatology Specialist Nurse, consideration of the immediate L to R Julie Campbell, Investors in Carers increased risk of hip fracture of the film-watching becomes that the staff at Boots pharmacy are Andy Macfarlane, (BADBIR). Allyson Brown, plus Consultant a stepping stone to facilitate Officer; Alison Tobin, Store Manager; Pennie committed to helping carers.’ The award, which names Ysbyty Dermatologists, Dr Andy should inform the clinical BCUHB Research and encourage people living Muir, Investors in Carers Regional Manager; Claire Stringer, Pharmacist Gwynedd as a ‘model centre,’ is for Macfarlane and Professor Alex decision-making process...’ with a chronic disease to attend and Carer Lead, added, ‘By Officer, Caroline recruiting the highest number of Anstey, has now been awarded a The research supports previous Claire Stringer, Pharmacist and Carer Lead; more structured educational participating in the Investors in Mulvaney Jones, and patients in North Wales to the UK- ‘model centre’ trophy by BADBIR studies linking use of hypnotics programmes.’ and Hazel Davies, Pharmacy Technician Carers scheme it has ensured that wide study, which will continue for the Most Improved Recruiting by older people with an increased The study was undertaken we’ve now got a structure in place Professor Alex Anstey to monitor patients until at least Centre in the Wales Region. risk of accidents, dependence, by Swansea University in Boots pharmacy in Fishguard delivered by Hywel Dda University that will help support anyone 2028. Caroline commented, ‘We cognitive decline and hip fracture. collaboration with Hywel Dda has been recognised for their Health Board and supported by looking after someone. Pioneering research into the The research intends to assess will continue to recruit for the The drugs are also thought to UHB, Abertawe Bro Morgannwg commitment and support for its local authority partners in ‘My colleagues have also been impact of long-term drug therapies the long-term safety of biologic study up to 2022. It’s doing so well cause drowsiness, delayed reaction UHB and Cardiff and Vale UHB. carers and their families. Carmarthenshire, Ceredigion and very supportive and hope that we to treat North Wales people treatments for psoriasis, which across the UK that BADBIR has times and impaired balance. The pharmacy has achieved Pembrokeshire. can help make a difference to carers with the chronic skin condition target a specific area of a patient’s extended the study as the more the Investors in Carers Bronze The Investors in Carers in our community.’ psoriasis has won a top award. immune system. These drugs are information they can collect, the Level award; a scheme which is initiative is designed to help health More than 140 psoriasis used to treat moderate-to-severe better.’ 4 | WPR | May 2017 WPR | May 2017 | 5 WWW.WALESHEALTHCARE.COM
BIOSIMILARS LUCOZADE ENERGY BIOSIMILARS: ACCESS THROUGH EDUCATION Biological medicines are playing a significant role on a global scale in providing effective IS CHANGING treatments for patients and contributing to improved survival rates, as well as providing a better quality of life. However, in order to increase access, biosimilar medicines – equivalent products which have no meaningful differences from the original or reference product in terms of quality, Lucozade Energy Original now contains approximately 50% less safety, or efficacy – also have important roles to play in providing choice for clinicians, driving down cost, and ultimately improving patient outcomes. Warwick Smith, Director General of the British glucose based carbohydrates. All flavours have significantly less Biosimilars Association (BBA) outlines the challenges and opportunities in the UK. glucose based carbohydrates - please check the label. considerable savings to the NHS awareness and knowledge as well compared with originator biologic as supportive guidance from drugs and, while they can’t organisations such as NICE to Some flavours will contain aspartame, which is a source of offer the same percentage price generate confidence in using reductions as traditional generic these products. The BBA – along phenylalanine. medicines, this reduction comes off with other industry partners – is a comparatively higher cost base. also taking part in and driving a So greater uptake in biosimilars number of initiatives. New products will appear on shelf from April 2017, for a time can potentially create savings via These initiatives have included competition which will allow working with NHS staff to develop both old and new bottles and cans may be on shelf together so already stretched budgets to be authoritative information about Warwick Smith more efficiently spent and crucially biosimilars as well as organising remember to check the label. increase patient access to these educational events. NHS England For biosimilar medicines fully to Biological medicines are vital treatments. These are the has published ‘What is a Biosimilar deliver their potential benefits for dominating global lists of the same principles which have always UK patients, continued education best-selling prescription drugs. Medicine?’ – a document which underpinned the generic medicines This applies to all Lucozade Energy flavours. and shared experience is a critical Very successful treatments provides key clinical and non- market in the UK which is among element of their introduction. for rheumatoid arthritis and clinical stakeholders with accessible the most successful in the world, It was the driving force behind autoimmune diseases have led the information on how to support and on average saves the NHS why we launched the British way, and as we move forward, other the appropriate use of all biological more than £13 billion every year Biosimilars Association (BBA) disease areas, such as oncology, are medicines, including biosimilar according to figures from the FOR PRODUCT INFORMATION PLEASE VISIT: [email protected] as an authoritative source of increasingly in demand. medicines for the benefit of NHS British Generic Manufacturers information to educate people – be However, with UK healthcare patients. Association (BGMA). OR CONTACT CONSUMER CARE ON 0800 096 3666 they patients, clinicians, regulators, budgets stretched by ageing This collaboration between Because of the lack of or policy-makers – about the populations, technology stakeholders is critical and we have comparable clinical experience opportunity that these important investment, and advances – seen the most effective uptake and thus understanding, some medicines provide. which mean diseases can be in the UK where commissioners clinicians and patients have not There are a number of reasons detected earlier and treated later and medical professionals work yet fully embraced the use of why this needs to take place. From – affordability and value are key together to implement biosimilars biosimilars, although there are a macro perspective, the impact elements of widening patient and share the resulting savings areas of clear progress and success, of biological medicines both now access. The UK, in particular, across their respective institutions. such as G-CSF. Regional variance – and increasingly in the future has been slower than some other One well-documented example across the UK has also been very – cannot be ignored or indeed European countries in fully of this is Southampton, where the mixed. However, if the NHS is to underestimated for patients and adopting the use of biological Trust is able to save £60,000 to cope with its budgetary pressures payors alike. medicines partly because cost and £80,000 per month and invest in while also maintaining access to Biological medicines are value need to be demonstrated via an additional nurse and pharmacist new breakthrough treatments, then protein-based and made or derived the National Institute for Health support. biosimilars must have a crucial role from living organisms. Unlike and Care Excellence (NICE). To maximise the benefits of to play going forward. traditional chemical equivalents, As acknowledged by the biosimilar medicines for both At the start of this year, they can be tailor-made so they NHS England Chief Executive, patients and the NHS, it is there were seven biosimilar bind to specific targets in the Simon Stevens, the NHS is at a important that clear, positive molecules on the market in the body. A biosimilar medicine is ‘crossroads’ and needs to change policy positions are adopted that UK (somatropin, follitropin alfa, manufactured to be highly similar and improve as it moves forward. link the efficiency and financial filgrastim, infliximab, epotein alfa, to an existing licensed ‘reference’ Long-term conditions now benefits to improving patient insulin glargine and etanercept). biological medicine after expiry account for 70 per cent of the access, otherwise the UK could However, this is set to increase due of its patent, with no meaningful health service budget, coupled face falling behind the rest of to a number of factors including Please note that Ribena (Squash and Ready to Drink) and Orangina will also be differences in terms of quality, with a £30 billion funding Europe. patent expiries, increasing clinical reducing in sugar during 2017. Please check nutritional label for information. safety, or efficacy. gap. Biosimilar medicines offer LUCOZADE ENERGY and the Arc Device are a registered trade mark of Lucozade Ribena Suntory Ltd. WPR | May 2017 | 7 WWW.WALESHEALTHCARE.COM WWW.WALESHEALTHCARE.COM
NEWS NEWS SCHOOLCHILDREN innovation. to managing allergies,’ explained Speaking to the BBC, Professor Lisa Owen, Specialist Nurse in SPECIAL PLAY A KEY ROLE Marc Clement, Chairman of the Paediatric Allergies. Institute of Life Science, explained, Lisa holds a weekly clinic at COMMUNITY IN NEW WEIGHT ‘5G is an opportunity to produce Wrexham Maelor Children’s PHARMACY MANAGEMENT resilient, robust bandwidth that Outpatients Department, but she is always there for the purpose of also leads the allergy awareness EVENT TO PROJECT healthcare. training scheme, in which she ‘That intelligent dressing uses orchestrates a training day every FOCUS ON nanotechnology to sense the state year for school nurses, delivering Children from Hywel Dda of that wound at any one specific an update on the latest information TRANSFORMATIVE Primary and Ninian Park Primary time. and best practice for dealing with were invited to submit ideas for ‘It would connect that wound children with allergies. CHALLENGES a healthy logo in line with the Professor Marc Clement to a 5G infrastructure and that In turn, the school nurses train launch of the FitFun programme infrastructure through your teachers working in local schools Following the Welsh government’s – a 10-week offering for families telephone will also know things how to look after the children in recent announcement concerning wanting to become healthier TRIAL ANNOUNCED FOR about you – where you are, how their classes who can have a wide pharmacy funding in Wales, together. active you are at any one time. range of allergies. key figureheads from the sector This initiative has been SWANSEA UNIVERSITY SMART ‘You combine all of that Lisa continued, ‘We’ve had real will come together for a special designed by Families First intelligence so the clinician knows success with working with schools event on 18th May to discuss Dietitians, with input from BANDAGE the performance of the specific and nurseries running this scheme the challenges in transforming families across Cardiff, and wound at any specific time and can in the East. the Welsh community pharmacy delivered in partnership with Swansea University's Institute of and help doctors keep track of then tailor the treatment protocol ‘It’s great to give teaching staff network. Sport Cardiff. Aimed at children Life Science is leading research patients' activity levels. to the individual and wound in more confidence in dealing with The event, which will take above a healthy weight, aged into the trial of bandages which It forms part of the £1.3 billion question.’ ALLERGY AWARENESS allergies. They can help children place at the Life Sciences Hub between eight to 11 years of age, use real-time 5G technology to Swansea Bay City deal which aims avoid their allergy triggers and also Wales centre in Cardiff Bay, is the sessions incorporate healthy monitor how a wound is healing to create a 5G test hub for digital recognise symptoms and look after being organised by Community eating, how much sugar is in food SCHEME IN WREXHAM AND them if they do have a reaction.’ Pharmacy Wales and the and drinks, healthy fats, how to DIABETES REPORT REVEALS RATE OF CARE FOR YOUNG PEOPLE Cambrian Alliance Group. It will read a food label, suitable portion FLINTSHIRE SEES SUCCESS feature guest speaker Vaughan sizes, and more. women with diabetes. Gething AM, Cabinet Secretary Kevin Jones, Families First • The success of the diabetic for Health, Social Care and Sport, A specialist nurse at Wrexham Wrexham and Flintshire. Dietician in the Public Health retinopathy screening service as well as a panel discussion Dietetic Team, commented, Maelor Hospital is leading a ‘Allergies are exploding in by experts on community • The ‘Think Glucose’ project is ‘We got in touch with schools pioneering allergy awareness the UK. Education and having pharmacy in Wales. All 716 Welsh supporting quality improvement of we’ve worked with previously training scheme for staff in good awareness of triggers, signs, community pharmacies have been patient care while in a hospital to get involved and give us some educational settings across and symptoms is absolutely key invited to the free event. Commenting on the findings, pictorial ideas. From those initial Mark Griffiths, Chairman Health Secretary, Vaughan drawings and ideas we thought we of the Cambrian Alliance Gething, said, ‘This report HEALTHCARE ASSISTANT WINS TOP AWARD could design a great logo which Group, explained, ‘We welcome demonstrates that paediatric appealed to children by putting who are anxious about having their the Welsh government’s diabetes care has made significant participation into practice.’ bloods taken. recent funding commitment strides in the quality of care and Meanwhile, Richard Evans, She said, ‘Many individuals to community pharmacy in the outcomes being achieved over Senior Graphic Designer at with learning disabilities need Wales. This was an important the past six years. The impact of Cardiff and Vale University to have their bloods taken on announcement that showed its the improvement in blood glucose Health Board, explained, ‘I a regular basis because of the support of our continued work as levels, as well as those in some was really impressed with the medication they take, or because primary healthcare providers. essential care processes, will reduce caricatures and the lettering the they have increased health needs ‘However, there is now a Health Secretary, Vaughan Gething the risk of future complications children did. which require regular monitoring greater expectation that Welsh significantly. This is good news for by their GPs. ‘I took inspiration from several The Annual Statement of Progress processes, such as foot and kidney pharmacy delivers additional children and young people. ‘This can cause a great deal of drawings and simplified them and for Diabetes highlights that the checks, have improved too. frontline services and this event ‘One of our key aims over the anxiety for our patients, and many came up with the design with the number of children and young The report also shows: is an important opportunity to coming years will be to continue Cemlyn Roberts of them are anxious about having broccoli, carrot and tomato.’ people with type 1 diabetes • discuss the challenges that will A decrease in the rate of people to work closely with the public their bloods taken. achieving blood glucose in the be faced in transforming the dying from cardiovascular disease, on prevention. While there are A healthcare assistant who of other nominees from across the ‘Cemlyn runs a programme of target range has increased from Welsh community pharmacy which has a high prevalence among no lifestyle factors associated helps adults with learning UK to be shortlisted for the Royal blood desensitisation for people 17.8 per cent (2014 to 15) to 27.2 network. We therefore encourage people with diabetes with type 1 diabetes, we must all disabilities overcome their fear College of Nursing’s Healthcare with learning disabilities which per cent (2015 to 16). all community pharmacists to • Improved care for patients in reduce our risk of developing type of needles has won a top national Assistant of the Year award. helps to alleviate their anxieties. Meanwhile, the number of attend.’ hospital with diabetes, with a 2 diabetes by being active, eating award. Cemlyn was nominated for This can involve showing patients these with high blood glucose The event runs from 6pm to decrease in the average length of a healthy, balanced diet and Ruthin-based Cemlyn Roberts, the award by Locality Matron for flash cards with images of people levels reduced from 21.6 per cent 8.30pm. stay maintaining a healthy body who works for Betsi Cadwaladr Health Liaison, Kim Scandariato, having their blood taken and (2014 to 15) to 18.6 per cent For more information, or to • weight.’ Health Board’s Health Liaison in recognition of his ‘patient, kind the equipment used, and taking (2015 to 16). Better opportunities for patients reserve your place, email susan@ Team for Learning Disabilities, and caring’ approach to supporting patients to visit the clinic room to The rates of young people to inform diabetes services positifgroup.co.uk. beat competition from hundreds patients with learning disabilities get them used to the environment.’ undergoing essential key care • Improved care for pregnant 8 | WPR | May 2017 WPR | May 2017 | 9 WWW.WALESHEALTHCARE.COM WWW.WALESHEALTHCARE.COM
PHARMACY PHARMACY
Last year 7,128 households were assessed as ‘threatened with homelessness’ in Wales. But with the role of the pharmacist extending to much more than just WORD ON THE STREET: raising awareness about this segment of the population, they can help reset the reality of sufferers – through methods such as regular engagement, medication HOMELESSNESS AND delivery, and more. Cat Whitehouse, of the leading homeless healthcare charity, Pathway, sheds light. PHARMACISTS
Imagine a world where you have people are more likely to have TAKE TIME TO problems and advises checking A constant relationship with patients, and an opportunity to using street drugs because they managed a specialist community nowhere to rest, wash, or eat. asthma, heart disease, hepatitis C, whether patients can open bottles, a healthcare worker, within build a relationship. This provides cannot cope with the impact of nursing team, providing outreach Where you have lost touch with or tuberculosis. EXPLAIN or dispense from blister packs. professional boundaries, can help a chance for ongoing monitoring hospital release, opiate withdrawal to homeless hostels and day the people you love, and have A St Mungo’s report found that Dosetting is seen as an to counter those changes, take time of mood and health conditions, and housing relocation all in one centres in London. She is the no idea where you’ll sleep that PRESCRIBING over 50 per cent of homeless expensive last resort, but it can to chat if you can. and a potential avenue into health day. founder of the UK’s largest and night. It’s a frightening, lonely, people have literacy problems, so increase concordance in patients Your work will be most screenings. busiest homeless health team, unhealthy existence – but for many HELP it’s vital that verbal information is who are struggling, potentially successful if you ask your patient’s Successful trials of pharmacy- OUT THERE AND Pathway King’s Health Partners, people, it’s a reality. An increasing Healthcare and prescribing may given as well as leaflets. avoiding a costly inpatient stay. permission to work with everyone based hepatitis / HIV screening and a member of the Faculty of number of people are becoming seem a world away from the person Take time to explain things Alternatively, slow release, once- involved in their care. That might have identified that many ‘at-risk’ DOING IT Homeless and Inclusion Health homeless because of rising rents, sleeping under a blanket in the and work with the patient. Not a-day versions of medications may mean letting support workers patients prefer walk-in services • Alison Hair and Richard Lowrie working group, examining safe redundancies, or benefit changes. doorway, or a family crammed everyone can predict when they help. know about potential side-effects and feel more comfortable being began working in homelessness medication dispensing in homeless into a bed and breakfast room; but will have access to food, so ‘take Sam also talks passionately or notifying prescribers if a person screened and receiving anti- after realising there were gaps in hostels. Government statistics show that you can play a key role in helping it before breakfast’ might not be about the need for patients stops collecting medication retrovirals at a pharmacy. mainstream NHS pharmaceutical last year: homeless people recover. helpful. Ask what is routine for being prescribed injectables to (especially if this is a warning sign Specialist Homelessness Nurse, services. Today, they are based ABOUT PATHWAY In England, patients (including that person – would arriving at a be assessed, urging professionals that a mental health problem or Sam Dorney-Smith, says that • 59,250 people or households at Hunter Street Homeless Pathway is a charity dedicated some on benefits) are charged day centre be a better reminder? not to assume that patients who substance misuse issue may have pharmacists can really help with were accepted as homeless in Service, Parkhead Health Centre to homelessness and health. It for medication. A three-month Kate Robinson, a Drug and have injected street drugs, can recurred). Support workers can smoking cessation, commenting, England and hostels across Glasgow, works in the NHS to create teams prescription may reduce costs, Alcohol Nurse at a central London safely inject insulin or Clexane also work alongside pharmacists to ‘This aspect of care is often • 18,628 people presented providing weekly sessions in a of doctors, nurses and housing but patients may struggle to store teaching hospital, believes that for example. Pharmacies offering help patients move from dosetting wrongly ignored for homeless themselves as homeless in multidisciplinary team. Half- specialists in hospitals to help medication or keep it dry. Some educating patients improves on-site dispensing may wish to to self-administration. patients, but with incredibly high Northern Ireland day clinics usually involve five patients access accommodation hostels restrict medications for concordance, saying, ‘Patients who consider linking with needle levels of COPD among the target • 34,662 people made or six patients, focussing on the and support. legal reasons or because they fear are withdrawing from heroin often exchange services. THE WIDER HOMELESS population, it’s vital that support homelessness applications in management of chronic diseases. The charity is home to the it may be stolen to sell (and this don’t understand the reasons for Even ‘safe’ methods of delivery COMMUNITY is offered.’ Scotland Independent prescribing has Faculty of Homeless and Inclusion is not always the most obvious Methadone dose titration. I explain might not be so safe. One Medication storage and improved the efficiency of the Health – a free network of 900 • 7,128 households were assessed drugs). the long half-life of Methadone, hospital pharmacy was asked not management is a huge problem HOSPITAL PHARMACIST clinics, and the pharmacists work professionals working with patients as ‘threatened with homelessness’ Free prescriptions in Scotland, and that an effective dose will be to dispense certain brands of a for many homeless hostels, Timely TTAs can make the closely with other specialists in the facing barriers to healthcare, such in Wales Northern Ireland and Wales have achieved over time. painkilling patch after finding and many patients haven’t had difference between a person getting team. as: ‘Unless the patient knows that out the active ingredient could medication reviews. Getting to housing, or sleeping on the street radically changed the prescribing • Kate Robinson is a Drug and Some will be sleeping on the they are being heard, there is a risk be removed and injected. Drug know local hostel workers can reap after leaving hospital. How? • Homeless people landscape. Alcohol Nurse at a central London streets, and many more will be that they’ll self-discharge to seek dealers were targeting patients, considerable rewards. Approaching a local council for • Vulnerable migrants Dr Richard Lowrie, Pharmacist teaching hospital. She provides ‘hidden homeless’: sleeping on heroin, abandoning vital medical leaving them without medication. Pharmacies can help by carrying housing often means queuing early at the homeless health service in assessment and treatment planning • People from gypsy and traveller a friend’s sofa, on buses, moving treatment. It’s much harder for Local knowledge is invaluable, leaflets for local housing support in the morning, as many use a ‘first Glasgow, explained, ‘Depending for patients with drug and alcohol communities between night shelters, or us to get back in touch with a so talk to patients and local teams. services to help patients. These come, first served’ system. on the medicine, I write a month- issues, patient advocacy, liaison • People involved in the sex exchanging sex for somewhere to homeless patient.’ also signal that you will not act Having TTAs ready first thing long prescription to be dispensed with existing treatment providers, industry sleep. A few words of explanation pejoratively towards homeless in the morning helps workers weekly. It reduces the amount that BUILD and referral to follow-up care. Most have physical or mental from a pharmacist could literally patients. ensure a patient will be seen. Most is lost or wasted, and it means that Many of her patients are homeless, The network brings together health problems or a dependency be the difference between life and RELATIONSHIPS homeless patients don’t have the I can monitor patients as they or at risk of losing their homes. In researchers, commissioners, on drugs or alcohol, often those death. money to come back to hospital adapt to new medicines. It helps Homeless people on the street are WHAT YOU CAN addition to her patient work she consultants, doctors, nurses, who do not will develop problems later, so it’s vital that they’re ready. the patient to build trust through often ignored. One man described gives guidance to clinicians on housing workers and pharmacists when faced with life on the streets. DO AS A… If patients with opiate regular engagement with the THINK METHOD feeling ‘invisible, less than human’. prescribing and management for and others through regional and Our home is important to our community pharmacist. Then, suddenly, patients beginning dependency are being released The method of medication delivery patients using drugs or alcohol, national updates and events. The sense of safety. People without a ‘Conversely, some patients to engage with services are COMMUNITY PHARMACIST on a Friday consider whether you is also important. through formal training and point- Scottish Faculty is particularly home are nine times more likely engage better if given the whole bombarded with an overwhelming Community pharmacists can offer a weekend methadone Specialist Nurse, Sam Dorney- of-care advice. active, often running training in to take their own life, and have month supply – it shows that we number of staff as they move dispensing medicines to aid in prescription. Your short-term Smith, describes great results • the region. high rates of depression and trust them to manage.’ between night shelters, hostels, the treatment of opiate addiction support could be the difference Samantha Dorney-Smith is a through breath-activated inhalers For more information, visit anxiety. Homelessness is also bad temporary accommodation, and have a unique opportunity to between a person engaging with Pathway Nursing Fellow. She is a for those with co-ordination www.pathway.org.uk. for physical health, and homeless flats. have daily contact with these support services or reverting to Nurse Prescriber and previously
10 | WPR | May 2017 WPR | May 2017 | 11 WWW.WALESHEALTHCARE.COM WWW.WALESHEALTHCARE.COM
ADHD ADHD ADHD: THE GP AND PHARMACIST CHALLENGE The plethora of brain research conducted throughout the past 20 years has resulted in a completely new perspective of ADHD. How can the sector move forward with this insight and apply it to prevent misdiagnosis? Dr Tony Lloyd, Chief Executive of the ADHD Foundation, offers his view.
Once viewed as a childhood an NHS disease impact report. services. lottery. Diagnostic protocols (20) parents and increased prevalence symptomology. clinicians to use generic medicines November. behavioural disorder, ADHD The mental health outcomes are NHS estimates that ADHD have improved since the wider of ADHD which may explain is understandable; however red- For more information, visit is now recognised as a lifetime alarming – with an estimated 40 affects five per cent of the school use of QB testing – an objective why one-in-three children born MAKING THE TREATMENT rated controlled psychotropic www.adhdfoundation.org.uk. genetic condition (1) (2) with per cent suffering from anxiety age population of 550,000 computer-based cognitive through IVF have ADHD. (26) CHOICE drugs affect different patients in distinct differences in the frontal and depression, and one-in-five children, and various researchers functioning test that measures (27) GPs could play a key role in Prescribing of ADHD medications different ways and tolerance to MEDICATIONS lobe, parietal lobe, cerebellum, attempting suicide. (9) Substance estimate that between 30 per ADHD core characteristics the early identification of children has doubled in the UK in the side-effects means that pharmacists cingulate gyrus, corpus striatum misuse, addiction and eating cent to 60 per cent are still at 80 per cent accuracy. (21) with ADHD if they were aware of past five years. Pharmaceutical should be advised to dispense WIDELY USED TO (3), as well as dopaminergic disorders are also more prevalent ‘symptomatic’ in adulthood. (15) Symptomology scales, however, the aetiology of the condition. companies state quite clearly that exactly what is prescribed. TREAT ADHD regulation resulting in differences in the ADHD population (10) (16) (17) still have a part to play when We receive lots of complaints medication should not be used in There have been several recent • Methylphenidate acts on in brain functioning. (4) (11) (12) – something not fully discerning how the condition from patients where their GP has isolation, yet many NHS trusts announcements by ministers dopaminergic function and is Like other neurodevelopmental understood by GPs. LOW DIAGNOSTIC impacts on daily functioning dismissed a request for an ADHD are still failing to implement calling for parity of esteem for prescribed in various fast release conditions, it is frequently ADHD is 70 per cent heritable, PREVALENCE for the patient. However, how assessment stating reasons, such NICE guidelines of multi-modal mental health services. In the case and slow release mechanisms comorbid with autism (5), sensory (12) (13) (14) and like ASD, Contrary to popular belief – ADHD impacts on the individual as, ‘You have a degree so you can’t support that includes CBT, psycho of ADHD, the government needs under the brand names: Equasym, processing difficulties, dyslexia, is a chronic spectrum disorder. ADHD is underdiagnosed in can vary widely as a result of possibly have ADHD’, or the fact educative, and psycho social to fund research in psycho social Medikinet, Concerta and Xenidate dyspraxia, tics and poor executive Symptoms include hyperactivity, the UK, with only three per cent environmental factors, such as they have reached adulthood, and training. interventions, such as CBT for • Atomoxetine branded as functioning skills. Comorbidity is inattention and impulsivity, of children diagnosed, and less early diagnosis, healthy lifestyle, many GPs still believe that this is Medication is the first – and ADHD and empower families Strattera and Guanfacine branded the rule, not the exception, with resulting in frustration, anxiety, than one per cent medicated. and in the case of children, schools purely a childhood condition. often the only – line of treatment. with the knowledge and skills to as Intuniv act on noredranegic over 70 per cent of those diagnosed intolerance and sometimes (18) (19) In Scotland, diagnostic that have well-trained staff able The ADHD Foundation is Although medication is the only take responsibility for their health function and can take up to six with ADHD having at least one aggressive ‘fight or flight’ prevalence is estimated at only to identify children with learning introducing training programmes intervention proven to significantly outcomes. weeks to become effective comorbidity. (6) (7) (8) DSM 5 behaviours which are the result one per cent. Where are the and developmental delay (rather for GPs, newly-qualified improve brain functioning, it The one-off cost of one year • made it possible for clinicians to of an inability to self-regulate remaining 250,000 UK children than poor behaviour, which sadly psychiatrists, and paediatricians to is not a cure and does not teach of multi-modal interventions at Lisdexamphetamine branded diagnose comorbidities, whereas emotion. It is, however, the impact who have the condition but have is still the main reason why most address this, but lack of resources those who suffer with ADHD the ADHD Foundation is the as Elvanse is a precursor that until five years ago, the patient’s on mental health as a direct result not been diagnosed? I would like children are referred to the NHS makes it difficult for clinicians to about how to self-regulate and equivalent to that of one year of becomes effective only after the needs were seen through a singular of the low emotional resilience to think that they are functioning by schools). access this much-needed training. become emotionally resilient, with medication – £700. While there digestive system converts it into diagnosis rather than recognising associated with ADHD that sufficiently well to not require ADHD is a heritable condition GPs need to understand the a strength-based approach to their will always be some for whom dexamphetamine the frequent comorbidity. should be a cause of concern for treatment. The truth, however, is in 70 per cent of cases, but genetic impact of ADHD on the lives of mental health so they can learn medication is necessary, there is a GPs. The impact of ADHD on that many are misdiagnosed with potential can be triggered and families and recognise the distress how to live successfully with this good case for a more far sighted WHY THE LACK OF life chance trajectories can result other mental health problems in acquired; for example, we know caused by the condition and how condition in the same way we treat view and an ‘invest to save’ UNDERSTANDING? in school failure, loss of status, and the adult psychiatric system. Only that deficiency in vitamin D unsupported ADHD can impact other chronic conditions, such as approach in meeting the needs of The impact on the lives of rejection by peers, sustained levels when patients see an expert is the (22), iron (23) and zinc (24) in on the long-term mental health of diabetes. those with ADHD, while making those living with the condition of anxiety, depression, psychosis, underlying ADHD identified and pregnancy can increase the risk those affected and the cost of their cost savings. in the UK has never been self-harm, increased risk of treated. factors of ADHD. Traumatic unnecessary life-long dependence WIDER SOCIETY The largest ADHD conference truly understood by mental addiction through self-medication Referral pathways vary birth and epilepsy (25) are also on health services through missed Pharmacists also need to know for GPs, psychiatrists and health practitioners and NHS and long-term unemployment – all significantly throughout the UK, risk factors. Research has proven diagnosis and misdiagnosis more about the medications used paediatricians in the UK is taking commissioners, due to the lack of of which come at cost to statutory so it is something of a postcode there is a correlation between older arising out of complexity of to treat ADHD. The imperative on place in Liverpool on 9th and 10th 12 | WPR | May 2017 WPR | May 2017 | 13 WWW.WALESHEALTHCARE.COM VISIT WWW.WALESHEALTHCARE.COM/AWARDS TO KEEP UP TO DATE ON THE LATEST AWARDS NEWS
ADHD FINALISTS
disorder/Pages/Introduction.aspx 17. Preuss U, Ralston SJ, Baldursson G et al. Study design, baseline patient characteristics and intervention in a cross-cultural framework: REFERENCES results from the ADORE study. European Journal of Adolescent Psychiatry 2006;15(1):4–14. doi:10.1007/s00787-006-1002-0 18. McCarthy, Suzanne; Asherson, Philip; Coghill, David; Hollis, Chris; MEET THE FINALISTS Murray, Macey; Potts, Laura; Sayal, Kapil; de Soysa, Ruwan; Taylor, 1. Faraone SV, Perlis RH, Doyle AE et al. Molecular genetics of Eric; Williams, Tim; Wong, Ian C. K. In: Attention-deficit hyperactivity attentiondeficit/ disorder : treatment discontinuation in adolescents and young adults. The wait is finally over – WPR is delighted to reveal the lucky contenders hyperactivity disorder. Biological Psychiatry 2005;57:1313–1323. British Journal of Psychiatry, Vol. 194, No. 3, 03.2009, p. 273-277. doi:0.1016/j.biopsych.2004.11.024 Research output: Contribution to journal › Article 10.1192/bjp. who have secured a place on the 2017 Welsh Pharmacy Awards shortlist. 2. Biederman J, Spencer T, Lomedico A et al. Deficient emotional bp.107.045245 regulation 19. http://www.thesundaytimes.co.uk/sto/news/uk_news/Health/ and paediatric attention deficit hyperactivity disorder: a family risk article1615092.ece analysis. Psychological Medicine 2012;42:639–646. doi:10.1017/ 20. Vogt C & Shameli A. Assessments for attention-deficit hyperactivity S0033291711001644 disorder: 3. Lugo-Candelas L, Posner J.Collective analytics: advancing the use of objective measurements. The Psychiatrist 2011;35:380–383. neuroscience of ADHD. The Lancet. Psychiatry.Vol4,No. 4 p266-268 The success reaped by the pharmaceutical industry throughout the last 12 months doi:10.1192/pb.bp.110.032144 April 2017. Doi:http://dx.doi/10.1016/s2215-0366(17)30056-1 21. Hall, C, Valentine A, Groom, M.,Walker,G, Sayal,K. Daley, D.Hollis 4. Martine Hoogman et al: Subcortical brain volume differences in has been simply staggering – hurdles have been triumphantly overcome, and new C,2015.The clinical utility of the continuous performance test and participants with attention deficit hyperactivity disorder in children and objective measures of activity for diagnosing and monitoring ADHD adults: a cross-sectional mega-analysis. The Lancet Psychiatry, 2017; ground brilliantly broken. in children: a systematic review EUROPEAN CHILD & ADOLESCENT DOI: 10.1016/S2215-0366(17)30049-4 PSYCHIATRY.1-23. With this in mind, it’s once again time to publicly honour those key contributors 5. Antshel, K. M., Zhang-James, Y., Wagner, K. E., Ledesma, A., & 22. Morales E1, Julvez J, Torrent M, Ballester F, Rodríguez-Bernal CL, Faraone, S. V. (2016). An update on the comorbidity of ADHD and ASD: Andiarena A, Vegas O, Castilla AM, Rodriguez-Dehli C, Tardón A, Sunyer and the positive changes they’ve cemented for generations to come. A focus on clinical management. Expert Review of Neurotherapeutics, J. Vitamin D in Pregnancy and Attention Deficit Hyperactivity Disorder- 16(3), 279-293. DOI: 10.1586/14737175.2016.1146591 like Symptoms in Childhood. That’s right – the 2017 Welsh Pharmacy Awards will soon be upon us. The annual 6. Reiersen A., Constantino J., Volk H., and Todd R. 2007 Autistic traits Epidemiology. 2015 Jul;26(4):458-65. doi: 10.1097/ in a population-based ADHD twin sample. Journal of Child Psychology EDE.0000000000000292. industry pinnacle will this year be taking place on 25th May at The Vale Resort, and Psychiatry 48(5) 464-472 23. http://health.usnews.com/health-news/mews/articles/2013/12/02/ 7. Pauc, R. Comorbidity of dyslexia, dyspraxia, attention deficit disorder Glamorgan, and delivering generous doses of glitz, glamour, sumptuous dining, and, low-iron-in-brain-a-sign-of-adhd (ADD), attention deficit hyperactive disorder (ADHD), obsessive 24. Shahin Akhondzadeh, Mohammad-Reza Mohammadi, Mojgan compulsive disorder (OCD) and Tourette's syndrome in children: a of course, prime networking during the night. KhademiBMC . Zinc sulphate as an adjunct to methylphenidate for prospective epidemiological study. URL http://dx.doi.org/10.1016/j. the treatment of attention deficit hyperactivity disorder in children: A clch.2005.09.007 Journal Clin Chiropr. 2005 Dec;8(4):189-198 double blind and randomized trial [ISRCTN64132371] Psychiatry 2004, 8. GermanòDivision of Child Neurology and Psychiatry Pediatric 4:8 - Upon publication this article will be freely available according to Department of Policlinico G. Martino , University of Messina , Gazzi- Read on and find out more about the deserving finalists who will be battling it out BMC Psychiatry's Open Access policy at http://www.biomedcentral. Messina, Italy , E; Antonella Gagliano, A. Division of Child Neurology com/1471-244X/4/8/ for the top accolade in the following categories: and Psychiatry Pediatric Department of Policlinico G. Martino , 25. Ettinger AB, Ottman R, Lipton RB, et al. Attention-deficit/ University of Messina , Gazzi-Messina, Italy &Curatolo, P Pediatric hyperactivity disorder symptoms in adults with self-reported epilepsy: Neurology Unit, Tor Vergata, University of Rome, Department of Results from a national epidemiologic survey of epilepsy. Epilepsia. Neuroscience , Roma, Italy Comorbidity of ADHD and Dyslexia. 2015;56:218-224. Abstract • Innovations in Service Delivery in Independent Pharmacy Pages 475-493 | Received 09 Nov 2008, Accepted 11 Aug 2009, 26. Lyall K, Pauls DL, Santangelo S et al. Fertility therapies, infertility, Published online: 16 Aug 2010. Download citation http://dx.doi. and autism spectrum disorders in the Nurses’ Health Study II. • Student Leadership Award org/10.1080/87565641.2010.494748Pages 475-493Received 09 Nov 2008 Paediatric and Perinatal Epidemiology 2012;26:361–372. doi:10.1111/ 9. Accepted 11 Aug 2009 • Delivery of Pharmaceutical Care j.1365-3016.2012.01294.x Published online: 16 Aug 2010 27. Mikkelsen, S. Olson, J.Bech, B. Obel, C. 2016 Parental age and Milberger S, Biederman J, Faraone SV, Murphy J, Tsuang MT. Attention • Business Development of the Year Independent attention-deficit/hyperactivity disorder (ADHD) Jørn Olsen2Department deficit hyperactivity disorder and comorbid disorders: issues of of Clinical Medicine, Clinical Epidemiolgy, Aarhus University, Aarhus, overlapping symptoms. Am J Psychiatry. 1995;152:1793-1799. • Asthma Project of the Year Denmark, 3Department of Epidemiology, Fielding School of Public 10. Lahey, B. "Children with ADHD at increased risk for Health, University of California, Los Angeles, CA, USA, depression and suicidal thoughts as adolescents." ScienceDaily. • Independent Pharmacy Practice of the Year Search for other works by this author on: ScienceDaily, 4 October 2010.
INNOVATIONS IN SERVICE DELIVERY IN STUDENT LEADERSHIP COMMUNITY PHARMACY INDEPENDENT SPONSORED BY: THE PHARMACISTS’ DEFENCE SPONSORED BY: NUMARK ASSOCIATION
MARK SWEENEY STACIE MARKS ASIM ALI DYLAN JONES PILL PHARMACY, NEWPORT DUDLEY TAYLOR PHARMACIES, LLANIDLOES PHARMACY WELSH SCHOOL OF PHARMACY WELSH SCHOOL OF PHARMACY Despite the business having been established for 11 years, Asim is always striving to reach new Service delivery and enhancement has been a key focus for Llanidloes Pharmacy for over 15 In Mark’s role as First Year Representative for the Stacie has recently been elected as the Treasurer for heights. years – an area that the pharmacy has always excelled in. Welsh Pharmacy Students Association (WPSA), the WPSA hot on the heels of a successful year as the With this in mind, he executed various actions in order to achieve the ultimate objective of During 2016, the team launched its most exciting and innovative offering to date. The he swiftly became aware that when new attendees lead British Pharmaceutical Students Association improving the prescription delivery service whereby community pharmacy-based independent prescribing service enables the community arrived at Cardiff University, they often felt nervous representative. the team could enhance the experience of ordering the pharmacist (independent prescriber) to treat patients with acute illness within the community and alone. Taking up the role of an RPS student champion has prescription and having the prescription dispensed. pharmacy on the high street. Determined to tackle this prevalence, he carried also enabled Stacie to actively engage with the society One of the movements in question included the Although in its infancy, this out a number of industrious actions, including and educate other students, encouraging them to installation of a VOIP system which allowed the service is already influencing choices creating a group on Facebook after results day, utilise their memberships. team to use five phones at once, thus ensuring prompt in the primary care pathway locally whereby new pharmacy students could interact and Subsequently, long-lasting links between pharmacy communication with patients. through enabling the patient to reassure one another. students at Cardiff University and the RPS have been Staff training has also been key, but the biggest make a choice about which Mark is also responsible for running admissions forged. achievement has been the introduction of a dispensing prescriber they need to see, offering tours of the Cardiff School of Pharmacy and robot which has allowed members of staff to offer the access to a local prescriber when the Pharmaceutical Sciences. patients a more personal professional service. surgery is closed, and providing an additional referral option for the surgery for acute illnesses. RICHARD GRIFFITHS GRIFFITHS PHARMACY, GARDEN CITY SARAH ALZETANI WELSH SCHOOL OF PHARMACY The establishment of a well-rounded staff team, who are confident and able to deliver and de- SPONSOR: SPONSOR: velop the services which the pharmacy has embarked NUMARK THE PHARMACISTS’ DEFENCE ASSOCIATION During her second year, Sarah officially became a upon, has been a particular standout accomplishment. student mentor for the Pharmacy School; a position The further roll-out of the offerings of the compre- which entailed providing academic and social support hensive dressings provision, chiropody, new nursing to first year pharmacy students entering university life. homes, and the development and improvement of the Thriving under the responsibility has also led to her Onpos nurses services have been refined to consider recent nomination for pharmacy mentor of the year. the patient at the centre, as well as ensure that patient Moving forward, Sarah is committed to continuing care is paramount, and that the service supports to support and improve the scheme in collaboration patients fully. with other mentors and supervisors, and has taken on In term of processes that have been put in place the role of Pharmacy Mentoring Consultant. regarding staff training for this delivery, the pharmacy conducts daily team briefings, and weekly staff meetings to review services.
GARY JONES ELIN HOOPER GWENNO WILLIAMS RANA AJAJ MAYBERRY PHARMACY, CAERPHILLY BORTH PHARMACY, BORTH, CEREDIGION WELSH SCHOOL OF PHARMACY WELSH SCHOOL OF PHARMACY Pro Delivery Manager was initiated after Gary was informed that his delivery driver would Determined to challenge the above-average levels of As First Year Representative for the WPSA, and From the very beginning, Rana has expressed enthu- be temporarily unavailable. Realising the difficulty in smoking in the pharmacy’s operating area, Elin set armed with the aim to build student engagement, siasm towards securing successful progression within replacing the role, he decided that it was time to make about launching a smoking cessation service that used a Gwenno has undertaken and developed impressive pharmacy education. In order to contribute positively a change and take control. new, more innovative approach to helping people quit ideas. to the development of the pharmacy degree, she Pro Delivery Manager was originally designed their nicotine addiction. A major feature of the role was to organise and de- participated in the GPhC Accreditation at Cardiff to improve the efficiency of the delivery service, but After undergoing additional professional training, liver a talk about WPSA and run tours of the Welsh School of Pharmacy and Pharmaceutical Sciences in over the last 12 months, the team has developed a Elin devised a bespoke programme of cessation activity School of Pharmacy on UCAS interview days for which she shared her views as to how well-integrated branch collection facility. Not only do they track every that critically centred on intense behavioural support, prospective students and their parents. the course is at Cardiff University. prescription that is delivered; they also track every such as sending post-consultation text messages of The following year, Gwenno became WPSA As the Chairperson of the Student Staff Panel, prescription that is collected from the pharmacy. encouragement, as well as providing an out-of-hours Chairperson and kicked off plans to overhaul Rana has effectively employed the platform to ensure Every time a prescription is placed on the shelf, it’s telephone service so that patients can contact her if the society and promote greater recognition and that necessary changes are implemented, such as logged through Pro Delivery Manager and a patient they feel like they are giving up. collaboration. preparing for the new pre-registration applications Elin has also effectively utilised platforms like social media and retail partnerships to both receives notification by email and text that their system, ‘Oriel’. prescription is ready to collect. engage the cessation service with its target audiences and increase its success. 16 | WPR | May 2017 #WPA17 #WPA17 WPR | May 2017 | 17 WELSH PHARMACY VISIT WWW.WALESHEALTHCARE.COM/AWARDS TO KEEP UP TO WELSH PHARMACY VISIT WWW.WALESHEALTHCARE.COM/AWARDS TO KEEP UP TO AWARDS 2017 DATE ON THE LATEST AWARDS NEWS AWARDS 2017 DATE ON THE LATEST AWARDS NEWS
BUSINESS DEVELOPMENT OF THE YEAR (INDEPENDENT) DELIVERY OF PHARMACEUTICAL CARE SPONSORED BY: AAH PHARMACEUTICALS SPONSORED BY: MEDCOM LIMITED
RAFIA JAMIL PHARMACY TEAM ALISON SPARKES BOOTS, CAERLEON ROAD, NEWPORT LLOYDSPHARMACY, MOUNTAIN ASH THE HEALTH DISPENSARY, NEATH Boots pharmacy in Knighton had historically strug- LloydsPharmacy in Mountain Ash operates a gled to provide enhanced and advanced pharmacy standard NHS community pharmacy contract on the It was back in 2011 when the team’s wellness clinic opened its doors next to the pharmacy – progressively services until Rafia took over the challenging role as ground floor, dispensing prescriptions and delivering establishing itself over the years and earning a steady footfall. Meanwhile, the pharmacy had picked up Pharmacist Store Manager in 2015. She was keen clinical services to the local population. On the first pace with the addition of some large care home contracts and was spread over two floors, leading to to make a difference to how the local community floor, in addition to the busy retail pharmacy, the team Alison feeling as though she was managing three separate entities. received ‘value added’ services from the pharmacy, and boasts a specialised care and professional services hub, With this in mind, and also propelled by the LEAD Wales project, and further education, she met up support the GP practices more. from which they supply a large number of care homes, with Michelle of Rose-Innes Design in which the brand was not only devised, but became a reality. Rafia first took the initiative of meeting with local in addition to providing community dosage systems to By combining the pharmacy and clinic, the services are increasingly accessible. GPs, practice nurses and district nurses to inform them a large number of domiciliary patients. Although largely private, the team does offer some free by way of competitions, samplers, or simply of the services which would be provided and how a Notably, a bespoke pharmaceutical care service for goodwill. The ultimate aim is the establishment of a charitable arm for those that can’t afford it. local ‘referral system’ could be set up to help patients to three mental health hospitals across South Wales has As a result of the total health model, pharmacists are able to advise on nutritional supplements in access these services. been developed, which includes prescription dispens- combination with NHS prescriptions and offer the evidence available on them and on complementary One of her most significant achievements has been in pioneering the delivery of the Simple ing, clozapine dispensing, stock supply using their Wholesaler Dealers Authority at the site, healthcare. Asthma Service in collaboration with Powys Local Health Board and a local GP practice. and an on-site technician support for stock reconciliation. The Simple Service ensures that all asthma patients receive the comprehensive care intend- In particular, at the Mountain Ash Care Home Centre, the pharmacy has been excited LINDA JONES ed by NICE, including an annual review. to introduce an electronic MAR Chart system to the care homes, and looks forward to MURCH PHARMACY, DINAS POWYS expanding its use. After discovering that the local GP practice was seeking to relocate to more spacious and modern premises, DEWI COOK the wheels were set in motion for the pharmacy’s development, with minor relocation applications being submitted. WELL PHARMACY, PORT TALBOT Building started on the new health centre site in the summer of 2015 in line with the aim of achieving a Eager for the sector to reap the rewards of a more SPONSOR: SPONSOR: modern, impressive design, with a pleasant environment for customers and staff. integrated approach to healthcare, Dewi regularly Demonstrative of the team’s innovative nature is the fact that they decided to invest in the compact dispens- attends clinical surgery meetings in which he is able to MEDCOM AAH PHARMACEUTICALS LIMITED ing robot, having established from audits that the boost communication and ensure that GPs are aware majority of their dispensing errors and ‘near misses’ of the value of community pharmacy in terms of were due to human ‘picking errors’. improving patient quality of life and alleviating some of Other notable changes which have since been the pressure on the NHS. put in place include a run of substantial drawers to Especially of interest is the fact that Dewi com- house split packs and bulky items, and the creation municated to the GPs the benefits of the Discharge of four dispensing stations, with the possibility of Medicines Reviews that his pharmacy is able to offer increasing to five, and two consultation rooms. patients, reviewing the medications recently-dis- Additionally, one of the technicians is a qualified charged patients are sent home from hospital with, so reflexologist, and thus the second consulting room that GPs don’t have to. As a result of this two-way understanding, the GPs now direct eligible is set up to provide complementary therapies and patients to community pharmacy for this service, saving surgery appointment time for local additional services, such as emergency hormonal GPs and facilitating a more joined-up approach to patient care.
ASIM ALI JONATHAN SMITH PILL PHARMACY, NEWPORT MAYBERRY PHARMACY TEAM, BLACKWOOD The pharmacy has continually showcased efforts to draw out the best from the business, including moving into At the Newport branch of Mayberry Pharmacy, which Jonathan manages as senior pharmacist, the team cares for more than new premises in 2015. 15,000 patients, managing their prescription and medication needs, and ensuring that they get the most from the medicines Enhancing the profile of the business has been a key priority, too, and assisted by the provision of additional they have been prescribed. services which were needed by the local community. An underlining motivation for the pharmacy has been the Jonathan recognised the necessity of stronger collaborative working, and with Mayberry Pharmacy’s support, organised fact that Pillgwenlly is a community-first community, and they therefore wanted to deliver a service and facility a six-month secondment with the Aneurin Bevan University Health Board, working one day a week as a practice-based which members could be proud of. pharmacist within its Newport North Neighbourhood Care Network. His role entailed leading a varied number of A further goal was the advancement of the team, which was achieved by employing new members of staff and patient-focused projects and initiatives, all designed to deliver better patient care and medicine compliance, while also isolating moving up current members in their roles in the pharmacy. Currently, the pharmacy boasts three pharmacists a legitimate opportunities to generate cost savings. day, with an ACT adding to the skill mix on offer. Alongside this, employing a series of audits supported by the data sourcing tool, Real World Retail, Jonathan adopted a Asim allocating importance to the presence of training and role progression has also led to the Counter number of initiatives designed to improve patient safety and facilitate targeted MURs. Assistant having recently qualified as a Dispensing Assistant, while a new member of staff is currently undertaking a counter assistant course, in which they’re flourishing, and possess a bright future in pharmacy.
18 | WPR | May 2017 #WPA17 #WPA17 WPR | May 2017 | 19 WELSH PHARMACY VISIT WWW.WALESHEALTHCARE.COM/AWARDS TO KEEP UP TO WELSH PHARMACY VISIT WWW.WALESHEALTHCARE.COM/AWARDS TO KEEP UP TO AWARDS 2017 DATE ON THE LATEST AWARDS NEWS AWARDS 2017 DATE ON THE LATEST AWARDS NEWS
ASTHMA PROJECT OF THE YEAR SPONSORED BY: NAPP PHARMACEUTICALS INDEPENDENT PHARMACY PRACTICE OF THE YEAR LIMITED SPONSORED BY: TEVA UK
VICTORIA CORNELIUS ALISON SPARKES & TEAM JAYNE SOLTYS & TEAM LLOYDSPHARMACY, BRIDGEND THE HEALTH DISPENSARY, NEATH WASHINGTON PHARMACY Given the pharmacy’s prime location situated within a small parade of various shops, near a dental practice, and in very close proximity to six By combining the pharmacy and clinic, patient care has remained core, with particular Washington Pharmacy has been an independent community pharmacy since the 1950s, and doctor surgeries, the team has the opportunity to cater for patients of all ages, accessing both routine and acute prescription services. emphasis on their ability to not only be aware of services, but to easily access them. With this in has been owned and managed by Jane Soltys since 2005. Every staff member has been trained on how they can be more involved in providing the best possible care to asthma patients, with the mind, a Customer Relationship Management system is being fully customised and invested Delivery of modern healthcare services from the outdated premises was a major constraint healthcare assistants playing an integral role in highlighting patients that may need extra support or advice with their asthma, recommending in by the team, helping them to recognise who is calling, make notes relevant to customer care, to Jane and her team. As a result, the opportunity to take an adjacent unit and double in size, over-the-counter products, and providing them with support to manage their medication-ordering process. and remind them about following up. along with the investment of refurbishing the premises As a company, LloydsPharmacy has developed the LloydsPharmacy Respiratory Support Service to further help patients control and un- Also beneficial – and adding a further professional to create a modern, and easily-accessible shop and derstand their condition. The initiative offers tailored solutions, from managing patients’ prescriptions and perfecting their inhaler technique, to edge to the brand – has been the introduction of a dispensary was a stimulus to business development undertaking the Asthma Control Tests and used In-Check dials to help offer personalised advice on how they can improve the management therapy booking system in 2016 which sends text re- and signalled a major expansion of healthcare services of their asthma. Also on offer is a specific service to support children living with asthma. minders, and enables series booking of appointments. to the Penarth community. Differentiating itself in the market, rather than From the outset, Jane and her team have taken showcasing rows of OTC shelving, the team opts major strides in identifying patient needs, and working for a themed approach to The Health Dispensary, together with other healthcare providers to make a and has created a large ‘events space’, offering them the positive impact on community care. flexibility to host health workshops. Notably, in 2015 they installed a new computer SPONSOR: software to deliver an eMar solution to residential RICHARD GRIFFITHS homes – this has since thrived and expanded to new NAPP PHARMACEUTICALS LIMITED GRIFFITHS PHARMACY, GARDEN CITY PAUL MAYBERRY & TEAM The pharmacy is perched within a small, industrial town in the region of Deeside, in which the MAYBERRY PHARMACY, BLACKWOOD prevailing focus of the town is supported by several large organisations. The consequence of there being The Mayberry Pharmacy Group launched in 1994, opening its first pharmacy in the historic an industrial-based local economy has been a higher than average level of patients with chronic chest town of Pontypool. Since then, it has grown to a chain of seven pharmacies, serving more than conditions, such as asthma and COPD. 100,000 patients. Aware of this prevalence, the team has carved out a mission to The ethos in which the staff operates entails working individualise healthcare for asthmatic patients, undertaking a num- hard to ensure that the pharmacies are more than SPONSOR: ber of measures to do so. These have included targeting patients just somewhere in which people attend to take their TEVA UK with asthma / COPD for detailed MURs, and utilising a video prescriptions. In fact, the team has developed the group animation to counsel patients on effective use of MDI inhalers. to be a chain of healthcare centres on the high street; Importantly, if the pharmacy identifies those patients who have accessible and available to all. In achieving this, they have difficulty in producing enough inspiratory flow for a turbohaler invested in the pharmacists of tomorrow, supporting or easi-breathe devices, they refer them to the GP to consider a the longevity of the industry by training pre-reg standard MDI plus spacer. pharmacists in new skillsets. Griffiths Pharmacy has also introduced use of the novel device Over the last 12 months, the pharmacy has invested called Flo Tone – this attaches onto a MDI inhaler and makes a significantly using the data and analytics tool Real note tone when the device is being used correctly at the right rate.
DAVE EDWARDS BOOTS, JOHN STREET, WHITLAND LINDA JONES & TEAM Dave has recently developed a new respiratory MUR+ service which focuses on inhaler technique and asthma control MURCH PHARMACY, DINAS POWYS – an extension on the work he has been doing for some time. Sharing his successes with Hywel Dda Local Health Board Although Murch Pharmacy’s roots were forged over 25 years ago, the team is always willing to adapt to change and innovation – has undoubtedly shaped their decision to introduce this enhanced service to reach more patients across the community. evidenced by them undergoing a minor relocation in 2016 to a new site. Dave’s interests in healthcare include asthma and COPD, while a couple of years ago, a chance comment from a This move presented the team with a prime opportunity to design a spacious dispensary with four dispensing stations; one located Boots pharmacy technician led him to explore the Isle of Wight inhaler project and the work of Jon Bell. Armed with right at the front so that straightforward prescriptions can be processed swiftly, minimising patient waiting time. The investment of a an in-check dial device, he set about targeting a group of asthma patients, and this interest drew him towards a smoking Consis B4 dispensing robot has facilitated this, while one of the dispensing stations is on a dedicated bench at the back of the dispensa- cessation qualification. ry for assembling MDS trays for a local residential home and an increasing number of community clients. Dave’s team highlights all respiratory medications and routinely discusses the condition and treatment with the patient. Recognising the benefits of collaborative efforts across the sector, the team enjoys a close working relationship with the adjoining Typically, Dave will take the patient to the consultation room and explain the mechanics of asthma with the use of posters surgery, as well as the other surgeries in the nearby town of Penarth and village of Sully. and other resources. He tells them about the actions and optimum use of their medication, explaining the benefits of having their asthma tightly controlled.
20 | WPR | May 2017 #WPA17 #WPA17 WPR | May 2017 | 21 WELSH PHARMACY VISIT WWW.WALESHEALTHCARE.COM/AWARDS TO KEEP UP TO WELSH PHARMACY VISIT WWW.WALESHEALTHCARE.COM/AWARDS TO KEEP UP TO AWARDS 2017 DATE ON THE LATEST AWARDS NEWS AWARDS 2017 DATE ON THE LATEST AWARDS NEWS
INNOVATIONS IN QUALITY & EFFICIENCY THROUGH TECHNOLOGY IN COMMUNITY PHARMACY HOSPITAL PHARMACY TEAM OF THE YEAR SPONSORED BY: POSITIVE SOLUTIONS IN SPONSORED BY: MARTINDALE PHARMA ASSOCIATION WITH WALLACH UK CLAIRE JEAN DEWI COOK MELANIE OWEN & THE T BLOCK PHARMACY TEAM LLOYDSPHARMACY, PEMBROKE CASTLE WELL PHARMACY, PORT TALBOT BETSI CADWALADR UNIVERSITY HEALTH BOARD LISA FOREY & THE OMNICELL INSTALLATION TEAM Although LloydsPharmacy in Pembroke Castle was al- Various reports have highlighted a serious concern The T Block Pharmacy Team ANEURIN BEVAN UNIVERSITY HEALTH BOARD ready recognised for delivering a high level of services to around the level of errors and lack of efficiency made comprises a group of pharmacy The RGH Pharmacy Omnicell ‘Vending’ a significant number of care homes in the surrounding when dispensing medication for vulnerable residents technicians and pharmacists that Installation Team is made up of a group of staff of area, including and patients in care homes. Notably, the 2009 are responsible for covering five varying grades – which include ATOs, technicians full prescription management, the team is always open CHUMS report revealed that on any one day, seven wards in the T Block at Ysbyty and pharmacists – who are responsible for working to new initiatives. out of ten residents experience at least one medication Gwynedd. Instead of working together to ensure that all Omnicell installations at In particular, they embraced the opportunity to error. in isolation, they now come ward levels are completed as seamlessly as possible. introduce the LloydsPharmacy Care First Electronic Prompted by the determination to reduce these risks together as a co-ordinated team The intrinsic nature of this approach is clear in that MAR Chart system to a number of the care homes for the sector, and ensure the safe and effective manage- to cover all the pharmacy services wards / departments are fully trained in operating the in order to enhance patient safety, reduce medication ment of medication in care homes across the country, that are provided at ward level, Omnicell machines from the very first ‘go-live’ date waste, and offer simplicity of use for the staff within the the Well Careplus service was conceived. thus lessening variation in the quality and quantity of services on offer. so that medication is accessible at all times, and that care homes. The service, which launched in October 2015, has This change has particularly resulted in a reduction in the average turnaround time for dis- patient welfare at ward level isn’t compromised. The merits of this new measure are clear to see, in that each resident’s medicine regime is grown to serving 8,000 residents in over 220 care homes in the UK, in just 18 months, in charge prescriptions which in turn supports patient flow through the hospital. Additionally, The team worked with the RGH Emergency instantly accessible, creating a comprehensive audit trail of all medicines administered – from which the whole medication management process is optimised digitally through the use of more patients are being counseled by pharmacy staff which is supporting concordance. Department to install four Omnicell machines into the department, which entailed remov- scheduled medication to Pro Re Nata pain relief and more. This knowledge can also be the Well Pad. The team also had an opportunity to pilot a satellite pharmacy scheme where they were ing and changing medication access in four sections of the department, while successfully still securely shared with GPs and pharmacies – through a secure login process – subsequently The barcode-enabled device acts as an extension of the pharmacy, using software, called able to work from a ‘dispensary’ in a room on T Block. ensuring that a safe and comprehensive service was maintained to all patients treated through presenting healthcare professionals and care givers with an accurate picture of the residents’ Proactive Care System, to track medication, reorder stock, and reduce wastage. the front door. wellbeing. PAUL SWITHENBANK & THE PHARMACY-LED GARY JONES ANTICOAGULATION TEAM BORTH PHARMACY, BORTH, CEREDIGION ABERTAWE BRO MORGANNWG UNIVERSITY HEALTH BOARD Gary’s employment of the innovative Pro Delivery SPONSOR: SPONSOR: Manager technology first began to take shape in 2014, POSITIVE SOLUTIONS IN ASSOCIATION WITH WALLACH UK The team has developed and MARTINDALE PHARMA when he realised that he required better control, not diversified the range and complexity just financially, but clinically, of what was becoming a of anticoagulant services provided, major part of his pharmacy business. managing approximately 2,000 The implementation of the system has since brought patients. a raft of benefits – with the pharmacy witnessing a The services in question include massive improvement in efficiencies. All staff can now receiving referrals for new and existing trace the collection, delivery of every prescription isn’t patients from acute care physicians dependent upon the driver’s knowledge or ploughing and GPs for anticoagulation, as well through wads of delivery paper, and when a patient as the dose initiation and stabilisation phones, the team is equipped to answer queries of patients for both Warfarin and Direct Acting Oral Anticoagulants – former patients remain immediately. within the clinic, the latter are followed up for up to six months, and once stabilised they can be Impressively, the surgery is set up as a hub and all prescriptions that are dispensed for patients transferred to primary care following liaison with their GP. attending it will be allocated to the hub. The surgery will then receive notification that the The pharmacists within the clinic are trained to inject and teach the administration of Low items are ready to collect and proof is obtained on collection – resolving any issues with Molecular Weight Heparin to patients who require cover where their degree of anticoagulation is missing items. sub-therapeutic. Additionally, those who need anticoagulant bridging prior to surgery or invasive procedures are also managed by the pharmacy team. JACQUI CAMPBELL PRITCHARDS PHARMACY, PRESTATYN CHRIS BROWN & TEAM Jacqui qualified as a pharmacist in 1990, and yearning for further learning opportunities, and always striving to achieve, she successfully acquired her NATIONAL RENAL MEDICINES MANAGEMENT GROUP own community pharmacy business in Prestatyn in 2003. From the outset of the South Wales Renal Network, as well as part of the Welsh Renal Clinical Network, the Renal pharmacy team Jacqui’s commitment to forward thinking has been demonstrated through her investment in automation – becoming the first community members have been innovators and leaders in service redesign and improvement. pharmacy in Wales to have a pharmacy robot. And despite the initial disruption to the pharmacy – as it entailed building an extension – the rewards In particular, since 2008, within the network arrangements, the team has driven national and regional changes – with the key exam- have been reaped. ples including anaemia management and post-transplantation immunosuppression. Since automation, the number of dispensing errors has reduced, while much better control of dispensary stock is now yielded as the robot A standout strength regarding the way the team functions is its focus on research and audit to not only understand opportunities, prompts when products are nearing their expiry date or have been in the robot for more than six months. The products can then be easily retrieved but to demonstrate the intended impact that they have made. Positively impacting the bigger picture, the team shares best practice and to check expiry dates. learning to the wider benefit of the service and NHS Wales. Heightened health and safety has also been secured in that storing medicines in the robot has meant that the pharmacy has a less cluttered Professional development has been central, too, and exemplified by the fact that all three of the only independent prescribers in the UK dispensary. to authorise blood transfusion are within the Renal Pharmacy Team at Morriston. 22 | WPR | May 2017 #WPA17 #WPA17 WPR | May 2017 | 23 WELSH PHARMACY VISIT WWW.WALESHEALTHCARE.COM/AWARDS TO KEEP UP TO WELSH PHARMACY VISIT WWW.WALESHEALTHCARE.COM/AWARDS TO KEEP UP TO AWARDS 2017 DATE ON THE LATEST AWARDS NEWS AWARDS 2017 DATE ON THE LATEST AWARDS NEWS
MANAGEMENT OF DIABETES IN COMMUNITY PHARMACIST OF THE COMMUNITY PHARMACY YEAR (INDEPENDENT) SPONSORED BY: NAPP PHARMACEUTICALS SPONSORED BY: CAMBRIAN ALLIANCE LIMITED
RICHARD GRIFFITHS DYLAN JONES GRIFFITHS PHARMACY, GARDEN CITY DUDLEY TAYLOR, LLANIDLOES PHARMACY Given the diverse nature of patients throughout the community with diabetes, the team has enlisted various strategies to ensure that they As an independently-owned local community pharmacy, Dudley Taylor Pharmacies Ltd has been providing pharmaceutical services receive a high level of care according to their needs. based in Llanidloes for around 20 years, being highly valued as an essential service within the community. The members of the team came together to examine as to how other local health professionals and services could be involved in Dylan has been Manager and Community Pharmacist at the pharmacy for 15 years, and commits time to understanding customers’ providing a balanced service that supports diabetics with all the elements of managing the condition. This involved the development unique needs. This frame of thinking led to the development of a range of additional services – both preventative and supportive – to help of a multidisciplinary approach to patient care which consisted of working in partnership with several practice nurses who run diabetic customers improve and manage their own health. Understanding the importance of collaboration, the team has also built strong links and clinics within a GP setting, in terms of referrals following screening of diabetics, as well as follow-on care as needed in terms of follow-up partnerships with other healthcare providers, including the local health board, the local GP surgery, district nurses, respiratory nurse, and after an MUR and poor sugar control being recognised. urgent care practitioners. Always capable of thinking outside the box, the team also negotiated a partnership arrangement with a local hotel which boasts a In addition to being the Manager of Llanidloes Pharmacy, Dylan’s remit incorporates a senior role within Dudley Taylor Pharmacies comprehensive gym and swimming pool in order to provide reduced priced gym memberships for patients with diabetes, encouraging Ltd in which he, among other duties, leads on contractual / professional issues for the 11 Welsh branches, represents Dudley Taylor on the them to work on their health. Welsh Regional Multiples Group, and carries out the Prescribing Advisor’s post at the local surgery. Additionally, for obese patients, the pharmacy provides the Lipotrim system which is a clinically proven, very low calorie diet system These networks offer an excellent insight into the strategy of healthcare in Powys and Wales – learning which he applies when piloting that delivers effective weight loss, while others may be referred to local Weight Watchers and Slimming World groups. new service approaches in his pharmacy.
JACQUI CAMPBELL GAVIN TAYLOR PRITCHARDS PHARMACY, PRESTATYN LLOYDSPHARMACY WATERFRONT MEDICAL CENTRE, BARRY Jacqui’s ethos for serving the local population is to ensure that medicines are dispensed in a safe and efficient manner, that every service commissioned by LloydsPharmacy Waterfront Medical Centre delivers pharmacy the local health board is offered to patients, and that the team offers for sale a SPONSOR: SPONSOR: services to a very wide demographic pool, encompassing patients range of products to suit customers’ needs. on the lower socio-economic scale, a considerable student popu- CAMBRIAN ALLIANCE NAPP PHARMACEUTICALS LIMITED Jacqui is particularly passionate about the palliative care service, and even lation, as well as patients on the higher end of the socio-economic before the introduction of the local enhanced service, made herself accessible scale. out-of-hours to the doctors and district nurses on-call should they need an The team implemented their Focus on Diabetes campaign in urgent prescription dispensed. She now continues to work closely with the May 2016, in line with the aim of helping customers who are al- district nurses to ensure that the business stocks the medicines, dressings, and ready diagnosed to ensure they take their medication appropriately, products they may require, including anticipatory cover for weekends and as well as encouraging customers who are at risk to get tested and, if bank holidays. necessary, get the treatments that they need. Jacqui has also been recognised for her active provision of pharmaceutical Significantly, the initiative enables attendees to manage their services to several residential and nursing homes across the community. She condition by offering foot checks or blood pressure tests, in which ensures that the residents receive their medicines in a timely manner, and that the free foot check service offers diabetic patients the chance to talk to the pharmacy team about their there is thorough communication between them and the prescribers to ensure safe medication practices. diabetes and any related diabetic foot problems, and to find out about the simple, everyday things One of the residential homes in question is a registered charity, which Jacqui sits on the Board of Trustees as a provider they can do to keep their feet as healthy as they can be. This then allows the staff to create personalised registered with CSSIW to ensure that the home complies with all necessary regulations. footcare routines which include how to regularly check for loss of sensation and check for damage to their feet. The pharmacy team was equipped with the necessary tools and training to help them embrace the ASIM ALI campaign, such as tips and techniques, and progress charts. MUSTAFA AMEER PILL PHARMACY, NEWPORT CRWYS PHARMACY, CATHAYS, CARDIFF The pharmacy is based in a community which is highly prevalent in the incidence of diabetes, so it’s been integral for the Having been qualified for three years and Superintendent for just over two, Mustafa has had to harness his ability to, not only adapt to, but team to reach, and assist, as many people as possible. initiate, a number of gradual changes. Especially effective has been the fact that the team is multilingual, and contacts the diabetes charities and the British The first, most significant change entailed carrying out a refit, which subsequently catered for the creation of a bigger dispensary area Heart Foundation for leaflets in multiple languages for patients. where the team could focus more on perfecting the essential services, before trying to take on additional services. This also allowed for a Under the branch of Project Next Generation, the pharmacy homed in on the education of the different generations consultation room in the shop, and thus more one-to-one confidential conversations with the patients. from the same households. The family members have been informed about the benefits of a healthy diet and exercise, Mustafa’s industrious and problem-solving nature is showcased in that he opened accounts with more suppliers to try to overcome issues while alterations were recommended in their meal plans, and signposting was offered to relevant support groups, includ- with shortages, and liaised with the main surgeries to communicate items that are on longer-term delays. The team has also worked with ing Diabetes UK and the Help 2 Quit stop smoking service. one of the surgeries, carrying out regular meetings to feedback services from the health board, and any issues that can be addressed. The pharmacy has also participated in community events, providing diagnostic testing and healthy living advice, and Continuing this mode of action, the pharmacy changed the way in which they order medication, slightly extended the opening times, is intending to extend their positive influence by way of currently being in the middle of formulating a Diabetes Open and has also informed local surgeries to phone them even after closing times in case there were any urgent scenarios. day in the local community in collaboration with a local surgery. The aim of this venture is to demonstrate that health professionals as a united team can be seen to offer essential information advice about this condition.
24 | WPR | May 2017 #WPA17 #WPA17 WPR | May 2017 | 25 WWW.WALESHEALTHCARE.COM WWW.WALESHEALTHCARE.COM
SUMMER SPECIAL SUMMER SPECIAL INHALER TECHNIQUE: MAKE NO MISTAKE As the prime season for foreign adventures edges closer, for many asthmatic sufferers, confusion as to how to best manage their condition is a major cause for concern. It’s easy to see why – given that a recent International CRITIKAL Study shed a startling light on the reality of poor inhaler technique. WPR talks to Professor David Price, Chair of Primary Care Respiratory Medicine at the University of Aberdeen, Director of the Observational and Pragmatic Research Institute, and ex- Chairman of the Respiratory Effectiveness Group, about the findings, and how these critical errors can be addressed.
they are. You can potentially make need to do something about this. however, important that patients patients will have a device which – such as a light which tells them if direction. up to 20 errors with each inhaler, One is the effects on people have proper time to be trained – at has a particular series of issues, they’re using it incorrectly. We need to ensure that patients and it’s very hard for clinicians to with asthma – their lifestyle is least once a year. and then another device which The other big thing is that we know exactly how to use them. focus on all 20. limited, and they’re also more Beyond that, the problem has another set of issues. It’s very must educate and try and find the So, the aim of this was to look likely to have asthma attacks. It also is that healthcare professionals important that we encourage device that’s easiest for that patient. WHAT ISSUES COME at these and to understand which leads to a bigger problem in that themselves don’t necessarily know consistent use, rather than employ What I always say to healthcare INTO PLAY WHEN areas are the most important. if patients aren’t seeing the benefit enough about how to use the two or three different inhalers. professionals is, ‘Stop trying to fit ASTHMATIC PATIENTS ARE What we found with the of their treatment, they may stop inhalers, so we need to ensure that The second thing is that we the patient to the device or the TRAVELLING? classical ‘press and breathe’ inhaler taking it. they’re educated. This study was need to make sure that we give drug – fit the device and drug to The most important thing is to was patients failing to empty the The other thing is that one about saying that there are many them the device which is easiest the patient and their instinctive remind patients not to forget their lungs – they breathed out before of the biggest healthcare spends things that we need to address for them to use – and certainly way of using it.’ inhalers! The patient should try they breathed in – and then in any setting today is asthma about inhalers, but let’s focus on one of the things that is happening to have an action plan from their pressing their inhaler before they and COPD and inhalers, and if the most important areas, rather today is that we’re doing quite well DO YOU THINK THAT doctor and remember to bring it started breathing in. patients inhale badly, they might than every single thing. Yes, it’s with innovation. But saying that, PACKAGING / LABELS with them, and make sure that they With dry-powder inhalers, the end up taking twice as much drug important to take the cap off the we should still be making sure that REPRESENT A MAJOR ROLE? know and understand what the simplest error was failure again to to get the same effect which can inhaler, but actually only two they can use that one adequately. Unfortunately, because of instructions are. If they don’t have empty the lungs first, and then not lead to waste. people in 5,000 in the study forgot What we have seen is that regulations, we end up with an action plan, and they’ve had breathing in hard and fast. Effective use of inhalers to. metered dose inhalers have packages which, although full of previous attacks from their asthma, This tells us that doctors, is probably one of the most become more advanced; they come information, are actually of little it’s really important for them Professor David Price pharmacists, and patients need to important interventions we can WHAT ADVICE SHOULD BE out slower and gentler, and are use to the patient. I think it’s to talk to their asthma nurse or focus on these particular problems, make in healthcare. TAKEN ON-BOARD WHEN more tolerant of people inhaling important for the regulator to be doctor about what they should do CAN YOU TELL US ABOUT Immunology: In Practice examined as well as their general education HELPING THE VULNERABLE incorrectly. thinking about how we can make and bring if they get into trouble. THE LATEST FINDINGS for the first time which errors of inhalers. WHY ARE PATIENTS NOT PORTION OF PATIENTS Also, we have inhalers with information that’s genuinely useful They sometimes need to think RELATING TO INHALER people make with their inhalers, BEING SUFFICIENTLY IMPROVE THEIR ASTHMA smaller spaces for people who for the patient. about where they’re going and ERRORS AND POORER and most importantly, the impact WHAT ARE THE WIDER EDUCATED? MANAGEMENT? can’t co-ordinate their pressing Very, very simple packaging consider their circumstances, ASTHMA OUTCOMES IN of this on their asthma control. SYSTEMATIC IMPLICATIONS There’s obviously a challenge There are several measures we can and breathing, and we have and instructions are important. and to make sure that their travel PATIENTS? Previous work has shown that OF FAILURE TO UTILISE in finding time for education – carry out to make it easier. One of new inhalers coming out that Sometimes things on the inhalers insurance is up-to-date. The new study published in the errors are impossible to know – no INHALER DEVICES certainly in some countries it’s very the things that we’ve found from will actually overcome that co- themselves can help – such as an Journal of Allergy and Clinical one has really worked out what CORRECTLY? hard to set up routine care services our research is that we should try ordination problem. There are also arrow showing that an inhaler There are several reasons why we in a way that supports that. It is, to keep devices consistent. Many some inhalers which give feedback needs to be pointed in a certain
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SUMMER SPECIAL Designed to deliver. THE (NOT SO?) GREAT OUTDOORS Revelling in the sun rays at barbeques, and setting off for scenic strolls across the countryside, summer’s arrival brings with it plans galore. But there’s nothing that dashes the illusion quite like the impact of seasonal allergies, particularly hay fever. AllergyUK's Nurse Advisor, Holly Shaw, overviews the main culprits – and how the pharmacist’s role in the symptoms management process has evolved.
COMING INTO SUMMER, and some are sodium cromoglicate. As I mentioned, it’s really really comes into play. WHAT ARE THE CORE HAY For more moderate signs of important that patients’ severity FEVER TRIGGERS? hay fever, the next step is the is matched to the appropriate FOR MANY, ALLERGIES It will be very individual as to inclusion of a steroid nasal spray treatment. For example, if they TEND TO MASQUERADE which pollen or aeroallergen hay – an intranasal corticosteroid have moderate-to-severe hay fever, AS OTHER ILLNESSES. DO fever patients are allergic to, but – and the key message here for they’re not going to get the results YOU HAVE ANY ADVICE • Ready in one flip of the cover the majority of hay fever patients healthcare professionals is that they or the symptom-management if FOR HEALTHCARE • For severe asthma and COPD*1 – about 80 per cent – are affected need to be showing patients how they choose the treatment options PROFESSIONALS TO AID by grass pollen. We have crops to use that spray. We know that that we’ve talked about. THEM WITH THE DIAGNOSIS ® • Provides cost-savings vs. Seretide which come into play during medications are only effective if If something isn’t working PROCESS? (salmeterol/fluticasone) Accuhaler® 50/500 mcg2 their particular cycle too. Hay patients take them correctly. The – if they’re using a nasal spray Whatever condition a patient fever can be year-round or specific nasal sprays can be antihistamine and don’t feel like it’s effective has, there’s always an alternative depending on which pollen etc. the or steroid-based, or a combination – there could be a reason, such diagnosis, and certainly *Aerivio Spiromax® is licensed for use in adults aged 18 years person is allergic to. of the two. as it not being properly utilised. with allergies, and hay fever and over and is available in one strength of 50/500 mcg.1 As well as that, there are some Just because one antihistamine in particular, the signs and WHAT ARE THE other add-ons, like saline nasal doesn’t work, doesn’t mean to say symptoms can often be seen in RECOMMENDED PATHS OF douching – irrigating the nasal that another one might not be of other conditions, such as chronic TREATMENT? passages with a saline solution benefit. rhinitis, and the common cold. The goal is to achieve symptom may provide some benefit to those It’s important that leading control, and everyone’s symptoms with inflamed airways – and HOW IMPORTANT IS THE questions are asked to get the Please refer to the Summary of Product should be reviewed and the dose of inhaled corticosteroid predisposed to low levels of serum potassium. Paradoxical diuretics. Use with other adrenergic-containing medicinal PHARMACIST’S ROLE IN Characteristics (SmPC) for full details of titrated downwards as appropriate to maintain disease bronchospasm may occur. In such patients treatment should products can have a potentially additive effect. Avoid use with are a little bit different, with decongestants can help too. right information. Take a detailed Prescribing Information. control. COPD Adults: One inhalation twice daily. Elderly: No be discontinued and a rapid-acting bronchodilator treatment ritonavir due to expected marked increase in fl uticasone treatment being based on their TREATING ALLERGIES, allergy-focused history from the dose adjustment required. Renal impairment: No dose initiated immediately. Systemic effects may occur, particularly propionate plasma levels. Concomitant treatment with HOW CAN THIS MINIMISED AND HOW HAS THEIR Aerivio® Spiromax® (salmeterol/fluticasone) severity. patient. adjustment required. Hepatic impairment: No data. at high doses prescribed for long periods. It is important that ketoconazole or other potent CYP3A inhibitors such as 50mcg/500mcg inhalation powder Abbreviated Prescribing Mild hay fever symptoms will POLLEN EXPOSURE BE SENSE OF RESPONSIBILITY It’s also important to Contraindications: Hypersensitivity to the active the patient is reviewed regularly and dose of inhaled itraconazole, and telithromycin should also be avoided. Information ACHIEVED? ENHANCED? substances or to any of the excipients. Precautions and corticosteroid is reduced to lowest effective dose. Prolonged Caution is recommended with moderate CYP3A inhibitors be treated with a daily, non- acknowledge if it’s out of your Presentation: Each delivered dose contains 45 micrograms warnings: Not to be used to treat acute asthma symptoms treatment with high doses of inhaled corticosteroids may such as erythromycin and long term treatment should be sedating antihistamine – the key • Wear wrap-around sunglasses The pharmacist has a key role to remit and you need help. of salmeterol (as salmeterol xinafoate) and 465 micrograms for which a fast and short-acting bronchodilator is required. result in adrenal suppression and acute adrenal crisis. avoided. Pregnancy and lactation: Not recommended. message there is ‘non-sedating’. that cover the corners of the eyes to play in educating patients with of fl uticasone propionate. Each metered dose contains 50 Additional systemic corticosteroid cover should be considered Patients should not be initiated on Aerivio Spiromax during an Effects on ability to drive and use machines: No or We recommend a first- prevent the pollen from irritating regards to hay fever. What we’re HOW DO YOU FORESEE THE micrograms of salmeterol (as salmeterol xinafoate) and 500 exacerbation, or if they have signifi cantly worsening or during periods of stress or elective surgery. Patients negligible infl uence on the ability to drive and use machines. FUTURE RELATIONSHIP micrograms of fluticasone propionate. Indications: acutely deteriorating asthma. Serious asthma-related adverse transferring from oral steroids may remain at risk of impaired Adverse reactions: Paradoxical bronchospasm, generation antihistamine; there them finding is that patients who come BETWEEN ALLERGIES AND Treatment of patients with severe asthma where use of a events and exacerbations may occur. Patients should continue adrenal reserve. Adrenocortical function should be regularly anaphylactic reactions including anaphylactic shock. are many different types and the • The application of a nasal through to the AllergyUK hotline combination product (inhaled corticosteroid and long-acting treatment but seek medical advice if asthma symptoms monitored in such patients. COPD patients should be Pneumonia (in COPD patients) Very Common: Headache, pharmacist is well placed to make often don’t want to burden their THE HEALTHCARE SECTOR? β agonist) is appropriate such as: patients not adequately remain uncontrolled or worsen after initiation of treatment. monitored for possible development of pneumonia as clinical nasopharyngitis. Common: Candidiasis of mouth and throat, allergen balm is encouraged for 2 those recommendations. What GP or health professional, and Increasing public awareness of controlled on a lower strength corticosteroid combination Patients who have an increased requirement for use of features of such infections overlap with symptoms of COPD bronchitis, hypokalaemia, throat irritation, hoarseness, adults – it acts as a pollen trap we do know about the slightly pharmacists are well placed to see allergies in a responsible way product or patients already controlled on a high dose inhaled reliever medication, or decreased response to reliever exacerbations. In COPD patients experiencing exacerbations, dysphonia, sinusitis, contusions, muscle cramps, traumatic • Wash your hair and hands when corticosteroid and long-acting β agonist. Aerivio Spiromax is medication should be reviewed. Patients who experience treatment with systemic corticosteroids is typically indicated. fractures, arthralgia, myalgia. Consult the Summary of older and the second-generation patients. Patients don’t need an is important; getting out key 2 you come in from the outside – indicated for the symptomatic treatment of patients with sudden and progressive deterioration in control of their Patients should seek medical attention if symptoms Product Characteristics in relation to other side effects. of antihistamines is that they appointment – they can walk in messages for the safe management COPD, with a FEV <60% predicted normal (pre- asthma should undergo urgent medical assessment and deteriorate with Aerivio Spiromax treatment. Discontinuation Overdose: An overdose of salmeterol may lead to: rinse the pollen off because it can 1 can make people feel sleepy and and access that expert knowledge. of the symptoms. bronchodilator) and a history of repeated exacerbations, who increase in corticosteroid therapy should be considered. Once of therapy in COPD patients may be associated with dizziness, increases in systolic blood pressure, tremor, be quite sticky drowsy, so we advocate the newer They’re a really great source for There’s lots of information out have signifi cant symptoms despite regular bronchodilator asthma symptoms are controlled consideration may be given symptomatic decompensation and such patients should be headache and tachycardia. Hypokalaemia can occur and • therapy. Dosage and administration: Not for use in to gradually reduce the dose of the inhaled corticosteroid. monitored. To minimise risk of oropharyngeal candida therefore serum potassium levels should be monitored. varieties, and that means that Don’t sleep with the windows people in the community. there and we know that patients children < 18 years of age. For inhalation use. Use daily. Patients should be reviewed regularly as treatment is stepped infections patients should rinse mouth with water. As with Potassium replacement should be considered. An overdose of people can carry on with their daily open; this allows the pollen Of course, we have to be are drawn to information online Reassess patients regularly. Dose should be titrated to the down. Lowest dose of inhaled corticosteroid should be used. other lactose containing products, the small amounts of milk fl uticasone propionate may lead to temporary suppression of lives. to enter the room which is mindful that even if a patient and doing their own research, so lowest dose at which effective control of symptoms is Treatment should not be stopped abruptly in patients with proteins present may cause allergic reactions. Interactions: adrenal function. In cases of chronic overdose adrenal reserve After that hay fever mainstay, problematic if you’re breathing that does go to see their GP, the GP it’s key that they go to reliable maintained. Asthma Adults: One inhalation twice daily. For asthma due to risk of exacerbation. Use with caution in Beta adrenergic blockers may weaken or antagonise the should be monitored until stabilised. Price: £29.97. Legal in all night use in treatment of patients with severe asthma only. Not patients with active or quiescent pulmonary tuberculosis and effect of salmeterol. Both non-selective and selective blockers category: POM. Marketing Authorisation Number: we recommend that you add on has a very short timeframe with sources in order to get the correct intended for the initial management. If an individual patient fungal, viral or other infections of the airway. Use with caution should be avoided. Potentially serious hypokalaemia may EU/1/16/1122/001-2. Marketing Authorisation things for management according that patient. They may write a information and care, such as requires dosage outside the recommended regimen, in patients with severe cardiovascular disorders or heart result from β agonist therapy. Particular caution is advised Holder: Teva Pharma B.V. Swensweg 5, 2031GA Haarlem, WHAT ABOUT THE COMMON 2 to individual symptoms. For prescription for a nasal spray, but AllergyUK – we have a hotline and appropriate doses of β agonist and/or corticosteroid should rhythm abnormalities and in patients with diabetes mellitus, in acute severe asthma as this effect may be potentiated by The Netherlands. Job Code: UK/MED/16/0153. Date 2 PATIENT PERSPECTIVE THAT they may not have the time to a website with detailed factsheets be prescribed. Once control of asthma is attained treatment thyrotoxicosis, uncorrected hypokalaemia or patients concomitant treatment with xanthine derivatives, steroids and of Preparation: November 2016. example, some patients will have issues with their eyes. They may THEY SHOULD CHANGE UP show the patient how it works. which can be accessed. wish to use eye drops – some of THEIR TREATMENT OPTION That’s where the pharmacist’s role For more information, www. Adverse events should be reported. Reporting forms and information can be found at www.mhra.gov.uk/yellowcard. those have antihistamines in them, TO PREVENT IT FROM in education and product choice allergyuk.org. Adverse events should also be reported to Teva UK Limited on 0207 540 7117 or [email protected] BECOMING INEFFECTIVE? WPR | May 2017 | 29 References: 1. Aerivio Spiromax Summary of Product Characteristics. 2. MIMS. Available at: http://www.mims.co.uk/drugs/respiratory-system/asthma-copd/seretide-accuhaler. Last accessed: January 2017. Approval code: UK/ARO/16/0002c Teva UK Limited, Ridings Point, Whistler Drive, Castleford, West Yorkshire WF10 5HX Date of preparation: March 2017
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SUMMER SPECIAL SUMMER SPECIAL ON THE LOOK OUT The arrival of this time of year often elicits patient concern regarding eye-related health HITTING THE BOTTLE issues. But which problems are specific to Appearance pressures, coupled with the social side of summer, and which are year-round? Dr Susan summer, may be encouraging the rise of a new type Blakeney, the College of Optometrists’ Clinical of eating disorder. Dr Sarah Jarvis, Medical Advisor to Adviser, offers an insight, and delves particularly Drinkaware, shares why we need to especially be on the into dry eye syndrome. lookout for signs of ‘drunkorexia’ among female patients – DEVELOPMENT OF THE TREATMENTS FOR THE look about 20ft away for about 20 in which they’re skipping meals in order to save calories to SYNDROME? CONDITION? seconds. That not only relaxes the drink alcohol. There are two main reasons for The treatment is usually some sort eye muscles, but it also gives you a dry eye. It can either be caused by of lubricant like dry eye drops. chance to blink. What we know is the patient not producing enough Patients may also have punctal that if you’re staring at a screen, it tears, or they can produce enough plugs put in the drainage holes that can reduce the blink rate. tears, but they aren’t of a good might help keep tears in the eyes a Also, if you have a portable We should all be encouraging our vitamins and minerals in amounts red flags for possible alcohol enough quality to stay in the eye little bit longer. device, then we recommend patients to pay attention to the that make any significant misuse, to suggest a possible case of REFERENCES due to quite a complicated three- You can also get some sprays looking down at it, rather than number of calories in alcoholic contribution to diets. The human ‘drunkorexia’. Women who drink layer structure. that are sprayed on the closed straight ahead, as when you look Dr Susan Blakeney drinks – in addition to helping body cannot store alcohol, and on an empty stomach may be more 1. Burke, Sloane C.; Cremeens, The bottom layer that’s closest eye lids and help to replenish the down, your eyelids naturally close combat our obesity epidemic, it removing it from the system takes prone to short-term alcohol-related Jennifer; Vail-Smith, Karen; WHAT ARE THE MOST to the eye is very thin and sticks oily layer on the front surface of a little bit and that lubricates the may enable many to make better priority over all other metabolic harm because of faster alcohol Woolsey, Conrad; Drunkorexia: COMMON SYMPTOMS OF DRY the tears to the eye, then you’ve the tears, and that reduces the eyes. Using a lower brightness is and healthier decisions about processes (4), including nutrient absorption and higher peak blood Calorie Restriction Prior to EYE SYNDROME? got the watery layer which is the evaporation. It could be that the suggested too, and try to avoid alcohol. But there are worrying absorption and fat burning. alcohol levels, but this is not Alcohol Consumption among It tends to cause signs of redness thickest layer by some margin, that tears aren’t of a good enough using a screen in a dark room. reports that an increasing Further clinical investigation is inevitable. There is no research College Freshman; Journal of and soreness in and around the makes up the bulk of the tears and quality because of a condition awareness of alcohol and its needed, but dieticians are reporting evidence to suggest women with Alcohol and Drug Education, eye, and sometimes there’s a bit increases when you cry. There’s also called blepharitis which involves DO YOU HAVE ANY ADVICE calorific content is leading to a new a link between binge drinking this combination of problems are v54 n2 p17-34 Aug 2010 of grittiness too. It can affect the an oily layer and that reduces the inflammation of the eyelid, and it FOR PROFESSIONALS phenomenon whereby people are behaviours and eating disorders, likely to be underweight, although 2. Knight and Simpson 2013, vision as if it’s very severe, then evaporation of the tears, and so can block the glands that produce WHEN THEY DISCUSS skipping meals so that they can like anorexia and bulimia: what the they may be at higher risk of Drunkorexia: an empirical your cornea no longer becomes if the tears evaporate too quickly, the oily layer of the tears. WITH PATIENTS HOW THEY binge drink without putting on media has termed ‘drunkorexia’. vitamin and mineral deficiency investigation of disordered smooth, and so you find that your then they don’t do the job of CAN MAINTAIN THEIR EYE weight. (1) No one is suggesting that than other women. eating in direct response to vision might fluctuate a little bit staying in the eyes long enough to IS THERE ANY RECENT HEALTH WHEN ON HOLIDAY? Reports (2) are suggesting that everyone who skips a meal now This is, of course, a particular saving calories for alcohol use when you blink or might be a little lubricate them. RESEARCH OR INNOVATION It’s about wearing decent quality some people have been known to and again so they can drink will go issue for post-menopausal women. amongst Australian female bit smudgy. Most of the time, it What’s really important is THAT WILL BE COMING INTO sunglasses from a reputable go an evening, or in some cases, on to develop an eating disorder. Passing the menopause and excess university students. Journal of doesn’t impact the vision though – that if patients think that they PLACE? manufacturer with a CE mark – a full day, without a meal so that However, a repeated pattern alcohol are both well-recognised Eating Disorders 2013 1(Suppl it just causes discomfort. might have dry eye, a diagnosis is Drop technology is constantly they don’t have to be expensive. they can drink instead. There should be considered as a high risk factors for osteoporosis. A 1):P6 necessary to find out what caused evolving. The problem with drops Also, advise them to wear a hat have also been reports of people risk behaviour, especially in those diet deficient in calcium because 3. Osborne, Sher, Winograd IS IT DIFFICULT TO it so the treatment is decided can be that as soon as they’re put with a brim. calculating how many calories are who are already vulnerable. Eating a woman has been restricting her 2011, Disordered eating DIAGNOSE? accordingly. in the eye, they start washing out, They should never wear in their drinks and offsetting their disorder experts also believe that calorie intake to ‘make space’ for patterns and alcohol misuse in Diagnosis is normally done by the and you really want them to stay in contact lenses when they’re going eating accordingly. problems can arise when someone’s alcohol is a further compounding college students: evidence for optometrist in which they’ll look HOW PREVALENT IS DRY the eye as long as possible without swimming as there’s a little bug Some reports from America pattern of skipping meals in order factor. “drunkorexia”?. Comprehensive at the quality of the patient’s tear EYE SYNDROME? smudging the vision. that lives in tap water and it’s (3) suggest that the phenomenon to drink leads to obsessing over As healthcare professionals, Psychiatry, 52;6;e12 Nov 2011 film; this can be done in several It’s pretty common. It’s estimated terrible if you get it in your eye. appears to be more prevalent food and this obsession starts to we need to maintain a high index 4. Raben et al 2003, Meals with ways. It can be done by putting a that about one in every three HOW HAVE EYE HEALTH Never be tempted to rinse contact among young, weight conscious control them. of suspicion for this problem, similar energy densities but rich little bit of stain in the tears, and people over the age of 65 RISKS EVOLVED OVER THE lenses with any type of tap water. women and seems to have evolved Many heavy drinkers are and be prepared to tackle the in protein, fat, carbohydrate, seeing if the cornea has any patches experience some problems with dry YEARS, SUCH AS EXPOSURE All year-round, regular eye from a need for girls and young notoriously secretive about issue promptly but sensitively. or alcohol have different effects of dryness on it that aren’t wetting. eyes, and it’s also more common TO MODERN DEVICES? examinations are encouraged – women in particular to meet two their alcohol intake, and women Alcohol-related harm wreaks on energy expenditure and They can also look at how quickly in women. It’s less prevalent in When using a screen, we encourage at least every two years – as the of society’s expected norms – being in particular may feel a social enough damage without the added substrate metabolism but not on the tear film evaporates. younger people. ‘visual hygiene’ which is a matter people who get glaucoma are often thin and being a drinker. stigma associated with alcohol complications of nutritional appetite and energy intake, Am of using your eyes effectively. We those who haven’t got their eyes Alcohol’s calories have no intake, particularly if they are also deficiency and possibly additional J Clin Nutr January 2003 vol. 77 WHAT FACTORS WHAT ARE THE suggest the ’20-20-20’ rule which tested in ages nutritional value and most mothers. There may be no clear psychological disturbance. no. 1 91-100 CONTRIBUTE TO THE RECOMMENDED means that every 20 minutes, you alcoholic drinks do not have indicators, other than the standard
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SUMMER SPECIAL SUMMER SPECIAL
could act as barriers. There are several ways that professionals. It is therefore important that brief Some overweight practitioners health professionals can overcome interventions are patient-centred. felt that they could empathise these barriers, such as increasing HOW TO RAISE THE ISSUE (8) more with overweight patients, their knowledge of obesity care It’s important to acknowledge whereas others felt that it would be and local pathways. The National the complexity of the condition PATIENT-CENTRED WEIGHING ON a hindrance. Institute for Health and Care – overweight and obese APPROACH A study participant explained, Excellence (NICE) provides patients often have a fear of, and These are some of the skills needed ‘Being a rather large person myself, guidance on obesity prevention unfortunately experience of, being for a client-centred approach: I find it sometimes a little bit and management, which can be labeled as ‘greedy’ or ‘lazy’. • Active listening sensitive to say, ‘You really ought to found on their website. Acknowledging the extent of • Good non-verbal THE MIND lose some weight’, when, actually, Health professionals can also the problem and emphasising the communication, such as eye the same person could be saying it talk to their local authorities about many and varied factors which contact and body language back to me.’ the weight management services contribute to obesity can help • Reflection – the ability to reflect We often see with summer that the surge in temperature Health professionals with a available in their area and how covey that this is not a condition weight in the healthy range also they can signpost to them. Having which should be blamed solely on words and feelings and to clarify prompts a renewed focus on fitness and health. To tie in thought that their weight could act a list of local resources, as well as ‘weak-willed’ individuals. that you have understood them as a barrier because patients might evidence-based printed and online One of the things health correctly with this – and the revelation that less than half of obese perceive a lack of empathy. tools to refer patients to is also professionals can do is link a • The ability to build rapport patients are advised by their physician to lose weight – This issue is also complex useful. patient’s weight to an existing from a patient perspective. Some World Cancer Research Fund medical concern. This will help Find out more about the Rachel Clark, Health Promotion Manager at World Cancer people may prefer to talk about has lots of free information provide a context for why the issue patient-entered approach by Research Fund, overviews how raising the issue can their weight with an overweight available to health professionals is being raised. Listening carefully listening to World Cancer professional to feel better to help them break down barriers to patient responses can provide Research Fund’s webinar at www. yield discomfort, and shares her top tips for you how can understood. Others might feel with their patients. some insight into their self- wcrf-uk.org/uk/here-help/health- approach this tricky territory. awkward bringing up the subject Training on how to raise the recognition, and motivation for professionals/webinar-obesity- with someone who is overweight issue in a non-judgmental way any treatment suggestions. and-cancer. because of the negative stigma will help address fears about the If patients are interested in attached to it. potential negative consequences. losing weight, health professionals TOOLS TO SUPPORT YOUR There are a variety of training should offer them practical advice WORK ADDRESSING THE BARRIERS courses available. Health and support. Having a list of World Cancer Research Fund While many people want to make receiving health professional advice comfortable introducing the topic they make. Health professionals The positive thing is that there is Education England lists some available options in the area is provides health professionals with changes to improve their health to lose weight. during a routine consultation if are worried that this could damage evidence that health professional good options on their new MECC helpful. free training and resources to help and are aware of the benefits There are many reasons why patients had come to see them the patient relationship and cause advice to lose weight increases platform. What we do know is that them talk to patients about how of losing weight, they may lack health professionals find it hard about something else. more harm than good. people’s motivation to lose weight Motivational interviewing, a patients actually do want to be lifestyle choices affect cancer risk. the motivation, knowledge, and to raise the issue of weight with One study participant For others, they were worried and change their behavior. (7) It is method that works on facilitating heard and understood, so that they For more information about resources needed to sustain long- their patients. The fact that commented, ‘Just bringing it up, about damaging their professional therefore important to address the and engaging motivation within a can have the opportunity to tell the free cancer prevention package, term changes. society tends to view overweight how do you bring it up, when reputation and didn’t want to be barriers that health professionals client in order to change behavior, their story. They also want to gain visit www.wcrf-uk.org/uk/here- Obesity is associated with a and obesity in a negative way they’ve come in about a cold? It’s seen as the ‘nagging doctor’. face. may be of interest to some health information and feel able to cope. help/health-professionals. range of health problems and is is just one of the barriers (5), really difficult, isn’t, it because Health professionals also linked to an increased risk of 11 leaving health professionals you know we’ve all got to be very expressed concern about patients common cancers, including breast feeling uncomfortable raising politically correct (PC) and people with mental health issues and the and prostate. The NHS costs and discussing the issue of weight get very hurt even with medical fear of compromising their duty attributable to overweight and because of this stigma. terms like obesity or overweight, it of care. REFERENCES DID YOU KNOW? obesity are projected to reach £9.7 A British Medical Journal can be really challenging.’ billion by 2050, with wider costs paper explored GPs’ and nurses’ There was also uncertainty LIMITED TIME AND to society estimated to reach £49.9 perceived barriers to raising the around what language and RESOURCES TO BRING UP A 1. www.yougov.co.uk/news/2014/01/03/new-years-resolutions- According to a study published in the Obesity journal late last year, billion per year. (2) topic of weight with patients (6), terminology to use, as overweight SENSITIVE TOPIC britain-looks-health-2014/ children are at greater risk of gaining unhealthy amounts of weight With around 62 per cent of the main barriers identified are and obese are generally seen as Lack of time was cited as a barrier, 2. www.noo.org.uk/NOO_about_obesity during summer vacation than during the school year. adults in the UK now overweight listed and discussed in this piece. negative terms. particularly for GPs. Both GPs 3. www.noo.org.uk/NOO_about_obesity/adult_obesity/UK_ Researchers in America studied more than 18,000 kindergartners or obese (3), health professionals However, those who had and nurses reported not having prevalence_and_trends over two years and found that obesity increased only during the two are being called on more and more LIMITED UNDERSTANDING received training in obesity sufficient resources or services to 4. www.bmjopen.bmj.com/content/3/11/e003693.full summer vacations, and not at all during the school years. to ‘Make Every Contact Count’ ABOUT OBESITY CARE management did feel equipped to signpost patients to, such as referral 5. www.britishjournalofobesity.co.uk/journal/2015-1-1-14 (MECC) and use opportunistic Some health professionals felt that raise the issue and support patients options and weight management 6. www.bmjopen.bmj.com/content/5/8/e008546.full moments to raise the issue of body they lacked the knowledge and to lose weight. information. If the resources were 7. www.ncbi.nlm.nih.gov/pmc/articles/PMC4264677/ weight with patients. Despite skills needed to support patients to not available to support patients, 8. Moira Stewart. Patient-centered Medicine: Transforming the strong calls to action, patient lose weight. They expressed beliefs CONCERN ABOUT NEGATIVE then raising the issue seemed Clinical Method. Second Edition. 2003 surveys suggest that less than half that there was no standardised CONSEQUENCES pointless. of obese patients are advised by approach to raising the issue with As mentioned, there is a stigma their physician to lose weight. (4) patients and reported that they surrounding overweight and OWN WEIGHT STATUS AS A In fact, a survey of 810 rely on various resources including obesity. Some health professionals BARRIER overweight and obese patients personal stories and media sources. worry that raising the issue could The majority of health found that only 17 per cent of They also expressed concerns be interpreted as a comment professionals in this study reported overweight and 43 per cent of about the appropriateness of about someone’s appearance or a that their own weight, and obese respondents recalled ever raising the issue. They didn't feel judgment about the life choices personal beliefs about weight loss,
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CLINICAL NEGLIGENCE WALESHealthcare.com Dr Edward Farnan, Medico-Legal Adviser at the Medical Defence Union, explores a few of BETTER SAFE the confidentiality risks which can scupper Join the Action healthcare professionals, and shares how the obstacles can be minimised. THAN SORRY Reach Healthcare Professionals Across Wales
email. Although convenient, others being able to view the screen it’s risky because it is easy to from the side. accidentally send information to Also, make staff aware that their THE MDU the wrong person, or to share it conversations may be overheard by ADVISES HEALTH with more people than intended. patients in the waiting area. and For example, the Information staff should always be mindful of PROFESSIONALS DO Commissioner fined an NHS being discrete and not discussing THE FOLLOWING TO organisation £70,000 after a confidential or identifying consultant’s letter was emailed information within earshot of PROTECT PATIENTS’ Dr Edward Farman to the wrong patient who had a others. CONFIDENTIALITY: similar name to the patient who should have received the email. Additionally, you should be • Fully acquaint yourself and your advice Confidentiality is an essential part careful not to send an email to colleagues with up-to-date legal • Prevent unauthorised access to of a trusting relationship between a group of patients using the requirements and GMC and NHS practice computers, for example, a doctor and patient. However, ‘to’ or ‘CC’ function instead of guidance on confidentiality, as well by using password protection there are a number of risks to the ‘BCC’ function. To do this as any local policies and providing members of staff, be aware of when protecting breaches patient confidentiality • Nominate a person to including locums, with unique patients’ confidentiality which because the recipients can see each be responsible for practices passwords. Always log out when have only increased as information other’s email addresses, it reveals and procedures for handling away from the computer, even for moves from paper to being stored who is on the mailing list, and short periods depending on the content of the confidential data digitally. • Ensure that paper records are email, it can also reveal the service • Report any loss of data So, what steps can you in locked cabinets when not in being offered to that patient. straightaway to the nominated implement to reduce these risks use. Both paper and computer It’s important to take extra person in your practice, so that and protect patients? records should only be accessible care when sending emails to action can be taken to prevent to members of the practice who are TECHNOLOGY prevent these easy mistakes from further breaches and the authorised to do so happening. Take your time, avoid information commissioner can be Under the 1998 Data Protection • Act, it’s your responsibility to using ‘auto select’ functions where informed, if appropriate Ensure that paper records and ensure that patient information it could be easy to click the wrong • Train all staff to keep computer screens cannot be seen is held securely and protected address, and always review the information confidential and by other patients from unauthorised or unlawful email before pressing send. reinforce the message regularly • Do not store patient data on processing. It might be a good • Write a confidentiality clause your own home computer, laptop, idea to seek the advice from an IT THE PRACTICE / CLINIC into contracts of employment and tablet, or other mobile device specialist on the best way to ensure There are many changes that can ensure the team are aware of the • Do not send information by We provide the latest happenings within the Welsh healthcare industry the security of patients’ digital be made to your practice or clinic need not to discuss patients or email unless you can be sure of the records. which can help reduce the risk of their care on social media sites recipient’s identity and that their confidential patient information across print, digital and awards. There has never been a better time to In reality, no system will ever • Keep discussion about the system is secure being inadvertently shared in the be 100 per cent secure, but if there clinical management of patients • Check the identity of telephone reception and waiting area. work with us and our products. Be part of the action and speak to an does happen to be an unauthorised private and out of earshot of the callers asking for information All computers at reception disclosure of information, you public about a patient, if necessary by will need to be able to justify the should be facing away from the engaged audience. • Have an information security calling them back via directory steps you have taken to prevent the counter so patients and other policy in place and ensure that all enquiries Powered by: confidentiality breach. Your Trust visitors attending the practice are staff are aware of it • Ensure that patients’ details or CCG Information Governance not able to see any information on are up-to-date before sending lead may be able to assist in this. the screen. You could also consider • Take professional advice before information to their home address Some of the most significant purchasing privacy filters for the connecting your computer to a confidentiality breaches involve computer screens, which prevent network and keep a record of the Contact our sales team on [email protected] or call 028 9099 9441 to discuss the available opportunities.
34 | WPR | May 2017 @MEDCOMwales Medical Communications Ltd www.waleshealthcare.com WWW.WALESHEALTHCARE.COM
NEWS
two tours of duty in Afghanistan NEW CPW on MERT (the military pre- hospital service). CHAIRMAN Dr Jones has been a part of EMRTS Cymru since its inception in 2015. ANNOUNCED Also known as the ‘Welsh Flying Medics’, the service provides consultant-delivered innovative Mark Griffiths has been pre-hospital critical care across revealed as the new Chairman Wales, by air and by road. It of Community Pharmacy Wales is achieved via an important (CPW). partnership with the Wales Air Born in Cwm, Ebbw Vale, Ambulance (WAA) Charity, Mark qualified in 1985 and a charitable trust which relies worked in various managerial and entirely on the generosity and locum positions. He purchased support of the Welsh public to his first business in 1997 and Consultant and Army Lieutenant, Colonel Ami help keep the helicopters flying. started Cambrian Alliance Buying Commenting on the news, Dr Group in 2000, along with five Jones Jones said, ‘It is a huge honour and other pharmacists. privilege to take over as National Mark is currently the PSNC Director. I feel that I am well member for Wales and attends WELSH FLYING MEDICS placed to do so, having worked pharmacy development group closely with the core team to set meetings, in addition to having up, and launch the service, and previously sat on Merthyr Local APPOINT NEW INTERIM then help to run it for its first two Health Board. years. Commenting on his new position, Mark said, ‘I consider NATIONAL DIRECTOR it a privilege and an honour to Consultant and Army Lieutenant, a Consultant in Anaesthesia and be Chairman of CPW at such Colonel Ami Jones, has been Intensive Care Medicine for the an important time in Welsh announced as the new interim Aneurin Bevan University Health pharmacy. There’s obviously a National Director of Wales’ flying Board. As well as her roles in the lot of work to be done, but with medics service. NHS, Dr Jones is a Lieutenant the back-up of the board and the Originally from Shropshire, Dr Colonel in the Royal Army executives of CPW, we’re more Jones lives in Abergavenny and is Medical Corps and has undertaken than capable of getting to a good deal with the Welsh government.’ He continued, ‘I’m just hoping that we can take the contractors LIFE SCIENCES NETWORK CALIN LAUNCHES with us on our plan to a more science products. service-based contract. The Irish launch event at ‘I’ll do the job to the best of Tyndall National Institute gave my ability and make the contract small and medium enterprises the best possible contract we can (SMEs) a chance to find out more for Welsh contractors.’ about what CALIN can offer, and to present their technology challenges and give their view of the CALIN project. Businesses were also able to engage directly Nanomedicine, cell biology, creating innovation, jobs and with CALIN with one-to-one wearable sensor systems, smart growth in both countries. project development meetings to implants: these are some of the CALIN brings together explore collaborations. areas of research in life sciences Bangor, Cardiff and Swansea Prior to the Irish event, which will be boosted by a new Universities in Wales, and CALIN’s Welsh launch took place network of experts who are based University College Dublin, the at the BioWales 2017 conference in Wales and Ireland, which was National University of Ireland, hosted at the Millennium Centre recently launched with events in Galway and the Tyndall Institute, in Cardiff. The CALIN team both countries. University College Cork in hosted a stand over the two-day The Celtic Advanced Life Ireland. The aim is to combine event and the CALIN project Science Innovation Network expertise with access to emerging was presented in a keynote talk by (CALIN) is a €12 million, technologies and routes to market CALIN academics Dr Paul Galvin four-year, Ireland-Wales-funded that will support businesses in the and Professor Shareen Doak. programme that is aimed at regions as they develop new life
36 | WPR | May 2017 WWW.WALESHEALTHCARE.COM WWW.WALESHEALTHCARE.COM
NUTRITION NUTRITION
The following Essential So how do all healthcare professionals, not just Nutrition Actions, dietitians, ensure that they’re helping to optimise PAEDIATRIC NUTRITION: recommended by the maternal and child nutrition? WHO, are embodied in the First 1,000 Days initiative, A good starting point is NICE Guideline PH11 Maternal and Child Health. To A WINDOW OF OPPORTUNITY and most are enshrined in summarise the priority recommendations, you need to know about the following (4): Department of Health and • The Healthy Start scheme and how eligible parents can access the benefits Having the power to determine and dismantle the long-term health of children, the NICE guidelines. • Women who are planning a pregnancy or in the first 12 weeks of pregnancy nutritional choices made during the first 1,000 days of life are of vital importance. require supplementation of folic acid 400 micrograms (μg) daily, before pregnancy and throughout the first 12 weeks, even if they are already eating foods fortified with Nicole Rothband, Specialist Paediatric Dietitian, and British Dietatic Association • Nutrition for adolescents and women folic acid or a diet rich in folate. (5mg folic acid daily is required for women who have spokesperson, weighs in on the growing need for healthcare professionals to during pregnancy and lactation diabetes or where there is a family history of neural tube defects) • Exclusive breastfeeding during the first • Vitamin D 10 micrograms / day (400 IU) should be taken throughout pregnancy. recognise and combat cases of malnutrition. six months of life (New guidelines now recommend that all adults and children over one-year-old take • Complementary feeding starting at six this level of vitamin D supplementation) (5) months, with continued breastfeeding to • How to encourage pregnant women and mothers to initiate and maintain two years of age and beyond breastfeeding and direct them to a structured breastfeeding programme using the • Nutritional care of sick or Breast Feeding Initiative (BFI) as the minimum standard generations who have better health that health visitor knowledge malnourished children and wellbeing through their lives.’ A QUESTION OF SERVICE of child malnutrition should be • How to advise parents on the introduction of complementary foods, in addition to (1) Malnutrition is not just a problem good, but this was considered to • Prevention of vitamin A deficiency in milk when infants are six months of age for developing countries. The not always be the case and it was women and children • All children aged from six months to four years should be given supplementation of A QUESTION OF GUIDANCE Patients Association began a reported that their advice was not • Prevention and control of anaemia in children’s vitamins A, C and D. Healthy Start vitamin supplements should be offered In 2013, the World Health project in February 2014 to always consistent with government women and children to parents receiving the Healthy Start benefit Organisation (WHO) published examine whether malnutrition advice. It was also found that • Consumption of iodised table salt • Health professionals and support workers who care for children under five years ‘Essential Nutrition Actions, among children is increasing, doctors required further support and women who may become – or who are – pregnant should train, as part of their Improving Maternal, Newborn, and to find out whether and training to develop their continuing professional development, to deliver education on all the above-mentioned Infant and Young Child Health existing methods used to detect skills as providers of nutritional recommendations and Nutrition’, summarising malnutrition in children are information. WHO guidance on nutrition adequate. The project focused Dentists and pharmacists were interventions targeting the first specifically on the ability of the also seen as having a key role in Nicole Rothband 1,000 days of life. primary, acute, and public health nutrition and that all health care The first 1,000 days encompass sectors to identify and then professionals, as well as education In 1990 the British epidemiologist, the time just before conception combat malnutrition wherever it and social care professionals, David J Barker, proposed a to two years of age. Many of exists. should be involved in public health hypothesis that intrauterine the recommendations in this One area examined by this education. (3) growth retardation, low birth document have become part project was the awareness of The consequences of child weight, and premature birth of our canon of public health malnutrition among health malnutrition are well-documented. have a causal relationship to the nutrition interventions intended and social care professionals. The causes can be multi-factorial, origins of hypertension, coronary to safeguard maternal and infant They found more education of and include inadequate dietary heart disease, and non-insulin- health. professionals on child malnutrition intake, disease, household income, dependent diabetes in middle age. The WHO guidance was was required; a lack of awareness and food security, maternal and References Since then, he has developed a new published against the backdrop among GPs about nutrition issues, childcare, health services and the developmental model to explain of some alarming data regarding and that GPs were considered environment. (1) Malnourished the origins of chronic disease. malnutrition. Malnutrition is to be slow at picking up cases children suffer from deficits in (1) publichealthjrnl.com/article/S0033-3506(11)00366- He concluded, ‘Many babies defined as a state of nutrition in of malnutrition, with 80 per growth and cognitive function. 0/fulltext in the womb in the Western which a deficiency or excess (or cent of cases being missed in the They are more likely to contract (2) bapen.org.uk/malnutrition-undernutrition/ world today are receiving imbalance) of energy, protein, and community. infections due to poor nutrition, introduction-to-malnutrition unbalanced and inadequate diets. other nutrients causes measurable As a result, they recommended which additionally affects their (3) patients-association.org.uk/wp-content/ Many babies in the developing adverse effects on tissue / body that GP practices should have nutritional status due to anorexia uploads/2015/01/Child-Malnutrition-in-the-UK.pdf world are malnourished because form (body shape, size and a GP with special interest in and or malabsorption. In the long- (4) nice.org.uk/guidance/ph11 their mothers are chronically composition) and function and children, and identified shortages term, addressing malnutrition can (5) gov.uk/government/uploads/system/uploads/ malnourished. Protecting the clinical outcome. (2) Globally, in in the numbers of health visitors reduce infant and child mortality, attachment_data/file/537616/SACN_ nutrition and health of girls and 2011, approximately 101 million and school nurses as potentially improve physical and cognitive Vitamin_D_and_Health_report.pdf young women should be the children under five years old were contributing factors. Health growth and development, and cornerstone of public health. Not underweight, 165 million stunted, visitors’ core role is to screen ultimately improve productivity. only will this prevent chronic and 43 million overweight or children through the First 1,000 (1) disease, but it will produce new obese. Days initiative. It was thought
38 | WPR | May 2017 39 | WPR | May 2017 WWW.WALESHEALTHCARE.COM
GLUTEN FREE COELIAC DISEASE SUPPORT FOR YOU STEPPING UP AND YOUR COELIAC PATIENTS
As part of Dr. Schär, Europe’s leading manufacturer of gluten free food, TO THE PLATE we’re committed to supporting you and your coeliac patients. While the recognition of coeliac disease is improving, Support for newly diagnosed Free access to the Dr. Schär with a fourfold increase in the last two decades, patients, including FREE taster box Institute, our dedicated online diagnosis remains worryingly low. Norma McGough, resource for healthcare professionals Coeliac UK Director of Policy, Research and Campaigns, The largest range of gluten free provides a glimpse into how community pharmacists prescription products in the UK Free-phone careline supported by are now being tasked with curbing these dangers and dietitians and home economists signposting the symptoms in patients earlier.
ORDER YOUR
of coeliac disease from under with both significant cost diagnosis to living with the implications for the NHS and the FREE TASTER condition. risk of individuals diagnosed later Our diagnosis campaign in life developing more serious isitcoeliacdisease? first launched complications. (1) With screening BOX REQUEST during the charity’s Awareness tools and a National Institute Week in May 2015 and focuses of Health & Clinical Excellence on raising awareness of the (NICE) clinical standard for CARDS FOR symptoms of coeliac disease and coeliac disease now in place, steering people towards a pathway Coeliac UK is campaigning to help to diagnosis. The campaign has tackle these issues. (3) NEWLY included a range of activities, targeting both people at risk of CAMPAIGNING IN coeliac disease and also healthcare COMMUNITY PHARMACIES DIAGNOSED professionals in primary care. Diagnosing coeliac disease can Recently-published research, be a challenge; this is largely PATIENTS Norma McGough based on primary care data and attributed to the wide range of spanning over two decades since symptoms, including ongoing 1990 has been used to underpin gastrointestinal problems, chronic TODAY the campaign activities. fatigue and anaemias due to iron, Coeliac disease is a common and investigations at a cost to the With one per cent of the UK B12 and folate deficiency. (4) In autoimmune disease associated patient and the NHS. (1) see contact details below population having coeliac disease, addition, a significant number with chronic inflammation of The treatment for coeliac but only 24 per cent of these of people (one-in-four) will have the small intestine, resulting in disease is adherence to a strict having a diagnosis, around half a been misdiagnosed previously malabsorption which leads to gluten-free diet which requires million people are suffering with with IBS. (5) NICE clearly states nutritional deficiencies. The long- eliminating foods containing undiagnosed coeliac disease across that it is necessary to screen for term complications of untreated wheat, barley and rye. Gluten is the UK. (2) In addition, it is taking coeliac disease before confirming a or undiagnosed coeliac disease found in cereal and flour based around 13 years, from the first diagnosis of IBS. (6) include osteoporosis, and intestinal staple foods like bread, as well as appearance of symptoms, to secure It is imperative that individuals lymphoma so the benefits of early a wide range of other processed a diagnosis of coeliac disease. have not removed gluten from To request your free Glutafin information pack please conatct us at [email protected] or diagnosis are well recognised. foods. Coeliac UK’s campaigning Late diagnosis is associated their diets before or during testing Late diagnosis is associated agenda is far-reaching to address call our careline 0800 988 8470 and quote MEDCOM. To register for free access to our online healthcare with repeated appointments to the for coeliac disease. Since the with repeated GP appointments the wide range of challenges GP and additional investigations, gluten-free diet is the treatment professional resource, including the latest research abstracts and expert webinars, visit drschaer-institute.com
40 | WPR | May 2017 WWW.WALESHEALTHCARE.COM Health & wellbeing toolkit to
COELIAC DISEASE support your coeliac customers for coeliac disease, once the diet Association of Primary Care of these results were attributed • Are accessing prescription is established, the markers for the (NAPC), the Pharmaceutical to customers on prescription or over the counter treatments disease disappear. While screening Services Negotiating Committee, medications, so people who had for irritable bowel syndrome or using serological antibody tests Pharmacy Voice, the Royal already seen a GP, were referred to anaemias (iron, B12 or folate (IgA tissue transglutaminase Pharmaceutical Society and the their GP for further testing. deficiency) (tTGA) or endomysial (EMA) is University of East Anglia to trial The pharmacy-led project was • Include gluten in their diet generally initiated in primary care, a pharmacy-led approach that published in the International (wheat, barley and rye) (and if they community pharmacies are ideally identified individuals at risk of Journal of Clinical Pharmacy have previously removed gluten, placed to recognise individuals coeliac disease. in 2016. (17). A further article, they should include at least one who may be at risk of coeliac The approach targeted has been published in the March meal containing gluten per day for disease and refer them to their GP. customers who were purchasing 2017 issue of the Pharmaceutical six weeks); and The symptoms of coeliac disease medicines in community Journal. (8) • may be put down to everyday pharmacies to treat IBS or iron, Following on from our project Have not been tested for coeliac lifestyle issues or may not be B12 or folate deficiency, either in 2015, we would like community disease before checked out because they’ve been over the counter or on prescription pharmacies to take an active For more information, email experiencing symptoms off and and who had not been tested for role in identifying those people [email protected], on for a long time. These people coeliac disease and were not on a who should be tested for coeliac and to find out more about the may be managing their symptoms gluten-free diet. Customers were disease. We’re asking pharmacists isitcoeliacdisease? campaign, or to with over the counter (OTC) asked if they wanted to have a free to identify people who may be at view the online assessment, visit treatments from community Point of Care Test (POCT) for risk of coeliac disease, to signpost www.isitcoeliacdisease.org.uk. pharmacies rather than going to coeliac disease. Nearly 10 per cent people to their GP surgery for the GP for an investigation. of the 550 patients that were tested screening. During 2015, Coeliac UK during the six-month trial had We’d like pharmacists to target teamed up with the National positive test results and 50 per cent people who: THE COELIAC REFERENCES one or two selections of biscuits, 1.Violato, M., et al., Resource use and costs associated with no cakes or buns, and limited coeliac disease before and Juvela Product Guide Customer Food Diary SUFFERER’S STORY choices for dinners. Food you after diagnosis in 3,646 cases: • • 27-year-old Leanne Seeley, from Co. Armagh, wouldn’t even imagine contained results of a UK primary care Customer Information & Recipe Resources gluten was cut from my diet, and database analysis. PLoS One, • Northern Ireland, first began to showcase and as well as the selection being so 2012. 7(7): p. e41308 suspect signs of the autoimmune disease over limited, it was extremely expensive. 2.West, J., et al., Incidence and 10 years ago. She shares with WPR her journey A loaf of bread with approximately prevalence of celiac disease 10 slices was over £2! and dermatitis herpetiformis All toolkit resources can be downloaded for free from in the UK over two decades: of diagnosis and condition control – and how Over the first few years, I did www.juvela.co.uk/downloads population-based study. Am J the question of choice often comes into play. slip and cheat on normal food, Gastroenterol, 2014. 109(5): p. possibly because of the lack of 757-68 The Juvela essential gluten-free foods She was a coeliac sufferer for many selection and taste. However, the 3.NICE, Coeliac disease quality years and although my symptoms more often you cheat, the more standard ; QS134. 2016 have been produced to support your weren’t identical to what hers had sensitive you become and soon 4.NICE, NG20 Coeliac disease; recognition, assessment and been, there were some similarities. even cheating on a small treat coeliac customers in following a healthy, once every few months became management. 2015 Just three days after following 5.Card, T.R., et al., An excess a ‘no-no’ for me. The pain and balanced gluten-free diet. a strict coeliac diet my symptoms of prior irritable bowel sickness wasn’t worth it anymore, improved. My vision wasn’t as syndrome diagnoses or All Juvela gluten-free products are blurry, my energy levels had and so I would say that it’s been a treatments in Celiac disease: increased, my appetite was coming good six years from I intentionally evidence of diagnostic delay. available from the pharmacy back, and the pains in my tummy ate anything containing wheat or Scand J Gastroenterol, 2013. had eased considerably! I decided gluten. 48(7): p. 801-7 6.NICE, Irritable bowel to stick this out and over the Luckily though, the selection of foods has improved greatly. The syndrome in adults: diagnosis coming weeks and months my and management 2008. variety of breads, biscuits, cereals, Leanne Seeley symptoms had either eased hugely, 7.Urwin, H., et al., Early For your FREE pharmacy toolkit call: 0800 783 1992 or completely disappeared. and even cakes, in supermarkets is recognition of coeliac I started really noticing my It isn’t an easy diet, however, a million miles away from what it disease through community symptoms at the age of 16; blurry and after a few months my cravings was 10 years ago. Restaurants have pharmacies: a proof of concept email [email protected] visit www.juvela.co.uk/hcp vision, fatigue, hair loss, bloating, for ‘normal food’ increased. The a good bit of catching up to do, study. Int J Clin Pharm, 2016. lack of appetite, weight gain – the food was bland, tasteless, and however more and more are adding 38(5): p. 1294-300 8. Wright, D., H. list went on. Unable to pinpoint very limited. There was only one at least one gluten-free option to their menu which is great to see. Urwin, and N. McGough, what was going on, my mum type of bread available which had How to identify symptoms of Here’s hoping the improvements suggested to me one day that I cut to be toasted to taste somewhat coeliac disease in community gluten and wheat from my diet. enjoyable. There were no cereals, continue! pharmacy and primary care. The Pharmaceutical Journal, Scotland’s favourite essential gluten-free foods 42 | WPR | May 2017 2017. 298; 7899
Juvela Scottish Pharmacy vers ad.indd 1 07/04/2017 08:49 WWW.WALESHEALTHCARE.COM WWW.WALESHEALTHCARE.COM
FEATURE FEATURE
on YouTube, promotional videos FORESEE IT HAPPENING? colleagues who are taking over an at ease, explain our role, and what that various trusts have done can There are so many ambassadors for individual’s care following a shift they should expect whilst in our also be found. it across the globe; it now has its change. That way, our patients and care. WHAT’S IN own legs and will continue to grow. their families will always know ‘Every member of our WHAT HAS THE RESPONSE There are also plans for a global who is looking after them, which staff – our front line clinical BEEN TO THE INITIATIVE, tour next year. in turn will help them to relax and and managerial staff and those AND WHICH KEY FIGURES The fact that there are various feel safe while in our care.’ who support them such as our HAVE GOT BEHIND IT? awards named after Kate will also administrative, portering, domestic The campaign has led to a huge keep it alive – but it’s a change that RAIGMORE HOSPITAL and catering staff – all have a very A NAME? response in a very positive way. The Renal Unit at Raigmore important role to play in delivering has stuck, for sure. Numerous key figures have Hospital in Inverness has compassionate care. A patient-centred, social-media-spiralling campaign lent their support, however the SPREADING THE enthusiastically embraced the ‘This campaign offers is hoping to change the healthcare experience highlights have got to be David initiative, with Anne Allan, an opportunity for us all to Cameron, Nicola Sturgeon, Teresa WORD Clinical Ward Manager, understand how important our for the better. Inspired by the late Kate Granger’s May, and Jeremy Hunt. This is in emphasising the benefits of its role is and to remind ourselves, WPR homes in on just some experience as both a consultant and cancer patient, addition to many chief executives sheer simplicity. despite how busy we may be, to do of the progress carved out as and celebrities, including Kylie all we can to make sure that our WPR finds out more about #hellomynameis. Kate’s legacy carries on. When announcing their Minogue, Michel Roux Jnr, and commitment, she said, ‘We always patients and clients have a positive Jeremy Clarkson. LEICESTER’S HOSPITALS do what we can to treat our experience in our care.’ patients with respect and dignity, It was back at the beginning of WHAT INSTITUTIONAL but this campaign has highlighted CARDIFF AND VALE 2015 when Leicester’s Hospitals CHANGES HAS that even something as simple as UNIVERSITY HEALTH BOARD announced their intention to co- of staff. #HELLOMYNAMEIS giving your name can make such a Health representatives and Fuelled by this realisation, operate – pledging their support TRIGGERED? difference to how they feel.’ the public also flocked to the and her husband, Chris, support, as one of the NHS organisations A LASTING A more compassionate health University Hospital of Wales Kate decided to start a campaign, supporting the #hellomynameis service, and the realisation that just THE SOUTHERN TRUST (UHW) to showcase their support primarily using social media campaign. LEGACY introducing yourself does make a Towards the end of 2014, it was for the cause. Prior to their formal initially – #hellomynameis – to WPR chats to Kate’s husband, Illustrating the significance of huge difference. revealed that the campaign was launch of it, staff from the clinical encourage and remind healthcare Chris Pointon, about the personalisation in the healthcare being adopted by health and board made it their mission to staff about the importance of campaign’s initial outing, and realm, John Adler, Chief Executive WHAT HAVE BEEN YOUR social caregivers across Northern enhance awareness, handing out introductions in healthcare; how his plans for its continued at Leicester’s Hospitals, explained, MOST MEMORABLE Ireland, to emphasise to staff free gifts and gathering pledges growth. ‘Backing this campaign was an it runs much deeper and builds the MOMENT THROUGHOUT THE the importance of introducing of support in the Concourse at easy decision. We had already basis for trust. CAMPAIGN’S EVOLUTION? themselves and discussing their UHW. WHO IS THE adopted it in small ways across the I think it was the realisation of proposed care and treatment with With the move marking the #HELLOMYNAMEIS organisation, but working with the how big it has become following them in a way that they can fully first time that a Welsh health CAMPAIGN AIMED AT? Listening into Action team and the UK tour in which we were so understand. board team officially backed the Kate Granger It isn’t aimed at any one individual other NHS trusts will push this to well-received. When launching approach, Consultant Intensivist, or group – everyone should the forefront of everyone’s minds. #hellomynameis across the Dr Paul Morgan, remarked that be utilising it and introducing ‘We want our patients to it was during a hospital stay in WHY IS THE HUMAN Southern Trust area, Chief the response to it has been ‘very KATE’S STORY themselves. remind us if we are busy and August 2013 with post-operative CONNECTION SO Executive, Mairead McAlinden, positive’. forget to introduce ourselves when Regardless of the reason – severe sepsis that she made the stark FUNDAMENTAL IN commented, ‘People who need ‘Lots of staff and visitors have we first meet them. I know how or mild; despite the duration – observation that many of the staff HEALTHCARE? health and social care services are been coming up to find out more Singer Kylie Minogue important the patient experience swift or long-term; and whatever looking after her didn’t introduce It’s a basic connection that takes often ill, injured or vulnerable and about the campaign and sign the gets behind the is to my staff and that they will all the warning that went before, a themselves before delivering care. seconds to do – but it builds a it is understandably a very anxious pledge. give their backing. hospital stay can be a daunting The repercussions were far and campaign lifelong relationship. time for them, so as health and ‘Visitors have thought that it is ‘As well as asking staff to tell prospect for patients. wide, with Kate believing the social care professionals we know a really good idea. The fact that the their patients their names, we are omission of such a basic step in WHAT WORK IS STILL TO BE how important it is to put them public are telling us this is a good Cushioning the leap out of their Since its inception, also reminding them to introduce communication to be incredibly DONE – AND HOW DO YOU idea is really encouraging.’ comfort zone are the little things, #hellomynameis has seen a surge wrong. from grins gracing those passing in success, garnering support from The Asda team shows by, to the softness of the bed linen healthcare trusts and famous faces support easing them to sleep. alike, and forming over one billion But, perhaps more importantly, impressions. it’s the absence of these gestures Picking up the initiative’s WHAT METHODS HAVE which can scupper the patient momentum, Kate and Chris even experience entirely. BEEN EMPLOYED TO DRIVE took #hellomynameis on tour after FORWARD THE CAMPAIGN? Prior to her sad passing earlier a national collaborative launch Various methods have been carried this year, the inspiring Kate with Listening into Action. They out, including a UK tour that Kate Granger possessed a unique insight Kate and husband visited 16 healthcare organisations and I did last year. This is as well into the running of our healthcare Chris Pointon with over a week, covering over 2,000 as presentations, posters, lanyards, facilities, having assumed David Cameron miles, enabling Kate to share her badges, and executive sponsorship. perspectives as both a doctor and story with almost 2,000 members If you search ‘#hellomynameis’ terminally ill cancer patient. But 44 | WPR | May 2017 45 | WPR | May 2017 WWW.WALESHEALTHCARE.COM WWW.WALESHEALTHCARE.COM
ALL WALES MEDICINES STRATEGY GROUP MIGRAINE
In their latest column, the All Wales Medicines Strategy Group provides an update on the THE JURY IS OUT largest single project which they’ve undertaken – addressing the escalation of antimicrobial resistance.
A HEADS UP communication, the process 6. The Chief Medical Officer for identifying jurors, topics for Wales should urgently draw Get the lowdown on the next major migraine for discussion and potential prescribers’ attention to their speakers. Members of the jury current practice treatments – from medication to electrical devices were appointed by an independent 7. All antibiotics should only be – as Migraine Action helps to break down the company and included broad available as prescription-only representation from across Wales. medicines much-misunderstood condition. The Citizens’ Jury was held in 8. A ‘levy’ on antibiotics should be Cardiff City Hall from 5th - 8th imposed to remind prescribers of July 2016. their value and to raise additional The jury was tasked with funds for research and social More than just a headache, a 50 per cent said that their migraine Now, further research is aiming to subject-reported ‘wellness’ on answering the following question: marketing migraine is a complex neurological attacks had prevented them from effectively interrupt the migraine headache-free days. Subjects ‘Antimicrobial resistance happens Jury to explore how patients and How should patients and the 9. The use of antibiotics in condition that can include nausea, sitting an exam! process in one of two ways. The report a reduction of fatigue when microorganisms change the public can help healthcare public contribute to anti-microbial agriculture needs further attention vomiting, slurred speech, visual But potential new hope is on first is by injecting monoclonal along with enhanced focus, when exposed to antimicrobial professionals reduce inappropriate stewardship, and what support 10. There should be a public disturbances, and even paralysis. the horizon for all those affected. antibodies that target CGRP and concentration, and improved drugs. Microorganisms that antibiotic prescribing. should the NHS offer them? debate about whether prescription However, currently there is Previous migraine treatments prevent the attack. The second is interaction in daily life (as reported develop antimicrobial resistance Since its inception in 2002, The jury concluded that charges should be introduced for no cure for it – leaving people have focused on dilated arteries by using a small molecule orally in an abstract presented at the are sometimes referred to as this has been the largest single substantial and urgent action is antibiotics like Sarah, aged 31, who suffers and veins in the head, due to many that aborts the attack. annual meeting of the American ‘superbugs’. As a result, the project undertaken by AWMSG needed, and in their final report regularly with attacks, to put her patients describing a throbbing Headache Society). This type medicines become ineffective and and it delivered one of the published in October 2016 The report was presented life on hold. pain in the head during an attack. NEW FINDINGS of reduction in the number of infections persist in the body, recommendations in AWMSG’s they made the following 10 to AWMSG on October 2016 She explained, ‘I had to give up Many of the early remedies There are five main companies: attacks and apparent overall health increasing the risk of spread to Medicines Strategy for Wales 2013 recommendations: and the minutes of that meeting work and tried twice to return, but constricted blood vessels, adding to Alder Pharmaceuticals, Amgen, changes could see a substantial others.’ to 2018, which tasks AWMSG 1. A substantial and co-ordinated capture the discussion. The due to missing too many days of the misperception that abnormal Eli Lilly, Merck, and Teva improvement in the quality of life World Health Organisation with working ‘in partnership social marketing campaign should Citizens’ Jury report is available being so ill, it just wasn’t possible. blood flow was key to the Pharmaceuticals, actively studying for those who experience attacks (WHO) with the public to ensure patients be conducted to change people’s on the AWMSG website (www. It’s hard when you want to work neurological condition. the drugs that impact CGRP on a very regular basis. and service users are involved in behaviour awmsg.org). and have a purpose, but your bad and racing to complete advanced These medications are now Antimicrobial resistance is a its work and decisions as equal 2. Provide specific education, The report was submitted to health prevents you. clinical trials of antibodies that moving into phase three trials. growing global problem, and is partners.’ information and advice in support the Welsh government in October CALCITONIN ‘My husband and I would like either neutralize CGRP by binding Up until now, the drugs have only thought to cause around 700,000 To tackle such a large project, of recommendation one to target 2016 and has been taken forward to start a family, but we cannot GENE-RELATED to it, or block its receptor. been administered for up to six deaths each year. Efforts to address a Citizens’ Jury Steering Group specific groups by the Welsh Antimicrobial at the moment as I am taking too All of these medications have months and long-term use could antimicrobial resistance are being was established, comprising 3. Before booking a GP Resistance Programme, a many painkillers and I worry about PEPTIDES completed phase two trials, with potentially lead to complications. made by many countries, as well as representatives from AWMSG’s appointment, people should be programme established by Public how I would be able to look after some interesting results. However, these early findings hold on a worldwide scale by the WHO. Patient and Public Interest Group helped to assess whether or not Health Wales (PHW), which aims a child during a very bad migraine Now focus has shifted to calcitonin Early findings show that promise. The Welsh government (PAPIG), representatives from they might need antibiotics, and to to address the increasing problem attack.’ gene-related peptides (CGRP). about half of trial patients will launched a plan at the end of 2015 the All Wales Therapeutics & cope better with their symptoms of antimicrobial resistance in With one-in-seven people in Previous research has implicated see their attacks reduced by 50 to tackle the threat of antibiotic Toxicology Centre (AWTTC), when antibiotics are not needed Wales. The ongoing work of this the UK affected by migraine, Sarah CGRP, a group of small proteins, per cent. About 30 per cent resistance. To support this, and and other individuals identified 4. Deferred or post-dated programme can be found on the isn’t alone in trying to manage as playing an integral role in the of people will have a 75 per to advise the Welsh government, by Professor Marcus Longley, the prescriptions should be much more PHW website. her attacks. In the last six months, pathophysiology and the initiation cent reduction in attacks, and the All Wales Medicines Strategy project lead based in the University widely used a migraine has prevented 75 per of migraine attacks. a little under 20 per cent of trial Group (AWMSG) commissioned of South Wales. 5. All primary care prescribers cent from being physically active, Studies have suggested that patients have seen all their attacks the Welsh Institute for Health The Steering Group met on should be required to demonstrate and 63 per cent of respondents CGRP is not just a vasodilator, completely go. In one study, the and Social Care (WIHSC), three occasions to discuss the their continuing competence from being able to attend work. Of but a previously unknown, monoclonal antibody that targets University of South Wales, to development of the project, and appropriate prescribing of those respondents still at school, pain-signalling neurotransmitter. the CGRP receptor has enhanced organise and undertake a Citizens’ including dates, venues, antibiotics
46 | WPR | May 2017 47 | WPR | May 2017 WWW.WALESHEALTHCARE.COM
MIGRAINE
NON- MEDICINAL of attacks of headaches and vitamins can provide an alternative Migraine Action is the UK’s migraines, and can enable migraine option for managing attacks. leading support charity for ELECTRICAL sufferer to significantly reduce the use of medication. Previous studies have shown that all affected by migraine DEVICES migraine sufferers can be deficient – there to bridge the gap GAMMACOR in magnesium, vitamin B2 and between people affected by In recent years, non-medicinal Similarly, gammaCore is a non- vitamin D. this neurological condition electrical devices have also invasive, handheld device which Like a preventative medication, and the medical world, received heightened focus for emits a mild electrical signal, this trialling one supplement at a by providing unbiased new migraine treatment. time to stimulate the vagus nerve. time for three months can help It is thought that stimulating the the individual to ascertain the information on all aspects CEFALY vagus nerve may reduce the levels effectiveness of the vitamin and of migraine, getting you Cefaly is a non-invasive, non- of neurotransmitter glutamate, whether another treatment is the answers you deserve. pharmaceutical supraorbital which has been identified as worth exploring. Providing information, transcutaneous stimulator device. playing a role in a number of Migraine Action receives many support and advice Through the electrode pad, Cefaly headache disorders. Evidence calls on complementary treatments through their dedicated provides precise electrical impulses shows that treatment with and recommends that patients to activate the supraorbital (upper) gammaCore is effective for some keep a diary to measure the success friendly helpline, Migraine branch of the trigeminal nerve (the without the side effects commonly rate of their chosen supplement, Action are there to help nerve implicated in some types associated with drugs. with patients seeking at least 30 per all affected by migraine. of migraine attacks). The signals cent frequency or intensity. The team works tirelessly desensitise the nerve fibres which Both electrical devices are now For more information on to raise awareness about are responsible for sending pain available in the UK for migraine current, new and non-medication the realities of living signals to the brain. sufferers to purchase, but are treatments, contact Migraine Exactly how Cefaly works is currently unavailable on the NHS. Action, weekdays from 10am to with migraine among not known, but it is thought that 4pm, on 08456 011 033 or visit the general public, and the stimulation raises the threshold www.migraine.org.uk. challenge misconceptions at which migraine pain begins to VITAMINS of the condition. overwhelm the nervous system and causes pain. Regular repetition With more patients keen to avoid of this helps reduce the number taking medication on a daily basis,
48 | NIHRWPR | | May April 2017 2017 ButecNEW 15 STRENGTH
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Butec patches contain an opioid analgesic. Butec® 5 and a withdrawal syndrome may occur. May affect diverticulitis, biliary colic, urticaria, dermatitis μg/h, 10 μg/h, 15 μg/h and 20 μg/h Transdermal Patch ability to drive and use machinery. INTERACTIONS contact, face oedema, urinary retention, erectile PRESCRIBING INFORMATION United KingdomPLEASE MAOIs, CNS depressants (e.g. benzodiazepines, dysfunction, sexual dysfunction, oedema, drug READ THE SUMMARY OF PRODUCT CHARACTERISTICS opioid derivatives, antidepressants, sedatives, withdrawal syndrome (including neonatal), BEFORE PRESCRIBING.PRESENTATION Butec 5 µg/h, 10 alcohol, anxiolytics, neuroleptics, clonidine). CYP chest pain, alanine aminotransferase increased, µg/h, 15 µg/h, 20 µg/h. Transdermal beige patches 3A4 inhibitors and inducers, products reducing accidental injury, fall. Please consult the SPC for containing buprenorphine. INDICATIONS Treatment hepatic blood flow (e.g. halothane). PREGNANCY details of other side-effects. LEGAL CATEGORY CD of non-malignant pain of moderate intensity when AND LACTATION Butec should not be used during (Sch3) POM PACKAGE QUANTITIES AND PRICE 4 an opioid is necessary for obtaining adequate pregnancy or in women of childbearing potential individually sealed patches: 5 µg/h transdermal analgesia. Butec is not suitable for the treatment of who are not using effective contraception. patch £7.92, 10 µg/h transdermal patch £14.20, 15 acute pain. DOSAGE AND ADMINISTRATION Butec The use of Butec during lactation should be µg/h transdermal patch £22.12, 20 µg/h transdermal should be administered every 7th day. Elderly and avoided. SIDE-EFFECTS Very common (≥1/10) and patch £25.86. Marketing Authorisation numbers adults over 18 years only: Use the 5 µg/h patch common (≥1/100, <1/10) side-effects are anorexia, PL 40431/0024 – 0027. MARKETING AUTHORISATION for at least the first 3 days of treatment, before confusion, depression, insomnia, nervousness, HOLDER Qdem Pharmaceuticals Limited, increasing the dose if necessary. Short-acting anxiety, headache, dizziness, somnolence, Cambridge Science Park, Milton Road, Cambridge, supplemental analgesics may be required during tremor, dyspnoea, constipation, nausea, vomiting, CB4 0AB, United Kingdom. Tel: 01223 426929. For titration until analgesic efficacy is attained. Do abdominal pain, diarrhoea, dyspepsia, dry mouth, medical information enquiries, please contact not use more than two patches at a time, up to a pruritus, erythema, rash, sweating, exanthema, [email protected]. maximum dose of 40 µg/h. CONTRA-INDICATIONS muscular weakness, application site reaction, DATE EFFECTIVE: February 2017. ® Butec and Known buprenorphine or excipient hypersensitivity, tiredness, asthenic conditions, peripheral oedema. QDEM are registered trade marks. © 2013 Qdem opioid-dependent patients, narcotic withdrawal Uncommon (< 1/100) but potentially serious Pharmaceuticals Limited. treatment, respiratory depression, use of monoamine side-effects are hypersensitivity, anaphylactic/ oxidase inhibitors (MAOIs) within the past 2 weeks, anaphylactoid reaction, affect lability, restlessness, myasthenia gravis, delirium tremens. PRECAUTIONS agitation, euphoric mood, hallucinations, libido Adverse events should be reported. Reporting forms AND WARNINGS Acute alcohol intoxication, head decreased, aggression, psychotic disorder, drug and information can be found at www.mhra.gov.uk/ injury, shock, reduced consciousness of uncertain dependence, mood swings, depersonalisation, yellowcard. Adverse events should also be reported origin, intracranial lesions or increased intracranial sedation, dysarthria, migraine, syncope, to Qdem Pharmaceuticals Limited on 01223 426929. pressure, severe hepatic impairment, history of paraesthesia, balance disorder, speech disorder, drug abuse, alcohol abuse, serious mental illness or convulsions, blurred vision, visual disturbance, seizure disorder. Not recommended immediately eyelid oedema, vertigo, palpitations, tachycardia, PI CODE: UK/QDEM-16010(6) postoperatively or for situations characterised angina pectoris, hypotension, circulatory collapse, PI APPROVED: January 2017 by a narrow therapeutic index or for rapidly hypertension, orthostatic hypotension, wheezing, varying analgesic requirements. Chronic use of respiratory depression, respiratory failure, asthma buprenorphine may lead to physical dependence aggravated, hyperventilation, dysphagia, ileus,
www.qdem.co.uk
® Butec and QDEM are registered trade marks. © 2013 Qdem Pharmaceuticals Limited. Date of preperation: March 2017 UK/QDEM-16023a(1)
ButecWelshPharmA4_16023a(1).indd 1 03/03/2017 13:14