AnnuAl newsletter of the MrII€¦ · meetings resume in the autumn. full details will be available...

• TheMedicalTechnologyIndustry-EmbracingtheChange

• ThePharmaceuticalIndustry-BringingHealthandEconomicGrowthtoIreland

• BreakingtheProcrastinationHabit

• MeetaMember

• RoboticAssistedRadicalProstatectomy

•WorkSmarter,WorkTogether

• HealthCheckRecommendedforFreeGPCareforUnderSixes!

• NoSweetnessinRisingCostsofDiabetes

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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: info@mrii.ie or 058 43955

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tel 058 43955 | e-mail info@mrii.ie | www.mrii.ie

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 meetings@mrii.ie

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 meetings@mrii.ie

• 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)

www.mrii.ie4

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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

www.mrii.ie 7

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L I F E S C I E N C E S

Contact dolores@designid.ie or john@designid.ie | 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.

www.mrii.ie10

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Sponsors&ExhibitorsNationalConference2014

AnnShanahan,KillarneyConventionCentreMickO’leary,AshfieldwithSeanMoynihan(Phoenixlabs)

OrlaByrne,PowerscourtHotel CiaraSexton,CastleknockHotel

ClaireMyler,RiverleeHotel MarionWard,CiaraShovlin,WardsCornerstore

www.mrii.ie 11

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L I F E S C I E N C E S

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

Amanwithoutagoalislikeashipwithoutarudder

ThomasCarlyle.

Yourinfluencelikeyourshadowextendstowhereyou

mayneverbe.

Youwillneverpersuadeanyonetobuyanythingunlessyouknowexactlywhatitis

youareselling.

MeetaMembereddie o’callaghan

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““

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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 87800info@thecliffhousehotel.comwww.thecliffhousehotel.com

lindaMcMahon,MRIIPresident,MrTedQueally,TevaPharmaceuticals

lindaMcMahon,MRIIPresident2013-15,MrFrancislynch,PresidentoftheIrishPharmaceuticalHealthcareAssociation(IPHA)

SomeofourexhibitorswhojoinedusfortheGalaDinner2014

PádraicÓMáille,NationalConferenceSpeaker2014

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NationalConference2014

KathrynandAliceCarney

MariaDelaney,EddieandSusanO'Callaghan,lizGardiner

GrainneBrennan,MRIIwhosuccessfullycompletedtheMRIIExamination2014’

Pre-GalaDinner2014

Pre-GalaDinner2014

JoeDuane-GalwayNaturalHealthCo,PádraicÓMáille,AndreaGaffneyandlindaMcMahon-MRII

EndaDarcy-MSD,MrPeterMurchan,ConsultantSurgeon

leonalau,Pfizer,lindaMcMahon,MRII,JohnWoods,Eurosurgical

JoanandJohnMoloughney

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DoyouholdtheMMRIIqualification?MRIIlapelPinsavailableon

requesttoMRIIFullMembers-emailinfo@mrii.ieto

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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

mriiambassador

Wearefortunatetonowhaveateamof30dedicatedAmbassadorsinplace.ThisrolehasquicklybeenestablishedasprestigiousleadershipinvolvementwiththeMRII.

OurobjectiveistohavefullMRIImembershipfromallHealthcareSalesProfessionalsincustomerfacingrolesandtohaveaclearcommunicationchannelbetweentheMRIIandallcompanies.Isyourcompanyrepresented?Ifnot,interestedparties(youmustbeacurrentFullmemberoftheMRII)shouldemailinfo@mrii.ieforfurtherdetails.

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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PaulByrneAnitaSherlock

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ashfield Healthcare MickO’leary mick.oleary@ashfieldhealthcare.com www.ashfieldhealthcare.ie

castleknock Hotel CiaraSextonGaelCookeAllen

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Hotel solutions MichelleThorntonCiaraHalpin

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Killarney convention centre

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Pmi ShaneFitzgerald info@thepmi.com www.thepmi.com

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river lee Hotel ClaireMyler claire_myler@doylecollection.com www.riverleehotelcork.com

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