annual newsletter of the mrii€¦ · meetings resume in the autumn. full details will be available...
TRANSCRIPT
• TheMedicalTechnologyIndustry-EmbracingtheChange
• ThePharmaceuticalIndustry-BringingHealthandEconomicGrowthtoIreland
• BreakingtheProcrastinationHabit
• MeetaMember
• RoboticAssistedRadicalProstatectomy
•WorkSmarter,WorkTogether
• HealthCheckRecommendedforFreeGPCareforUnderSixes!
• NoSweetnessinRisingCostsofDiabetes
P H A R M A | D E V I C E S
L I F E S C I E N C E S
AnnuAl newsletter of the MrIIIssue5•July2014
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President’s WelcomeMs Linda McMahon, MRII President 2013 – 2015
national conference 2014Thank you to our Sponsors
Main National Conference Sponsors 2014• PfizerHealthcareIreland,BusinessSessions
• Quintiles,PresidentsWelcomeDinner
What’sinside...President’sWelcome............................3
DiaryDates2013-2015......................4
TheMedicalTechnologyIndustry-embracingthechange............................6
ThePharmaceuticalIndustry-BringingHealthandEconomicGrowthtoIreland....................................7
BreakingtheProcrastinationHabit....9
SponsorsandExhibitors2014........10
MeetaMember...................................12
AddictioninIreland.....................................15
Ambassadors........................................16
Roboticassistedradicalprostatectomy-PO’Malley,ConsultantUrologist..........................18
WorkSmarter,WorkTogether.........20
HealthcheckrecommendedforfreeGPcareforundersixes!...........21
NosweetnessinrisingcostsofDiabetes.................................................22
PullOutandKeep ExhibitorReference............................23
CONNECTisanannualpublicationproducedin-housebytheMRII.Foradvertisingplease
contact: [email protected] or 058 43955
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Venue: heritage hotel, Portlaoisecost: MrII Members €400 / non Members €600duration: 2 saturdaysdates: saturday July 5 and saturday July 12time: 11am - 5pmlecturer: Dr. Brendan o’Connor, senior lecturer in Biochemistry at Dublin City universityregister & further information: telephone Andrea Gaffney 058 43955 or email [email protected]
traditionally the pharmaceutical industry has been completely dominated by ‘small chemical’ drug molecules. over the next few years this is set to change dramatically. over 50% of new drugs in clinical testing are now ‘biopharmaceuticals’. these are protein or nucleic acid based pharmaceuticals used for therapeutic or in vivo diagnostic purposes, produced by means other than direct extraction from a native (non-engineered) source.
COURSECONTENT:
Saturday11. Introduction to concept of Biopharma2. recombinant DnA technology3. Gene therapy/Antisense technology4. Protein Chemistry/Proteins functions (emphasis on defense/receptor/hormone/transmitters)5. recombinant proteins & Biosimilars/Biobetters site-directed mutagenesis - potential for design of new biopharma drugs
Saturday26. Biopharma drug delivery – specific problems associated with biopharma drugs7. Pharmacogenetics – genetic variation in the response to biopharma drugs8. 'Biopharmacodynamics' selected examples of ‘block-buster’ biopharma drugs
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introductionto BiopharmaTheMRIIareofferingthiscoursetobothmembersandnon-members.
ProfFrankBarry,ScientificDirector,REMEDI,NationalConferenceSpeaker.ProfBarrypresentedafascinatingupdateontheworkcarriedoutatREMEDIonStemCellTherapy
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President’sWelcomems linda mcmahon, mrii President 2013 – 2015
Asweenjoyanotherbeautifulsummer,IamverypleasedyouhavetakentimeouttoreadyourcopyofCONNECT.
Ihavecommencedthesecondofmytwoyearterm.OurverysuccessfulNationalConferencewasheldinMay,ourbusinesssessionswereofaveryhighstandard.CouncilandIhavetakenonboardfeedbackfromourmembers.ManywishtoattendtheNationalConferenceeachyearbutfindthetimeandfinancialcommitmentdifficulttomeet.In2015wewillchangetheformattoaonedayeventinDublin.Dublinmemberswillhavetheoptiontoattendasresidentsornon-residents,therewillbejustoneovernightstayforthoseattendingasresidents.Ilookforwardtobringingyoufurtherdetailsinduecourse.
AnotheritemofchangewhichwebringtoourstudentmembersisinrelationtotheExamination.In2015theExaminationwillmovetoDublinanditwillchangetoSaturdaytoavoidtimeoffterritory.The2015ExaminationwillbeheldonMarch282015.
Ourstrengthisinourmembership,yourmembership.Weofferthosewhoareengagedincustomerfacingroleswithinthelifesciencessectoranopportunitytojoinwithusandtostaystrongasaprofessionworkingwithallyourindustrycolleagues.
Thankyouallforyourfeedbackandencouragement.Yourinteractionwithme,myCouncilandourofficeiscrucialasweasanorganisationandindustrycolleaguescontinuetonavigatethroughchange.
Inparticular,thanksmustgotoallthemembers,bothpastandpresentwhohavebuilttheMRIIonaverysolidfootingwithinourindustry.
Weareveryfortunatetohaveaveryloyalbaseofsupportersandsponsors.Theircontributioniscrucial,youwillfinda‘pulloutandkeep’exhibitorlistingonthebackcover–rememberingthesebusinessesduringtheyearaheadshouldbeapriorityforasmanyofyouasispossible.
Ourindustrypartners’supportcontinuesthroughchallengingtimes.Weareindebted
alsotothesecompanies,listedonpage7.
WeareworkingforasectorthatisextremelyimportanttoIreland’seconomy,youractiveinvolvementduringtheyearaheadwillformanintegralpartoftheInstitutessuccessesandgrowthduring2014/15.
Ilookforwardtoworkingwithourmembers,supportersandfriendsonceagainthisyear.
Linda
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Venue: heritage hotel, Portlaoisecost: MrII Members €400 / non Members €600duration: 2 saturdaysdates: saturday August 9 and saturday August 16time: 11am - 5pmlecturer: Dr. Brendan o’Connor, senior lecturer in Biochemistry at Dublin City universityregister & further information: telephone Andrea Gaffney 058 43955 or email [email protected]
• Describe the basic principles of pharmacodynamics and pharmacokinetics.• Distinguish between pharmacology and biopharmacology.• Identify problems associated with pharma/biopharma drug delivery.• understand the way the body inactivates drug action.• understand the basics of pharmaco-genetics• examine the cardiovascular system as a models target for drug action.
PART1-PHARMACO-KINETICS,WHATTHEBODYDOESTOTHEDRUGLecture Content
1. Basic principles of Pharmacology (basic definitions, basic chemistry/structure, sources etc)2. routes of administration (roAs)3. Drug metabolism and Biotransformation4. Introduction to Pharmacogenetics
PART2-PHARMACO-DYNAMICS,WHATTHEDRUGDOESTOTHEBODYLecture Content
1. Pharmacogenetics and Adverse Drug reactions (ADrs)2. Drugs affecting the Cardiovascular system3. Drugs affecting the urinary system4. Introduction to Biopharmacology
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TheMRIIareofferingthiscoursetobothmembersandnon-members.
introduction to Pharmacology
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MRIIDiaryDates2014/15meetings resume in the autumn. full details will be available on www.mrii.iemeetings open to members and non-members.
MRIICouncil
Linda McMahonPRESIDENT
Garrett MaySOCIAlMEDIA/E-lEARNING
ADvISOR
Neil Mac CourtCOUNCIlMEMBER
ImpressionDesign&Print
Pam LargeCOUNCIlMEMBERBoehringerIngelheim
Sharon GeraghtyCOUNCIlMEMBER
A.MenariniPharmaceuticals
David McCarthyCOUNCIlMEMBER
lundbeck
John WoodsCOUNCIlMEMBER
Eurosurgical
Joe DuaneCOUNCIlMEMBER
GalwayNaturalHealthCo.
Anita O’DwyerCOUNCIlMEMBERGlaxoSmithKline
John ElliottCOUNCIlMEMBER
PfizerHealthcareIreland
Mr francis lynch, President of the Irish Pharmaceutical healthcare Association (IPhA) and Mr ted Queally, Cns/Palliative Care, teva Pharmaceuticals Ireland ltd. Mr Queally was the IPhA Medal winner for the highest scoring candidate in the MrII examination 2014.
IPHAMedalWinner2014
PastPresidentsoftheMRIITomCollins(RIP); 1984-1986JackKinsella; 1986-1987JohnMcCarthy; 1987-1988KevinKelly; 1988-1989PaddyDyar; 1989-1990PatKinsella; 1990-1991CiaránO’Kelly; 1991-1992SinéadCadden; 1992-1993MichaelO’Brien; 1993-1994RobinWard; 1994-1995PeterSheedy; 1995-1996AndrewO’Regan; 1996-1997NoeleenByrne; 1997-1998JohnCarr; 1998-1999JohnMcCarthy; 1999-2000DaraghMoran; 2000-2001HowardSimpson; 2001-2002NualaO’Connell; 2002-2003DonalCurran; 2003-2004CiaranMacFadden; 2004-2005MaryThérèseO’Connell; 2005-2006JohnFenlon; 2006-2007TonyGlynn; 2007-2008Pamelalarge; 2008-2009KelvinaGalavan; 2009-2010GarethFair; 2010-2011AlisonO’Keeffe; 2011-2013
“IntroductIon to BIopharma”SaturdayJuly5andSaturdayJuly12.
“IntroductIon to pharmacology”SaturdayAugust9andSaturdayAugust16.
BothcoursesarefulldaysintheHeritageHotel,Portlaoise-seeinsidefrontcoverforfulldetails.
“let’s talk pensIons”PensionsandInvestmentGuidelines,JamesFinucane,Invesco,October1,4.30pm,CitywestHotel.
“healthcare complIance and What It means For me”Fionalynch,MedicalManager,Janssen-Cilag,September25,4.30pmCork,ClarionHotel.
mrII examInatIon 2015March28,2015,Dublin.(venuetobeconfirmed)
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BOOK YOUR MEETING TODAY
Ireland’s Most InnovativeMeeting Room
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TheMedicalTechnologyIndustry-embracingthechangesarah-Jane larkin - imsta interim ceo
“Itisnotthestrongestofthespeciesthatsurvive,northemostintelligent,buttheonemostresponsivetochange.”CharlesDarwin
WhatatimeofchangeHealthcareandHealthcarecompaniesarelivingthrough,whenalltheapparatusoftheIrishHealthsystemischangingaroundus.TheprogrammeforGovernmentpromisedthemostfundamentalreformofourhealthserviceinthehistoryofthestate.Attheendof2012theMinisterforHealthDrJamesReillylaunchedFutureHealth–AStrategicFrameworkforReformoftheHealthService2012-2015,todeliveronthispromise
WehaveseenchangeathospitallevelwiththeadventoftheHospitalGroups.AtthefundinglevelwiththeproposedintroductionofUniversalHealthInsuranceandtheimminentarrivalofMoneyFollowsthePatient.AtthestructurallevelwiththeDepartmentofHealthtakingbacksignificantresponsibilitiesfromtheHSE.Attheprocurementlevel,withtheintroductionofnewEUprocurementlegislationaimedatsimplifyingandbringingmoreflexibilitytotheprocurementprocess.
TheworkofIMSTAsincethebeginningofthisyearhasconcentratedonthesechanges,makingthepositionoftheMedicalTechnologyIndustryknowntoGovernmentandtheDepartmentofHealthandreadyingmembersfortheimplicationsofthesechangesformedicalsupplycompanies.
TheyearstartedwiththedevelopmentoftheIMSTApositionpaperonMoneyFollowsthePatient.ThisnewwayoffundinghospitalsusingaDRGsystemwillhaveanimpactonhowMedicalTechnologyisprocured,particularlynewinnovativetechnologies,whichmaychangethesettingofcareorsignificantlyimpactoncurrentprocedures.IMSTAfollowedupthisworkwithproductivemeetingswiththeofficialsresponsiblefordevelopingandimplementingthenewfundingmodel,toimpressourviewsonhowinnovationshouldbeaccommodatedwithinthenewsystem.
RecentlyIMSTArespondedtotheGovernmentsrequestforfeedbackandsubmissionsontheirplansforUniversalHealthInsurance.Oursubmissiondetailedconcernsregardingthestandardbasketofgoodsandensuringthatthiswasprocedureratherthanproductbased.WealsorequestedthatwherenewtechnologiescannotimmediatelybeaccommodatedinthebasketthatmechanismswouldexistintheUHIsystemtoensurepatientaccessandchoice.WebelievethatthesearevitalmechanismsinanyUHIsystemtoensurethatpatientaccesstomedicaldevicesisnotrestricted.
WearefinalisingaprocurementwhitepaperinconjunctionwithDrPaulDavisofDCU.ThisdocumentoutlinesthebenefitsofstructuredevaluationfordevicesandaprocurementforumbetweentheHSEandindustry,particularlyinlightofthechangesthenewEUprocurementlegislationwillbringtobearontheprocessesusedtoprocuremedicaltechnology.Wewillalsomakethiscaseinour2015Pre-BudgetSubmission.
Allinallabusysixmonths,wheremostofIMSTA’skeypositionshavebeenadvanced.Thenewhealthcarelandscapewillrequireashiftinthewaythemedicaldeviceindustrydoesbusiness.ThenetworkofcollectiveexperienceofIMSTAmemberscanhelpincreasetheunderstandingofallstakeholdersofthecrucialroleofmedicaltechnologyandnewinnovativeapproachestodeliveringhealthcare.Thiswillensurethatpatientsreceivethemostappropriatemedicaltechnologyfortheminthelongterm,notjustthecheapest.
MRIIExaminationvenuechangetoDublin
the next sitting of the mrii membership examinationwill be on march 28th 2015 in dublin (venue to be confirmed).HealthcareSalesProfessionalscomefromavarietyofbackgrounds.Somearegraduatesandsomearenot,somearesciencegraduatesandnursesandsomearenot.InanefforttostandardisethebackgroundeducationallevelofHealthcareSalesProfessionalstheMRIIMembershipExaminationisofferedasageneralstandard.BysittingandpassingitHealthcareSalesProfessionalshaveshownanin-depthknowledgeofAnatomy,Physiology,ClinicalMedicineandPharmacology.SurgicalTechniqueshavealsorecentlybeenaddedtooursyllabus.Inadditiontheywillhavedemonstratedanuptodateunderstandingoftheindustryinwhichtheywork/proposetowork.
Thebenefitsareenhancedcredibilityandrespectfromtheiremployersandthemedicalprofessionbygivingthemastronggroundingintheareasmentionedabove.AlsotheHealthcareSalesProfessionalwillhavetheconfidenceintheknowledgethattheyhavethefundamentalsforallfuturetrainingbothinternallyandexternallythroughtheircompanyproductsandtherapeuticareas.
www.mrii.ie6
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ThePharmaceuticalIndustry-bringinghealthandeconomicgrowthtoIrelandPhilip Hannon, communications and Public affairs manager, irish Pharmaceutical Healthcare association (iPHa)
Overthepast40years,Irelandhasestablisheditselfasacentreofexcellenceforthepharmaceuticalindustry.Foracountryofjustover4.5millionpeople,wepunchwellaboveourweightinthedynamicworldofinternationalpharmaceuticalproductionanddevelopment.Formanyyears,successiveGovernmentshavefosteredasupportiveenvironmentwhichhasallowedtheindustrytoprosperandtothrive.Alowcorporationtax,abalancedregulatoryenvironment,togetherwithahighlyeducatedworkforce,havecreatedtheconditionswhere8ofthetop10globalpharmaceuticalcompanies,producing5ofthetop20globalblockbustermedicines,arelocatedhere.
likewise,7ofthetop10globalbiopharmaceuticalcompanieshaveapresenceinIreland.
Aswellasbeingaverysignificantcontributortotheexchequerthroughtaxation,thepharmaceuticalindustryemploysalmost50,000people,bothdirectlyandindirectlyandalongwiththemedicaldevicesector,isresponsibleforover50%ofIreland’sexports.Ireland’seconomyispredictedtoexpandby3.5%in2014,thefastestrateofgrowthinsevenyearswiththeEconomic&SocialResearchInstitute(ESRI)forecastingadditionalgrowthof3.7%in2015.Muchofthiseconomicgrowthcanbedirectlylinkedtothepharmaceuticalindustry.
Between2011and2013,forexample,€1.7billionwasinvestedinthesector,creatinganadditional1,500jobsatatimewhenthecountry’sunemploymentratewasatacripplinglyhighrate.
ThevalueofthepharmaceuticalindustrytoIrelandand,inparticular,toIreland’scontinuingeconomicrevivalwasclearlyevidentintheESRIreportontheIrisheconomyin2009whenthecountrywaslanguishinginthegripoftheeconomicrecession.
Duringthattimethepharmaceuticalindustrycontinuedtoinvestandpharmaceuticalproductsaccountedfor34.5%oftotalgrossindustrialoutputin2009,byfarthelargestcontributor.Computerandelectronicproductsaccountedfor17.2%,andfoodaccountedfor16.5%inthesameperiod.
Aswellassupportinghighlyskilledjobsthroughtaxationandexports,theresearchbasedpharmaceuticalindustryinparticularcontinuestoworkwiththeStatetoensurethatinnovativemedicinescanbemadeavailabletopatientsataffordableprices.Since2007,theindustryhashelpedtheHSEtosecuresavingsofatleast€800minthemedicinesbill.
industry supporters
Without the loyal support we receive from our industry colleagues our continuing efforts would not be possible. Thank you to each and
every one of the following:
PFIZER HEALTHCARE IRELAND - SPONSOR OF NATIONAL CONFERENCE BUSINESS
SESSIONS 2014A.MenariniPharmaceuticalsltd.
AbbvielimitedAmgen
AstellasPharmaAstraZenecaPharmaceuticals
(Ireland)ltdBayerScheringPharmaClonmelHealthcareDaiichoSankyoFreseniusKabiGlaxoSmithKline
IpsenPharmaceuticalsIrishCollegeofGeneralPractitioners
(ICGP)Janssen-Cilagltd
leoPharmalundbeck(Ireland)ltd
MedaMSDIreland(HumanHealth)ltd
NovartisNovoNordisk
RocheProductsIrl.ltd.Sanofi
ShirePharmaceuticalsIrelandltd.UnitedDrugNationalConference2014Speakers:MrBarryHeavey,HeadoflifeSciencesatIDAIreland,
DrGerardCrotty,ConsultantHaematologist,MrPeterMurchan,ConsultantSurgeon
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Contact [email protected] or [email protected] | T: + 353 1 293 1070 | W: www.designid.ie
Design ID Marketing is a full-service design and marketing agency. We specialise in developing solutions that are both commercial and creative, and support our clients’ business objectives.
Design ID Marketing can help you…n improve your market sharen reposition your productn engage your audience bettern develop your online presence.
Creative solutions for growth using print & digital media
spot PrizesThe following provided our 2014
National Conference spot prizes. We thank all sincerely for their generosity:
AthloneSpringsHotelBallsbridgeHotelCastleleslieCitywestHotel
ClaytonHotelGalwayClydeCourtHotelCliffHouseHotelCrokeParkHotel
ThedHotelDroghedaFinnstownHouseHotel
FitzpatrickHotelGalwayPenCompanyGlenloAbbeyHotelGlenroyalHotelHotelMeyrick
KilkennyOrmondeO'CallaghanHotelsDublin
OspreyHotelNaasRadissonBluHotelandSpaGalway
RochestownParkHotelRoyalMarineSavoylimerick
SheratonAthloneHotelWaterfordCastle
Thishasbeenachievedthroughaveragepricereductionsof30%peritemreimbursedunderthevariousStatecommunitydrugsschemes.Theaveragecostperitemofmedicineisnowrunningat2001/2002levels.
The2012pricingAgreementbetweentheindustryandtheStatecontainsmechanismstoyieldafurther€400millioninsavingsbytheendof2015.
Therobustcontributionofthepharmaceuticalindustrytotheeconomicstrengthofthenationisveryapparent,andthebenefitsintermsofbetterhealthoutcomesshouldnotbeunderestimated.Ground-breakingmedicinesandvaccinesdevelopedandproducedbycompanieswithapresenceinIrelandareimprovingsurvivalratesandfacilitatingthebettermanagementofchronicillness,eliminatingorreducingtheburdenofdiseaseandincreasinglifeexpectancy.
TheOECDhasrecentlyshownthattherewasanincreaseinlifeexpectancyinIrelandof4yearsbetween2000and2011,withinnovativemedicinesplayingapivotalrole.
Peoplewithsuchconditionsasdiabetes,rheumatoidarthritisandHIvareabletolivefullerlivesasaresultofnewmedicines.MuchsuccesshasbeenachievedintreatingcancerinIreland,
withlong-termsurvivalratesimprovingsignificantlyinthepastdecade–from42%intheperiod1994-1999to60%in2005-2009inmenandfrom52%to62%overthesameperiodinwomen,dueinparttoinnovativemedicines.
AsIrelandemergesfromatorridperiodinoureconomichistorythereareveryrealgroundsforoptimism.Althoughournationaldebtremainshighandemigrationcontinues,economicgrowthhasreturnedandunemploymenthasfallensignificantly.
TheIDAcontinuesitsimpressiveworkinattractingnewforeigndirectinvestmenttoIrelandbolsteringanindustrialbasethatisbecomingmorediverse.
Attheheartofthisindustrialbaseremainsthepharmaceuticalindustry,whichiswovenintothefabricofourcountryandforanationStatenotyetacenturyinexistence,itissomethingofwhichweshouldbeveryproud.
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BreakingtheProcrastinationHabit
Participantsonourprogrammessaythatprocrastinationisthenumberonehabittheywouldlovetobreak.Itfeaturesonmostpeople’sself-improvementwishlists.Peopleofallagesandfromallwalksofliferepeatedlyfallintotheprocrastinationtraponadailybasis.Despiteattendingvariouscoursesandmakingnumerousresolutionstostopprocrastinating,thehabitpersists.Thefunnythingisthatwecan’tnecessarilytellaprocrastinatorfromtheoutside.likeourselves,theywillalwayslookverybusy,butwewon’tknowiftheyarebusydoingsomething,nothing,oranythingbutwhattheyshouldbedoing.However,wedoknowalltooclearlywhenweourselvesareprocrastinating,asitalwaysproducesunhappinessanddissatisfactionwithinandgrossinefficiencywithout.
Sowhydowekeepondoingit?Wouldweeverencourageourfriendsorcolleaguestoprocrastinate?No!Yetweourselveskeepfallingintotheprocrastinationtrap.Thereasonforthisisthatdeepdownwemustbelievethatprocrastinatingisbringingusvalue.Wethinkifweputthejoboffuntillaterwewillsomehowbeinabetterpositiontodoit.Butisthiseverthecase?let’slookatanexample.Thereissomethingtodo,aphonecall,itneedstobedonebutforsomereasonwedon’twanttodoit,weputitofffornow,wetellourselvesthat“itwillbebetterifweputitofftilllater”,“we’llbemoreprepared”,“we’llhavemoretime”,“we’llbemorerelaxedthenextdayit’spushedfurtherout”andsoweproceeduntilthelastpossibleopportunity.Whileourinitialpostponingmaywellgrantusanimmediatesenseofrelief,itdoesn’tlastlong.Shortlyafterpostponingwhateveritisthatneededtobedone,thereliefisreplacedwithagitation,confusionandmentalclutterallofwhichbecomemoreintenseanddistracting(evenpanic)asthedeadline
drawsnear.Thisnoiseintheheadisfurthercompoundedwithalitanyofalltheotherthings(apartfromthephonecall)thatwehavetodo.ThisallcreatestheillusionthatIamverybusy;andwhenweareaskedbyothershowweareoutpourtheusualreplies:“ohverybusy”,“notenoughhoursintheday”etc.Thisisthebigliewetellourselvesandothers.Thisbusythinkingisalsoaconsiderabledrainonourenergysupplyandexplainswhywecanbesoexhaustedattheendofanordinaryday’swork.Italsoimpactsnegativelyoneverythingelsethatwehavetoattendtobothpersonallyandprofessionally–notalotgoingforit!
Thereisanimportantpointinallofthis,andonewhichwemustrealise,thatis,theIambusyfeelingisnottheresultofallIhavetodo,itistheresultofallthatIamnotdoing.Whenthejobortaskiseventuallytackled,itisneverasbadasweimagined,weexperiencegreatreliefandwonderatourownstupidityinputtingitoffinthefirstplace.
Procrastinatingisnevertherightresponse.Itisbeingoutoftunewiththeworld,outofstepwiththenaturalflowofevents.Thismaysoundalittlestrongbutprocrastinationisactuallyquitecowardlybecauseitinvolvesshirkingornotfacinguptoourresponsibilities.Thereisonlyonetimetocatchthebusandthatiswhenitisinfrontofyou,allthatisrequiredisonesimpleandeffortlessstep.However,procrastinatingisliketryingtocatchthebusafteritleavesthestation:complicated,unproductiveandagreatenergy-waster.Howmuchofourdayisspenttryingtocatchthebusafterithasleftthestation?
Wepostponeanddelaytasksbasedonwhatwelikeanddon’tlike–ourpreferences.Weputoffwhatwedislikeandweengagefullywithwhatwelike.Writinglistsandschedulingtasksareoftenseenasthesolutionandwemaygivemuchtimetowriting,rewritingandgenerallistmanagement,tellingourselvesthatwearegettingmoreorganised.Butifwearehonest,mostofourlistwritingisoftennothingmorethananaccurateaccountofwhatwearenotdoing.listsandschedules,bythemselves,donotsolvetheproblembecausetheydon’taddresstherealcause.
Thecauseofprocrastinationisaninternalone,it’saninsidejob.Procrastinationhappenswhenwearegovernedbyourpreferencesratherthantheneedsofthesituation.Ourinternalcompassissetonthewrongcourseandnoamountoflistswillcorrectthiserror.Weneedtoshiftthecourseawayfrommeandmypreferencesandontotheneedrightnow.
How?Theantidoteisbothsurprisingandsimpleandcomesintheformofashortquestion:Whatistheneedrightnow?Thisquestionridsourmindofpreferencesandclarifiestheneedofthemomentwhichcanthenbeattendedtosimplyandefficiently,withoutlossofenergy.Sodon’tprocrastinateanymore,insteadaskyourselfthequestionwhatistheneedrightnow?andfaithfullyfollowtheanswer.Ifnotnow,thenwhen?
BrianMcGeoughMcGeoughTrainingltd.www.mcgeough.ie
MRIIMembershipApplicationscanbecompletedonline
AnyonewhowishestoapplyforMRIImembershipcandosoonlineat
www.mrii.ie
TheMRIIwelcomesmembershipapplicationsfromallhealthcaresalesprofessionalsworkinginacustomerfacingroleinthelifesciencessector,whichencompassesPharmaceuticalandMedicalDevicecompanies.Join
onlineatwww.mrii.ie(Tel:058.43955)
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Sponsors&ExhibitorsNationalConference2014
AnitaSherlock,QuintilesPresidentsWelcomedinnersponsor
MichelleThornton,CiaraHalpin,HotelSolutions
ChoiceHotelGroup,RaymondKelleher,louiseMcClean
CatrionaMurphy,TaniaDunne,CathyJoyce,SusanSheahan,DarraghO'Connor,DalataHotels
ShaneFitzgerald,PMI
TheMRIIiscommittedtothepromotionofprofessionalismandbestpracticeforallitsmembers.ProvidingGoldstandardeducation,
careerdevelopmentandnetworkingopportunitiesforthoseworkingincustomerfacingroleswithinthehealthcaresector.
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Sponsors&ExhibitorsNationalConference2014
AnnShanahan,KillarneyConventionCentreMickO’leary,AshfieldwithSeanMoynihan(Phoenixlabs)
OrlaByrne,PowerscourtHotel CiaraSexton,CastleknockHotel
ClaireMyler,RiverleeHotel MarionWard,CiaraShovlin,WardsCornerstore
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MyRoleandWhatitInvolvesIamprivilegedtoworkatlundbeckIrelandforthepast5yearswithtrulygiftedpeoplewhomhavebeenverysupportivetome.IamaTerritoryManagercoveringGeneralPractitioners,PracticeNursesandPharmacistsintheSouthwestspecialisinginPsychiatryandNeurology.lundbeckisuniqueamongstpharmaceuticalcompanies,byfocusing100%ofitsresearch,productionandmarketingactivitiesonproductsforthetreatmentoftheCentralNervousSystem(CNS).
ChallengesThismarketplaceisbecomingmorechallengingacrossallsectorsoftheindustry.Patientfocusandwellbeinghasalwaysbeentotheforeyettheconsistentfocusondeliveringmorewithlessisextremelychallengingandsomethingyounoticeonadailybasis.ThequalityandempathyofourHealthcareProfessionalsaresecondtonone.Asaresultoftheongoingchallengesandcutbacksweseemanytalentedpeopleleavingourshores,thisissadasindeedistheeffectonpatientsseekingtogainsamedayservices.
OpportunitiesThequalityofservicesandmedicalpracticeshavegreatlyimprovedoverthepastnumberofyears.Manypracticesarenowdoingtheirowndiagnostics.Physiotherapy,Nutritionist,andCounsellorServicesalsoprovideaqualityresourcewithafocussedapproachonpreventionandwellbeingforpatients.
StrengthsPeople.Itrulyenjoymeetingandengagingwithpeople.ItissomethingIhavealwaysenjoyedfromayoungagepullingpintsinapub.IloveinteractingwithpeopleandmustsayIamprivilegedinmyroleatlundbeckIrelandtocalltosomanyGeneralPractitioners,PracticesNursesandPharmacists.Igainalotofmystrengthfromthepeoplearoundmewhomhavebeensosupportive,friends,familyandcolleagues.IhavelearntovertimethatyouareonlyasgoodasthosepeoplearoundyouandIamgratefultothemall.“We’llkeepherlit”
MRIIAmbassadorRoleIamcurrentlyontheAmbassadorprogrammefortheMRII.TheMRIIiscommittedtothepromotionofprofessionalismandbestpracticeforallHealthcareSalesProfessionalsprovidingeducationalandsocialopportunitiesforallmemberstointeract.IhavegainedmanymeaningfulrelationshipsoverthepastnumberofyearsandfoundthesupportandguidanceIreceivedfromMRIImembersbothinadvanceandindeedduringtheInstituteexaminationmostbeneficial.IfeelitisonlyrightthatIofferothersthesamesupportandguidancethatwasaffordedtome.
BeforeJoiningthePharmaceuticalIndustryIwasonsomewhatofadifferentroadinthatasayoungfellaIdidjobslikehelpingthemilkmantosortingbottlesandbarrelsandpullingpintsinapubtoqualifyingasaPlasterer.FollowingbreakingmyankleplayingfootballIdidaSalesandMarketingcourseasaresultatSamcoinCorkbeforegaining4weeksworkexperienceatCadbury.These4weeksbecame17yearswhereIworkedatvariouslevelswithintheorganisationbeforejoiningthepharmaceuticalindustry
in2009.ThetransitionfromFMCGtoPharmaceuticalswasverystimulatinginthatitgreatlyincreasedmyknowledgebaseandchallengedmegreatlytodoso.Ihavealsobeenofthebeliefthatthereisnothingthatyoucannotdoorachieveinlifeitismoreabouthowyouadaptandapplyyourselftovarioustasksandroles.WithoutquestionIhadtoleanonpeopleIvalueandrespectgreatly.Itrulycan’tthankthemenough.
FavouritePlacestoStayWestCorkhasgotitall.Ruggedunspoiledandgreatcraic.
TheBrehonHotelKillarneyisastone’sthrowfromhome,theirstaffareextremelyfriendlykindandwelcoming.(EventoaCorkman).
BestcountryvisitedMyfavouriteplacevisitedhastobePortugal.Themostbeautifulbeaches,restaurantsandthepeoplearesofriendlyandhospitable.
Interests&HobbiesFamily-mywifeandIhavethreechildren.It’sgreattowatchthemgrowanddevelopandinmanywaystheirinterestsandhobbieshavebecomeours.WhenIdogetachancetochilloutIenjoycyclingandroadrunning,greatwaystoswitchoffandrecharge!
FavouriteQuotes
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ThomasCarlyle.
Yourinfluencelikeyourshadowextendstowhereyou
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youareselling.
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A Hotel for Seaside LuxuryRegarded as one of the finest small luxury
five-star hotels in Ireland, The Cliff House Hotel is a 39-room Irish seaside boutique hotel in
the traditional fishing village of Ardmore. Our privately owned hotel also features an intimate
Irish destination spa as well as a Michelin-starred restaurant.
The building seems to defy gravity, clinging to a cliff on the south side of Ardmore Bay where there has long been a fishing village. From sun-drenched terraces and private balconies it is
possible to see Ardmore’s golden sands, lobster pots and dolphins that play out on the water. All our luxury rooms and suites are sea facing while
many are interconnected to provide family-friendly configurations. Our intimate destination
spa, The Well, is a key attraction.
A split-level, loft-style suites make one feel like one is staying in a chic private home. Ground
floor living areas, accented with pieces from our collection of original 18th-century campaign furniture, have deep sofas, flat-
screen TVs and cosy fireplaces.
Upstairs, rooms are defined by their Cliffside location, with floor-to-ceiling glass doors
opening on to a large private veranda that’s large enough for lounging. A sense of nature fills
the bathrooms, where huge stone baths and glass-sided showers ensure the ocean views
and fresh sea air are always present.
+353 24 [email protected]
lindaMcMahon,MRIIPresident,MrTedQueally,TevaPharmaceuticals
lindaMcMahon,MRIIPresident2013-15,MrFrancislynch,PresidentoftheIrishPharmaceuticalHealthcareAssociation(IPHA)
SomeofourexhibitorswhojoinedusfortheGalaDinner2014
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JoeDuane-GalwayNaturalHealthCo,PádraicÓMáille,AndreaGaffneyandlindaMcMahon-MRII
EndaDarcy-MSD,MrPeterMurchan,ConsultantSurgeon
leonalau,Pfizer,lindaMcMahon,MRII,JohnWoods,Eurosurgical
JoanandJohnMoloughney
mrii laPel Pin
DoyouholdtheMMRIIqualification?MRIIlapelPinsavailableon
request.
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AddictioninIreland
MR.ROlANDEANDERSON,B.S.S.(HON.),C.Q.S.W.,Alcohol/AddictionCounsellor.Dublin2.FormerNationalAlcoholProjectDirector(2000-2011)fortheIrishCollegeofGeneralPractitionersandauthorof“livingwithaProblemDrinker–YoursurvivalGuide(2010)SheldonPress
IntroductionDoyoulikethetitleofthispiece?ShouldIhavewritten‘Irelandinaddiction’?!Ourlittlecountryhasaseriousproblemwithaddictivesubstancesandbehaviours.Iamgoingtoconcentrateonalcoholdependenceandalcoholproblems.However,Ifearthatweareinforatsunamiofotheraddictionstoo.Inparticularweareseeingmorepeoplepresentingwithgamingandgamblingproblemsaswellasanincreaseininternetpornandotherformsofsexualaddiction.Itisfrighteninglyeasytoaccessallformsofpornographyandhaveyounoticedtheproliferationofgamblingadvertisementsontelevision?Gamblinghasbecometooeasyandinacoupleof‘clicks’youcanliterallyloseafortune.
ContextAddiction,inallitsforms,isallaroundusandyetitisoftenbadlymissedinthemedicalarena.Medicalpractitionersareverybusy,stressedoutthesedaysandinsomelocalareashavelittlesupportduetotheabsenceofreferralsourcesandtreatmentoptions.Inaddition,Doctorshavetheaddedproblemsof;
• Poorundergraduatetraininginthisarea(incredibletothinkhowlittletrainingisprovidedwhenaddictiontakesupsomuchoftheworkloadwhenqualified)
• lackoftimeandheavyworkloads,(torepeat)
• Afearofopening‘Pandora’sbox’(especiallyatprimarycarelevel)
• Thebeliefthatwhattheydowillmakenodifference
• Andtoemphasisethepointalreadymade,poorlocalresourcesanddifficultyaccessingsuitabletreatmentforpatientsandtheirfamilies
Theseareallverygenuineissuesandthereareofcoursemanyotherfactorsatplaytoo.Anotherstrikingproblemisthataddictionoftenhastobeuncoveredatconsultationsbecausepatientsandfamilymembersareashamedandguilty.However,thereisnostereotypeofwhatsomeonewithanaddictionproblemlookslike,soundslikeorsmellslikeexceptintheextremepresentations.IfDoctorshavesomeinappropriatestereotypeintheirmindstheywill‘miss’manypeoplewithsignificantproblems.
Whatisaddiction?Whenisanaddictionanaddiction?And--Canyoubeaddictedtoanything?Wellno!--wehavetodistinguishbetweenhealthypursuitsandthenegativeeffectsofaddictiontosubstancesandharmfulbehaviours.Formethesignsofdependenceonanysubstance,activityorbehaviourinvolvesomeorallofthefollowingatleast;• Progressivedeteriorationinhealth
andappearancewithincreasingobsessionandcompulsion
• Detrimentalchangeofpersonality• Severesufferingonthepartofthe
individualandhis/herfamily• Aninabilitytocontrolthebehaviour
ortheingestionofthatsubstance• Denialandcoveringup• Compromisingone’sownvalue
system• Thepresenceofguiltorshame• Furtivenessorsecret‘indulgence’• Neglectofself,familyandother
interestsThisisnotanexhaustivelistbutit’snotbadasasimpleguidelineandgivessomeofthecriteriatokeepawatchoutfor.
Symptoms/signsthatmayalsoindicatethepossiblepresenceofaddiction;
GeneralHealth;bloodpressure,headaches,tiredness,vaguesymptoms,infections,liverproblems,gout,heartproblems,skindisorders,weightloss/gainetc
Sexualhealth;pregnancyandfertilityproblems,foetalalcoholsyndrome,STI’s,morningafterpills,assaultsandrape
OccupationalHealth;absenteeism,‘presenteeism’(atworkbutnotreallythere!),accidents,incidents,fraudetc.
MentalHealth;depression,suicidalideation,anxiety,phobias,confusion,moodswings,andinsomnia
Other;maritalproblems,domesticviolence,childsexualabuse,etcAndagainlotsmorebesides.
AlcoholWehaveaterribleproblemwithouruseandabuseofalcohol.Mostoftheinternationalleaguesputusnearoratthetopforconsumptionlevelsandbingedrinking.Insimpletermswedrinktoomuch,fortoolongandtoooften,overrelativelyshortperiodsoftimewithsevereconsequencesintheshortmediumorlongtermformanypeople.Acuteproblemsandincidentsaswellaschronicillnessoccurasadirectconsequenceoftheamountandpatternsofourdrinking.Womenandgirlsareatgreaterriskasareyoungerandolderpeople.Whendrunk,youngerpeoplearemuchmoreatriskofexperimentingwithotherdrugsandsoareatfurtherriskofmorecomplicatedaddictions.The‘Goon,goongoon’culturemadefamousbyMrs.DoyleintheTvcomedy‘FatherTed’isaliveandwellforpushingteaandalcohol!Thereishorrendoussocialpressureonpeopletoimbibe.InmyworkIregularlyspendalotoftimehelpingpatientswhoareintheprocessofrecoverytobecomfortablewitha‘story’astowhytheyarenotdrinkingtoresistpressureandtostaysober.Thephrase‘haveone’or‘nottobeastickinthemud’orsomesuchgetsworseattheendofdrinkingeveningsandeventsaspeopleget‘tankedup’andlosesensitivityandtact.
Forsomethemedicalconsequencesarethe‘wake-up’callandtheygethelpbutsadlyformanythemedicalsequealaareterminalorresultinchronicillness.Themedicalconsequencescomemuchlaterforothersandallowfolktofoolthemselvesintobelievingtheyare‘bullet
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proof’.longbeforethemedicaldifficultiesarisepeoplewhoaredrinkinginaharmfulordependentmannershowsignsofadevelopingproblemthatareregularlyunnoticed.Partofthisblindeyeisduetoaculturaltoleranceofheavydrinking.Ihaveknownfamiliestoreportdomesticviolence,secretivedrinking,bizarrebehaviour,chronicmemorylossandmuchmoreandtoNOTassociatethesesignsasalcoholrelated.Manypeopleinthethroesofaddictivedrinkingarealsounawareofthedevelopingproblem.Isupposebackinthedaythiswascalledclassicdenial.Partners,spouseandchildrensufferdreadfullyinaddiction.Theylivewithinconsistency,volatilemoods,uncertainty,neglectandabusetovaryingdegreesandinsomecasestoalarmingextents.TheuntoldstoryinIrelandistheamountoftormentandharmthatchildrenhaveexperiencedduetoparentalalcoholproblems.Manyexperiencesignificanttraumainthehome.
RecentlymostoftheseissuesabovewereconfrontedbytheNationalDrugMisusestrategywhichreportedonitstwoyeardeliberationsinFebruary2012.Forthefirsttimealcoholwasincludedinthedrugstrategyandthatitselfwasremarkableandindicatedprogress.Therewerenumeroussuggestionsandplansastohowwecouldtackleournationalpredilectionbutasreaderswillhavenoticedthereportwasnotreceivedwellbymanysectionsofthecommunityandincertainpoliticalareasdespiteitincludingalmostalloftheleading‘experts’inthefield.ItshouldbepointedoutthattheDrinksindustrywerepartofthegroupandissuedaminorityreportaswellaslobbyingpoliticiansbeforetheinkwasdryontheconclusions.
Weneedstrongpoliticalleadershiptoconfrontthevestedinterestsifwewanttoimplementrealchange.Wealsoneedperhapstofocusmoreonharmreductionasinkeepingwiththestrategyonotherdrugs.Readersofthisnewsletterwillbeinterestedtohearthatanewdrugwillshortlybelaunchedtoreduceconsumptionforpatientswithalcoholdependence.Iamhopefulthatthismighthelpsomepeopletoreducetheharmthatiscausedforthemselvesandtheirfamilies.Selincro(Nalmefene)producedbylundbeckhasbeenavailableinEuropewithinterestingpositiveresultsandmayhelppatientswhowillnotorcannotstopdrinking.ImustdeclarethatIhelpedlundbecktodevelopBRIEFcases,acomprehensiveresourcepackaboutpsychosocialinterventionstosupportprimarycareinhelpingpatientswithalcoholproblems.Iamdelightedwiththeresponsewehavebeengettingfromprimarycare.TheideaisbasedonBriefInterventions.TheBstandsforBegin,RforReassure,IforIntervene,EforEngageandFforFinish.ItprovidesGPswithall
theyneedtoassessalcoholproblemsandincludespatientinformationleaflets,drinkdiariesetc.Theresourcehelpstoendconfusionovermanyissuesincludingstandarddrinks.Thereishugeignoranceamongstthepopulationaroundwhatconstitutesastandarddrinkandmanypeoplearedrinkingoverlowriskweeklyguidelinesregularly.‘WineO’clock’onaFridayisthenorminmanyhouseholdswheremorethanabottleeachisconsumed.
ConclusionsAddictionsareincreasingatanalarmingrate.Alcoholcontinuestobethemainproblem.Polydruguseandabuseisworryinglycommonamongyoungerpeople.Thosesufferingfromaddictionarenoteasytodetectbymedicalandpara-medicalpersonnelunlesstheyare
inanadvancedstate.Ifwecouldhelppatientstoreducetheirdrinking,sothattheyhavelessharmfulconsequences,itwouldbeanenormousimprovementonthecurrentsituation.Wemustalsohelpthosewhoaredependentandprovidemoresupportforfamiliesandchildren.Greatertreatmentresourcesforpatientsespeciallypeoplewithoutprivatehealthinsurancearebadlyneeded.Finally,weneedtoactivelysupportourhealthcareprofessionalstodothisimportantwork.AbighelpwouldbetoprovideadequatetrainingmodulesforDoctorsonaddictionatundergraduatelevel.
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AmbassadorsA.MenariniPharmaceuticalsltd. vanessaHardyActavis MartinaSweeneyAmgen BrendanBalfeAshfieldHealthcare EmmaRandallAstraZeneca(Irl)ltd. DavidMaloneBoehringerIngelheimltd. PamlargeClonmelHealthcare MarieMcAuliffeDaiichiSankyo PaulMuldoonDrFalkPharma HowardSimpsonEurodrugPharmaWholesalers MikeBlackwellEurosurgical JohnWoodsGileadScienceslimited SusanlyonsGlaxoSmithKline MartinMurphyGrünenthalPharmaltd. GarvanToomeyJanssen-Cilagltd MickFlemingKRKAPharma JohnClancyleoPharma KenMcDonaldlundbeck(Ireland)ltd EddieO’CallaghanMeda KarenOsborneMSDIreland(HumanHealth)ltd AislinnHorganPamexltd. BarryO’DwyerPfizerHealthcareIreland leonalau-Primary
JohnElliott-SecondaryPhoenixlabs SeanMoynihanRocheProductsIrl.ltd. KathrynCarneySanofi KevinHynesTeva SaundraFlynnTillotts SineadCaddenUCBPharma GarethFairAlumni KevinKelly
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Wearefortunatetonowhaveateamof30dedicatedAmbassadorsinplace.ThisrolehasquicklybeenestablishedasprestigiousleadershipinvolvementwiththeMRII.
OurobjectiveistohavefullMRIImembershipfromallHealthcareSalesProfessionalsincustomerfacingrolesandtohaveaclearcommunicationchannelbetweentheMRIIandallcompanies.Isyourcompanyrepresented?Ifnot,interestedparties(youmustbeacurrentFullmemberoftheMRII)[email protected].
Wearemindfulofeveryone’sworkloadanddonotwishtoaddtothis.TheAmbassadorwillhavefullsupportfromCouncilandouroffice.
Theroleincludes:• Beingthemainpointofcontact
betweentheInstituteandyourcompany
• SeekingopportunitiestoinformyourcolleaguesandmanagersofthebenefitsofMRIImembership
• DeliveringupdatestoyourcolleaguesontheMRIIinrelationtocurrentevents,coursesandregionaleducationalmeetings
• AssistingwithgeneratingasfullanattendanceatourNationalConferenceeachyearfromyourcompany
PicturedattheIMSTAAnnualConference,March2014,GarrettMay-CouncilMemberMRIIandAndreaGaffney-NationalCo-ordinatorMRII
Dr.BrendanO’Connor,SeniorlecturerinBiochemistryatDCU(centre),picturedwithattendeesattheMRIIPharmacologyCourse,January2014.Includedinthegroupare;vanessaHardy-A.Menarini;EmmaRandallQuinn-AshfieldHealthcare;ErikJackman-Grunenthal;leeCorbett-Grunenthal;ThomasMurphy-JanssenCilag;MickFleming-JanssenCilag;JohnElliott-Pfizer;DeirdreParlon-SanofiAventis;vivienneMartin-SanofiAventis;ShaneO'Connor-SanofiAventis;RonanWalsh-SanofiAventis;NatashaCaulfield-Tillotts;NicolaWalsh-Tillotts;SaundraFlynn-Teva;DavidFitzpatrick;GaryGlennon-BBraunMedical,JohnWoods–Eurosurgical.
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Roboticassistedradicalprostatectomy-anewdevelopmentinthetreatmentofprostatecancerinIrelandmr P o’malley, consultant Urologist, Galway clinic.
RoboticAssistedRadicalProstatectomy(RARP)isanewlydevelopedtechnologyinthesurgicaltreatmentoforganconfinedprostatecancer.TheprocedurewasfirstperformedinIrelandattheGalwayClinicin2007.Todateover500caseshavebeenperformedwithexcellentpatientoutcomesandresultsmatchingthebestinternationalstandards.
Formenwithprostatecancersuitableforradicalsurgicaltreatmentanumberofapproachesareavailable.Priortoadvancesinsurgicaltechnologytheopenapproachofradicalretropubicprostatectomywasused.Minimallyinvasivetechniqueshavedevelopedastandardlaparoscopicapproachtoradicalprostatectomyandmostrecentlyroboticassistedradicalprostatectomy.Allapproachesaimtoachievecurewithoncologicalclearanceofthetumourwhilstpreservingurinarycontinenceanderectilefunction.
Whatisroboticassistedsurgery?RoboticassistedtechniquesweredevelopedbyNASAandtheAmericanmilitaryinthelate1980swithviewtoprovidingsurgicaltreatmenttofrontlinepersonnelfromaremotelocation.Refinementofthesesystemsledtothedevelopmentofa“master-slave”deviceconsistingofaroboticsurgicalarm(slave)controlledfromasurgicalconsole(master)linkedbyacomputerinterface.Thedavinci®SurgicalSystem(IntuitiveSurgicalInc.,Sunnyvale,California)istheleadingcommerciallyavailablesurgicalrobot.Roboticassistedsurgeryhasbeenadoptedbymanysurgicalspecialtiesincludingpaediatricsurgery,cardiothoracicsurgery,obstetricsandgynaecologybutinitiallyitwasinthefieldofurologyandspecificallyradicalprostatectomythatsurgicaltechniquesweredeveloped.ThefirsttotallylaparoscopicteleroboticradicalprostatectomieswereperformedinMay2000atFrankfurtUniversity.Thefirst10caseswerepublishedbyBinderandKramer[1]formerlyopensurgeonswithlittlelaparoscopicbackground.
Howdoesroboticsurgerywork?Sittingatthesurgicalconsolethesurgeonmanipulatesthecontrolsusingaprocessorthatfilters,scalesandrelaystheexactmovementsofthesurgeon’shandsandfingerstotheendoscopicinstruments.Thereisnomeasurabledelaybetweenthemovementofthesurgeon’scontrolsandthemirroredmovementoftheinstruments.Thesurgeonvisualisesthesurgicalfieldviaabinocularcamera.Alternationbetweencameraandinstrumentcontrolisregulatedbyfootpedalswhichalsocontainaclutchmechanismandsurgicaldiathermycontrol.Thesurgeonatalltimesdirectsthesurgicalinstrumentsduringthesurgerywithnoindependentactionperformedbytherobot.Theprimarysurgeonisaidedbyabedsideassistantwhochangestheroboticinstrumentsandintroducessuturesetcwhenrequired.
Whataretheadvantagesofroboticsurgery?TheperceivedadvantagesofRARPcanbebroadlydividedintobenefitstothepatientandadvantagesaffordedtothesurgeonduringtheprocedure.
Vision:Fromthesurgicalperspectivetheprocedureisperformedwiththreedimensionalbinocularvisionallowingaccuratedepthperceptionofthesurgicalfield.Thebinocularmagnificationcanbeadjustedfromtentofifteentimesnormalthussignificantlyimprovingidentificationofvitalstructures.Thelatestmodeliscurrentlyfittedwiththeaddedadvantageofadigitalzoomtechnologyallowingmaximumfocusparticularlyattheextremesofthesurgicalfield.Thisallowsmicrosurgicaltechnologytobeusedonamacroscopicscale.
ergonomics and acquirement of skill:Thesurgicalergonomicsofthistechnologyhasalsobeenshowntobeadvantageous.Apartfromthesurgeonbeingseatedinacomfortablepositionduringtheprocedurethereisaneasiertransferralofopensurgicalskillstotheroboticassistedmethod.Thismethodofsurgeryiscompletelyintuitivemeaningthatthesurgicalmovementsmadebythesurgeonaredirectlymirroredbytheroboticarmsandinstruments.Conventionallaparoscopicsurgeryiscounterintuitive.Thesurgicalinstrumentoperatesaboutafulcrum(chop-stickeffect)andthemovementoftheinstrumentsaredirectlyopposite
Fig1.Surgeonseatedattheroboticconsolewiththeroboticcarthousingthesurgicalinstruments.
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tothemovementsofthesurgeonshandiesurgeonshandmovesdowntheinstrumenttipmovesupwardsinthesurgicalfield.Indeed,robot-assistedlaparoscopyallowsforfasterlearningofsuturinganddexterityskillsthandoesmanuallaparoscopy[2,3].Therefore,thetrainingforanovicelaparoscopistlearningcomplexlaparoscopicprocedureslikeRPisconsideredshorterwhenusingthedavincidevice[4].Moreimportantly,recognisedfellowshiptraininginroboticsurgerywillreproducetheimpressiveresultsacceptedastheinternationalstandard.
dexterity:Thehumanhandhaswhataretermedfive“degreesoffreedom”inrelationtomovementanddexterity.Theroboticinstrumentationcontainsanendowristwhichallowsthesurgeoneightdegreesoffreedominrelationtocomplexmovementatthesurgicalsite.Thisisachievedbythesurgeonmovinghis/herownhandintoapositionofmaximumpronationforexampleandthen,byemployingtheclutchmechanism,hishandcanassumeaneutralpositionwithoutthesurgicalinstrumentmoving.He/shecanthenproceedtofurthermovetheinstrumentaboutthesameaxisupto540degreesofrotation.Thisisahugeadvanceinsurgicaldexterityallowingcomplexmanoeuvressuchaslaparoscopicsuturingbeeasilymasteredandimproved.Theroboticinterfaceprovidestheadeptopensurgeonwiththetoolsnecessarytotransferhis/herskillsintoalaparoscopicarena.Italsoprovidesabetterplatformforeventhemoderatelyandwellskilledlaparoscopicsurgeontoworkwithgreateraccuracyandperhapsimprovedefficiency.
Fig2.Surgicalendowristmirroringsurgicalhandmovementwitheightdegreesoffreedom.
motion scaling and tremor filter:Theroboticinterfaceallowsadjustmentofmotionscalingresultinginextremelyfineanddelicatemovementattheinstrumenttipsatarotiorangingfrom5to15:1dependingonthesetting.Thisenablesthesurgeonsmovementstobedownscaleddependingontherequiredsurgicaltask.Allphysiologicaltremorinthesurgeonshandisfilteredout.
Pneumoperitoneum:Theinsufflationofcarbondioxideintotheperitonealcavityformsthepneumo-peritoneum.Thisprovideshaemostatictamponadeallowingabettervisualizationofstructuresincludingtheneurovascularbundleunobscuredbybleeding.Thisresultsinminimalbloodloss.Theroboticdissectionoftheneurovascularbundleinanantegradefashionfrombladdernecktoapexwithlesstractiononprovidesasurgicaladvantage.Theabsolutecontrolofbleedingfromthedorsalveincomplexatroboticspermitsanastonishinglyprecisedissectionofthesphinctermusculatureattheprostaticapex.Thismakesapicaldissectionmuchmorerefine(asitecommonlyassociatedwithpositivemargins)andalsofacilitatessphinctericpreservation.
Patient benefits:Patientsreceivethebenefitsofminimallyinvasivesurgery.Thisistranslatedintoashorterhospitalstaywithlesspostoperativepainmedication.Earlymobilisationallowsforearlierreturntonormalactivities.Manyinstitutionshavereportedearlierreturntoandimprovedcontinenceratesalongwithimprovedratesofpostoperativeerectilefunctionwhilstimprovingonthepositivemarginratescomparedtotheopensurgicalratesfromthesamecentres.[5]
results:TheresultsattheGalwayClinichavebeenencouraging.Oncologicaloutcomeswithcompletecancerremovalhavebeenexcellentwithwellover90%ofmencuredwithsurgeryalone.Interoperativebloodlosshasbeenextremelylow(lessthan200mls)withnopatientrequiringabloodtransfusionfollowingsurgery.Patientscanexpecttobedischargedonthesecondpost-operativedaythusimprovingtheirrecoveryinthefamiliarenvironmentoftheirownhome.Functionaloutcomesareagainveryencouraging.Urinaryincontinenceisnowaveryrareproblemafterthistypeofsurgerybutmoreimportantlytherecoveryofurinarycontroloccursveryquicklyfollowingsurgery.Sexualfunctionispreservedincaseswhereanervesparingprocedurecanbecarriedoutallowingnormalerectilefunctionpostoperatively.
instillation:TheinstillationoftheDavincisystemrequiredaninitialinvestmentoftwomillioneurobasedonanactivitybusinesscaseoverthelifetimeofthemachine.Newtechnologydevelopmentsareexpensivefromtheoutset,likealltechnology,timewillimproverefinementandpricereduction.Theoverallhealtheconomicsofthisprocedureneedstotakeintoaccountthereducedhospitalstayalongwiththeearlyreturntonormalactivity.
SurgeonswhooperatetheDavincirobotarefellowshiptrainedintheprocedureofroboticassistedradicalprostatectomy.Structuredtrainingisessentialandhasbeenshowntotranslateintobetteroutcomes[6].Theatrenursingstaffarespeciallytrainedinthesetup,procedureanddevicemaintenanceensuringfamiliarityandshortsetuptimes.
Roboticassistedsurgeryisfuturisticandhasshownencouragingresultscomparedtomostopensurgicalseries.Initialfinancialcostsarehighbutpropertrainingalliedwithasafeandstructuredprogramsetuphasachievedimpressiveoutcomesforpatientswhochoosethismethodoftreatmentfortheirprostatecancer.references:1. BinderJ,KramerW.
Robotically-assistedlaparoscopicradicalprostatectomy.BJUInt2001;87:408–10
2. YohannesP,RotariuP,PintoP,SmithAD,leeBR.Comparisonofroboticversuslaparoscopicskills:Isthereadifferenceinthelearningcurve?Urology2002;60:39–45
3. SearleR,TewariA,ShrivastavaA,PeabodyJ,MenonM.Surgicalroboticsandlaparoscopictrainingdrills.JEndourol2004;18:63–6
4. AhleringTE,SkareckyD,leeD,ClaymanRv.Successfultransferofopensurgicalskillstoalaparoscopicenvironmentusingaroboticinterface:initialexperiencewithlaparoscopicradicalprostatectomy.JUrol2003;170:1738–41
5. A.Tewari,A.Srivasatava,M.Menon*Aprospectivecomparisonofradicalretropubicandrobot-assistedprostatectomy:experienceinoneinstitution.vattikutiUrologyInstitute,HenryFordHealthSystem,Detroit,MIand*DepartmentofUrology,CaseWesternReserveUniversitySchoolofMedicine,Cleveland,Ohio,USABJUInt2003;92:205-210
6. vickersetal EurUrol2008
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WorkSmarter,WorkTogethernuala Hannon, director Hannon oncology education ltd
Ishareavision.‘Ireland will have a system of cancer control which will reduce our cancer incidence, morbidity and mortality rates relative to other EU15 countries by 2015. Irish people will know and practice health promoting and cancer-preventing behaviours and will have increased awareness of and access to early cancer detection and screening. Ireland will have a network of equitably accessible state-of-the-art cancer treatment facilities and we will become an internationally recognised location for education and research into all aspects of cancer.’ CancerControlStrategy2006.
IntroductionIdohaveavision,andamcommittedtoachievingexcellentservicesforpatients,becauseIamanurseandthat’swhatnursesendeavourtodo.Butwedonotdoitaloneandeveryone’scontributiontoachievingthebigvisioniswelcomeandimportant.Demandsoncancerservicesarerising.The“multi-disciplinaryteam”needhelp.IseeHealthcareSalesProfessionalsaspartofthatbroaderteamandcanplayakeyroleinbringingscientificdevelopmentstothestaffthatsupportandeducatethepatients.ThisarticleaimstoshowhowHealthcareSalesProfessionalscansupportHCP’stodevelopknowledgeandindoingsofacilitatethepursuitofexcellencesoughtbyall.
NurseIhave20yearsnursingexperience,15ofwhichdealingdirectlywithcancerpatients.Now,asaneducatorIamusingmyclinicalexpertiseandknowledgetodeliverbespoketrainingandeducation.Iamfamiliarwiththechallengespatientsfacewhendiagnosedwiththisdisease.Iknowthattheservicespatientsrequirearestretchedandroutestotreatmentschallenging.Ihaveseenfirsthandthe
fear,painandangstexperiencedbyfamilies.Patientsneedaccurateclinicalinformation,deliveredsensitively,bycaringprofessionals.HCP’salsoneedaccurateclinicalinformationdeliveredbycaringprofessionals.HealthcareSalesProfessionalshaveexcellentopportunitiestobringinternationalknowledgetoHCP’swhocanthenuseittodeliverexcellenceinpatientcare.
HealthcareSalesProfessionalHealthcareSalesProfessionalshavebeencontributingtotheeducationalneedsofHCP’sforaslongasmycareerremembers.Breakfastmeetingupdates,lunch-timejournalclubs,conferencesupportandeveningmeetingswithexpertspeakershaveallcontributedtothebodyofknowledgethataimstoimprovepracticesandtreatments.
Butnothinglastsforeverandinchangingtimesnewwaysofdisseminatinginformationneedtobesmartandcreative.likenewtherapieseducationdeliverymustbeclever,targetedattherightaudienceandeffectiveinachievingresults,inotherwordsbespoke.
CreativityinhealthcareCreativityintacklingdifficulthealthcareissuesisnotanewconcept.Oneinspiringpoliticiandidsomanyyearsago.Sometimesithelpstolookbackwhenlookingtothefutureandexaminetheonceradicalideasthatarenowtakenforgranted.
Dr.NoelBrownewaselectedministerforHealthin1948andwasahighlycontroversialfigureinIrishpolitics.BorninWaterfordhisfatherwasaninspectorfortheNationalSocietyforthePreventionofCrueltytoChildrenand,partlyasaresultofthiswork,alloftheBrownefamilybecameinfectedwithtuberculosis.Bothparentsdiedofthediseaseduringthe1920s,andseveralofBrowne'ssiblingsalsosuccumbed.BrownehimselfsufferedaresurgenceofTBwhileamedicalstudentinTrinityCollegeDublin.AfterhisrecoveryheworkedinmanysanatoriainIrelandandEnglandandsoonrecognizedthattoaffectrealchange,politicswastheonlyway.AtthattimeinIrelandthiswasaradicalconcept.Afterhiselectiontopoliticsheintroducedmassfreescreeningfortuberculosissufferersand
solddepartmentassetstofinancehiscampaign.This,withtheintroductionofstreptomycin,helpeddramaticallyreducetheincidenceoftuberculosisinIreland.Dr.Browne’scontributiontohealthcarewasradicalanditisfairtosaythathepushedtheboundariesonhisquestforhealthexcellence.
CurrentsituationToday,itisanormalexpectationthatpoliticiansshapehealthcare.Whatradicalthinkingneedstobeintroducedinthiserathatwillbewrittenabout60+yearsfromnow?ScienceandresearchfirmlyformthebasisforhealthcaredecisionsandtheNationalControlProgramme2006,recognisesthathealthtechnologyassessmenthasavitalrolein;
“Ensuringthatcaretechnologies,includingdrugs,areusedinamannerappropriatetotheirabilitytomaximisehealthgainandachievevalueformoney.”
Wouldyoudareattendyourmeetingswithouttherelevantresearchpapertosupportyoursalesapproachandcosting?MustnotyourknowledgebeevidencebasedandasfluentastheHCPyouaremeeting?Thelanguageofclinicaltrials,MABs’,Anti-Egfr’s,TKI’s,geneticmutationsisnowthenativelanguageofaHealthcareSalesProfessionalinoncologyandessentialinordertocommunicateeffectively.Myprogrammesincludeallaspectsofoncologytrainingandincludetargetedtherapymanagement.
TheFutureHowcanyoutranslatescientificknowledgeintopracticetoaffectmeaningfuloutcomesforyourtherapies?Traditionalmethodsofsharinginformationremainveryvaluablebutareincreasinglyhardertoachieve.Tightercontrolsonincentives,increasedpressureonHCP’stimeandfreelyavailableinformationhaschangedtheroleoftherep.Cancerfiguresarerising.StatisticsfromtheNationalCancerRegistryarefrightening.ThereportoncancerprojectionsforIreland2015-2040showsthattheincidenceofcancerinIrelandisexpectedtodoubleby2040.
Integratingscientificknowledgeintopracticeandusingnewdrugswillrequirefibrepowerefficiency.ThisiswhereIseetheroleoftheHealthcareSalesProfessionaldevelopingnotdisappearing.
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Informationpackageswithdetailsofclinicaltrials,newtargetedtherapies,translationalcancerresearchdevelopmentsandpatientsupportprogrammeswillneedtobedeliveredtoHCP’sintheformof“speedupdates”and“hotreporting”.Usingapps,teleconferencingandinternationalconferencefeedbackmechanismswillenableHCP’stopassontheinformationtoeachotherandtopatients.OftenwhenIhavebeentreatingpatientsforwhomthefutureappearsbleak,newsofabreakthrough,howeversmallofferedgreathopetothatperson.Itisessentialthatpatientstooarehearingofadvancesinresearch.
OnenovelformoflearningtechnologyIhaveusedhasbeenproveninclinicaltrialstoincreaseknowledgeretentionbyupto170%.Randomizedtrialshaveshownthattheprinciplesofspacededucationandtestingcanimprovelong-termretention,boostlearnerengagementandmostimportantlyimprovepatientcare.Trainingisdeliveredviaquestionssenttoauser’smobiledeviceoverspacedintervals,anddoneinamannerthatpromotescompetitionandfunamongstlearners.It’salmostlikeagame!Isplayinggamestoenhancelearningaboutcancerradical?Progressive?Smart?
ConclusionCommitmenttoexcellenceinpatientservicesisacommongoalforallwhocontributetocancercare.Thechallengesforpatients,HCP’sandHealthcareSalesProfessionalsaremany.Creativeeffortsbyalltobringinternationalbestpracticetoeverypatientarecalledfor.Educationandlearningtechniquesneedtobesmart,targetedandmodern.HealthcareSalesProfessionalswanttodeliverthescientificevidencetotheircustomers,whileHCP’snaturallywanttodeliverthebestservicestheycantotheirpatients.HealthcareSalesProfessionalsandHCP’scancollaboratetogetscientificknowledgefromthebenchtothebedsidemoreeffectively.It’snotthatradical.Icanhelpyoudoit.
Worksmarter,worktogether!
connect with me on linkedin or contact me via www.hannononcologyeducation.ieifyouarepassionateaboutEducationinHealthcare,Oncology,orifyoubelievecreativityisthesolutiontomanyofourhealthcareproblems.
HealthcheckrecommendedforfreeGPcareforundersixes!By Gerard slevin, Health economist
Economicsisthesocialsciencethatstudiesthebehaviourofindividuals,householdsandorganisations,whentheymanageorusescarceresources,whichhavealternativeuses,toachievedesiredends.Weassumethatpeoplewillbehaverationally,withtheaimtomaximisetheirutilityfromthesescarcemeans.
WewouldallagreethattheidealscenariowouldbeifwehadfreehealthcareforeveryoneandcouldremoveanyfinancialbarriertoattendingtheGP,butthatsimplycan’thappenasresourcesarelimited.ThepercentageofGDPabsorbedbyhealthcareexpenditureintheOECDcountrieshasdoubledsincethe1960s.ThiscombinedwiththecurrenteconomicclimatewherethehealthserviceexecutiveisbehindbudgetsuggeststhatiftheGovernmentiswillingtopayfortheseservicesthentheseprovisionsarecomingfromsomeotherareaofthesystem.Thismayalsoindicatethatothervulnerablepatientsmaybeaffectedandputinaqueuebehindthosewhoarehealthyandcanaffordtopay.ItwouldseemunethicaltoselectchildrenofhighearnersforfreeGPcareoverpatientswithchronicdiseases,lowerincomeandthosewhoareconsideredvulnerable.Basingmedicalcardsondateofbirthratherthanincomeseemstobeastrangeselectioncriterion.
Fromacostperspectiveitishardtounderstandwhyonewouldreducechildbenefitinrecentyearsforthosewhoareinneedandredistributesomeofthatincometothosewhoarenotinneed.Underthecurrentsystemthisagecohortalreadyreceivesfreevaccinationswhichareasignificanthealthbenefit.Whatarethespecifichealthtargetsbehindthecurrentproposalandhowwilltheybemeasured?Rememberthereisanopportunitycostinvolvedinsuchadecision-willthetangiblehealthbenefitsofthisdecisionoutweighthebenefitsifthemoneywasspentelsewhere?
IfrecentreportsaretruethenGeneralPracticeinIrelandisatbreakingpointwithmanystrugglingandsomeonthevergeofinsolvency.ManypeopleforgetthatGPsarebusinessowners,justlikeyourlocalsupermarket.Theyhavealltheregularbillsofanybusinessowneraswellasbeingresponsibleforemployingappropriatemedicalandadministrativestafftoprovideanacceptableservicetopatients.Thetwomainfactorsinrunninganybusinessareincomeandcosts.Inanyprivatebusinessifthemarginalcostexceedsmarginalrevenueinproducingoneextraunitofagoodorservicethenthebusinessisdestinedforfailure.
Itisestimatedthat240,000childrenacrossthecountrywillbenefitfromtheproposedchangeinpublichealthpolicy.TheGovernmentwillprovideadditionalfundingof€37milliontomeetthecost.Recently,theIrishMedicalOrganisationhasstatedthatvisitswillincreasebyapproximately16%.Ineconomicsthereisaconceptcalledmoralhazardwhichsuggeststhatpeoplewillincreasetheuseofaservicewhentheydonothavetoexperiencethefullconsequencesandresponsibilitiesoftheiractions.Inessence,therewillbemoreGPvisitswhenpeoplearegettingtheserviceforfree.
Potentiallyfourmajorproblemslieahead.Itseemsthatthereislittleornosparecapacityingeneralpracticeascurrentlystructured.MoreGPvisitswillrequiremoreinvestmentinresourceswhichwillincuradditionalcostsonthecurrentstressedsystem.Fromthedistributedfigures,calculationswouldindicatethatthemarginalcostwillexceedthemarginalrevenueforGPsandthosewithgoodbusinessacumenwillbackawayfromsuchadeal.TointegratechangeinanyorganisationtheremustbeacommonconsensusfromallpartiesinvolvedanditseemsthattheGPshaveyettobuyintotheproposedchanges.SamedayaccessmaybecomeacommodityofthepastasGPsmaynotbeabletofacilitateeveryoneinneed.Finally,theGovernmentmayrealisethatwhenthecostbenefitanalysisiscompleteddownthelinegreaterhealthoutcomesmayberealisedelsewhere.
IftheGovernmentistogettheallclearforthisproposalfurtherinvestigationsarerecommended.
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NosweetnessinrisingcostsofDiabetesBy Gerard slevin, Health economist
Diabetesisachronicdiseasethatoccurswhenthepancreasdoesnotproduceenoughinsulin,orwhenthebodycannoteffectivelyusetheinsulinitproduces.Itconsistsofbothtype1(apersonwhoisinsulindependent)andtype2(apersonwhodoesnothaveenoughinsulinortheinsulinisnotworkingproperly)isapublic-healthissueofsignificantepidemiologicalandeconomicimportancebecauseofitschronicnature,highandrapidlyincreasingprevalence,seriouscomplicationsandtheneedforpatientstoreceivelong-termcare.Type2accountsforaround90%ofalldiabetesworldwide.Thecausesarecomplexbuttherapidincreaseinobesityandlackofphysicalactivityhasamajorroletoplay.
Globallytheincidenceofdiabetesislikelytoexceed250millionpeopleby2025.Irelandisplayingitspartinthisfigureand
astheincidenceofdiabetesincreases(approximately200,000peoplehavethediseaseinIrelandatpresent)thediseaseistakinganeverincreasingfractionoftheGovernment’sbudget.Peoplewhodonothaveacloseassociationwiththediseasemaynotbeawareofthevastcostsassociatedwithsuchachronicillness.Itisacommonmisconceptionthatprescriptionmedicationscontributetothemajorityofthecosts.Therealityisthattheyaccountforlessthan50%ofthetotalcost.Tocalculatethetotalcostofachronicillnessweneedtolookatitfromasocietalperspective.Thecostsaremadeupofdirectcosts(medication,hospitalisationanddeliveryofclinicalservicesandareusuallybornebypublicorprivatehealthsystems),indirectcosts(thevalueofchangesinproductivityintheworkforceorthevalueofnon-worktimethatisvaluedbyindividualsandemployers)andintangiblecosts(qualityoflifebeingaffectedbecauseofpain,suffering,anxietyandstress).Societyattimesdoesnotaccountforthemanydaysmissedfromwork,thelackofsleepduetopainorthestressoforganisingtransporttoaspecialist.Thecostsdon’tstopthereasdiabetesisassociatedwithmanycomplicationssuchasulcersandfootinfections.Itisalsoaleadingcauseofblindness,amputationsandkidneyfunctionissues.Thisiscompoundedbythediseasehavingmanyothersecondarycomplications(cardiovascular,neurologicalandrenalissuesaresuchexamples)whichallbringhighcostsandputmorestrainonlimitedresources.
Toaddresssuchcosts,whicharespirallingoutofcontrol,ourGovernmentneedsshort,mediumandlongtermstrategiesinplace.Anationalscreeningprogramme,apromotionalcampaignhighlightingthebenefitsofregularcheckupswithyourlocalGPandagreateremphasisoneducationaboutthediseasewouldhelpenormously.Therearethousandsofpeoplewhohaveyettobediagnosedandasaresulttheircomplicationsaregettingworse.Ourschoolsneedmorehelpanddirectioninhighlightingtheriskfactorsandsymptomswhilepresentingtheadvantagesofbothagooddietandregularexercise.RecentlyitwasproposedthatPhysicalEducationshouldbecomeanexamsubject.Ifitdoescometofruitionthenitmaybeanidealstagetohighlightthedetrimentaleffectsofallchronicdiseasesfrombothamicroandmacroperspective.
Asbudgetstightenfurtheranddemandforservicescontinuetogrowcollectiveresponsibility,fromeachindividualandpolicymakers,isrequiredtoaddresscostcontainmentofthischronicillness.Ifwecontinuetoignorethisresponsibilitytherewillbeserioussocialrepercussionsinthemediumandlongerterm.Inrecentyearswehaveallunfortunatelybecomeonlytooawareofthescarceresourceswhichexistwithinthehealthsystemandituptoeachandeverycitizentoactrationallytomaximisetheoutcomesthatcanbeachievedfromsuchresources.Noamountofsugarcoatingcandisguisethisfact.
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