Medical Independent 13th January 2026

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The Mater’s push to raise standards An external review shows the challenges in improving quality and safety in a large tertiary hospital.

Paul Mulholland reports

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4-6

Consultant-led innovation Engagement with the consultant innovation fund is continuing to grow.

David Lynch reports

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When appearances deceive On a train to Edinburgh, a tense seat dispute taught George Winter not to judge strangers too quickly

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20

NEWS 1-12 ● CONFERENCES 14-16 & 29-30 ● OPINION 17-20 ● CLINICAL 23-28 ● MCQs 28 ● LIFE DIARY 32 ● QUIZZES 33 ● MOTORING 34-35 ●

Medical Council requested sight of C&AG audit cert CATHERINE REILLY

The Medical Council sought prior sight of its audit certificate from the Office of the Comptroller and Auditor General (C&AG). The certificate referenced a significant breach of public procurement policy.

On 10 June 2025, the Council’s audit and risk committee (ARC) heard that the 2024 fi nancial statements had been cleared by the C&AG’s audit team for signoff. According to ARC meeting minutes, the C&AG’s Office had indicated it was likely the audit certificate would reference issues associated with the Council’s procurement of services from Ms Yvonne Clancy/

Empowering Leadership Ltd. The committee “deemed it not unreasonable” that the Council be given advance notice of the proposed wording and “requested the executive to engage with the Office of the C&AG” in that regard. The committee noted that this issue could give rise to media coverage, stated the minutes released under Freedom of Information law.

A spokesperson for the Office of the C&AG confi rmed that the Medical Council had requested sight of the audit certificate in advance. The wording (as appears in the published audit certificate) was provided.

The C&AG’s report to the Oireachtas, dated 27 June 2025, noted:

“The statement on internal control discloses that in 2024 the Medical Council incurred significant expenditure where the procedures followed did not comply with public procurement guidelines.”

According to the Council’s financial statements, it identified “procedural control weaknesses” in relation to the engagement (initial appointment and subsequent extensions) of consultancy services from Ms Clancy through her company Empowering Leadership.

In 2022, Ms Clancy was engaged for a period of six months under a “sole source justification”. Initially, this was for human resources consultancy for “urgent operational needs”. She also supported an or-

ganisational design project. Due to “urgent and evolving” business needs, the engagement was extended into 2023 and 2024.

A formal tendering process, or other appropriate procurement process, was not utilised in accordance with procurement legislation and with the Council’s procurement policies and procedures. The Council’s non-compliant extension of the services resulted from a “series of unforeseen circumstances, ongoing organisational changes, and urgent resource needs”.

In 2024, following an internal recruitment competition for an interim CEO, Ms Clancy was selected as the preferred candidate. She held this position from 20 September to 6 December 2024. Ms Clancy was paid on an invoice basis and charged “under business consultancy under a contract for

GALLERY 36&37 ● CLASSIFIEDS 39

service”. The payment included VAT at 23 per cent.

The cost of the interim CEO’s salary from 20 September to 6 December 2024 was €49,077.

During this time, Ms Clancy received no additional payment over and above the previous rate for her services, a Medical Council spokesperson told the Medical Independent. Ms Clancy ceased working with the Council at the end of 2024.

The total amounts paid to Empowering Leadership were €45,756, €240,650, and €268,171 for 2022, 2023, and 2024, respectively. There is no suggestion that Ms Clancy had any role in decisions around the procurement of her services.

The Council has revised its procurement policies to ensure “alignment with public procurement requirements”, according to its financial statements.

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News

Full implementation of consultant contract ‘patchy’, meeting hears DAVID LYNCH

The full implementation of the public-only consultant contract (POCC) to allow for “increased patient contact hours” is “patchy”, heard a joint Department of Health/ HSE meeting.

Minutes of the 23 September meeting of the Sláintecare programme board noted that the growth in consultant numbers combined with the introduction of the POCC was “enabling hospitals to deliver key services such as outpatient appointments” over six days a week.

However, “the full potential of this contract is yet to be realised.”

Members welcomed “successful implementation” of

Rise in consultants engaging with innovation fund

the POCC in some sites in terms of increased patient contact hours. However, the minutes noted that the level of implementation “across the board is patchy, which points to significant potential for improvements”.

The board was established in 2021 to drive the principles of Sláintecare reform throughout the health and social care service. It is co-chaired by the Secretary-General

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DAVID LYNCH

Engagement with the consultant innovation fund (CIF) has grown over the last two years, with 2026 expected to see a further increase, this newspaper understands.

The CIF was formally launched for applications in early 2024. In its fi rst operational year, 463 consultants engaged with the fund through individual or pooled applications, according to figures provided to the Medical Independent (MI).

“Engagement continued to grow in 2025,” a HSE spokesperson told MI. The CIF was established under the public-only consultant contract to “empower” consultants to lead innovation and research projects that directly enhance patient care, service delivery, clinical pathways, and outcomes.

According to HSE figures, in 2024, €4.7 million in project funding was approved. Th is increased to €6.18 million in 2025, a 31 per cent increase aligned with the growth in applications and the wider distribution of funding across consultant groups.

The number of consultants engaged with the CIF rose significantly in 2025, with 769 involved, representing a 66 per cent increase in participation year-on-year.

Based on the trajectory of the first two years, with increasing consultant awareness, strengthened governance processes, and expanded pre-submission supports, further increases in engagement are anticipated in 2026.

Engagement has broadened both geographically and across specialities. While Dublin hospitals continue to account for the largest proportion of applications, “participation grew markedly” in Cork, Galway, and Sligo.

“Growth across anaesthesiology, pathology and laboratory medicine, and paediatrics and neonatology reflect specialities with strong innovation momentum,” according to the spokesperson.

“The CIF is unlike any other innovation fund internationally, giving consultants a direct pathway to develop and implement ideas that transform patient care,” Dr Clíodhna McHugh (PhD), Innovation Specialist, Lead on the CIF, told MI. “The projects we are seeing across Ireland show the extraordinary creativity and leadership of consultants in every specialty.” See news feature, p10.

of the Department and the CEO of the HSE, and reports to the Minister for Health. It also comprises other senior members of the Department and the HSE. Asked about the “patchy” implementation across hospital sites, a HSE spokesperson told the Medical Independent that “hospital specific” data would need to be sought from the health regions. However, the spokesperson confi rmed that the national uptake of the POCC continued to rise.

As of November 2025, some 2,182 consultants had changed to the POCC, while 1,079 new entrants held the POCC. Th is provided a total of 3,261, which is over twothirds of consultants working in the public health service.

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News Feature PAUL MULHOLLAND paul@mindo.ie

Inside the Mater’s push to raise standards of care Documentation obtained through Freedom of Information law shows the challenges in improving quality and patient safety in a large tertiary hospital. Paul Mulholland reports

Q

uality and patient safety (QPS) has become an increasingly prominent issue in healthcare in recent years.

While expectations around standards of care continue to grow, efforts to strengthen quality and safety are often constrained by staffing pressures, capacity limits, and financial challenges across health systems.

In Ireland, many voluntary hospitals have reported significant recurring deficits, underlining the difficulty of delivering sustained improvement in this context.

An external review obtained by the Medical Independent (MI) under Freedom of Information law provides insight into how these pressures have shaped the Mater Misericordiae University Hospital’s (MMUH) approach to QPS, and the challenges involved in translating ambition into practice.

An executive QPS committee was established several years ago to strengthen oversight and deliver improvements in this area.

The development of a comprehensive QPS programme for the hospital was one of the 15 objectives listed in MMUH’s Strategic Plan 2022–2025. As part of achieving this aim, MMUH commissioned an independent review of its QPS governance in 2023.

A spokesperson for the hospital told MI the review was procured to ensure compliance with good governance practices.

The spokesperson said one motivating factor for the focus on QPS was the Covid-19 pandemic.

“In the period following the Covid-19 pandemic the delivery of healthcare underwent significant change,” according to the spokesperson. “In response, the Mater Hospital decided to pause and carefully assess how these changes impacted its approach to quality and patient safety.”

The review, which was carried out by Deloitte, was intended to help understand how the hospital managed QPS issues and identify any potential structural gaps that may have emerged during “this challenging period”.

The review commenced in July 2023 and concluded in mid-2024, with its findings subsequently considered by hospital management and the board.

Structure and governance The review examined the hospital’s governance structures for the area. It noted the QPS committee had already been established to provide assurance to the MMUH board that the hospital delivered high standards of care and maintained appropriate governance structures and controls.

At an executive level, the hospital also had a QPS directorate, represented by the Director of Quality Assurance and Organisational Design.

Credit: istock.com/Natali_Mis

The review found it maintained regular communication with key executive groups, including the medical executive, the serious incident management team (SIMT), and the clinical directorate leads forum through the Clinical Lead for QPS. According to the report, the executive quality and patient safety steering group (EQPS), chaired by the CEO and comprising senior leaders such as the Chief Operations Officer, Director of Nursing, Executive Clinical Director, and the Clinical Director for QPS, played a central role in supporting the CEO in securing assurance on the effectiveness of the QPS model.

The SIMT fulfilled a critical clinical function within this framework, it stated.

Ten multidisciplinary QPS sub-committees reported to the EQPS steering group and appeared to be “well balanced” in their composition.

However, the report noted that there was “variance in the efficiency and effectiveness of meetings” held by the sub-committees.

They were “often largely dependent on the experience and connections of the Chair to drive the quality of the conver-

sation and action-orientated output, and the availability of administrative support to circulate pre-reading materials, record and circulate minutes and follow up on actions”.

There was a “varied and inconsistent” approach to reviewing and signing off on policies and procedures within committees.

“Meetings may divert from the pre-defined agenda, run over time or be cancelled at short notice on occasion,” according to the review.

“Committees are not subject to review, either self-review or by an independent reviewer.”

It noted MMUH had no active patient representative on any QPS-orientated committee given the sensitive nature of the discussions during these meetings.

“The Mater may consider periodically inviting a patient representative to speak about a particular experience or event and test the acceptability of their current approach in the future,” stated the review.

“This individual would not be [a] formal recurring member. This will be considered as part of the design of the future model and new ways of working."

There is no clear evidence of a recurring cycle of QPS operational planning being undertaken

Reactive A key finding of the review was the “reactive nature” of the hospital’s QPS directorate. “[F]orward planning and strategy development does not appear to receive the level of prioritisation that QPS directorate representatives might wish to take place,” according to the review. “There is no clear evidence of a recurring cycle of QPS operational planning being undertaken.”

The review found it was acknowledged that a commitment to this type of activity was beyond the capacity of the existing team given the breadth of its current remit.

“This represents a constraint to delivering on the strategic ambition for the QPS directorate as outlined in the strategic plan.”

The review also found that the approach to QPS-specific strategy development and service planning was “varied across clinical directorates”.

At the time the consultation process was undertaken by Deloitte, no clinical directorate had a designated representative to support the planning and delivery of QPS commitments and responsibilities or to explicitly assist with the design and development of improvement strategies and initiatives.

Capacity and skillset According to Deloitte, the core QPS team at MMUH was widely respected for its organisational knowledge and specialist expertise across all areas of quality and patient safety.

The Clinical Lead for QPS, the QPS Manager, and the Risk Manager sat on most QPS-related committees.

“This investment of time and resources provides a strong asset to the organisation from a QPS viewpoint.”

However, the review found the level of involvement placed significant pressure on these roles, which needed to be balanced with their day-to-day responsibilities.

The review highlighted several capacity gaps.

There was no dedicated analytics support to interpret the substantial volume of QPS data or to provide meaningful, data-driven insights for reports to the board, executive steering group, or sub-committees.

The QPS team also lacked technical support for configuring Datix – the hospital’s recently acquired incident reporting and risk management system.

MMUH’s current systems and business intelligence capability were often cited as a “source of frustration” among staff during the review process.

Deloitte found the procurement of and roll-out of Datix offered the basis to significantly overhaul and expand the business intelligence capability of the QPS function.

This could also have a positive impact on associated workflows and business processes, across QPS specifics such as risk management, incident management, complaints and claims, for example.

“The approach by the QPS directorate to designing and delivering custom modules is recognised as a significant undertaking,” according to the review.

“The overall pace of Datix implementation and the change management approach to support implementation was noted as a concern by senior leaders. A dedicated re-

THE MEDICAL INDEPENDENT | 13 JANUARY 2026

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Feature News

source is required as a matter of urgency to support the implementation of the tool and increase its utilisation to derive the full value on offer for the hospital.”

When the review was conducted, the time commitment associated with individual training – which often took the form of one-on-one sessions in areas such as risk management and the appropriate use of a risk register – was high.

Also, patient liaison services operated largely in a reactive mode, focused primarily on managing complaints.

In addition, the QPS directorate did not have the capacity to drive a sustained quality improvement agenda, nor the tools or methodologies needed to build quality improvement (QI) capability across the workforce.

The directorate functioned with ‘lean’ resources, relying heavily on team members to cover for colleagues during leave or absence.

Succession planning was limited or absent, and key positions – such as the clinical director – lacked formal processes for handover or shadowing.

“This presents risk to the Mater and may be damaging to staff retention, continuity and knowledge retention, and development objectives,” according to the review.

Responsibilities and accountability Deloitte found that key roles and responsibilities within the QPS directorate were clearly defined.

However, the day-to-day operational demands and the reactive nature of the directorate meant that some responsibilities were deprioritised.

The review stated the directorate took a “hands-on” approach to service delivery.

For example, the Risk Manager and QPS Manager were heavily involved in one-toone training, provided early guidance on incident responses, and managed update reports for the EQPS and the board.

While thorough, this approach was time-intensive and, according to the report, may not be the most efficient use of senior QPS leadership time.

Each QPS sub-committee had terms of reference outlining its purpose, membership, chair, and reporting lines.

Although the review stated some duplication existed, this was not thought to be pervasive or problematic.

However, there was a lack of complete clarity among senior leadership regarding the specific function of the board’s QPS committee, which Deloitte said needed to be addressed.

Clinical Directorate Leads met bimonthly at a dedicated operations meeting, but due to the variable agendas, QPS matters were not consistently discussed.

These leads also met separately with the CEO to review key issues, risks, and priorities within their directorates.

“However, it was noted that this siloed arrangement does not allow for the cross-pollination of ideas or co-creation of solutions to common issues experienced amongst directorates,” according to the review.

“It is acknowledged, however, that the EQPS steering group does provide a focus on a pan-hospital viewpoint.”

Another observation from the consul-

tation process was the inconsistent approach taken by the clinical directorates in relation to QPS activities.

“Clinical directorates would benefit from enhanced structure and standardisation regarding QPS responsibilities.”

Processes The creation of QPS policies generally fell within the remit of the QPS directorate.

However, once developed, policies were not always consistently distributed, and their interpretation could vary across services. At a hospital level, the use of Q-Pulse – the hospital’s electronic system for managing policies, procedures, and compliance documentation – was inconsistent. It was unclear whether a standardised review cycle existed or was adhered to, the review found.

Approaches to risk management also varied across specialties, departments, and clinical directorates, highlighting the need for a more standardised process across the hospital.

Each risk register was at a different stage of maturity, with some long-established and others more recent. The risk

clinical audit effectiveness committee for consideration and/or approval.

“The approach to clinical audit should follow the seven stages of clinical audit whenever possible/appropriate,” according to the review.

Deloitte found that the “initial positioning” and subsequent escalation of QPS issues and concerns were “not sufficiently clear”.

“Staff most often directly escalate risks in the first instance to one of a number of potential points – for example, directly with the QPS directorate or the Nursing Quality and Patient Safety Lead. This practice is indicative of a system that is not sufficiently mature across directorates.”

Pan-hospital relationships Deloitte said that “significant potential exists to further leverage and ‘formalise’ forms of collaboration with other MMUH structures and teams relevant to the QPS agenda”.

The hospital’s Transformation Office was commonly cited as a strategic asset and a driver of transformational change within the hospital.

Stakeholders spoke with pride regarding the high-quality clinical care provided to patients

manager provided hands-on oversight, monitoring the registers closely and frequently challenging or reassigning risk ratings where appropriate.

Education and training on the fundamentals of risk reporting were being delivered alongside the Datix implementation, in the form of one-to-one, hour-long sessions for each Operations Manager within their clinical directorate or department. While thorough, the report stated this reliance on individual sessions was neither a sustainable way to meet internal requirements nor an efficient use of senior QPS expertise.

In the consultation process, “[a]n element of frustration was raised regarding the lack of communications to ‘close the loop’ following a SIMT review.”

“Equally, the inconsistent manner to which recommendations and remedial measures are implemented post-review represents a potential area of focus within a future updated QPS model for MMUH,” according to Deloitte.

“Additional rigour is required to ensure the recommendations and review findings are widely communicated and that the accompanying implementation plan is executed in full per agreed timeframes.”

Further work was also required to formalise the various forms of clinical audit which were underway across the hospital, and for all proposals to come before the

“It would be beneficial to both parties, the QPS directorate and the Office, to consider future ways of working to optimise future involvement and shared ways of working,” according to the review.

Given their shared purpose, Deloitte recommended that the nursing quality and patient safety team and the QPS directorate should explore opportunities to collaborate more strategically and deliver shared objectives in a planned manner.

It said all QPS-focused fora should adopt a more structured approach to communication, guided by principles of closedloop communication, and carefully consider the methods used to engage staff to ensure messages are clearly and effectively conveyed.

Development and training Individual directorates and services had established their own curricula and induction materials covering elements of QPS to support patient safety education. For example, the pharmacy and medication optimisation (PAMO) directorate had developed specialised training on viral vector handling for all staff within PAMO. While such local initiatives were valuable, according to the review, it was important as the hospital grows that the QPS

Continued on p6 

MINDO NUMBERS

677

people were hospitalised with respiratory illness at the end of 2025 (30 December), according to the HSE.

2,321

new respiratory illness cases were notified in the last week of the year.

140,000

patients are expected to be seen at the additional GP clinics during the winter period.

125,000

individuals have registered to use the HSE Health App, according to the Department of Health.

210,000 downloads of the App have occurred since its launch last year.

29,900

people engaged with the Irish Cancer Society’s ‘Your Health Matters’ roadshow in 2025, up from 27,300 the previous year.

2,236

health consultations took place at the roadshows.

THE MEDICAL INDEPENDENT | 13 JANUARY 2026

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News Feature



Continued from p5

directorate is actively involved in these developments to ensure consistency in QPS standards across the organisation.

At the time of the review, the use of the new learning management system (LMS) ‘Mater Learn’ was limited in terms of QPS. However, the system did “present significant potential to support and promote access to QPS learning”.

“Opportunities to expand beyond compulsory modules should be explored and planned for in the future.”

It was noted that the LMS was not sufficient nor appropriate for the end-to-end delivery of all training and some QPS programmes would always be supplemented with toolkits and methodologies and other supports.

“Resource considerations around this will need to be appropriately factored into the future design of the QPS directorate,” according to the review.

Overall, QPS education was managed within the newly established learning & development (L&D) function.

While the QPS Manager and Risk Manager collaborated with the L&D team to develop QPS module content, competing day-to-day operational demands meant this work was not always prioritised.

“Training in terms of quality improvement methodologies and toolkits requires planning and delivery if the ambition to enhance a hospital-wide focus on QI is to be realised,” according to the review.

Culture Deloitte said the importance of quality and a strong patient safety culture was evident from all consultations conducted during the review process.

“Stakeholders spoke with pride regarding the high-quality clinical care provided to patients,” it stated.

While the review process did not entail a specific culture audit, discussions conducted consistently gave a strong sense of the values and practices that support the positioning of and commitment to high quality and safe care.

The review found “quality and [the] patient experience” were centrally positioned in terms of the stated strategic priorities of the hospital.

“However, the patient’s voice is notably absent at committee level within the hospital and there is no evidence of engagement with a patient council or equivalent in the design and development of services or programmes within the organisation,” according to the review.

“This is an input to the QPS agenda that remains significantly underdeveloped relative to local and international peers.”

Deloitte recommended that consideration should be given to the best approach to capturing the patient’s voice and how this can be disseminated throughout the system and be reflected in the operation of MMUH. The commitment of the hospital to establish people, culture and organisational development programmes was also acknowledged.

“It will be important that QPS is appro-

Mater Misericordiae University Hospital priately represented within these and that future initiatives are constructed with targeted QPS gains at the core.”

Recommendations The review was completed in 2024. The final report outlined 48 recommendations centred around: Structures and processes; resourcing; education and training; and clinical governance.

Some nine of these were deemed ‘high priority’. These included the need to ensure “that the future design of the QPS directorate considers all aspects of the existing role and remit with the objective to reassign responsibilities (and the associated resources) if such are not deemed core to the QPS objectives of the Mater”.

Another high priority recommendation was that the future QPS model at MMUH should consider incorporating additional capacity to the directorate, such as a dedicated lead for QPS improvement, and additional “time-capped” support to accelerate the implementation of Datix.

The introduction of a standard approach across clinical directorates to ensure that QPS “is suitably prioritised” was another issue of high priority, as was revising clinical audit procedures.

The review also said work was required to drive a more standardised approach to risk management procedures/processes across the hospital ecosystem.

In addition to other high priority recommendations, the review recommended the development of an overall QPS strategy.

Board discussion QPS and the Deloitte review were regularly discussed by the hospital’s board. In addition to the external review, MMUH’s internal audit committee was undertaking work in the area, which was also discussed.

At its meeting in July 2024, it was confirmed that the Deloitte review would be presented and summarised to the board in September.

MMUH CEO Ms Josephine Ryan Leacy told board members that two WTEs had been appointed to assist with the project.

The then Chair Mr David Begg said that “this has to be progressed as much as possible”.

Non-Executive Director Ms Anne Vaughan confirmed that MMUH “wants to be a leader in QPS”.

“It was noted that it is a challenge with current resources, but putting two positions in place is important,” according to the minutes.

“The board noted that the senior responsible officer has to be identified to drive the priority recommendations.”

Ms Vaughan said that MMUH was expanding “at a significant rate” and “given the level of services and the increase in the patient cohort there are significant challenges”.

As a result of growing levels of activity, Executive Clinical Director Prof Jim Egan said that MMUH had “ongoing challenges with surges”.

In September 2024, Director of Quality Assurance and Organisational Design Ms Suzanne Dempsey provided an update on the Deloitte report.

“There were a number of recommendations which are now being assessed in terms of available resources,” according to the minutes.

The board noted that this was an important strategic investment that MMUH has to resource given how important it is for patient care.

“It was noted that the board wants to see momentum and progress in this area.”

At the December 2024 meeting, Ms Ryan Leacy and Ms Dempsey agreed to “drive and progress” the recommendations from the external QPS review, as well as those contained in a relevant internal audit report.

Director of Finance Ms Brid Cosgrove explained that assurance mapping was “a very important exercise so that the board understands what the risks are and where they are coming from”.

The new “comprehensive” QPS strategy was discussed. Ms Dempsey sought approval for the document.

“The board confirmed that the strategy is approved subject to the understanding that no additional resources are available… noting that MMUH has to use the resources available to drive this strategy forward,” according to the minutes.

Implementation A spokesperson for the hospital confirmed to MI the QPS strategy was completed and launched in 2024.

“It outlines the hospital’s vision and ambition for the next five years, with the goal of becoming a global leader in patient safety,” according to the spokesperson.

Since the strategy was developed, the spokesperson said that progress has been made across several areas in implementing the Deloitte report’s recommendations.

Two roles, an Operational Manager and a Quality Improvement Lead within the QPS directorate, were recommended in the review. However, due to restrictions on recruitment in the HSE’s Pay and Numbers Strategy, no funding was available to fill these roles, MI was told.

“In response, an Executive Lead was reassigned to support the QPS directorate, reflecting the hospital’s renewed focus on enhancing quality and patient safety,” according to the spokesperson.

The QPS directorate is led by a consultant clinician whose role is split evenly between clinical practice and QPS leadership (0.5 WTEs each).

“This represents an increase from the previous allocation of 0.25 WTE to the QPS Clinical Director role and aligns with the resourcing model used for other clinical director roles within the hospital,” said the spokesperson.

Of the recommendations identified as high priority, three have been completed and a further three are currently in progress.

Completed recommendations include the introduction of a standardised approach across clinical directorates to ensure that QPS is suitably prioritised within existing leadership discussions; enhancements to board-level QPS committee oversight; and the universal use of a centralised repository for QPS documentation to streamline policy deployment, governance, review and sign-off processes.

A new performance meeting, chaired by the CEO and involving each hospital directorate, has also been established to strengthen clinical accountability for QPS. This forum focuses on quality metrics, risk management, clinical audit, and shared learning from incidents.

In addition, funding has been secured to connect HSeLanD – the Executive’s online learning and development platform – with MMUH’s own system to enable improved reporting and oversight of completed staff education programmes.

The QPS directorate has also been building links with the HSE Dublin and North East Health Region, holding a series of meetings with quality and patient safety leads for the region.

“The Mater Hospital continually strives to improve its services to patients and work to implement the remaining QPS recommendations is ongoing, through established governance and management structures,” according to the spokesperson.

The spokesperson also pointed out a quality and patient safety showcase is currently being planned for April 2026.

THE MEDICAL INDEPENDENT | 13 JANUARY 2026

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News

‘Financial stress’ on GEM students highlighted in Council report CATHERINE REILLY

The absence of graduate-entry medicine (GEM) bank loans has “created financial stress” for students, a Medical Council report has stated.

In March 2025, a Medical Council accreditation team visited University of Limerick’s (UL) GEM programme as part of the re-accreditation process. The Council’s report noted that the programme’s “appeal” had diminished following the withdrawal of a Bank of Ireland loan, resulting in a 30 per cent decrease in Irish student applications. The absence of loans had “created financial stress for students” with some having to “work fulltime while completing their studies”.

GEM programmes are offered by four medical schools in the Republic of Ireland. The Irish/EU tuition fees start at approximately €15,000 per annum. The Bank of Ireland product, which was the last remaining GEM-specific loan, was closed to new applicants in 2022.

Prof Colum Dunne, Head of School, Foundation Chair and Director of Research, UL School of Medicine, confirmed the UL programme had experienced a reduction in numbers applying through the CAO.

Image: iStock.com/Davizro

“That reduction was approximately in line with the figure mentioned [in the Council report]. Notably, in the most recent CAO numbers, applications to the UL GEM programme increased, which may represent a reversal of that trend,” he told the Medical Independent.

He stated the lack of a loan mechanism “may result in the inability of potential medical students to attend university”

and pursue a career in medicine. This “may also translate into a reduced number of graduates” joining the Irish healthcare system.

“There is also a potential narrowing of the demographic of medical students, with a potential advantage for those students who can access funding through means other than bank loans.”

The Irish Medical Schools Council has

Vacant chief ethics position set to be filled this year DAVID LYNCH

The Department of Health plans to fill the position of Chief Health Ethics Officer this year. The position was formerly titled as Chief Bioethics Officer (CBO).

A Department spokesperson told the Medical Independent (MI) that health ethics “is a complex interdisciplinary field” requiring ethical, clinical, and practical competencies.

The position of Chief Health Ethics Officer will be progressed in early 2026, “with a view to filling the role.” In the interim, the Department continues to access relevant expertise as necessary, they added.

In February 2025, MI reported there were no plans to recruit a new CBO. The post has remained unfilled since September 2022, when the former CBO Dr Siobhán O’Sullivan left the role. The CBO was responsible for monitoring the bioethics environment to identify emerging issues and to provide evidence-based policy and legislative advice in the field.

Separately, the Royal Irish Academy (RIA) life and health science committee recently released two event reports on bioethics in Ireland.

The first report arose from the forum on the future of Irish bioethics, which took place in October 2024. This event brought together experts and stakeholders to crit-

ically examine bioethical frameworks in Ireland.

Mr Oliver Feeney, Chair of the RIA working group for the forum, said the report highlighted “the need for a greater national focus on supporting inclusive, ongoing discussions of bioethical issues in Ireland”.

“The event explored the potential benefit of a systemic approach to bioethics, encapsulating national coordination, capacity building, public involvement, and policy advisory roles.

“As of September 2025, it is 10 years since the last official meeting of the national advisory committee on bioethics (NACB). It is vital that Ireland is equipped with the means to confront and address the many increasingly complex bioethical challenges that lie ahead for our society.”

The Department has previously informed this newspaper that the NACB is no longer a functional committee.

The second RIA report is the result of a symposium on fundamental biomedical research, which took place in February 2025.

This event highlighted the success of fundamental biomedical research across the island and emphasised the continuing need for increased funding for fundamental research to build and sustain national capacity and improve the career paths and prospects for biomedical researchers.

provided information to Government departments “regarding this challenge” in the context of potential solutions and healthcare workforce planning.

UL’s School of Medicine has not experienced a high drop-out rate, according to Prof Dunne. He said it provides “effective student support mechanisms through dedicated professional and academic staff”.

“The School of Medicine and the UL Foundation have provided financial supports for students in financial difficulty or from economically disadvantaged backgrounds.”

The Programme for Government promised a “tuition fee support scheme” for GEM students. The Programme also committed to providing more GEM programmes focused on preparing students for careers in rural and remote medicine.

University of Galway is due to commence a GEM programme in 2027.

A Department of Further and Higher Education spokesperson said the State provides a subsidy to higher education institutions “towards the cost of GEM provision for EU student places”.

They said GEM students may be eligible to apply to the Student Assistance Fund.

“In addition, tax relief at the standard rate of tax may be available in respect of tuition fees paid for approved courses at approved colleges of higher education. A rent tax credit may also be available.”

The spokesperson said any “expansion of student supports is subject to the annual estimates process”.

‘Absence’ of regional governance structures for worker safety DAVID LYNCH

The “absence” of regional governance structures for healthcare worker safety was raised at a HSE meeting.

The issue was noted at a meeting of the HSE performance committee in September 2025. The HSE confirmed that this matter was under consideration, according to meeting minutes.

A HSE spokesperson told the Medical Independent it was undertaking a comprehensive management review of occupational safety and health support and governance structures. This was in the context of the new “structures that have evolved over the Sláintecare programme of work”.

This review was required to ensure that “despite organisational changes, staff safety continues to be optimally integrated into the risk-based safety management system, and into all aspects of the HSE’s activities”.

The spokesperson confirmed that the review will be undertaken in the first half of this year. They added that responsibility for occupational safety and health falls to HSE line managers and senior managers under the Safety, Health, and Welfare at Work Act 2005.

Section 80 of the Act, in particular, applies to the senior leadership team and other mid-level managers who have functional control over the activities of their organisation.

“Line management structures are clearly defined in the HSE and have remained so over the Sláintecare implementation period. Occupational safety and health responsibilities at all levels of management within the organisation are described within the HSE’s corporate safety statement (CSS).”

The CSS formally sets out the high-level responsibilities, structures, and resource requirements for maintaining a safe and healthy environment for employees, service users, visitors, and all who come in contact with HSE services and/or may be affected by HSE activities.

Mater Private Network

Women’s Heart Summit

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2026 Westbury Hotel, Dublin

Saturday, January 24th

Welcome & Opening Address

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In association with the Dublin Cardiovascular Research Forum and supported by the Irish Cardiac Society.

CPD applied for.

8:45am – 9am

Dr. Róisín Colleran, Course Director, Consultant Cardiologist, Mater Private Network

Session 1

Keynote Presentation

9am – 10am

Heart Disease in Women: Under-recognised, Under -diagnosed, Under-treated: A Report from the Lancet Commission Prof. Roxana Mehran, Professor of Medicine & Director of Interventional Cardiovascular Research and Clinical Trials, Mount Sinai School of Medicine, New York

Session 2

Dr. Róisín Colleran

Prof. Roxana Mehran

Dr. Fernando Alfonso

Dr. Louise Fitzgerald

Prof. Colin Berry

Prof. Mark Dayer

Dr. Magid Awadalla

Prof. Julie De Backer

10am – 11:15am

Spontaneous Coronary Artery Dissection: An Under-recognised Cause of MI in Women Dr. Fernando Alfonso, Head of Department of Cardiology, Hospital Universitario de la Princesa, Madrid Menopause, Her Heart Matters Dr. Louise Fitzgerald, General Practitioner, Grafton Medical, Centric Health, Dublin Sex Considerations in ANOCA and MINOCA Prof. Colin Berry, Professor of Cardiology and Imaging at the University of Glasgow, Director of the British Heart Foundation Centre of Research Excellence, Glasgow

Break

11:15am – 11:45am

Session 3

11:45am – 1pm

“Men Die Suddenly and Women Fade Away” – Differences in Heart Failure Between Men and Women Prof. Mark Dayer, Consultant Cardiologist and Clinical Lead for Heart Failure, Mater Private Network Breast Cancer Therapy-related Cardiotoxicity in Women Dr. Magid Awadalla, Consultant Cardiologist, Mater Private Network ESC Guidelines for the Management of CVD and Pregnancy Prof. Julie De Backer, Genetic Cardiologist, Ghent University Hospital, Ghent

Wrap up & Close

1pm

Registration For in-person attendees, register via QR code.

For online attendees, register via www.MedCafe.ie www.materprivate.ie

THE MEDICAL INDEPENDENT | 13 JANUARY 2026

10

News Feature DAVID LYNCH david@mindo.ie

Consultant-led innovation across the health service Engagement with the consultant innovation fund has grown over the last two years, with 2026 expected to see a further increase. David Lynch reports

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ngagement with the consultant innovation fund (CIF) is on the rise, according to figures provided to the Medical Independent (MI).

The CIF was established under the public-only consultant contract (POCC) to “empower” consultants to lead innovation and research projects that directly enhance patient care, service delivery, clinical pathways, and outcomes.

While the POCC was introduced in 2023, CIF activity began in 2024. The fund enables each consultant to access up to €8,000 annually, with the option for groups of consultants to pool their allocations, up to €50,000, for larger, jointly delivered innovation initiatives.

The CIF is administered centrally through the HSE Spark Innovation Programme and has rapidly become a key driver of clinician-led innovation across the Irish health system.

Formally launched for applications in early 2024, in its first operational year, 463 consultants engaged with the fund through individual or pooled applications.

“Engagement continued to grow in 2025,” a HSE spokesperson told MI. According to HSE figures, in 2024, €4.7 million in project funding was approved.

This increased to €6.18 million in 2025, a 31 per cent increase aligned with the growth in applications and the wider distribution of funding across consultant groups.

This growth reflected “strong awareness” of the fund and increasing confidence among consultants in putting forward innovative, service-improvement-focused proposals.

“This number rose significantly in 2025, with 769 consultants involved, representing a 66 per cent increase in participation year-on-year.”

Engagement has broadened both geographically and across specialties. While Dublin hospitals continue to account for the largest proportion of applications, “participation grew markedly” in Cork, Galway, and Sligo.

“Growth across anaesthesiology, pathology and laboratory medicine, and paediatrics and neonatology reflect specialties with strong innovation momentum,” according to the spokesperson.

Increase Overall, 2025 saw substantially higher demand and greater reliance on pooled consultant teams, “demonstrating sustained and maturing engagement” with the fund.

Uptake by consultants has also increased substantially since the fund’s introduction. Applications rose from 212 in 2024 to 365 in 2025, representing a 72 per cent increase. Of these, 194 were approved in 2024, and 265 in 2025. Pooled applications also grew from 106 to 172.

Photo Credit: iStock/greenbutterfly

According to the HSE, this reflected the strong and growing interest in multidisciplinary and multi-consultant “innovation approaches”.

Entering the new year, the HSE said that based on the trajectory of the first two years, with increasing consultant awareness, strengthened governance processes, and expanded pre-submission supports, further increases in engagement are anticipated in 2026.

“The CIF is unlike any other innovation fund internationally, giving consultants a direct pathway to develop and implement ideas that transform patient care,” Dr Clíodhna McHugh (PhD), Innovation Specialist, CIF Lead, told MI. “The projects we are seeing across Ireland show the extraordinary creativity and leadership of consultants in every specialty.”

Dr McHugh added that consultants are using this fund to drive meaningful improvements in patient care, digital transformation, and service redesign.

“As we continue to strengthen our processes for 2026, we strongly encourage consultants to engage early, particularly with the pre-submission phase and the new deadlines, so that we can support them to bring their ideas to life and maximise the impact of this unique national fund.”

POCC Interest in the CIF has grown in parallel with the rising number of consultants signing up to the POCC. According to minutes of the September meeting of the Sláintecare programme board, members were told 3,090 consultants had signed the POCC as of the end of August 2025.

This was made up of 943 new entrants and 2,147 change of contracts. By the end of August, approximately two out of three consultants (66 per cent) were working on a POCC. IHCA Consultant representative groups have been supportive of the new fund. Speaking last year at an IHCA symposium on championing sustainability in the health service, the Association’s President Prof Gabrielle Colleran said it was her aspiration that new projects would emerge from the CIF and that many could be scaled-up to national implementation.

“I believe we have a unique opportunity thanks to the generous innovation funding available under the new consultant contract,” she told the audience.

Speaking to MI at the same symposium in January, Mr Jared Gormly, Head of the

The projects we are seeing across Ireland show the extraordinary creativity and leadership of consultants in every specialty

HSE Spark Innovation Programme, said that he expected consultant engagement with the CIF to increase “We are optimistic because for the consultants who have engaged with it so far, it has worked well for them,” he told MI. “So, we think it will become almost a routine [that consultants will apply for it annually].”

On 12 November 2025, Spark hosted ‘AI [artificial intelligence] in Practice’, showcasing 27 CIF-funded projects across 2024–2025. These projects demonstrated advances in diagnostics, imaging, automation, simulation training, and patient engagement, and showcased the growing culture of innovation driven by consultant-led initiatives.

The HSE Spark Innovation Programme “is highly satisfied” with the progression of the CIF. The fund is enabling consultants to deliver tangible, system-level improvements across the health service, according to the HSE spokesperson.

Funded projects span a wide range of areas. These include service redesign and pathway optimisation, such as one-stop clinics and streamlined referral systems.

They also cover digital and technology-enabled care, including AI-supported decision tools, workflow automation, and telemedicine.

Challenges According to the HSE’s online CIF portal, consultants highlighted several challenges during the 2024 and 2025 cycles, including delays in fund transfers and limited time to use the funding before year-end. They also reported difficulties acting on Spark team feedback within tight timelines, as well as problems securing the required signatures for approved projects in advance of fund transfers.

To address these issues, a number of changes have been introduced to the CIF (see https://healthservice.hse.ie/ staf f/spark-innovation-programme/ consultant-innovation-fund/).

These include a stronger emphasis on early engagement through the portal’s pre-submission application form, which allows consultants to receive feedback on their proposals.

2026 applications For the 2026 cycle, applicants who wish to receive feedback from the Spark team before final submission must submit their proposal by 16 January 2026, while final submissions must be made by 3 April.

The CIF has “rapidly established itself as a major enabler of clinician-led innovation” within the Irish health service, the HSE spokesperson told MI. With strong participation, diverse project activity, and significant growth in engagement across 2024 and 2025, the fund is already delivering tangible improvements in patient care and service delivery. Ongoing enhancements will ensure that the CIF remains an effective and sustainable cornerstone of consultant-led innovation into 2026 and beyond, according to the HSE Consultant Innovation Fund – Formal Application is available at: https://surveys.hse.ie/s/12FZCF/

Ireland – licensed pack now available

Around half of all postmenopausal women experience one or more symptoms of vaginal atrophy1. Unlike vasomotor symptoms, vaginal dryness, soreness, burning, itching and dyspareunia are unlikely to resolve without treatment2. Ovestin 1mg per gram vaginal cream relieves these symptoms by replacing oestrogen – helping to restore vaginal tissue back to normal. *Ovestin (also marketed as Aacifemine and Estriol ASPA) is Europe’s leading vaginal atrophy treatment.

References 1. Hamoda H, et al. Menopause Practice Standards. Post Reprod Health 2022; 28(3): 127-132.

2. Wysocki S, et al. Management of vaginal atrophy: implications from the REVIVE survey. Clin Med Insights; Reprod Health 2014; 18: 23-30. 3. Data on file. Vaginal Oestrogen Sales. July 2025.

Prescribing Information Ovestin (Estriol) 1 mg per gram Vaginal Cream Please consult the Summary of Product Characteristics (SmPC) before prescribing. Active Ingredient: Estriol 1 mg per gram Vaginal Cream. One application contains 0.5mg estriol. Indications: Treatment of symptoms of vaginal atrophy due to oestrogen deficiency in postmenopausal women. Pre and post operative therapy in postmenopausal women undergoing vaginal surgery. Dosage and Administration: Intravaginal. See SmPC for practical instructions. Atrophy of lower urogenital tract: 1 application per day for the first weeks (maximally 4 weeks), followed by a gradual reduction, based on relief of symptoms, until a maintenance dosage is reached, e.g. 1 application twice a week. Use lowest effective dose for the shortest duration. Pre-surgery: 1 application per day for 2 weeks. Post-surgery: 1 application twice a week in the 2 weeks after surgery. Contra-indications: Known, past or suspected breast cancer; Known or suspected estrogen-dependent malignant tumours (e.g. endometrial cancer); Undiagnosed genital bleeding; Untreated endometrial hyperplasia; Previous or current venous thromboembolism (deep venous thrombosis, pulmonary embolism); Known thrombophilic disorders (e.g. protein C, protein S, or antithrombin deficiency); Active or recent arterial thromboembolic disease (e.g. angina, myocardial infarction); Acute liver disease, or a history of liver disease where liver function tests have failed to return to normal; Known hypersensitivity to estriol or any excipients; Porphyria.

Warnings and Precautions: For postmenopausal symptoms, HRT should only be initiated if quality of life is adversely affected. Evidence on risks associated with HRT in premature menopause is limited. The balance of benefits and risks in younger women may be more favourable than in older women. Carefully appraise risks and benefits at least annually and HRT should only be continued as long as the benefit outweighs the risk. Before and during HRT, complete a personal and family medical history and complete

The No.1 vaginal oestrogen in Europe*3 investigations, including mammography, in accordance with screening standards and clinical needs of the individual. Treat vaginal infections before starting. Advise the patient what breast changes to report.

Discontinue immediately if a contra-indication is discovered or in cases of jaundice or deterioration in liver function, significant increase in blood pressure, new onset of migraine-type headache and pregnancy.

Epidemiological evidence from large meta-analysis suggests risk of breast cancer is not increased in women with no history of breast cancer. Risk of stimulation of recurrence of breast cancer is unknown.

Refer to the SmPC for a list of situations requiring close supervision and information regarding potential HRT related concerns. Unlikely to be clinically relevant drug interactions due to minimal systemic absorption - see SmPC for further details. Use in pregnancy, suspected pregnancy, or in breast-feeding is contraindicated.

Adverse Events: Application site pruritis, vaginal burning sensation, vaginal discharge, flu-like symptoms, breast discomfort and pain reported. These adverse reactions are usually transient and may indicate high dosage. Refer to the SmPC for further information including details regarding systemic HRT and the risk of ovarian cancer, venous thromboembolism, ischaemic stroke, estrogen dependent neoplasms, gall bladder disease, skin and subcutaneous disorders, dementia and vaginal bleeding. Category: B (product subject to medical prescription which may be renewed). Marketing Authorisation Number: PA1691/017/001.

Marketing Authorisation Holder: Aspen Pharma Trading Limited, 3016 Lake Drive, Citywest Business Campus, Dublin 24, Ireland. Further information available on request from: Aspen Pharma Trading Limited, aspenmedinfo@professionalinformation.co.uk or 00353 1 6308400. Date of revision: August 2025.

Reporting of suspected adverse reactions: Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/ risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via: HPRA Pharmacovigilance Website: www.hpra.ie Adverse events should also be reported to Aspen Pharma Trading Ltd by contacting DUB-GM-Drugsafety@ie.aspenpharma.com or via fax: 003531 6308411 IE-EST-06-25-00002

IE-EST-07-25-00004 August 2025

Ovestin Irish 250mm x 346 Medical Independent Ad.indd 1

18/08/2025 12:37

THE MEDICAL INDEPENDENT | 13 JANUARY 2026

12

News Feature NIAMH CAHILL

New ‘One Health’ plan aims to curb antimicrobial-resistance A coordinated whole-of-society approach is at the centre of Ireland’s latest efforts to reduce the growing threat of antimicrobial-resistant bacteria. Niamh Cahill reports

A

t the end of last year, the Government published Ireland’s One Health National Action Plan on Antimicrobial Resistance 2026–2030. Also known as iNAP3, it is the third national action plan on the issue.

The new plan was launched on European Antibiotic Awareness Day on 18 November and during World Antimicrobial Awareness Week, which ran from 18 to 25 November.

The HSE also launched its own document – Antimicrobial Resistance and Infection Control (AMRIC) Action Plan 2026–2030 – to complement the Government’s strategy.

The Medical Council and Irish Pharmacy Union, among other healthcare organisations, released statements and advisories during the awareness week regarding the misuse or overuse of antibiotics in an attempt to raise awareness among the public and remind all healthcare professionals of the dangers.

As iNAP3 outlines, it is widely known within healthcare that antimicrobial resistance (AMR) “presents a significant and escalating threat to public and animal health, food security, and our shared environment”.

But awareness among the public is not as widespread as it is among clinicians, and this needs to change if Ireland is to succeed in its efforts to reduce AMR within the community and prevent further unnecessary deaths, according to the plan.

‘One Health’ The ‘One Health’ approach is acknowledged as the most effective way to address AMR globally and is promoted by the European Commission and the World Health Organisation (WHO).

A spokesperson for the Department of Health explained to the Medical Independent that the goal of the concept “is to encourage multidisciplinary collaborative efforts across different sectors such as human health, animal health, agriculture, and the environment to achieve the optimal health outcomes for people and animals”.

“It advocates a ‘whole-of-society’ approach, recognising that the health of people is connected to the health of animals and the environment,” the spokesperson said.

According to the WHO, AMR was directly responsible for 1.27 million global deaths in 2019 and contributed to 4.95 million deaths. It has warned that without action deaths could rise to 10 million per annum by 2050.

In a factsheet it has published on the issue, the WHO states that the “misuse and overuse of antimicrobials in humans, animals and plants are the main drivers in the development of drug-resistant pathogens”.

It describes antimicrobial resistance as one of the top 10 global public health threats facing humanity.

This is why the Organisation has stepped up efforts to monitor AMR worldwide. In October last year, the WHO released its Global Antibiotic Resistance Surveillance Report 2025.

It found that between 2018 and 2023, antibiotic resistance increased in over 40 per cent of the pathogen-antibiotic combinations monitored by WHO, with an average annual rise of between 5 and 15 per cent.

The report noted how the incidence of AMR varies greatly worldwide. Resistance was highest in south-east Asian and eastern Mediterranean WHO regions where one in three reported infections were resistant.

The document highlighted how drug-resistant gram-negative bacteria are becoming more dangerous internationally, with over 40 per cent of E coli and more than 55 per cent of K pneumoniae resistant to third-generation cephalosporin antibiotic treatment.

More than 100 countries, including Ireland, reported data to the WHO on AMR, the report noted. However, many countries were unable to submit reports due to a lack of adequate systems to gather reliable information. iNAP3, jointly published by the Minister for Health and Minister for Agriculture,

Food and the Marine, also details how AMR is a growing threat to global health and how it can undermine the effectiveness of life-saving treatments. AMR can cause increased hospital admissions, greater healthcare costs, treatment failure, severe illness, and death, according to iNAP3.

While it outlines various ways to tackle the growth in AMR nationally, it also notes the advances made to date.

The first Government plan seeking to tackle the rise in AMR was published in 2017. According to Minister for Health Jennifer Carroll MacNeill, much progress has been achieved since this time.

The progress includes a 50 per cent reduction in the sale of highest priority critically important antimicrobials for use in food-producing animals between 2018 and 2023. Separately, a 25 per cent overall reduction in antimicrobial sales for food-producing animals in the same period has occurred.

A national veterinary prescription system to facilitate enhanced monitoring and reporting of antimicrobial use in animals has been developed. The website (www. antibioticprescribing.ie) is another step forward, according to iNAP3.

But it is evident that much greater action is required, as well as an increased awareness among the public on ways they can help to reduce antimicrobial resistance.

AMR is a complex and evolving threat that will require “continued commitment from every sector and from each one of us”, according to Minister Carroll MacNeill.

Objectives iNAP3 sets out six objectives. The first of these is an “increased emphasis on communication, behaviour change, education, and diagnostics”.

This will involve, among a number of other measures, the launch of a public information campaign to raise awareness of AMR and an assessment of the impact of the campaign.

Enhanced education and training of professionals within food, animal, and health sectors is also planned. Learning within schools and educational institu-

For doctors, reducing AMR means ensuring that antibiotic medicines are only prescribed and administered when they are genuinely needed

tions will be another avenue being pursued under the plan.

The second objective sets out the enhancement of surveillance of antibiotic resistance and use. This will include the creation of a national system to monitor healthcare-associated infections in intensive care units and surgical site infections by 2030.

As part of the HSE Strategic Plan for Laboratory Services 2026–2035, improved detection of infection and AMR is also being sought.

The third objective seeks to reduce the spread of infection and disease through strengthening infection prevention control measures in healthcare facilities and communities, as well as increasing vaccine use.

The Government, under its fourth target, is seeking to optimise the use of antibiotics in human and animal health. It wants to reduce antibiotic consumption in Ireland by 27 per cent by 2030.

Some 90 per cent of antibiotic use in human health in Ireland occurs in the community, according to iNAP3.

The Government plan states the HSE will explore “population antimicrobial prescribing… in daytime GP services”.

The fifth objective focuses on research, with the promotion of research and sustainable investment in new medicines, diagnostic tools, vaccines, and other interventions.

The sixth and final aim centres on the coordination of a multi-sectoral approach across Government and State agencies in tackling AMR. The plan notes that the national interdepartmental AMR committee “brings together the key stakeholders in the human health, animal health, and environmental sectors”. The HSE’s plan similarly sets out its targets under these six objectives.

Commenting on the HSE plan, Dr Eimear Brannigan, HSE National Clinical Lead for AMRIC, said: “We have become reliant on antibiotics being effective to treat or prevent infection during many of our routine operations, for critical surgery such as organ transplants, cancer treatment, and treatment of many illnesses.”

“Unfortunately, a lot of antibiotics have been used in people, animals, and crops, often when they were not always appropriate. Because of this, many bacteria or bugs have adapted and become resistant to different types of antibiotics.”

In a statement from the Medical Council, its CEO Dr Maria O’Kane said increasing awareness of AMR is critical to protecting patients, arguing that the issue cannot be addressed in isolation.

“For doctors, reducing AMR means ensuring that antibiotic medicines are only prescribed and administered when they are genuinely needed. Antimicrobial medicines should only be used where they are required to treat serious infections. For patients, not every illness requires an antibiotic, and your doctor will advise you on the most effective treatment. Avoiding unnecessary antibiotics helps protect their effectiveness for the future.”

Further detail is available at https://assets.gov.ie/static/ documents/94afd4eb/106235_DOH_-_ iNAP3_Report_v11_-_pages_1.pdf

If you suspect ATTR-CM, consider VYNDAQEL▼ (tafamidis) 61 mg – the first and only treatment proven to reduce all-cause mortality and frequency of CV-related hospitalisations in patients with wild-type or hereditary ATTR-CM.1,2 ATTR-CM is an underdiagnosed, overlooked cause of heart failure.3 Once diagnosed, untreated patients have a median survival of ~2–3.5 years.4 You can change that. Timely diagnosis and treatment of ATTR-CM has been predicted to extend mean life expectancy by 5.46 years (wild-type) and 7.76 years (hereditary) compared with delayed diagnosis.5 Help your patients add meaningful new steps to their journey, with proven efficacy, while retaining their quality of life – with VYNDAQEL2,6

Visit www.vyndaqel.ie for more information.

This medicinal product is subject to additional monitoring. This will allow quick identification of new safety information. Healthcare professionals are asked to report any suspected adverse reactions. Refer to section 4.8 of the SPC for how to report adverse reactions.

Vyndaqel 61 mg soft capsules (tafamidis) Prescribing Information: Before prescribing Vyndaqel please refer to the full Summary of Product Characteristics. Presentation: Vyndaqel 61 mg soft capsules.

Each soft capsule contains 61 mg tafamidis. Uses: Vyndaqel is indicated for the treatment of wild-type or hereditary transthyretin amyloidosis in adult patients with cardiomyopathy (ATTR-CM). Dosage: Treatment should be initiated under the supervision of a physician knowledgeable in the management of patients with amyloidosis or cardiomyopathy. When there is a suspicion in patients presenting with specific medical history or signs of heart failure or cardiomyopathy, etiologic diagnosis must be done by a physician knowledgeable in the management of amyloidosis or cardiomyopathy to confirm ATTR-CM and exclude AL amyloidosis before starting Vyndaqel, using appropriate assessment tools such as: bone scintigraphy and blood/urine assessment, and/or histological assessment by biopsy, and transthyretin (TTR) genotyping to characterise as wild-type or hereditary.

The recommended dose is one capsule of Vyndaqel 61 mg (tafamidis) orally once daily. Vyndaqel 61 mg (tafamidis) corresponds to 80 mg tafamidis meglumine, tafamidis and tafamidis meglumine are not interchangeable on a per mg basis. Vyndaqel should be started as early as possible in the disease course when the clinical benefit on disease progression could be more evident. Conversely, when amyloid-related cardiac damage is more advanced, such as in NYHA Class III, the decision to start or maintain treatment should be taken at the discretion of a physician knowledgeable in the management of patients with amyloidosis or cardiomyopathy. There are limited clinical data in patients with NYHA Class IV. If vomiting occurs after dosing, and the intact Vyndaqel capsule is identified, then an additional dose of Vyndaqel should be administered if possible. If no capsule is identified, then no additional dose is necessary, with resumption of dosing the next day as usual. There are no recommended dosage adjustments for elderly patients or patients with renal or mild and moderate hepatic impairment. Limited data are available in patients with severe renal impairment (creatinine clearance less than or equal to 30 mL/min). Tafamidis has not been studied in patients with severe hepatic impairment and caution is recommended. There is no relevant use of tafamidis in the paediatric population.

Method of Administration: The soft capsules should be swallowed whole and not crushed or cut. Vyndaqel may be taken with or without food. Contra-indications: Hypersensitivity to the active substance or to any of the excipients as listed in section 6.1 of SPC. Warnings and Precautions: Contraceptive measures should be used by women of childbearing potential during treatment with tafamidis and for one month after stopping treatment. Tafamidis should be added to the standard of care for the treatment of patients with transthyretin amyloidosis. Physicians should monitor patients and continue to assess the need for other therapy, including the need for organ transplantation, as part of this standard of care. As there are no data available regarding the use of tafamidis in organ transplantation, tafamidis should be discontinued in patients who undergo organ transplantation. Increase in liver function tests and decrease in thyroxine may occur. This medicinal product contains no more than 44 mg sorbitol in each capsule. Sorbitol is a source of fructose. The additive effect of concomitantly administered products containing sorbitol (or fructose) and dietary intake of sorbitol (or fructose) should be taken into account. The content of sorbitol in medicinal products for oral use may affect the bioavailability of other medicinal products for oral use administered concomitantly. Pregnancy and Lactation:

Tafamidis is not recommended during pregnancy and in women of childbearing potential not using contraception.

Available data in animals have shown excretion of tafamidis in milk. A risk to the newborns/infants cannot be excluded. Vyndaqel should not be used during breastfeeding. Interactions: In a clinical study in healthy volunteers, 20 mg tafamidis meglumine did not induce or inhibit the cytochrome P450 enzyme CYP3A4. In vitro tafamidis inhibits the efflux transporter BCRP (breast cancer resistant protein) at the 61 mg/day tafamidis dose with IC50=1.16 μM and may cause drug-drug interactions at clinically relevant concentrations with substrates of this transporter (e.g. methotrexate, rosuvastatin, imatinib). In a clinical study in healthy participants, the exposure of the BCRP substrate rosuvastatin increased approximately 2-fold following multiple doses of 61 mg tafamidis daily dosing. Likewise, tafamidis inhibits the uptake transporters OAT1 and OAT3 (organic anion transporters) with IC50=2.9 μM and IC50=2.36 μM, respectively, and may cause drug-drug interactions at clinically relevant concentrations with substrates of these transporters (e.g. non-steroidal anti-inflammatory drugs, bumetanide, furosemide, lamivudine, methotrexate, oseltamivir, tenofovir, ganciclovir, adefovir, cidofovir, zidovudine, zalcitabine). Based on in vitro data, the maximal predicted changes in AUC of OAT1 and OAT3 substrates were determined to be less than 1.25 for the tafamidis 61 mg dose, therefore, inhibition of OAT1 or OAT3 transporters by tafamidis is not expected to result in clinically significant interactions. No interaction studies have been performed evaluating the effect of other medicinal products on tafamidis. Undesirable Effects: The following adverse events were reported more often in 176 ATTR-CM patients treated with tafamidis meglumine 80 mg compared to placebo: flatulence [8 patients (4.5%) versus 3 patients (1.7%)] and liver function test increased [6 patients (3.4%) versus 2 patients (1.1%)]. A causal relationship has not been established. Safety data for tafamidis 61 mg are available from its open-label long-term extension study.

Adverse reactions from cumulative clinical data in ATTR-CM participants: Common (≥ 1/100 to < 1/10) Diarrhoea, rash, pruritus. Legal category: S1A. Marketing Authorisation Numbers: EU/1/11/717/003– 61mg (30 capsules). Marketing Authorisation Holder: Pfizer Europe MA EEIG, Boulevard de la Plaine 17, 1050 Bruxelles, Belgium. For further information on this medicine please contact: Pfizer Medical Information on 1800 633 363 or at medical.information@pfizer.com. For queries regarding product availability please contact: Pfizer Healthcare Ireland, Pfizer Building 9, Riverwalk, National Digital Park, Citywest Business Campus, Dublin 24 + 353 1 4676500.

Ref: VY 61MG 3_0 Last revised: 02/2023

ATTR-CM, transthyretin amyloid cardiomyopathy; CV, cardiovascular 1. VYNDAQEL 61 mg (tafamidis) Summary of Product Characteristics, 2023. 2. Maurer MS et al. ATTR-ACT study investigators. Tafamidis treatment for patients with transthyretin amyloid cardiomyopathy.

N Engl J Med. 2018; 379:1007–1016. 3. Witteles RM et al. Screening for transthyretin amyloid cardiomyopathy in everyday practice. JACC Heart Fail. 2019; 7:709–716. 4. Maurer MS et al. Addressing common questions encountered in the diagnosis and management of cardiac amyloidosis. Circulation. 2017; 135:1357–1377. 5. Rozenbaum MH et al. Estimating the health benefits of timely diagnosis and treatment of transthyretin amyloid cardiomyopathy. J Comp Eff Res. 2021; 10:927–938. 6. Rapezzi C. Efficacy and safety of tafamidis in transthyretin amyloid cardiomyopathy: results of the ATTR-ACT trial. European Society of Cardiology Congress 25–29 August, 2018.

PP-VYN-IRL-0236. May 2024.

THE MEDICAL INDEPENDENT | 13 JANUARY 2026

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Conference Coverage RCPI Institute of Medicine, Annual November Symposium, No 6, Kildare Street, Dublin, 27 November 2025

Deconstructing ALS: From the bedside to precision medicine Prof Orla Hardiman delivered the 2025 Bryan Alton Medal Lecture on advances in amyotrophic lateral sclerosis research, and what is required for future progress

T

his year’s RCPI Institute of Medicine Bryan Alton Medal was awarded to Prof Orla Hardiman in recognition of her exceptional contributions to clinical neurology, translational neuroscience, and the global understanding of amyotrophic lateral sclerosis (ALS).

The awarding of the medal took place during the Institute’s November Symposium, held on 27 November 2025 in No 6, Kildare Street, Dublin.

In her 2025 Medal Lecture – titled ‘Deconstructing amyotrophic lateral sclerosis: From bedside to bench and back again’ – Prof Hardiman explored why ALS research has reached a critical juncture and what changes are needed for meaningful therapeutic progress. Central to her lecture was the message that advances in ALS depend on a continuous interplay between clinical observation and laboratory investigation, with each informing and strengthening the other.

Heterogeneous Prof Hardiman highlighted a central insight that has guided much of her research: ALS is far more heterogeneous than traditional definitions suggest. While typically described as a progressive motor neurone disorder, that definition misses the broader clinical reality.

“Amyotrophic lateral sclerosis is known as a rapid-onset loss of upper and lower motor neurones, but up to 13 per cent of patients present with frontotemporal dementia [FTD] and a further 50 to 70 per cent have significant cognitive and behavioural impairment.”

Prof Hardiman explained that this offers essential information about the underlying biology of the disease.

“Understanding the basis of heterogeneity is crucial to the success of future drug development.”

Despite its complexity, ALS remains one of the most reliably diagnosed neurodegenerative conditions with near-perfect clinicopathological correlation. It is this combination of diagnostic clarity and broad heterogeneity that makes the condition, in her view, “an exemplar of the wider family of neurodegenerations.”

Unlike Alzheimer’s or Parkinson’s disease, ALS often presents in late mid-life and its variants such as slow progressors, restricted phenotypes, rapidly advancing forms, those with cognitive impairment and those without, challenge any assumption that it is a single disease.

A cornerstone of Prof Hardiman’s research philosophy is the conviction that the bedside must inform the bench and not the other way around.

“My primary objective as a clinician scientist has been to understand the heterogeneous pathological mecha-

My primary objective as a clinician scientist has been to understand the heterogeneous pathological mechanisms underlying ALS and FTD

Pictured L-to-R: Dr Emer Kelly, Director of Education and Training, Institute of Medicine, RCPI; Prof Ed McKone, Dean, Institute of Medicine, RCPI; Prof Orla Hardiman, Bryan Alton Medal Lecturer and recipient; and Dr Lisa Costelloe, Consultant Neurologist nisms underlying ALS and FTD and to develop processes and technologies that can characterise that heterogeneity,” she explained.

Her research spans epidemiology, genomics, cognition and behaviour, neurophysiology, neuroimaging and early-phase clinical trials. By capitalising on the Irish ALS/ MND [motor neurone disease] population-based register, which she began over 30 years ago, her team has made several landmark contributions in the field.

These include identifying a new susceptibility gene (ANG), showing that ancestral background affects risk and disease features and uncovering biological links between ALS and certain neuropsychiatric conditions.

Advanced neurophysiology techniques developed by her team allow researchers to track network-level changes as the disease progresses, reinforcing the view of ALS as a multi-system disorder.

“By focusing on patient attributes at the bedside as the starting point, our objective is to provide a scientifically robust pathway back from the bench to guide future therapeutics,” she said.

Prof Hardiman emphasised that, despite over 80 phase 2 and 3 clinical trials, life expectancy for ALS patients still remains just three to five years from symptom onset.

This stark reality highlights the urgent need to rethink traditional approaches to research and treatment. This, she noted, is further compounded by the limits of traditional research models.

Limitations Current research models have significant limitations: Animal studies cannot capture the full complexity of the human nervous system, particularly the cognitive and behavioural aspects of ALS, while post-mortem studies provide only static snapshots rather than dynamic insights into disease progression.

She outlined several critical unanswered questions: ▶ Why do some individuals carrying high-risk genetic variants never develop ALS? ▶ Why do some patients progress rapidly while others remain stable for years? ▶ What is the basis of discordant families, where disease manifests in non-gene carriers? ▶ What drives cognitive or behavioural symptoms in only a subset of patients? ▶ What are the pathobiological implications of the clinical and genomic overlap between neuropsychiatric conditions and ALS? ▶ And crucially, what protective or homeostatic mechanisms might delay or prevent disease onset, or even lead to a neuropsychological endophenotype rather than clinical disease?

“To make real progress, we need large-scale human datasets and improved analytic tools. Unless we embrace this approach, we risk repeating past errors, and the likelihood of developing truly effective disease-modifying therapies will be greatly reduced,” she argued.

Precision ALS Looking ahead, Prof Hardiman discussed Precision ALS, an Ireland-led project supported by Research Ireland, ADAPT, and FutureNeuro. The initiative aims to combine clinical data, biomarker results, genomic information, and device-based measures in one large system.

The goal is to allow researchers to apply artificial intelligence (AI) and machine learning to large datasets, helping to identify new subgroups of patients who share biological features. These subgroups may respond differ-

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Continued on p16

THE MEDICAL INDEPENDENT | 13 JANUARY 2026

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Conference Coverage RCPI Institute of Medicine, Annual November Symposium, No 6, Kildare Street, Dublin, 27 November 2025



Continued from p14

ently to treatments and could form a basis for precision medicine trials.

Given the extent of clinical heterogeneity in ALS, she argues that artificial intelligence and machine learning will be essential for identifying new, data-driven patient subcohorts like groups that may share underlying biology, but appear indistinguishable in the clinic.

The initiative reflects a broader trend in neurology – moving beyond one-size-fits-all approaches and embracing precision medicine strategies that consider genetic background, biomarkers, and functional phenotypes. By leveraging these tools, researchers hope to develop therapies targeted to specific subgroups, improving both efficacy and patient outcomes.

Multidisciplinary care However, scientific innovation alone is not enough. A significant part of Prof Hardiman’s career has focused on improving clinical care for people with ALS. Her team has shown that outcomes are better when care is delivered through a centralised multidisciplinary service, backed by community outreach and home visits.

“We now know that clinical care for those with ALS is radically improved by a multidisciplinary model with extensive community outreach and home visits,” she said.

“We have shown that this type of model has a significant impact on both survival and quality-of-life.”

Th is model also provides researchers with detailed longitudinal data, helping to link clinical observations with underlying biological mechanisms and inform the direction of research and the development of new treatments.

Prof Hardiman acknowledged the difficulties the field has faced, but also expressed optimism. ALS will not be solved with a single treatment because it is not a single disease. But the tools now becoming available such as large-scale data, advanced analytics, and detailed phenotyping offer real hope.

“Traditional clinicopathological correlation served us well in the 20th Century, but a rigorous, data-rich 21st Century approach now has the capacity to address its limitations,” she added.

Medal Prof Edward McKone, Dean of the Institute of Medicine, presented the Bryan Alton Medal to Prof Hardiman, one of the Institute’s highest honours recognising significant contributions to clinical and academic medicine in Ireland.

She joins previous recipients including Prof Rose Anne Kenny, Prof Geraldine Murphy, Prof Tim O’Brien, and Prof Fergus Shanahan.

The medal presentation coincided with the annual Stearne Lecture, delivered this year by Prof John V Fahy, University of California, San Francisco, US, whose talk on sub-phenotyping asthma and chronic obstructive pulmonary disease reflected the Symposium’s broader emphasis on precision medicine.

The Institute of Medicine will continue these impor-

We now know that clinical care for those with ALS is radically improved by a multidisciplinary model

Dr Emer Kelly, Director of Education and Training, Institute of Medicine; Prof Ed McKone; Prof John V Fahy, Stearne Lecturer 2025; and Prof Eleanor Dunican, Consultant Respiratory Physician

tant discussions in 2026 starting with its Spring Symposium taking place on 22 January. This event brings together leading voices from medicine, academia, and industry to share diverse perspectives on how structured training, effective communication, and focused learning can inspire and retain trainees in today’s de-

manding healthcare environment.

To register for the Spring Symposium, visit https://webeur.cvent.com/event/15bd1670-3788-4584-9a3dabfb1dc953c1/summary This article was produced by the RCPI.

Profile: Prof Orla Hardiman Prof Orla Hardiman is a graduate of University College Dublin (UCD).

Following postgraduate training in Dublin, she moved to Boston in the US to complete her neurology residency at the Harvard Longwood Neurology Programme, where she served as Chief Resident in Neurology. She subsequently undertook Fellowship training in neuromuscular disease at Massachusetts General Hospital and Harvard Medical School.

Prof Hardiman returned to UCD in 1991 as a Newman Scholar in the Department of Physiology and was appointed College Lecturer in Physiology in 1994. She became a Consultant Neurologist at Beaumont Hospital, Dublin, in 1996 and was elected a Fellow of the RCPI in 2001. In 2004, she became the first Irish-based neurologist to be elected a Fellow of the American Academy of Neurology, followed by Fellowship of the American Neurological Association in 2014.

In 2007, she received a Health Research Board Clinician (HRB) Scientist Award and established an affiliation with Trinity College Dublin (TCD) as Clinical Professor of Neurology. She founded the Academic Unit of Neurology at TCD in 2011 and, in 2013, was appointed Ireland’s first Professor of Neurology. She was the HSE National Clinical Lead for Neurology before the current Clinical Lead, Prof Sinead Murphy, assumed the role.

Prof Hardiman has received

numerous international honours and awards, including the inaugural American Academy of Neurology Palatucci Award for Advocacy in Neurology (2003), the ALSA/AAN Sheila Essey Award in ALS (2009), and the Forbes Norris Award from the International ALS Alliance (2011).

She also won the eminent HRB Impact Award in 2023.

Her primary research interests include the epidemiology, causes, and treatment of amyotrophic lateral sclerosis (ALS). Her work has focused on the clinical and genetic overlap between ALS and frontotemporal dementia, as well as the epidemiology, clinical features, and healthcare needs of people with young-onset neurodegenerative conditions.

She is the author of a large number of international peerreviewed research articles, a textbook on neurodegeneration, and serves on numerous national and international boards and advisory panels.

THE MEDICAL INDEPENDENT | 13 JANUARY 2026

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Editorial

PAUL MULHOLLAND paul@mindo.ie

Fostering consultant innovation

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anuary is always a difficult month for the health service.

Hospitals are under sustained pressure, emergency departments are crowded, and clinical teams are stretched by winter illness, staffi ng gaps, and rising demand.

While it can be easy to focus on the negatives, it is important to remember, especially during periods like this, some of the positive developments taking place.

For instance, a provision in the public-only consultant contract (POCC) seeks to support consultants to develop and implement ideas that improve patient care and service delivery on the frontline.

All consultants employed under the POCC are entitled to access an annual fund to support innovation projects, research, and new ways of working. The purpose is simple: To give consultants the resources to turn good ideas into real, deliverable improvements within the health system.

A feature in this issue of the Medical Independent shows that engagement with the consultant innovation fund (CIF) has been increasing since it was introduced in 2024.

Applications rose from 212 in 2024 to 365 in 2025. Of these, 194 were approved in 2024, and 265 in 2025.

This engagement is expected to rise further in 2026.

To date, funded projects have covered a broad range of areas, including service redesign and pathway optimisation – such as one-stop clinics and streamlined referral systems – as well as digital and technology-enabled care.

The CIF is allocated to consultants to spend on innovation activity within their own clinical setting or in partnership with colleagues in other services.

In terms of funding, individual consultants can access up to €8,000 per calendar year, rising to €12,000 where unused continuing medical education funding is included.

Funding can also be pooled with other consultants or through Sparkled funding calls for larger projects.

While leadership sits with the consultant, projects must be supported by the relevant clinical director, executive clinical director, or line manager. According to the HSE, this sign-off is needed to ensure that the project aligns with organisational priorities and can be implemented and sustained.

Applications are submitted through a dedicated online portal and are supported by the HSE Spark Programme. The Spark team provides advice on innovation practice, regulation and implementation within HSE systems. They can also support projects with design input, research guidance and planning for spread and scale, helping consultants strengthen their proposals and avoid common pitfalls.

Once funding is transferred, projects are live, with support and check-ins provided throughout the year.

For 2026, changes have been introduced to address challenges identified by consultants in previous years, including delays in fund transfers and limited time to use funds.

A pre-submission deadline of 16 January 2026 has been set to allow for early feedback, with a final application deadline of 3 April 2026.

Fund transfers will take place in February, April, and May, in order to provide more realistic timelines for implementation.

Taken together, the CIF offers a practical way to support frontline clinicians to improve how care is delivered, even during periods of high pressure. By backing locally-led ideas with meaningful resources, improvements can be made which are grounded in everyday clinical experience. In a system under sustained strain, the CIF demonstrates how modest, well-targeted investment can enable improvements in everyday clinical care.

READER COMMENTS REACTION TO OUR NEWS STORY, ‘CHAIR SOUGHT BRIEFING ON BEAUMONT PRIVATE CLINIC’, 23 DECEMBER “As someone who lives a long way from Dublin I’d be concerned @CarrollJennifer that new consultants on the POCC will only want to work in hospitals co-located with private facilities (which only exist in Dublin). Surely this is wrong and goes against the ethos of the POCC.” Angela Coll, @AngelaEnnis14, 1 January

REACTION TO OUR NEWS STORY, ‘PUBLIC HEALTH STRATEGIC WORKFORCE PLAN IN DEVELOPMENT’, 23 DECEMBER “Would be great to see reform of regional health protection roles in this restructuring. The new consultant contract defined our role pretty well. But would be great to see the Senior Medical Officer role become a consistent, welldefined, seven-day senior medical decision-maker role.

“Similarly, would be great to give health protection nurses enhanced roles on a seven-day rota. They’re a skilled and enthusiastic cohort and should be sent on prescriber courses so they can manage chemoprophylaxis etc. IMHO they should be empowered to lead some of our outbreak control teams too and have an expanded role in TB clinics.

“Probably need a health protection nurse practitioner role, ultimately. We’re lucky to have a talented group of nurses, who are keen to work at the top of their license. If we don’t let them do that, they’ll move to other services.”

Dr Niall Conroy, @NICU_doc_salone, 23 December

REACTION TO GATHERING AROUND CANCER CONFERENCE COVERAGE, ‘UPDATE ON PROSTATE CANCER SURVIVORSHIP PROJECT’, 23 DECEMBER “At #GatheringAroundCancer2025, Ms Bríd O’Riordan @CancerInstIRE @Stjamesdublin shared INSPIRE: A nurse-led survivorship model for men with advanced prostate cancer. Focused on quality-of-life, INSPIRE = Individualised Care. Read more in Medical Independent.”

Trinity St James’s Cancer Institute, @CancerInstIRE, 23 December

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THE MEDICAL INDEPENDENT | 13 JANUARY 2026

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Opinion Medico-Legal

Making surgical handovers safer Ms Jessica Ryan and Prof Deborah McNamara discuss an innovative study funded by the Medical Protection Society Foundation, which shows how a simple, four-step surgical handover system can enhance safety for patients

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very morning, surgical teams meet to hand over emergency patients from the night before. This is a high-stakes communication event. Missing information, unclear priorities, and competing clinical demands can turn a routine exchange into a point of vulnerability for patients. This problem has grown as working time limits increased the number of handovers of care without a corresponding increase in training or support. Despite available guidance, many doctors work autonomously. As a result, practice remains highly variable, and safety has depended on individual effort rather than system innovations. We identified a major evidence gap, a lack of a gold standard for practice. Our research group felt there had to be a safer, more standardised approach to handover.

the majority of handovers (86.7 per cent vs 4 per cent, all p<0.001).

2. Clear improvements in patient physiology. A higher proportion of patients had improved vital signs within 12 hours (21.5 per cent vs 16.8 per cent), with an even greater effect by 24 hours (26.8 per cent vs 20 per cent, both p<0.01) when SIPS handover is used. This demonstrates that structured communication translates into measurable direct patient benefit.

3. Fewer safety issues and better staff experience. Staff reported fewer handover related safety events after SIPS was introduced (5 per cent vs 20 per cent, p=0.004). They also rated handover as more efficient, safer and of higher quality, with fewer instances of missing information and fewer patients who turned out to be sicker than expected (p<0.05 for all).

Designing a new approach to handover To tackle this problem, we undertook a programme of research. We carried out a systematic review of 41 interventional studies highlighting gaps in the literature and best evidence; a systematic review of educational interventions, which informed the design of a new handover training curriculum; a mixed-methods, multisite study to identify common pitfalls and barriers to practice; a national survey of surgical trainees in Ireland to assess practice on a wider scale; and an observational study examining the impact of involving junior team members in the handover process.

A major finding was the persistent misconception that handover involves one-way transmission of information, with most interventions relying on documentation or electronic tools. In reality, handover is a conversation between colleagues that must achieve both accurate information transfer and confirmation of understanding. This body of work led us to design an evidence-based behavioural intervention that addressed all identified gaps in practice and focused on the moments of highest communication risk. Previous successful handover models target only the individual patient presentations.

Our intervention restructured the entire meeting from start to finish.

What SIPS does not do (and why that is okay) SIPS does not replace electronic lists or specialty-specific proformas. It sits above them as a structured human-to-human conversation. It will not fix insufficient staffing or inadequate infrastructure. But it supports teams to work safely and deliver the best possible care within existing constraints. Nor does it replace clinical judgement; it simply defines the safe minimum for handover. Teams can add more detail as needed.

The SIPS surgical handover system This is a four-step system that defines the minimum required for safe surgical handover: S – Sick patients – Start the handover with a discussion of the highest risk patients; I – ISBAR – Use succinct, structured patient presentations: Identity, situation, background, assessment, recommendation; P – Prioritise – Provide a list of the most urgent patients and tasks for the next shift; S – Summarise – The receiving team closes with a brief recap to confirm shared understanding.

Image: iStock.com/Akarawut Lohacharoenvanich

What we studied Over three years, we implemented SIPS across two university hospitals and compared outcomes before and after the change. In total, the study included 2,261 emergency general surgery patients, 126 handover meetings, and 182 staff members across both sites.

Our evaluation covered: ▶ Handover quality (independent observations by trained research nurses); ▶ Patient physiology (changes in early warning scores at six, 12, and 24 hours); ▶ Safety events (daily staff reports of handover-related issues);

▶ Staff experience (surveys of efficiency, quality and safety); ▶ Implementation (evaluation of adoption, fidelity and sustainability).

What changed with SIPS 1. Better handover, same meeting length. After SIPS, handover meetings were significantly better quality without lasting longer. The sickest patients were flagged at the outset in almost every meeting (98.6 per cent vs 4 per cent), priorities were documented far more often (79.6 per cent vs 28 per cent), and the receiving team closed with a summary in

Limitations and what is next Our evaluation used a before-and-after design rather than randomisation, and clinical data were collected retrospectively from paper charts. These are real-world limitations familiar to most readers. Even so, we observed credible improvements in patient physiology and safety without lengthening meetings.

Our manuscript, recently published in JAMA Network Open, reports the full results of our study.

We are thankful to have had the support of the MPS Foundation – a global not-forprofit research initiative that invests in research into patient safety and the wellbeing of healthcare professionals – to progress this work. Next, we plan to test SIPS at scale in hospitals with digital patient records and real-time data capture and we look forward to sharing these findings.

References available on request

A major finding was the persistent misconception that handover involves one-way transmission of information, with most interventions relying on documentation or electronic tools

Ms Jessica M Ryan is a surgical researcher at RCSI focused on surgical team communication and patient safety.

She led the design and evaluation of SIPS across two Irish hospitals as part of her recently completed PhD. Prof Deborah McNamara is President of RCSI and Consultant General and Colorectal Surgeon at Beaumont Hospital, Dublin.

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THE MEDICAL INDEPENDENT | 13 JANUARY 2026

20

Opinion

When appearances deceive On a train to Edinburgh, a tense seat dispute taught me not to judge strangers too quickly GEORGE WINTER Read more by George Winter at www.mindo.ie

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his year I’m continuing my resolution made in April 2025: Don’t raise your voice to strangers.

My Edinburgh-bound train had stopped in Durham and two men in their twenties – one of them bespectacled – sat down across the aisle from me.

A Big Guy in his thirties then appeared, asserted loudly that one of them was in his seat, and ordered them to leave. They explained politely why they were in the correct seats. Big Guy leaned in threateningly. I glanced across. One of the younger men adjusted his glasses and repeated quietly that these were their seats. On reaching Newcastle, Big Guy stormed off the train beneath a cloud of suppressed rage.

On our way again, the bespectacled man opened a sports bag and removed satin shorts and a striped satin singlet with the name ‘Gilbert’ on the back. Curious, I leaned across and asked his companion if they were boxers. “No,” he replied, indicating his friend, “Bailey’s a professional mixed martial arts [MMA] fighter – sometimes called cage fighters.” My first thoughts were that Big Guy had had the luckiest of escapes, and that hitting people who wear glasses can be freighted with great risk. Bailey – ‘The Bone Collector’ – Gilbert was competing at Glasgow’s Braehead Arena the following night, and a pleasant conversation ensued in which I learned about training, diet, and fight preparation from

Bailey and his coach. But my main lesson was the folly of making character judgments based on a person’s appearance or occupation.

I sensed that the term “cage-fighting” had not earned my fellow travellers’ full endorsement, an impression reinforced after reading ‘Caged morality’ in the journal Qualitative Sociology (2011, 34: 143–175). In this article, Abramson and Modzelewski highlight the uncritical assumption that the motivations driving “the casual fan to watch men or women fight in a cage are the same as those that drive fighters to spend 20 to 30 hours a week in the gym”. Indeed, Abramson and Modzelewski found that many professional MMA athletes and coaches find the cage-fighting label distasteful as “[t]hey feel it plays upon imagined violence in the minds of observers while downplaying the skill and dedication they believe are at the sport’s core”.

Yet there is no denying that MMA can be hazardous.

For example, Hutchison et al, writing in American Journal of Sports Medicine (2014, 42: 1352–1358), reported that their analysis of 844 MMA events between 2006 and 2012 found a knock-out (KO) rate of 6.4 per 100 athlete-exposures (12.7 per cent of matches), concluding that “[r]ates of KOs and technical KOs in MMA are higher than previously reported rates in other combative and contact sports”. And in the same issue of the journal Reider cites a meta-analysis of MMA injuries which found a composite injury rate of 229 per 1,000 athlete-exposures. Further, “[t]he portion of injuries sustained by the head was high, varying from 67 per cent to a whopping 78 per cent. Laceration (37 per cent to 59 per cent), fracture (7 per cent to 43 per cent), and concussion (4 per cent to 20 per cent) were the most

common injury types.”

Perhaps it’s unsurprising to read that the British Medical Association (BMA) has previously called for mixed martial arts and boxing to be banned, as reported in the BMJ (2007,335:469). But in a spirited response to the article, GP Dr Robert Morley notes that MMA is “an amalgam of other combat formats, five of which are now Olympic sports. Some of the submission arm locking and choking techniques used in judo are identical to those used in MMA.… Would the BMA have judo banned too?” It’s a good question, and those favouring boxing and MMA bans should read the introduction to Hugh McIlvanney’s McIlvanney on Boxing (1996), where he suggests that talk from members of the BMA who chatter “about ‘legalised brain damage’ and ‘legalised grievous bodily harm’ is gimmicky sloganising, a case of going into the debating ring with a horseshoe in the glove”.

In any case, when it comes to “legalised grievous bodily harm” many of its leading exponents tend to be rugby players who sometimes swap punches during matches.

Such displays don’t prompt medical authorities to call for the sport to be banned; indeed rugby-related thuggery is often viewed with twinkle-eyed tolerance and many a broad grin, inviting the inference that it’s simple over-exuberance from boys – and generally well-educated ones − who will be boys. It’s not the case today, but when organised brawling was deployed in the name of rugby – with management’s endorsement – participants’ reputations were enhanced, not diminished.

For example, the philosophy of “getting one’s retaliation in first” was epitomised during the 1974 British and Irish Lions tour of South Africa with the infamous ‘99’ call, which was not a call to arms, but a call for fists to be thrown. Such was his enthusiasm during what came to be known as the Battle of Boet Erasmus Stadium, that medic JPR Williams ran some 40 yards to punch opposing players.

I wish Bailey Gilbert a successful – and injury-free – 2026 and I hope that Big Guy keeps his temper under control.

The tyranny of unsolicited demands From gardening advice to ‘requests’ from hospital doctors, I’m rarely short of people telling me what to do.

DR PAT HARROLD Read more by Dr Pat Harrold at www.mindo.ie

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henever I meet him, we ask each other how our gardens are. Even though my day was busy, we went through the quick enquiry.

Then he went off script.

“Do you know what they are talking about?” he said, throwing his head in the general direction of the waiting room. I didn’t.

“They are saying you should turn the back into a car park.”

I am blessed I know, having a large window in my office overlooking a garden.

I would call it a small Ark: A place of biodiversity with long grass, unruly bushes, and free-range trees. I have lost count of the number of men (they are always men) who look out and say: “I should have brought the lawnmower.”

I could have told him that I find him and his tribe incomprehensible. They see the lawn as an unruly beast that must be tamed on a weekly basis, or the country’s done for.

The few days of the week they are not in the car, they sit on mini-tractors and might as well be on the M50. Do I tell them what to do? Sometimes. And sometimes we get to the

business of their health or lack of it.

The urge to advise somebody how to do something you know sod all about is strong in us. Every seasoned publican has been told they should put out more tables, or fewer, open an extension, or close one, open late, open early, or open somewhere else.

In fact, you can spot a hardened publican because they will contradict everything you say. If you remark we were lucky to win last Sunday, he will tell you we were by far the better team. And they will tell the next punter, who extols the team that we were rubbish. They have heard it all: You should have a session, a holy hour, serve cocktails. That the music should be turned up, or down, or off.

So they have evolved a talent for disagreeing with you, just in case.

Nobody, not even a publican, likes less to be told what to do than a GP. We are fey spirits, happy to ply our craft among the people, like a Gypsy Scholar. We are roving traditional musicians, making sweet sounds among the poor and the sick, while the orchestras in the hospitals make extravagant and loud noises.

Yet when we settle into our computers with a contented sigh, we are assaulted with demands and requests. The emergency department doctor who confirmed the fracture wants you to write a letter to the orthopod who is standing beside him. The orthopod, in turn, wants you to order a test because he couldn’t be arsed. The intern rings

to know what tablets the patient is taking, even though they were prescribed by his team the week before and is the probable reason the poor crathur is in hospital at all.

It is easier than looking it up, so they make you look it up. The uneducated chancer of a politician thinks your letter could be stronger and wants you to do it again and the psychiatrist wants you to write to them about the person with schizophrenia his team have been treating for 20 years because an appointment got mixed up. Then the nursing home wants you to copy out medications for their records and berate you for your poor handwriting.

Is it for this, you ask, as you transcribe some more nonsense, that you spent the long evenings of your youth studying the Krebs cycle and the anatomy of the knee joint? Nobody can do what you can do, not the emergency department doctor, or the orthopod, or the intern. Yet they expect you to do what they should either be doing if they had the time or the inclination.

I try not to act like the contrary publican. But it can be difficult, when an SHO, lolling in the hospital office like the Emperor Nero on his couch, commands the GP to do a blood test that any of the med students, nurses, or phlebotomists who are waiting on his whim could do. The fact that it had already been done by the GP and is in the referral letter seems to be a mere detail.

If only you could get any of them on the phone – you could tell them what to do.

Patients at risk of anaphylaxis should carry 2 Adrenaline auto-injectors1 ABBREVIATED PRESCRIBING INFORMATION EpiPen (adrenaline) 300 micrograms solution for injection in pre-filled pen, EpiPen Junior (adrenaline) 150 micrograms solution for injection in pre-filled pen Please refer to Summary of Product Characteristics (SmPC) before prescribing Indications, Dosage and Administration: the emergency treatment of severe allergic reactions (anaphylaxis) to insect stings or bites, foods, drugs and other allergens, as well as idiopathic or exercise induced anaphylaxis.

Posology: Paediatric population: Usual paediatric dose is 0.01 mg/kg body weight.

However, the prescribing physician has the option of prescribing more or less than these amounts based on careful assessment of each individual patient and recognizing the life threatening nature of reactions for which this is being described.

A dosage below 150 micrograms cannot be administered with EpiPen adrenaline Auto-Injector. The physician should consider using other forms of injectable adrenaline if lower doses are felt to be necessary for small children. Children and adolescents over 30 kg in weight: The usual dose is 300 micrograms for intramuscular use. Children between 15 kg and 30 kg in weight: The usual dose is 150 micrograms for intramuscular use. Children below 15 kg in weight: The suitability of EpiPen Junior has to be judged individually. The use in children weighing less than 7.5 kg is not recommended unless in a life-threatening situation and under medical advice. Adults: The usual dose is 300 micrograms for intramuscular use. An initial dose should be administered as soon as symptoms of anaphylaxis are recognized.

In the absence of clinical improvement or if deterioration occurs, a second injection with an additional EpiPen or EpiPen Junior Auto-Injector may be administered 5 15 minutes after the first injection. It is recommended that patients are prescribed two EpiPen or EpiPen Junior pens which they should carry at all times. The physician prescribing an EpiPen or EpiPen Junior Auto-Injector must ensure that the patient understands the indications for use and the correct method of application. Therefore, the physician should discuss the patient information leaflet, the correct handling of the Auto-Injector and the possible symptoms of an anaphylactic shock in detail with the patient. Method of administration: EpiPen Auto-Injectors are intended for immediate administration in patients, who are determined to be at increased risk for anaphylaxis, including individuals with a history of anaphylactic reactions.

For intramuscular administration into the anterolateral thigh, not the buttock. It is designed to inject through clothing or directly through the skin. The patient/carer should be- informed that following each use of EpiPen or EpiPen Junior • They should call for immediate medical assistance, ask for an ambulance and state “anaphylaxis” even if symptoms appear to be improving. • Conscious patients should preferably lie flat with feet elevated but sit up if they have breathing difficulties.

Unconscious patients should be placed on their side in the recovery position.

• The patient should if possible remain with another person until medical assistance arrives.

Presentation: Solution for injection in pre-filled pen (Auto-Injector). Clear and colourless solution. EpiPen: A single dose (0.3 ml) contains 300 micrograms (0.3 mg) adrenaline (epinephrine). EpiPen Junior: A single dose (0.3 ml) contains 150 microgram (0.15 mg) adrenaline (epinephrine). Contraindications: There are no known absolute contraindications to the use of EpiPen or EpiPen Junior during an allergic emergency. Warnings and precautions: All patients who are prescribed EpiPen or EpiPen Junior should be thoroughly instructed to understand the indications for the use and the correct method of administration. It is strongly advised also to educate the patient’s immediate associates (e.g. parents, caregivers, teachers) for the correct usage of the EpiPen or EpiPen Junior in case support is needed in the emergency situation. The patient should be instructed to dial 112, ask for ambulance, state anaphylaxis to seek emergency medical assistance immediately after administering the first dose in order to have close monitoring of the anaphylactic episode and further treatment as required. The Auto-Injectors should be injected into the anterolateral aspect of the thigh. Patients should be advised not to inject into the buttock. In case of injection performed by a caregiver, immobilization of the patient’s leg should be ensured during injection to minimize the risk of leg laceration, bentneedle or other injuries. The product is for single use only and in no case the used pen should be reused. Adrenaline is ordinarily administered with extreme caution to patients who have a heart disease. Adrenaline should only be prescribed to those patients, but also those suffering from diabetes, hyperthyroidism, hypertension and elderly individuals if the potential benefit justifies the potential risk.

There is a risk of adverse reactions following epinephrine administration in patients with high intraocular pressure, severe renal impairment, prostatic adenoma leading to residual urine, hypercalcaemia and hypokalaemia. In patients with Parkinson's disease, epinephrine may be associated with a transient worsening of Parkinson symptoms such as rigidity and tremor. The patient/carer should be informed about the possibility

of biphasic anaphylaxis which is characterised by initial resolution followed by recurrence of symptoms some hours later. Patients with concomitant asthma may be at increased risk of a severe anaphylactic reaction. Accidental injection into hands or feet resulting in peripheral ischaemia has been reported. Patients may need treatment following the accidental injection. In patients with thick sub-cutaneous fat layer, there is a risk for adrenaline not reaching the muscle tissue resulting in a suboptimal effect.

A second injection with an additional EpiPen may be needed. EpiPen and EpiPen Junior contain sodium metabisulfite which may rarely cause severe hypersensitivity reactions including anaphylactic symptoms and bronchospasm in susceptible people, especially those with a history of asthma. Patients with these conditions must be carefully instructed in regard to the circumstances under which EpiPen or EpiPen Junior should be used. This medicinal product contains less than 1 mmol sodium (23 mg) per dose, i.e. essentially 'sodium -free'. Patients should -be warned regarding related allergens and should be investigated whenever possible so that their specific allergens can be characterised. Interactions with other medicinal products and other forms of interaction: Caution is indicated in patients receiving drugs that may sensitise the heart to arrhythmias, including digitalis and quinidine.

The effects of adrenaline may be potentiated by tricyclic antidepressants, monoamine oxidase inhibitors (MAO-inhibitors) and catechol -O-methyl transferase inhibitors (COMT inhibitors), thyroid hormones, theophylline, oxytocin, parasympatholytics, certain antihistamines (diphenhydramine, chlorpheniramine), levodopa and alcohol.

Adrenaline inhibits the secretion of insulin, thus increasing the blood glucose level. It may be necessary for diabetic patients receiving adrenaline to increase their dosage of insulin or oral hypoglycaemic drugs. Observe: The ß-stimulating effect can be inhibited by simultaneous treatment with ß -blocking drugs. Fertility, pregnancy and lactation: Pregnancy: Clinical experience in the treatment of pregnancy is limited.

Adrenaline should be used during pregnancy only if the potential benefit justifies the potential risk for the foetus. Breast-feeding: Adrenaline is not orally bioavailable; anyadrenaline excreted in breast milk would not be expected to have any effect on the nursing infant. Fertility: As adrenaline is a substance that naturally occurs in the body, it is unlikely that this drug would have any detrimental effects on fertility. Undesirable effects: Side effects associated with adrenaline's alpha and beta receptor activity may include symptoms such as tachycardia and hypertension as well as undesirable effects on the central nervous system.

Very common (≥1/10): None Common (>1/100, <1/10): None For details of uncommon, rare and very rarely reported adverse events and those of unknown frequency, see SmPC. Reporting of adverse reactions: Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via HPRA Pharmacovigilance, Website: www.hpra.ie. Adverse reactions/events should also be reported to the marketing authorisation holder at the email address: pv.ireland@viatris.com or phone 0044(0)8001218267.

Legal Category: Subject to prescription which may be renewed (B) Marketing Authorisation Number: PA23355/011/001 (EpiPen Junior), PA23355/011/002 (EpiPen) Marketing Authorisation Holder: Viatris Healthcare Limited, Damastown Industrial Park, Mulhuddart, Dublin 15, DUBLIN Ireland Full prescribing information available on request from: Viatris, Dublin 17.

Email: enquiry.ire@viatris.com Date of Revision of Abbreviated Prescribing Information: 30 Jun 2023 Reference Number: IE-AbPI-EpiPen-EpiPenJunior-v003 Reference: 1.EMA.Better training tools to support patients using adrenaline auto-injector. EMA/465403/ 2015. Available at: https://www.ema.europa.eu/en/news/better-training-tools-recommended-supportpatients-using-adrenaline-auto-injectors. Last accessed 06 March 2025. www.viatris.ie Job code: IE-EPI-2025-00005 Date of preparation: March 2025

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Paediatrics Clinical DONNA COSGROVE, MPSI, PhD

Paediatric pain: A different kind of pain Due to a variety of factors, a child’s pain is different to that experienced by adults, and historically has been under-recognised and under-treated

P

ain is “an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage”. It is detected by nociceptors, which are present in most body tissues and are responsive to thermal, chemical, and mechanical stimuli.1 Noxious stimuli cause tissue injury and activate nociceptors indirectly when chemical substances (ie, potassium, serotonin, bradykinin, histamine, prostaglandins, leukotrienes, substance P) are released.

The mechanical or chemical stimuli are then converted into action potentials, which travel up to the dorsal horn at the posterior of the spinal cord. From here, the stimulus goes up to the thalamus through the anterolateral system, and also to the somatosensory cortex. Emotional and cognitive components, in conjunction with nociceptive impulses, lead to the sensation of pain.

Historically, children’s pain has been under-recognised and under-treated: Minimal or no anaesthesia was used in infant surgery even into the 1980s.2,3 We now know that the nociceptive system starts functioning at the 20th week of gestation.

Studies looking at the activity around pain pathway nerve terminals have observed that nociceptive neurons do not form a specific structure in the spinal cord in preterm neonates, meaning that the premature newborn brain is actually more sensitive to pain than the adult brain, and is not always able to distinguish between noxious and innocuous stimulation.1 Children have a higher concentration of nociceptors per square meter of body surface compared to adults, and a higher level of neuromediators (meaning a higher sensitivity level). The plasticity and specific features of a child’s nervous system means that prolonged or repeated pain at a young age can increase pain sensitivity in adulthood.3

Photo Credit: istock.com/ljubaphoto

A child’s pain is different to pain that is experienced by an adult not only due to brain development, but also due to the different emotional and psychological factors that affect comprehension and response.

Healthcare settings can feel unfamiliar and overwhelming for babies, children and young people, especially when meeting multiple healthcare workers.3,4 At times, children may be viewed as passive recipients of care, which can lead to poor communication, with the child not being fully heard, or not given sufficient information.

A positive healthcare experience builds confidence, supports decision-making, and improves how a child understands and manages their condition. Healthcare workers can foster this by introducing themselves, encouraging active involvement in treatment discussions, and treating patients and carers with kindness, compassion and respect.

Young people aged 16 or over are generally presumed to have capacity to make their own healthcare decisions, with parents and carers playing less and less of a role as children grow more independent.

Clear, honest information – particularly about pain and how it will be managed – helps reduce anxiety. Creating a calm environment, using distraction and therapeutic play, and validating a child’s pain experience all contribute to better, more supportive care.

0

1

2

Face

No expression or smile

Occasional grimace or frown, withdrawn, disinterested; appears sad or worried

Frequent to constant frown, clenched jaw, quivering chin; distressed looking face; expression of fright or panic

Legs

Normal position or relaxed; usual muscle tone and motion to arms and legs

Uneasy, restless, tense; occasional tremors

Kicking, or legs drawn up; marked increase in spasticity; constant tremors or jerking

Activity

Lying quietly, normal position, moves easily; regular rhythmic breaths (respiration)

Squirming, shifting back and forth, tense or guarded movements; mildly agitated (head back and forth, aggression); shallow, splinting breaths (respirations); occasional sighs

Arches, rigid, or jerking; severe agitation; head banging; shivering (not rigors); breath holding, gasping, or sharp intake of breaths; severe splinting

Cry

No cry (awake or asleep)

Moans or whimpers, occasional complaint; occasional verbal outburst or grunt

Crying steadily, screams or sobs, frequent complaints; repeated outbursts; constant grunting

Consolability

Content, relaxed

Reassured by occasional touching, hugging, or ‘talking to’; can be distracted

Difficult to console or comfort; pushing away caregiver; resisting care or comfort measures

Paediatric pain assessment The updated World Health Organisation (WHO) analgesic ladder advocates five principles in terms of the correct use of analgesics, which is relevant to adults and children:5 ▶ Use oral forms where possible. ▶ Give at regular intervals. ▶ Administer based on pain severity, where

Table 1: The Face, Legs, Activity, Cry and Consolability Scale (FLACC) for children aged two months to seven years6

severity is assessed by a pain intensity scale. ▶ Tailor the dose to the individual patient. ▶ Maintain attention to detail throughout the prescription of pain medications.

For optimal pain management, frequent and appropriate assessment of pain should be performed, ie, in severe pain, a pain assessment should be performed every two to four hours. The specifics of pain location, quality, duration and intensity should all be assessed and recorded, and assessments repeated as necessary.1 Due to the subjective nature of pain, self-reporting by the child is preferred, however, in pre-verbal or non-verbal children, monitoring behavioural signs (facial expression, cry, irritability, feeding, sleep disturbance and activity levels) physiological parameters (heart rate, respiratory rate, blood pressure, skin colour, oxygen saturation), and reports from caregivers are also useful to indicate discomfort levels.1,5 Importantly, the absence of change in physiological parameters does not mean absence of pain.

More than 60 assessment tools are available for the paediatric population, with no evidence to recommend one over any other, although it is vital that a developmentally-appropriate assessment tool should be used.

One of the most commonly used tools for young children, due to its ease of use, is the Face, Legs, Activity, Cry and Consolability Scale (FLACC) (Table 1).6 The FLACC scale is an observational tool to assess pain, validated for children from the age of two months to seven years, in many different pain conditions. A revised version (r-FLACC) is also available, which includes additional behavioural measures for improved pain assessment in children with cognitive impairment.7 To use the scale, paediatric patients who are awake should be observed for one to five minutes or longer. If asleep, they should be observed for five minutes or longer. Based on observations during this time each category is scored on the 0–2 scale, which results in a total score of 0–10:6 ▶ 0: Relaxed and comfortable. ▶ 1–3: Mild discomfort. ▶ 4–6: Moderate pain. ▶ 7–10: Severe discomfort or pain or both.

This score can then be used to guide pain management decisions.

Pain management Acute pain Pain relief can make examination and testing of the patient easier, meaning that a diagnosis may be more easily made. There is evidence that early treatment of pain does not affect diagnostic accuracy.1 In infants and young children, the following evidence-based methods to prevent or treat pain can be offered, especially for acute needle pain:8

Continued on p24 

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Clinical Paediatrics

 Continued from p23

▶ Topical anaesthesia, ie, lidocaine and prilocaine (eg, Emla cream). ▶ Sucrose or breastfeeding for infants aged 0-12 months. ▶ Comfort positioning, such as swaddling or skin-to-skin for infants; sitting upright on a parent or carer’s lap for those aged six months and older. ▶ Age-appropriate distraction, ie, toys, books, blowing bubbles, apps, games, electronic devices.

First-line pain medications, paracetamol and ibuprofen, can be used as monotherapy or together for more severe pain, with or without additional physical and psychological approaches.1 Ibuprofen is more effective than paracetamol for treatment of acute pain like musculoskeletal trauma, headache, and dental pain, and has a similar safety profi le. In fact, ibuprofen has comparable efficacy to oral morphine for treatment of sprains, fractures, and post-orthopaedic procedures and tonsillectomy, with a superior safety profi le.

For dental pain and pain post-tonsillectomy, the combination of paracetamol and ibuprofen is more effective than paracetamol alone. Where fi rst-line options are not working for children in acute severe pain, opioids can be used. Intranasal fentanyl is a common choice due to its effectiveness and minimal distress at administration.

Morphine is the most common intravenous agent. Any patient being treated with opioids must be monitored and have the medication titrated as appropriate.

Multimodal analgesia, which combines

different classes of pain-relieving drugs and non-pharmacological approaches, acts synergistically for more effective pain control – and has fewer side-effects – than a single analgesic or modality.8 When used successfully, non-pharmacological measures are able not only to reduce pain and anxiety, but also reduce the amount of medication required.1,3 Effective multimodal analgesia approaches include:8 ▶ Medications: Basic analgesia, ie, paracetamol, NSAIDs, COX-2 inhibitors; opioids, ie, tramadol, morphine, methadone; adjuvant analgesics, ie, gabapentin, clonidine, amitriptyline. ▶ Rehabilitation: Physical therapy, graded motor imagery, occupational therapy, psychology (ie, cognitive behavioural therapy). ▶ Additional non-pharmacological modalities: Diaphragmatic breathing, bubble blowing, hypnosis, progressive muscle relaxation, biofeedback, aromatherapy, acupressure, acupuncture; physical properties such as massage, heat compresses, ice packs, repositioning.2 Anxiety and mood can also impact pain experience. By offering patients a chance to express any fears or concerns, this gives an opportunity to provide reassurance by, ie, reviewing their pain plan.2 Chronic pain Chronic pain (lasting for more than three months) is reported in 11-to-38 per cent of children.1 As in adults, lower socioeconomic status, anxiety, depression and low self- esteem are associated with chronic pain occurrence. The most common types of chronic pain in children are headaches,

abdominal pain, and musculoskeletal pain.

The best way to manage chronic pain is by using multiple approaches: Psychological, physical, occupational and pharmacological; and individualised to the patient, with the primary aim being functional improvement rather than strictly pain reduction. These strategies are likely to be more successful with the involvement of the parents/caregivers.

Involving parents and caregivers in the clinical discussion around pain management of their child informs and empowers them to help in providing optimal pain management at home. Psychological strategies like distraction and physical strategies like appropriate wound dressing or encouraging physical activity are useful, teachable skills to take home. Adequate analgesics should also be prescribed.

Untreated pain Accurate assessment of paediatric pain can be extremely difficult. In paediatric patients admitted to hospital, pain may not be assessed adequately or regularly. There are a myriad of reasons for this, including:1,2,3 ▶ Limited experience and training in acute pain management in children. ▶ Crowded emergency rooms in the hospital environment. ▶ Individual clinical condition. ▶ Variations in children’s age, development, communication levels, personalities and temperaments. ▶ Lack of clinical standards. ▶ Underuse of pain scoring tools. ▶ Old misconceptions (ie, ‘children do not feel as much pain as adults’).

Untreated acute pain (due to, ie, disease, trauma, surgery, interventions or

‘Green whistle’ for children approved for emergency pain relief following clinical trial A major international clinical trial, led in Ireland by a team from Children’s Health Ireland (CHI) (Prof Michael Barrett, with Co-Investigator Dr Carol Blackburn, and Research Nurses Madeleine Niermeyer, Ellen Barry, and Rachel Gallagher, supported by the emergency department team), has found that methoxyflurane, delivered via the familiar ‘green whistle’ (Penthrox), provides significant and rapid pain relief for children aged six years and older with acute trauma injuries.

The study, conducted through the CHI Clinical Research Centre, which is supported by the Health Research Board (HRB) and Children’s Health Foundation (CHF), marks a major step forward in emergency paediatric care.

The MAGPIE trial (Methoxyflurane analgesia in paediatric injury emergency) evaluated the use of methoxyflurane in over 240 children aged six to under 18 years presenting with moderate or severe pain in emergency settings. The results are clear: Children who received

methoxyflurane experienced a faster and greater reduction in pain compared to those given a placebo treatment.

Children in pain described the pain relief while inhaling the green whistle.

Of note, only one-in-10 of those treated with methoxyflurane needed rescue or extra pain medication, compared to one-in-three in the placebo group – highlighting its effectiveness as a first-line treatment in emergency care. While some mild side-effects such as dizziness, euphoria, and altered taste were more common in the methoxyflurane group, these were expected, short-lived and well-tolerated.

The MAGPIE trial was led by UK Chief Investigator Dr Stuart Hartshorn, Birmingham Children’s Hospital, and conducted utilising the international Paediatric Emergency Research United Kingdom and Ireland (PERUKI) research network. It builds on previous adult trials and now confirms methoxyflurane’s effectiveness and safety for children in clinical settings.

The trial has now concluded and

its findings support wider paediatric adoption of methoxyflurane as part of standard pain relief protocols in emergency departments and prehospital settings.

“The success of the MAGPIE trial is a testament to the dedication and professionalism of our entire team in CHI. Delivering a randomised controlled trial for children in pain in a busy 24/7 paediatric emergency department is no small feat, balancing emergency care with rigorous research protocols, all while supporting children and families in distress. I’m incredibly proud of our staff, whose commitment to care made it possible to carry out this important study to the highest standard. The green whistle offers an option that can be delivered quickly, effectively addressing pain, and improving the care experience for patients and their families. We are very proud to have been part of its approval,” said Prof Michael Barrett, Irish Lead and Co-Investigator for the MAGPIE trial, and Paediatric Emergency Medicine Consultant, CHI at Crumlin.

disease directed therapy) can lead to fear or avoidance of future engagement with the healthcare system, therefore adequate pain management is vital.8 Even untreated needle pain (from, ie, vaccinations, blood draws, cannulations) can result in needle phobia, hyperalgesia, and anxiety about the procedure, resulting in avoidance of healthcare.

Exposure to severe pain without sufficient pain management is ultimately linked with increased risk of chronic pain, anxiety and depressive disorders in adulthood; increased morbidity and mortality, and increased burden on healthcare resources.1 Conclusion Pain in children is a complex sensory and emotional experience, influenced by developing neurological pathways, making early and repeated pain particularly impactful across the lifespan. Accurate and developmentally-appropriate assessment is essential to guide management choices that may include pharmacological and/or non-pharmacological strategies.

Effective, compassionate pain management not only reduces suffering, but also prevents long-term consequences such as chronic pain, anxiety, needle phobia, and avoidance of healthcare.

References 1. Trottier ED, Ali S, Doré-Bergeron MJ, Chauvin-Kimoff L. Best practices in pain assessment and management for children.

Paediatr Child Health. 2022;27(7):429-37 2. Rodkey EN, Riddell RP. The infancy of infant pain research: The experimental origins of infant pain denial. J Pain.

2013;14(4):338-50 3. Pancekauskaite G, Jankauskaite L. Paediatric pain medicine: Pain differences, recognition, and coping with acute procedural pain in the paediatric emergency room. Medicina (Kaunas).

2018;54(6):94 4. National Institute for Health and Care Excellence (NICE). Babies, children and young people’s experience of healthcare.

NICE guideline NG204. London: NICE; 2021. Available at: www.nice.org.uk/ guidance/ng204 5. Gai N, Naser B, Hanley J, Peliowski A, Hayes J, Aoyama K. A practical guide to acute pain management in children. J Anaesth. 2020;34(3):421-33 6. Children’s Health Ireland. FLACC behavioural pain assessment scale.

Dublin: Children’s Health Ireland; 2017. Available at: https://media. childrenshealthireland.ie/documents/ Pain-FLACC-Behavioural-Pain-AssessmentScale-.pdf 7. Malviya S, Voepel-Lewis T, Burke C, Merkel S, Tait AR. The revised FLACC observational pain tool: Improved reliability and validity for pain assessment in children with cognitive impairment.

Paediatr Anaesth. 2006;16(3):258-65 8. International Association for the Study of Pain. Pain in children: Management.

Fact sheet. Washington (DC): IASP; 2021.

Available at: www.iasp-pain.org/resources/ fact-sheets/pain-in-children-management/

THIS INFORMATION IS INTENDED FOR HEALTHCARE PROFESSIONALS ONLY THIS INFORMATION IS INTENDED FOR HEALTHCARE PROFESSIONALS ONLY THIS INFORMATION IS INTENDED FOR HEALTHCARE PROFESSIONALS ONLY

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IMPORTANT NOTICE: Breastfeeding is best. Nutriprem Human Milk Fortifier, Nutriprem Protein Supplement, Hydrolysed Nutriprem, Nutriprem 1 and 2 are Foods for Special Medical Purposes for the dietary management of preterm and low birthweight infants. They should only be used under medical supervision, after full consideration of the feeding options available, including IMPORTANT NOTICE: Breastfeeding is best. Nutriprem Human Milk Fortifier, Nutriprem Protein Supplement, Hydrolysed Nutriprem, Nutriprem 1 and 2 are Foods for Special Medical Purposes breastfeeding.

Hydrolysed Nutriprem, Nutriprem 1 and 2 are suitable forFortifier, use as the sole source of nutrition for preterm andNutriprem, low birthweight infants.

Refer toFoods label for Special details. Medical Purposes IMPORTANT NOTICE: Breastfeeding is best.

Nutriprem Human Milk Protein Supplement, Hydrolysed 1 and 2 are for the dietary management of preterm and low birthweight infants.

They Nutriprem should only be used under medical supervision, after Nutriprem full consideration of the feeding options available, including for the dietary management of preterm and low birthweight infants. They should only be used under medical supervision, after full consideration of the feeding options available, including breastfeeding.

Hydrolysed Nutriprem, Nutriprem 1 and 2 are suitable for use as the sole source of nutrition for preterm and low birthweight infants. Refer to label for details.

HMF: Human Milk Fortifier. breastfeeding. Hydrolysed Nutriprem, Nutriprem 1 and 2 are suitable for use as the sole source of nutrition for preterm and low birthweight infants. Refer to label for details.

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Available at www.mims.ie (accessed August 2025). **Nutriprem Human Milk Fortifier is only used in specific cases in the community and under the supervision of Neonatal HMF: Human Milk Fortifier.

Dietitian. †Market comparison of preterm formula (August 2025). 1. Boehm, et al. Arch Dis Child Fetal Neonatal Ed. 2002;86:F178–81. 2. Knol, et al. Acta Paediatr. 2005;94(449):31–3. 3. Mihatsch, et *MIMS online.

Available at www.mims.ie (accessed August 2025). **Nutriprem Human Milk Fortifier is only used in specific cases in the community and under the supervision of Neonatal *MIMS online.

Available at www.mims.ie (accessed August 2025). **Nutriprem Human Milk Fortifier is only used in specific cases in the community and under the supervision of Neonatal Paediatr. al. Acta † 2006;95(7):843–8.

Dietitian. † Market comparison of preterm formula (August 2025). 1. Boehm, et al. Arch Dis Child Fetal Neonatal Ed. 2002;86:F178–81. 2. Knol, et al. Acta Paediatr. 2005;94(449):31–3. 3. Mihatsch, et Dietitian. Market comparison of preterm formula (August 2025). 1. Boehm, et al. Arch Dis Child Fetal Neonatal Ed. 2002;86:F178–81. 2. Knol, et al. Acta Paediatr. 2005;94(449):31–3. 3. Mihatsch, et ActaPaediatr.

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Clinical Paediatrics ELEANOR BURKE 1 and ROBERT KERNAN 1,2 1 Children’s Health Ireland, Temple Street 2 CHI Child and Adolescent Complex Obesity Service, Children’s Health Ireland

Obesity in children and adolescents Paediatric obesity is a disease with multisystem complications, which drives referrals to subspecialist clinics in all areas of paediatrics

I

nternational data from the World Health Organisation (WHO) highlights the frightening trend in obesity in children over the last few decades – with 8 per cent of children and adolescents aged five to 19 years old now living with obesity (equating to 160 million young people), compared to just 2 per cent of children and adolescents worldwide with obesity in 1990 (31 million young people). This is in addition to the 20 per cent of children who are classified as overweight worldwide in 2022 compared with 8 per cent of children in 1990.1

Many parents and health practitioners alike have preconceptions that childhood obesity is transient and that most children grow out of this as they progress through adulthood, with statements such as ‘puppy fat’ or ‘waiting for a growth spurt’ frequently heard. Research suggests that this is not the case for children and adolescents living with obesity. Half of all children over six years old with obesity will have obesity in adulthood. This figure increases further for adolescents with obesity to 80 per cent, and with it, all the secondary non-communicable complications of obesity.6

Defining obesity as a disease Obesity is generally defined as abnormal or excessive fat accumulations which presents a risk to health. It was first included in the International Classification of Diseases as far back as 1948, and yet adolescents with the disease of obesity can still face stigma today when attending healthcare appointments, mainly due to a misconception that it is a cosmetic issue caused by over-eating and lack of impulse control.

Following a steady trend of increasing incidence of obesity internationally, many health authorities have further emphasised obesity as a disease. In 2013, the American Medical Association classified obesity as a “chronic, relapsing, multifactorial, neurobehavioral disease wherein an increase in body fat promotes adipose tissue dysfunction…. Resulting in adverse metabolic, biomechanical and psychosocial health consequences”.2 The European Commission equally identified obesity as a chronic disease in 2021, describing it as a “chronic relapsing disease, which in turn acts as a gateway to a range of other non-communicable diseases, such as diabetes, cardiovascular disease, and cancer”.2 Recognition of obesity as a disease is crucial as it allows strategies to be put in place for prevention, identification, early intervention, and treatment to improve patient health, quality-of-life and overall mortality, whilst reducing healthcare costs.

Aetiology Obesity is a chronic disease, which is caused by a complex interplay of genetic, psycho-social, and lifestyle factors, impacted hugely today by the obesogenic environment in which we live. ‘Set-point theory’ suggests that humans have a predetermined weight range, which is regulated by neuroendocrine physiological mechanisms. Once this ‘range’ is upregulated by biopsychosocial events, including stressful life events and living in an obesogenic environment, it becomes hugely challenging to downregulate this set point again.7 Upon successful weight loss, the body triggers adaptive responses such as modulation of satiety hormones, altered food preferences through behavioural change, and reduction in metabolism. New pharmacological therapies aim to target some of the hormonal receptors which influence satiety and fullness.

Childhood obesity in Ireland Obesity among Irish children mirrors this international trend. The Irish Childhood Obesity Surveillance Initiative (COSI) is an ongoing, systematic process of data collection, analysis, and reporting on childhood obesity in primary school children in collaboration with WHO Europe. The most recent report from 2022–2023 estimates that in primary school, 17.7 per cent of children are living with overweight or obesity.3 Children attending schools classified as more disadvantaged have significantly higher rates of obesity compared to their more affluent counterparts.

Similar adolescent data from the ‘Growing up in Ireland study’ confirms this trend, with 24 per cent of adolescents living with overweight/obesity in 2020, compared with 18 per cent in 2006, and 13 per cent in 1990.4 Within this adolescent cohort, there was a substantial increase in both the amount and the severity of obesity. In 2020, 8 per cent of adolescents had obesity, compared with 3 per cent in 2006, and 0.5 per cent in 1990 (p<0.001).4 Paediatric obesity is a disease with multisystem complications which drives referrals to subspecialist clinics in all areas of paediatrics. For example, a child with obesity may require respiratory consultation for obstructive sleep apnoea, endocrinology input for insulin resistance or type 2 diabetes, nephrology for hypertension, neurology for intracranial hypertension, orthopaedics for slipped upper femoral epiphysis or Blount’s disease, gastrointestinal input for hepatic steatosis, and dermatology input for hidradenitis suppurativa, to name but a few. The psychological burden of the disease of obesity is significant, with adolescents reporting low self-esteem, bullying, marginalisation, and high rates of school absenteeism. Paediatric obesity is a strong predictor of lifelong adverse health outcomes, with increased rates of cardiovascular disease, hypertension, and type 2 diabetes leading to decreased life expectancy.5

Management in the Irish context The Irish framework for management of child and adolescent obesity is guided by the HSE Model of Care for the Management of Overweight and Obesity.8 Effective obesity treatment involves a multidisciplinary team (MDT) approach with a focus on parental education and familial behavioural change. First-line treatment is lifestyle intervention with nutritional support, physical activity, and behavioural therapy.

An audit of the MDT-guided ‘W82GO’ programme at Children’s Health Ireland (CHI) showed a reduction in body mass index standard deviation scores (BMI-SDS) in almost twothirds of children attending the lifestyle advice programme over a 12-year period. This shows that most children living with overweight or obesity can be managed at primary and secondary level, although an increase in health and social care professions (HSCP) support at local community level is crucially required to meet the national demand. Children with ‘complex obesity’ (BMI >99.6th centile with two or more obesity-related complications) meet criteria for referral to CHI’s tertiary complex obesity service, established in 2023.

Pharmacological therapies are relatively novel in paediatric obesity, but are being used with increasing frequency worldwide. Glucagon-like peptide-1 (GLP-1) agonists have shifted the paradigm for obesity treatment as they permit the opportunity to treat the disease of obesity itself, rather than reactively treating its complications.

GLP-1 receptor agonists – liraglutide (max 3mg) daily subcutaneous injection and semaglutide (max 2.4mg) weekly injection were licenced and approved by the European Medicines Agency for use in adolescents 12 years and older in 2018 and 2023, respectively. These medications are commenced at low doses and titrated gradually to full doses as tolerated. They act by regulating hunger via central nervous system effects and delayed gastric emptying, and improve metabolic parameters by increasing insulin secretion and reducing insulin resistance.9 In addition to this, there is some evidence that GLP-1 agonists regulate reward pathways involved in eating behaviours, and may reduce impulsivity and binge eating patterns.10 Evidence for GLP-1 receptor agonist efficacy in the paediatric population is scarce compared to the adult population. For liraglutide, the SCALE Teen randomised-controlled trial (RCT) demonstrated a statistically-significant

reduction in BMI in adolescents on liraglutide over a 56week treatment period compared with placebo – a BMI reduction of 10 per cent or more occurred in 26.1 per cent of participants when combined with intensive lifestyle intervention alone.11 However, once liraglutide was stopped, adolescents in the trial rebounded back to their original BMI. Semaglutide has shown a higher level of weight reduction compared to liraglutide, whilst its administration as a weekly injection compared to a daily injection makes it more tolerable to adolescents, thus promoting compliance. The STEP TEENS clinical trial at week 68 showed average body weight loss of 14.7 per cent among adolescents on the medication, with >10 per cent body weight loss in 61.8 per cent of users, and >15 per cent body weight loss in 53.4 per cent of users.12 This medication was generally well tolerated in both RCTs, with transient gastrointestinal disturbance the most commonly reported side-effect. There is an increased risk of pancreatitis and gallstones compared to placebo, whilst this medication is contraindicated if there is a family history of medullary thyroid hyperplasia and in pregnancy.

When extrapolating the data from these trials for use in a clinical context, it is important to note that the patient group selected in both trials had a stabilised weight trajectory for three months prior to starting medication. Each patient also underwent intensive lifestyle advice focusing on nutrition and activity for a 12-week run-in period prior to starting anti-obesity injectable medication. This emphasises the importance of using GLP-1s as an adjunct to HSCP supports, rather than using medication as an alternative in isolation.

Further questions remain to be answered when using GLP-1 agonists for obesity management. There is limited evidence for efficacy of GLP-1s in children under 12 years at present, but small safety studies show promising weight stabilisation effects.13 No long-term data is available yet for young people on GLP-1 agonists, and as mentioned, weight gain tends to rebound upon cessation. This raises the question, will a paediatric patient commenced on GLP-1 agonists require them for life? Could micro-dosing of GLP-1s be effective in maintaining BMI control, once weight-loss has been achieved? When will GLP-1 agents be available orally (studies ongoing), and will they have the same weight-loss benefit as their injectable counterparts?

Looking to the future for Irish young people In Ireland, GLP-1 receptor agonists are not reimbursed for treatment of obesity in children and adolescents. This places the responsibility on parents to self-fund this medication, which costs around €150–€200 per month. Given the higher prevalence of the disease of obesity in socially disadvantaged areas, this expense is prohibitive to most families.

This has the potential to further widen the gap in obesity distribution between social classes.

Even for those families that can afford medication in the short-term, GLP-1 agonists are not a short-term therapy option. Petition to Government agencies for funding for these agents as part of a wider national weight management strategy is ongoing. Irish adults have access to liraglutide through the HSE managed access protocol if they meet criteria: ≥35kg/m2 with prediabetes and high risk of cardiovascular disease, and have an effective response to medication after 12 weeks.14 Through this managed access protocol, the medication is funded and can be accessed outside of specialised tertiary obesity services. There is a need for Irish adolescents to be included in all future programme planning, including access to anti-obesity medication, to provide early intervention in order to reduce the risk of future complications, which will inevitably occur when obesity follows most of these young people into adulthood.



Continued on p28

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THE MEDICAL INDEPENDENT | 13 JANUARY 2026

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Clinical Paediatrics



Continued from p26

In line with international standards, there are plans for paediatric bariatric surgery as part of the HSE Model of Care for the Management of Overweight and Obesity 2025.8 This will be one national centre for a select group of young people, located within the new National Children’s Hospital, consisting of a consultant-led MDT for complex case management, assessment, and approval for bariatric surgery and comprehensive pre-, peri-, and post-operative education and support. Internationally, paediatric bariatric surgical options focus on laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass surgery.15,16 Exact criteria will be further outlined in national guidelines upon their completion and publication.

Resources for practitioners For Irish healthcare professionals wanting to access educational resources or resources to provide families under their care, there is a wealth of information available on www. childhoodobesity.ie – the national paediatric obesity management website developed by Sláintecare and the RCSI. This includes a series of e-learning modules with continuing professional development accreditation for healthcare professionals on childhood obesity, leaflets for parents, and links to international guidelines. Additional resources available include the ‘Making every contact count’ e-learn-

ing module for paediatric and adult practitioners on HSELand, and the Healthy living with CHI booklet, available on the CHI website, www.childrenshealthireland.ie

References 1. World Health Organisation. Obesity and overweight [Internet].

Geneva: WHO; 2025. Available at: www.who.int/news-room/factsheets/detail/obesity-and-overweight [cited 2025 Oct 14] 2. Burki T. European Commission classifies obesity as a chronic disease. Lancet Diabetes Endocrinol. 2021;9(7):418 3. Kilduff O, Slattery J, Lee C, O’Brien S, et al. The Childhood Obesity Surveillance Initiative (COSI) in the Republic of Ireland – Findings from 2022 and 2023. Dublin; 2024 4. Layte R, McCrory C. Growing Up in Ireland: Key findings from the longitudinal study of children. Dublin; 2018. Available at: www. growingup.gov.ie/growing-up-in-ireland-publications/ 5. Rubino F, Cummings DE, Eckel RH, Cohen R V, et al. Definition and diagnostic criteria of clinical obesity. Lancet Diabetes Endocrinol.

2025;13(3):221-262 6. Simmonds M, Llewellyn A, Owen CG, Woolacott N. Predicting adult obesity from childhood obesity: A systematic review and meta-analysis. Obes Rev. 2016;17(2):95-107 7. Ganipisetti VM, Bollimunta P. Obesity and Set-Point Theory. [Updated 2023 Apr 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan. Available at: www.ncbi.nlm.nih.gov/ books/NBK592402/ 8. Health Service Executive. National Clinical Programme for Obesity [Internet]. Model of Care for the Management of Overweight and

Obesity. 2020. Available at: www.hse.ie/eng/about/who/cspd/ ncps/obesity/model-of-care/ 9. Agosta M, Sofia M, Pezzino S, D’Amato S, et al. Efficacy of liraglutide in paediatric obesity: A review of clinical trial data. Obes Med. 2024;48:100545 10. Bartkoski M, Poweleit EA, Stancil SL. GLP-1 Agonists for paediatric psychopharmacology: Opportunities and cautions. Clin Transl Sci. 2025;18(6):e70262 11. Kelly AS, Auerbach P, Barrientos-Perez M, Gies I, et al. A randomised controlled trial of liraglutide for adolescents with obesity. N Engl J Med. 2020;382(22):2117-2128 12. Weghuber D, Barrett T, Barrientos-Pérez M, Gies I, et al.

Once-weekly semaglutide in adolescents with obesity. N Engl J Med. 2022;387(24):2245-2257 13. Mastrandrea LD, Witten L, Carlsson Petri KC, et al. Liraglutide effects in a paediatric (7–11 years) population with obesity: A randomised, double-blind, placebo-controlled, short-term trial to assess safety, tolerability, pharmacokinetics, and pharmacodynamics.

Paediatr Obes. 2019;14(5):e12495 14. Health Service Executive. Liraglutide (Saxenda) [Internet]. Available at: www.hse.ie/eng/about/who/cspd/medicines-management/ managed-access-protocols/liraglutide-saxenda-/ [cited 2025 Oct 16] 15. Hampl SE, Hassink SG, Skinner AC, et al. Clinical practice guideline for the evaluation and treatment of children and adolescents with obesity. Paediatrics. 2023;151(2):e2022060640 16. National Institute for Health and Care Excellence. Overview | Overweight and obesity management | Guidance | NICE. 2025 Jan 14 [cited 2025 Oct 14]; Available at: https://www.nice.org.uk/ guidance/ng246

MCQs

MULTIPLE CHOICE QUESTIONS

Question 3

Umbilical hernia in young children A. B. C. D. E.

Question 4

Involves a protrusion through a split in the linea alba.

Never strangulate.

Left alone will normally heal in the first few months of life.

Should be strapped until healing has occurred.

If still present at one year, should be operated on.

In the treatment of eczema, recognised side-effects of emollient use include A. B. C. D. E.

Question 5

Typical age at presentation is eight to 15 years.

In 10 per cent of patients it is bilateral.

Limits flexion and external rotation at the hip.

Prognosis is worse the younger the child at onset.

When suspected, patient should be referred urgently to a specialist.

Dryness of the skin.

Staining of the skin.

Topical sensitisation.

Thinning of the skin.

Stinging.

In polycythaemia vera A. B. C. D. E.

Median age of presentation is 55 to 60 years.

Presenting symptoms include pruritus.

Patients are at risk of developing myelofibrosis.

Initial treatment is frequent venesection.

Contraindicates the use of low-dose aspirin.

B. FALSE. Generally easily reduced, though very rarely may strangulate.

C. TRUE. Unless an underlying abnormality exists, eg, ascites, hypothyroidism.

D. FALSE. No treatment required unless still present at age of four years or if it is very large, when can be repaired as a day case.

E. FALSE. See D.

A. B. C. D. E.

ANSWER 1 A. FALSE. Late adolescence or early 20s.

B. FALSE. By definition must arise from within the patient’s mind.

C. TRUE. To avoid triggering the obsession and the anxiety it arouses.

D. TRUE. Through maintaining the obsession the patient may be rewarded with a decrease in anxiety, albeit temporary.

E. FALSE. An SSRI, and higher doses may be required for at least 12 weeks for a full treatment trial.

In Perthes disease

ANSWER 4 A. FALSE. This is the main indication for their use.

B. FALSE. Potassium permanganate may cause this.

C. TRUE. Their preservatives may, rarely, cause contact allergy.

D. FALSE. This is a risk with topical steroid use.

E. FALSE. Topical antibiotics may cause this.

Question 2

ANSWER 2 A. FALSE. Five-to-nine year-olds; boys rather than girls.

B. TRUE. Avascular necrosis of unknown aetiology.

C. FALSE. Often no abnormality on examination, but if there is, it will be limited internal rotation.

D. FALSE. Worse prognosis with increasing age.

E. FALSE. Managed by observation and avoidance of vigorous exercise, so no need for urgent referral.

A. Peak age of onset is in the early 50s.

B. Obsessions can arise either from within the patient’s mind or from an outside agency.

C. Marked avoidance behaviour is characteristic.

D. The object of compulsions is to decrease anxiety.

E. The drug treatment of choice is clomipramine.

ANSWER 5 A. TRUE. And median time to death if untreated is 18 months.

B. TRUE. Plethora, conjunctival injection, gout, splenomegaly, cerebral symptoms, CVA. C. TRUE. And leukaemia.

D. TRUE. And then, if necessary, hydroxyurea.

E. FALSE. Reduces thrombotic events and, in the absence of significant contraindications, all these patients should be on it.

In obsessive compulsive disorder

ANSWER 3 A. FALSE. Through a weakened umbilical cicatrix. The paraumbilical hernia will not heal spontaneously unless small.

Question 1

Imagery: istock.com

THE MEDICAL INDEPENDENT | 13 JANUARY 2026

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Conference Preview Irish Nephrology Society, Winter Meeting, Imperial Hotel, Cork, 23–24 January 2026

Nephrology community to gather in Cork for key national meeting The Irish Nephrology Society Winter Meeting will feature expert talks and discussion on the latest developments in the field

T

he Irish Nephrology Society (INS) will hold its Winter Meeting at the Imperial Hotel in Cork on 23–24 January 2026. The two-day event will bring together nephrology specialists, trainees, and guests for updates on key areas of kidney care. The programme features clinical talks, case discussions, and expert sessions covering both Irish and international developments in the field.

Opening The meeting opens on Friday 23 January with a welcome delivered by Dr Sarah Moran, Consultant Nephrologist, Cork University Hospital (CUH). She will be followed by Dr Blathnaid O’Connell, ASPIRE Fellow at CUH, who will present an update on obstetric nephrology. An interactive obstetric nephrology clinical case discussion will follow.

After a short break, the session will continue with a presentation on pre-conception counselling. This will be followed by Dr Claire McCarthy, Consultant Obstetrician, Cork University Maternity Hospital, who will speak about medication safety in pregnancy. Closing remarks for the evening will be delivered by Dr Eva Long, Consultant Nephrologist, CUH. In parallel with these talks, a specific NCHD session will also be held.

A conference dinner will take place later that night, with places reserved during registration.

Second day Saturday 24 January begins with registration, tea, and coffee, along with an opportunity to meet the event sponsors.

Dr Moran will deliver the morning welcome before the day’s scientific programme begins.

The first session starts with an update on the Irish End-Stage Kidney Disease (ESKD) Registry, presented by Dr Conor Judge, Consultant Nephrologist, University Hospital Galway. Dr Judge’s primary focus is applying artificial intelligence (AI) solutions to enhance patient care, including chronic conditions like hypertension.

He leads the development of an AI clinical decision support system for hypertension management at the University of Galway. He is a clinical mentor with the Bioinnovate programme at the University.

He also received several research awards including a Health Research Board (HRB) Clinician Scientist Fellowship, the Enterprise Ireland Clinical Innovator Award, the Cleveland Clinic Award, and a Wellcome Trust/HRB Irish Clinical Academic Training PhD Fellowship.

An article published on the HRB Open Research Platform last year, which Dr Judge contributed to, was titled ‘Working towards a national ESKD data system

Image: iStock.com/adventtr

Dr Conor Judge

Prof Jon Barratt

for Ireland’.

The article concluded: “The stakeholder engagement process successfully identified core requirements and governance priorities for a national ESKD data system. The creation of individual workstreams to inform system design and operationalise these requirements are the next steps in this process.”

Following Dr Judge’s presentation, Dr

Claire Kennedy, Consultant Nephrologist, St James’s Hospital, Dublin, will then speak on optimising home therapies for ESKD. Ms Carol Moore, CEO of the Irish Kidney Association, will then present on the role of the patient voice in Irish nephrology. A short questions and answers period will bring the session to a close before a break.

The second session will focus on IgA

The stakeholder engagement process successfully identified core requirements and governance priorities for a national ESKD data system

nephropathy (IgAN). Prof Michael Clarkson, Consultant Nephrologist, CUH, will begin with guidance on optimising standard care in IgAN. He will be followed by Prof Jon Barratt, Consultant Nephrologist, University of Leicester, UK, who will discuss progress and future directions in IgAN research and treatment.

Prof Barratt leads the renal research group at the University. His research is focused on a bench-to-bedside approach to improving the understanding of the pathogenesis of IgAN. He is the IgAN rare disease group lead for the UK national registry of rare kidney diseases and a member of the steering committee for the International IgA Nephropathy Network. He works closely with pharmaceutical companies interested in new treatments for IgAN and is Chief Investigator for a number of international randomised controlled phase 2 and 3 clinical trials in this area.

Dr Blathnaid O’Connell and Dr Nick Mayer will then present challenging clinical cases. A panel discussion will conclude the session before lunch.

The third session will open with Prof Austin Stack, Consultant Nephrologist, University Hospital Limerick, who will speak on the burden of glomerular disease in the mid-west.

Prof Stack’s research is focused on better understanding the burden, impact, and treatment of chronic kidney disease and acute kidney injury, including modifiable risk factors and measuring the impact of interventions.

He directs the kidney research consortium at the University of Limerick and spearheads the development of an Irish National Kidney Disease Surveillance System. His work has been funded by the American Heart Association, National Institutes of Health, HRB, and Enterprise Ireland.

He is a reviewer for Wellcome Trust UK, Chief Scientist Office for Research Scotland, and National Institutes of Health.

Next, Prof Mark Little, Consultant Nephrologist, Tallaght University Hospital, Dublin, will discuss machine-learning-informed approaches to maintenance therapy decisions in ANCA-associated vasculitis.

A short questions and answers session will follow before a break.

The fourth session begins with Dr Maeve Crowley, Consultant Haematologist, CUH, who will deliver an update on thrombotic microangiopathy. She will be followed by Prof Atif Awan, Consultant Nephrologist, Children’s Health Ireland, who will speak on rare disease in Ireland. Questions and answers will close the session.

The meeting will end with updates on the work of the Society and closing remarks from Prof Donal Reddan, INS President.

THE MEDICAL INDEPENDENT | 13 JANUARY 2026

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Conference Agenda Irish Nephrology Society, Winter Meeting, Imperial Hotel, Cork, 23–24 January 2026

PROGRAMME FRIDAY 23 JANUARY 16:30 – 17.00 17.00 – 20.30 17.00 – 17.05 17.05 – 17.35 17.35 – 18.05 18.05 – 18.20 18.20 – 18.40 18.40 – 19.00

REGISTRATION, TEA/COFFEE

11.10 – 11.30

How to optimise standard of care in IgAN – Prof Michael Clarkson, Consultant Nephrologist, CUH

11.30 – 12.30

Progress and future directions for IgAN – Prof Jon Barratt, Consultant Nephrologist, University of Leicester, UK

12:30 – 12:45

Challenging clinical cases – Dr Blathnaid O’Connell and Dr Nick Mayer

ObNephro interactive clinical case discussion

12:55 – 13:15

PANEL DISCUSSION

TEA/COFFEE

13:15 – 14:00

LUNCH/MEET THE SPONSORS

NCHD SESSION WELCOME COMMENTS – Dr Sarah Moran, Consultant Nephrologist, Cork University Hospital (CUH) Obstetric nephrology – An update – Dr Blathnaid O’Connell, ASPIRE Fellow, CUH

Pre-conception counselling – TBC Medication safety in pregnancy – Dr Claire McCarthy, Consultant Obstetrician, Cork University Maternity Hospital

SESSION 3 14.00 – 14.30

Burden of glomerular disease in the mid-west – Prof Austin Stack, Consultant Nephrologist, University Hospital Limerick

14.30 – 15.00

ANCA-associated vasculitis – Machine learning informed approaches to maintenance therapy decisions – Prof Mark Little, Consultant Nephrologist, Tallaght University Hospital, Dublin

REGISTRATION/TEA/COFFEE/MEET THE SPONSORS

15.00 – 15.15

QUESTIONS & ANSWERS

WELCOME COMMENTS – Dr Sarah Moran, Consultant Nephrologist, CUH

15.15 – 15.35

TEA/COFFEE/MEET THE SPONSORS

CLOSING REMARKS – Dr Eva Long, Consultant Nephrologist, CUH 21.00

SESSION 2

CONFERENCE DINNER (Please ensure to book your space when registering)

SATURDAY 24 JANUARY 8.30 – 9.00 9.00 – 9.15

SESSION 4

SESSION 1 9.15 – 9.45

9.45 – 10.15

Irish ESKD Registry Update – Dr Conor Judge, Consultant Nephrologist, University Hospital Galway Optimising home therapies in end-stage kidney disease – Dr Claire Kennedy, Consultant Nephrologist, St James’s Hospital, Dublin

10.15 – 10.45

Patient voice in Irish nephrology – Ms Carol Moore

10.45 – 10.55

QUESTIONS & ANSWERS

10.55 – 11.10

TEA/COFFEE/MEET THE SPONSORS

15.35 – 16.05

Thrombotic microangiopathy – An update for nephrologists – Dr Maeve Crowley, Consultant Haematologist, CUH

16.05 – 16.35

Rare disease in Ireland – Prof Atif Awan, Consultant Nephrologist, Children’s Health Ireland

16.35 – 16.45

QUESTIONS & ANSWERS

16.45 – 17.00

Irish Nephrology Society updates and CLOSING REMARKS – Prof Donal Reddan, President, Irish Nephrology Society

TARGETING IMPROVED CONTROL IN ANCA-ASSOCIATED VASCULITIS (GPA/MPA)

In combination with a rituximab or a cyclophosphamide regimen: • TAVNEOS® (avacopan) was non-inferior (p<0.001) but not superior to a GC regimen in achieving remission at Week 261,2 • TAVNEOS® was superior in sustaining remission at Week 52 (p=0.007)1,2

A first-in-class treatment for GPA/MPA which selectively targets C5aR1, recognised by EULAR and KDIGO.1,3–6 TAVNEOS® in combination with a rituximab or cyclophosphamide regimen, is indicated for the treatment of adult patients with severe, active granulomatosis with polyangiitis (GPA) or microscopic polyangiitis (MPA).1 TAVNEOS® demonstrated a well tolerated safety profile with the most common serious adverse reactions being liver function abnormalities (5.4%) and pneumonia (4.8%).1 C5aR1,, complement component 5a receptor 1; EULAR,, European Alliance of Associations for Rheumatology; GC, glucocorticoid; KDIGO KDIGO, Kidney Disease: Improving Global Outcomes.

The advocate study was a 52 week, phase 3 randomised, double-blind, double dummy controlled trial with patients assigned to receive Tavneos 30mg BD (N=166) or prednisone tapering schedule for 20 weeks (60 mg per day tapered to discontinuation by week 21 (N=164)). All the patients received either cyclophosphamide (followed by azathioprine) or rituximab. No rituximab was given beyond the first 4 weeks.

Non-study supplied GCs during the screening had to be tapered to ≤20mg per day when entering the study, and further tapered to 0 mg by the end of week 4 of the study.

Primary endpoints: % of patients in clinical remission (BVAS of 0 and no GC use in previous 4 weeks) at week 26 % of patients in sustained remission at week 52, defined as clinical remission at week 26 through to week 52 Tavneos®▼ (avacopan)

Prescribing Information – Republic of Ireland For full prescribing information refer to the Summary of Product Characteristics (SmPC) Active ingredient: Avacopan Presentation: Hard capsules available as 10 mg.

Indication: Tavneos, in combination with a rituximab or cyclophosphamide regimen, is indicated for the treatment of adult patients with severe, active granulomatosis with polyangiitis (GPA) or microscopic polyangiitis (MPA).

Dosage and Administration: Treatment should be initiated and monitored by healthcare professionals experienced in the diagnosis and treatment of GPA or MPA. The recommended dose is 30 mg taken orally twice daily, morning and evening, with food.

Tavneos should be administered in combination with a rituximab or cyclophosphamide regimen as follows: rituximab for 4 weekly intravenous doses or, intravenous or oral cyclophosphamide for 13 or 14 weeks, followed by oral azathioprine or mycophenolate mofetil and, glucocorticoids as clinically indicated. If a patient misses a dose, the missed dose is to be taken as soon as possible, unless within three hours of the next scheduled dose.

Treatment must be re-assessed clinically and temporarily stopped if: alanine aminotransferase (ALT) or aspartate aminotransferase (AST) is more than 3 times the upper limit of normal (ULN).

Treatment must be temporarily stopped if: ALT or AST > 5 × ULN, a patient develops leukopenia (white blood cell count < 2 × 109/L) or neutropenia (neutrophils < 1 × 109/L), or lymphopenia (lymphocytes < 0.2 × 109/L), or a patient has an active, serious infection. Treatment may be resumed: upon normalisation of values and based on an individual benefit/risk assessment.

Permanent discontinuation of treatment must be considered if: ALT or AST > 8 × ULN, ALT or AST > 5 × ULN for more than 2 weeks, ALT or AST > 3 × ULN and total bilirubin > 2 × ULN or international normalised ratio (INR) > 1.5, ALT or AST > 3 × ULN with the appearance of fatigue, nausea, vomiting, right upper quadrant pain or tenderness, fever, rash, and/or eosinophilia (> 5%), or an association between

avacopan and hepatic dysfunction has been established.

Contraindications: Hypersensitivity to the active substance or to any of the excipients.

Special warnings and precautions: Hepatic transaminases, total bilirubin, and white blood cell (WBC) count must be obtained prior to initiation of therapy and patients must be monitored for hepatic transaminase and total bilirubin at least 4 weeks after start of therapy for the first 6 months of treatment, and as clinically indicated. In the postmarketing setting, drug-induced liver injury and vanishing bile duct syndrome (VBDS), including cases with fatal outcome, have been reported. Avacopan must be avoided in patients with signs of liver disease, such as elevated AST, ALT, alkaline phosphatase (ALP), or total bilirubin > 3 times ULN. Treatment with avacopan must not be initiated if WBC count is less than 3.5 × 109/L, or neutrophil count less than 1.5 × 109/L, or lymphocyte count less than 0.5 × 109/L. Patients must be assessed for any serious infections.

Avacopan has not been studied in patients with hepatitis B, hepatitis C, or human immunodeficiency virus (HIV) infections. Be cautious when treating patients with a history of tuberculosis, hepatitis B, hepatitis C, or HIV infection. Monitor patients treated for ANCA-associated vasculitis according to standard practice for clinical signs and symptoms of Neisseria infection. Pneumocystis jirovecii pneumonia prophylaxis is recommended for adult patients with GPA or MPA during avacopan treatment, as appropriate according to local clinical practice guidelines.

The safety of immunisation with live vaccines, following avacopan therapy has not been studied. Administer vaccinations preferably prior to initiation of treatment with avacopan or during quiescent phase of the disease.

Angioedema has been reported in patients receiving avacopan and avacopan must be withheld in cases of angioedema. The use of strong CYP3A4 enzyme inducers, including grapefruit juice, with avacopan is to be avoided.

Patients anticipated to require long-term administration of these medicinal products are not to be treated with avacopan. If short-term co-administration cannot be avoided, closely monitor the patient for disease recurrence.

Avacopan is a moderate inhibitor of CYP3A4 in vivo and

may increase the plasma exposures of concomitant medicinal products that are CYP3A4 substrates. Adjust doses or monitor for adverse effects as per the respective product’s Summary of Product Characteristics. Avacopan co-administration with simvastatin increased simvastatin exposure significantly. Refer to simvastatin’s Summary of Product Characteristics for dose adjustments. Patients with GPA or MPA are at risk of cardiac disorders such as myocardial infarction, cardiac failure, and cardiac vasculitis. A treatment regimen based on the combination with cyclophosphamide followed by azathioprine may carry an increased risk for cardiac disorders as compared to a regimen based on the combination with rituximab.

Immunomodulatory medicinal products may increase the risk for malignancies. The clinical data are currently limited. This medicinal product contains macrogolglycerol hydroxystearate, which may cause stomach upset and diarrhoea.

Overdose: It is recommended that the patient is monitored for any signs or symptoms of adverse effects, and appropriate symptomatic treatment and supportive care are provided.

Special populations: No dose adjustment is required in elderly patients. No dose adjustment is needed based on renal function nor for patients with mild or moderate hepatic impairment. Avacopan has not been studied in subjects with severe hepatic impairment (Child-Pugh Class C) and it is therefore not recommended for use in these patient populations. Avacopan has not been studied in patients with anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis with an eGFR below 15 mL/ min/1.73 m², who are on dialysis, in need of dialysis or plasma exchange, nor in patients with severe disease manifested as alveolar haemorrhage. The safety and efficacy of avacopan in children below 12 years of age and adolescents (12-17 years of age) have not yet been established. No data are available in children below 12 years of age. Avacopan is not recommended during pregnancy and in women of childbearing potential not using contraception. A decision must be made whether to discontinue breast-feeding or to discontinue/abstain from

therapy with avacopan, taking into account the benefit of breast-feeding for the child and the benefit of therapy for the woman.

Undesirable effects: Very common (≥ 1/10): Upper respiratory tract infection, nasopharyngitis, headache, nausea, diarrhoea, vomiting, liver function test increased, WBC count decreased. Common (≥ 1/100 to <1/10): pneumonia, rhinitis, urinary tract infection, sinusitis, bronchitis, gastroenteritis, lower respiratory tract infection, cellulitis, herpes zoster, influenza, oral candidiasis, oral herpes, otitis media, neutropenia, abdominal pain upper, blood creatine phosphokinase increased. Uncommon (≥ 1/1,000 to < 1/100): angioedema. Not Known (frequency cannot be estimated from the available): Drug-induced liver injury, vanishing bile duct syndrome.

The most common serious adverse reactions are liver function abnormalities (5.4%) and pneumonia (4.8%).

Please consult the SmPC for further information on undesirable effects.

Legal category: POM MA Number: EU/1/21/1605/001, EU/1/21/1605/002, EU/1/21/1605/003 Date of autorisation: 11/01/2022 MA Holder: Vifor Fresenius Medical Care Renal Pharma France, 100–101 Terrasse Boieldieu, Tour Franklin La Défense 8, 92042 Paris la Défense Cedex, France.

Tavneos® is a registered trademark Document number: IE-AVA-2500007 Date of preparation: January 2025 Additional information is available on request.

▼ This medicine is subject to additional monitoring.

Adverse events should be reported. Reporting forms and information can be found at http://www.hpra. ie/homepage/about-us/report-an-issue Adverse events should also be reported to Vifor Fresenius Medical Care Renal Pharma, care of Vifor Pharma Ltd. Tel: +44 1276 853633.

E-mail: MedicalInfo_UK@viforpharma.com

References: 1. TAVNEOS EU SmPC. 2. Jayne D, et al. N Engl J Med 2021;384(7):599–609. 3. European Medicine Agency (2021). First-in-class medicine recommended for treatment of rare blood vessel inflammation.

Available at: https://www.ema.europa.eu/en/news/first-class-medicine-recommended-treatment-rare-blood-vessel-inflammation. Date accessed: September 2024. 4. Bekker P, et al. PLoS One 2016;11(10):e0164646.

5. Hellmich B, et al. Ann Rheum Dis 2023;0:1–18. 6. Kidney Disease: Improving Global Outcomes (KDIGO) ANCA Vasculitis Work Group. Kidney Int 2024;105(3S):S71–S116.

Job code: IE-AVA-2500046 l Date of preparation: November 2025

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Life Diary

JANUARY

MI

SATURDAY 17 Irish Liver Foundation (ILF), Annual Liver Study Day, RCSI, 26 York Street, Dublin 2. The ILF is a charity founded in 2022 that brings together patients, families, and healthcare professionals to improve liver health in Ireland. Its goals include promoting high-quality research into liver disease, driving innovation in care delivery, advocating for better policies, and reducing stigma around liver conditions. The Foundation also supports patient education, access to diagnosis and treatment, and strives to ensure world-class care for liver disease across the island. The ILF will host its third Annual Liver Study Day, bringing together GPs, consultants, and healthcare professionals involved in the care of patients with liver disease.

This year’s programme will feature state-of-the-art lectures on bariatric intervention in liver disease, sarcopaenia, liver disease in the critical care setting, and new therapies for autoimmune liver disease.Speakers include: Prof Helen Heneghan, St Vincent’s University Hospital, Dublin; Prof Karen Boland, Beaumont Hospital, Dublin; Dr Donal Ryan, St Vincent’s University Hospital, Dublin; and Dr Cathal Clifford, Our Lady of Lourdes Hospital, Drogheda. Visit: https://www.liverfoundation.ie/ SATURDAY 24 Beacon Hospital Annual GP Educational Morning, O’Reilly Hall, University College Dublin, Dublin 4.

CME accreditation has been applied for.

Visit: https://www.beaconhospital.ie

33 MINDO QUIZ

Test your knowledge and win €50

34 MOTORING

Dr Alan Moran on how BYD’s Sealion 7 makes its case

36 GALLERY

Royal Academy of Medicine in Ireland, Research Awards

37 GALLERY

RCPI St Luke’s Symposium and President’s Dinner

FEBRUARY THURSDAY 5 Health Summit 2026, Croke Park Convention Centre, Dublin 3. The Health Summit will bring together healthcare leaders, policymakers, clinicians, and innovators to discuss the future of Ireland’s health system under the theme ‘Putting health and wellbeing at the centre of our healthcare system’. The conference will explore topics such as embedding wellbeing into policy and practice, preventative care, patient-centred design, digital health innovation, and workforce sustainability.

This event provides a key platform for sharing ideas and shaping the national health agenda for 2026 and beyond.Visit: https://healthsummit.ie FRIDAY 6 Future Neuro Clinical Conference, Gibson Hotel, Point Square, North Wall, Dublin 1. The conference will focus on using AI in neurology to advance care and drive clinical innovation in Ireland.

Visit: https://futureneurocentre.ie TUESDAY 10 – SATURDAY 14 Charter Meeting 2026, RCSI, 123 St Stephen’s Green, Dublin 2. Charter Meeting 2026 will include a diverse programme of surgical and clinical events, including: National audit and case-presentation sessions, symposia on next-generation cancer care and artificial intelligence in surgery, a VideoSurgery meeting for surgical trainees and consultants, parallel-group sessions across numerous specialties (neurosurgery, ophthalmology, orthopaedics, cardiothoracic surgery, etc), and lectures such as the Abraham Colles and Carmichael Lectures. CPD credits will be available. Visit: https://www.rcsi.com/ THURSDAY 19 SPHeRE Annual Conference, RCSI, 123 St Stephen’s Green, Dublin 2. The theme of the conference is ‘Bridging the gap: Advancing population health equity in Ireland’. Keynote

Photo: istock.com/skynesher

speakers include Prof Susan Smith, Professor of General Practice, Trinity College Dublin; and Mr Bernard Gloster, CEO, HSE. Visit: https://www.sphereprogramme.ie MARCH WEDNESDAY 4 – THURSDAY 5 Trinity Health and Education International Research Conference (THEconf2026), Trinity College, Dublin 2. The theme for this conference is ‘Healthcare in a changing landscape’. As health systems undergo profound transformation, this conference offers an opportunity to explore the many forces shaping the field, from demographic shifts and evolving patient needs to technological advances, new models of care, and the challenges of a rapidly changing world. The event will feature a diverse lineup of national and international speakers who will share insights and innovations from across the healthcare space. Topics will include child and family health; healthy ageing and intellectual disability across the lifespan; maternal health; mental health, addiction and recovery; older persons’ health and wellbeing; and practice and healthcare innovation.

Visit: https://www.tcd.ie/nursing-midwifery/eventsand-conferences/theconference/ WEDNESDAY 11 – THURSDAY 12 Irish Paediatric Emergency Medicine Association (IPEM), Annual Conference, Crowne Plaza, Dublin Airport. The IPEM is a professional body that represents clinicians across Ireland who care for children in emergency settings. It brings together practitioners from both paediatrics and emergency medicine to promote education, innovation, advocacy, and research in paediatric emergency medicine (PEM). In recent years, IPEM has formally partnered with the Irish Association for Emergency Medicine, providing a dedicated forum for PEM professionals within a broader emergency medicine network. IPEM 26, themed ‘Stronger Le Chéile’, will bring together paediatric emergency medicine clinicians and multidisciplinary teams for two days of keynote lectures, hot topics, parallel sessions, and updates in paediatric emergency care. Pre-conference workshops will take place on Tuesday 10 March.

Visit: https://ipem.ie FRIDAY 27 All Island Congenital Heart Disease Network, Annual Conference, Croke Park Stadium, Dublin 3. This in-person event brings together healthcare professionals, researchers, and patients to share knowledge and advancements in the field of congenital heart disease.

APRIL THURSDAY 16 – FRIDAY 17 Irish Society for Rheumatology (ISR), Spring Meeting, Hotel Kilkenny. The ISR is an organisation of members with specialist training in rheumatology, including consultants, trainees, scientists, and researchers. The Society organises and hosts regular platforms and conferences allowing members to present clinical and scientific material; and promotes ongoing education and training in rheumatology at all levels.Visit: https://isr.ie MAY WEDNESDAY 13 – FRIDAY 15 Irish College of Ophthalmologists (ICO), Annual Conference, Galmont Hotel, Galway. The ICO is the recognised training and professional body for medical and surgical eye doctors in Ireland.

The College provides and supports education and learning for ophthalmologists in training, in practice, and those who work alongside them as they deliver care to patients.Visit: https://www.eyedoctors.ie JUNE THURSDAY 11 – FRIDAY 12 Irish Society of Gastroenterology (ISG), Summer Meeting, Radisson Blu Hotel, Limerick. The ISG is an organisation of medical specialists working in the field of gastrointestinal and liver disease and associated research. The Society also caters for specialist trainees and non-medical scientists.

It organises and host regular platforms and conferences allowing members to present clinical and scientific material; and promotes ongoing education and training in gastroenterology at all levels.Visit: https://isge.ie SEPTEMBER SUNDAY 27 – WEDNESDAY 30 International Society for Quality in Healthcare (ISQua), 42nd International Conference, Convention Centre, Dublin 1. ISQua is a memberbased, not-for-profit organisation dedicated to promoting quality improvement in healthcare.

Its 2026 conference will be held in partnership with the Department of Health and the HSE. The programme will continue to build on areas central to advancing healthcare quality and safety globally. Previous conference tracks have included topics such as patient safety, quality improvement, co-production, integrated care, health innovation, workforce development, external evaluation, and climate change and sustainability in healthcare.

Visit: https://www.isqua.org

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Mindo Quizzes Life

OUR NEW ADDRESS

Post your answers to: Mindo Quizzes, The Medical Independent, Greencross Publishing Ltd, Unit 1, The Village Mill Enterprise Park, Rathnew, Co Wicklow, A67V186. Closing date for entries is 27 January 2026

WIN €50

SPORTS QUIZ 13 January 2026 Q1

Who is the new PDC World Darts Champion?

Q2

Who was recently sacked as manager of Celtic Football Club?

Q3

Who was named as the RTÉ 2025 Sportsperson of the Year?

Q4

Which NFL team secured the opening pick in the 2026 draft this coming April?

Q5

The first tennis major of the year begins later this month in Melbourne, Australia. Who is the defending women’s singles champion?

Q6

Which League of Ireland club secured promotion to the Premier Division for the upcoming season by winning last season’s First Division?

CROSSWORD COMPETITION

SUDOKU

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9 DECEMBER 2025 ANSWERS, SOLUTIONS, AND WINNERS The winner of the 9 December 2025 Crossword is Dr Noha Nogud, Co Westmeath The winner of the 9 December 2025 Sporting Quiz is Dr Liz Cullen, Co Kildare

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Cup play-off semi-final? A: Czechia Q2

Who won the 2025 MotoGP championship? A: Marc Márquez

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What three nations will play Ireland in the pool stage of the men’s

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Rugby World Cup in Australia in 2027?

A: Scotland, Uruguay, and Portugal Who was named Athlete of the Year at the Irish National Athletics

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Awards for 2025? A: Kate O’Connor Q5

Who won the first of snooker’s triple crown events, the UK

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Championship, earlier this month? A: Mark Selby came out of retirement and tasted victory in her first bout back in

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Across ACROSS 1 Figure of speech (8) 5 Person in charge at work (4) Wireless (5) at work (4) 59- Person in charge 10 Stage performer (5) 911 - Wireless (5)of Parliament (10) Member 14 Complete (6) (5) 10 - Stage performer 15 Special ___ : film illusion (6) 11 of Parliament (10) 17- Member Secret plot (10) 20 Body of burning gas (5) 14 - Complete (6) 21 Model; perfect (5) 22- Special Wife of___ a knight (4) (6) 15 : film illusion 23 Plot outline for a play (8) 1 - Figure of speech (8)

the ring? A: Kellie Harrington

Solution to Crossword Competition

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13 January 2026

17 - Secret plot (10)

Down DOWN 1 Small pond (4) 1 - Small pond (4) 2 Periodic movement of the sea (4) 3 Cameraman2 (12) - Periodic movement of the sea (4) 4 Set of clothes (6) - Cameraman (12) 6 Person not 3accepted by society (8) 7 Physical power (8) 4 - Set of clothes (6) 8 Contentment (12) 6 - Person not accepted by society (8) 12 Calm and free from strife (8) 13 Reference point; norm (8) 7 - Physical power (8) 16 Reviewer (6) 18 Put on an item of clothing(12) (4) 8 - Contentment 19 Too (4) 12 - Calm and free from strife (8)

20 - Body of burning gas (5)

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16 - Reviewer (6)

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18 - Put on an item of clothing (4)

23 - Plot outline for a play (8)

19 - Too (4)

THE MEDICAL INDEPENDENT | 13 JANUARY 2026

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Life Motoring

Read more at www.mindo.ie

DR ALAN MORAN

I

BYD’S SEALION 7 MAKES ITS CASE

f you consider ‘new energy’ vehicles, which include hybrids, BYD is the fastest growing manufacturer by far in this class. The growth of the company has been simply exponential, and soon they will have to scrap their famous tagline – the biggest car company you’ve never heard of.

Another thing you will not have heard of is their 1,000-volt charger, which can recharge their vehicles at 2km per second. That’s 120km per minute – for all practical purposes, the same as an internal-combustion car.

Expect a charger to be coming to a station near you, just don’t try holding your breath at the same time. And speaking of charging and range anxiety, one lady I spoke to who drove a BYD full-time told me her way of reducing “charging station anxiety” or “will it/won’t it charge my car” is to have four apps on her phone for different companies.

Whatever works.

Torsion resistance Another concept introduced to us was the torsion resistance of the car. Basically, it is the resistance to twisting. We were given the value of 40,000Nm for the Sealion 7. A Bugatti Veyron, an exceptional piece of engineering with its chassis made from carbon fibre, would have a value of about 60,000Nm. The Tesla model Y, its closest rival, has a value of 21,000Nm. By the way, cutting the roof from a car, such as Porsche’s Boxster, can halve the value compared to the equivalent tintop (Cayman). In older convertible sports cars this was evident when parking with one wheel on a footpath, which would make a door difficult to open.

Anyway, the relevance today is that the higher the value, the more rigid the shell of the car, enhancing crash safety, and improving suspension isolation to allow it to do its work independently of the flex of the body. Hence, higher is better.

On the road And this translated into how the Sealion drives. Although we had a dry week for the test, cornering felt like it was on rails.

One characteristic of all electric vehicles is they will find grip wherever it is available.

I got the feeling the Sealion didn’t have to search too hard, despite being a tall SUV. I also judged the suspension as firm, but felt it was a little fussy. However, recently, in Drogheda we have come to have some of the worst road surfaces in Co Louth. Other car companies have years of experience in developing suspensions, but as a new company, and certainly new to Ireland, I will give BYD leeway on this.

One common trait of electric SUVs is a high boot floor. But in view of its height, you will sit higher (160mm taller than the BYD Seal) and this gives more footroom in the already spacious rear. Boot size is 520 litres with the seats up. Lowering them yields 1,789 litres. In practical terms, I could get the bike in lengthways and only had to remove the bike’s front wheel. There is also a 58-litre front boot.

We were given the decibel rating for the Sealion and its nearest rival, and at about 100km/h there were only a few decibels between them, with both just under 70dB. Now I know it is a log scale, but I don’t believe I would be able to detect a differ-

The growth of the company has been simply exponential, and soon they will have to scrap their famous tagline – the biggest car company you’ve never heard of

ence at that level. Take it from me, it is quiet inside. However, the radio is not great, which is odd because the sound system is otherwise excellent. I know I have said this before about BYD, but maybe if I keep saying it they will fix it.

Previously, I found the BYD driver-alerts a little overwhelming, but the volume appears to have been dialled well down and they are no longer as intrusive as before. A new addition is the camera facing the driver on the A-pillar. Spend a few seconds too long looking at the dash and an alert immediately appears telling you to get your eyes back on the road. Yawn once and you’re told to have a break.

Equipment The Sealion 7 is generous with its standard equipment, including: 360-degree cameras; adaptive cruise control (the only one to have); traffic sign recognition; intelligent speed limit control; front and rear collision warnings; and cross-traffic alerts; high beam control; blind spot detection; automatic emergency braking; amongst many other items.

The basic model is called Comfort, with a single rear motor producing 230kW, or 308bhp. Engine torque is 380Nm, allowing it to reach 0–100km/h in 6.7 seconds with top speed of 215km/h. I was privileged to have the AWD version, which has another

THE MEDICAL INDEPENDENT | 13 JANUARY 2026

35

Motoring Life

Photo Credit: iStock/ASphotowed

Photo Credit: iStock/ASphotowed

160kW (215bhp), giving a combined figure of 390kW (522bhp) and 690Nm of torque and a 0–100km/h time of 4.5 seconds.

Two batteries are offered (82.5kWh and 91.3kWh), with two powertrain options giving range options from 456km (WLTP combined figure), up to 502km.

Comfort and Design packages can be recharged at up to 150kW, (10–80 per cent in 32 minutes) with the Excellence model offering 230kW speeds (10–80 per cent in 24 minutes).

Priced at €49,125, the BYD Sealion 7 feels more luxurious and roomier than its US rival – and that was before they foolishly removed their indicator stalks.

THE MEDICAL INDEPENDENT | 13 JANUARY 2026

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Life Gallery

Photos: David Coleman/Bobby Studio

Royal Academy of Medicine in Ireland, Research Awards, RCSI, Dublin, 28 October 2025

Pictured L-to-R: Dr Jeffrey Glennon and Dr Patrick O’Sullivan

Dr Colm Healy; Ms Linda Ahern; Dr Dolores Keating; and Dr Caroline Hynes

Prof Colum Dunne; Dr James Powell; Ms Clodagh Powell; Prof Nuala O’Connell; and Dr Patrick O’Sullivan

Prof Emer Shelley and Ms Catherine Ryan

Dr Helen O’Donnell and Dr Kieran Walsh

Dr Dermot Power; Mr Mark Quigley; and Mr Declan Daly

Ms Clodagh Powell and Dr James Powell

Dr Sadhbh Hurley and Mr Robert Cronin

Mr Tom Kelly and Dr Anna Ridgeway

Dr Chris Greene; Dr Emma Connolly; Dr Jeffrey Glennon; Dr Caroline McCarthy; and Dr Gintare Valentelyte

THE MEDICAL INDEPENDENT | 13 JANUARY 2026

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Gallery Life

Photos: David Coleman & Ross Coleman – Bobby Studio

RCPI St Luke’s Symposium and President’s Dinner, No 6, Kildare Street, Dublin, 16 October 2025

Pictured L-to-R: Ms Audrey Houlihan, Chief Executive Officer, RCPI; Minister for Health Jennifer Carroll MacNeill; and Dr Diarmuid O’Shea, President, RCPI

Dr Diarmuid O’Shea; Dr Mary Davoren; Dr Ellen Cosgrave; Prof Edward McKone; Dr Dana Alyaqout; Dr Awadelkareem Mustafa; Dr Robert Califf; Prof Michael Keane; and Dr Maeve Doyle

Dr Pamela O’Connor; Prof Trevor Duffy; Prof Richard Greene; Dr Patrick Nash; Ms Audrey Houlihan; Dr Diarmuid O’Shea; Prof Mary Horgan; Prof Andrew Elder; Dr Colm Henry; and Prof Dara Byrne

Dr Diarmuid O’Shea; Dr Kirstyn James; Prof Mary Higgins; Prof Karina Butler; Dr Fionnuala Cox; and Prof Liam Plant

Prof Áine Carroll; Dr Diarmuid O’Shea; Dr Ana Rakovac; and Prof Diarmuid O’Donovan

Dr Fionnula Cox and Prof Mary Keogan

Dr Susan Cameron; Dr Sean Maher; and Dr Bearach Reynolds

Prof Hilary Hoey, who received the St Luke’s Medal; and Dr Diarmuid O’Shea

Dr Ellen Cosgrave and Dr Fiona Cullinane

Ms Mary Robinson, who received the Stearne Medal from the College, in conversation with Dr Diarmuid O’Shea

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RXDX Product Focus

STUDENT AWARDED INAUGURAL A.MENARINI SCHOLARSHIP FOR DIABETES RESEARCH

Credit: Andrew Downes, Xposure

Pictured L-to-R: Prof Fidelma Dunne, Director, HRB Diabetes Collaborative Clinical Trial Network, University of Galway; scholarship recipient Ms Ruth Alejandra Huerta Sinesio; Prof Martin O’Donnell, Executive Dean, College of Medicine, Nursing and Health Sciences, University of Galway; and Mr Francis Lynch, CEO, A.Menarini Pharmaceuticals Ireland University of Galway, in partnership with the Health Research Board (HRB) Diabetes Collaborative Clinical Trial Network, has announced the inaugural A.Menarini Pharmaceuticals Ireland Scholarship.

The successful student is Ms Ruth Alejandra Huerta Sinesio, originally from Mexico City, who was awarded the scholarship for her outstanding achievements and commitment to advancing diabetes research and patient care.

The A.Menarini Pharmaceuticals Ireland Scholarship, supported by Galway University Foundation, provides full financial support for a student in the Master of Science in Clinical Research.

Ms Sinesio was selected from a highly competitive field of candidates, demonstrating a strong dedication to improving health outcomes through her work and experience. The award will enable her to pursue advanced training and contribute to pioneering research activities, as well as strengthening her role within the Diabetes Collaborative Clinical Trial Network and broader diabetes community.

Prof Fidelma Dunne, Director of the HRB Diabetes Collaborative Clinical Trial Network and the Institute for Clinical Trials at University of Galway, said: “We are immensely proud of Ruth Alejandra and all she has accomplished to date in her career. Her passion, drive, and commitment embody exactly what this scholarship stands for.

We are deeply grateful to A.Menarini for their generous support, which enables us to nurture the next generation of clinical researchers who will make a transformative difference in Ireland and far beyond. Their investment in education and research ultimately supports the lives of people living with diabetes.”

Ms Sinesio said: “This scholarship motivates me to keep striving for excellence. I’m grateful to A.Menarini for this award, which supports my professional growth and my mission to address a major public health challenge. It’s an honour to be supported by a community that believes in students’ ability to improve care for people with diabetes. I hope to turn my experience and motivation into a lasting impact, honouring my loved ones and improving lives worldwide.”

As part of A.Menarini Pharmaceuticals’ support for students at University of Galway, the company will provide three further annual scholarships in the coming years to support students demonstrating academic excellence, leadership, community engagement, or financial need.

The company has also pledged support for education and training within the HRB Diabetes Collaborative Clinical Trial Network, including professional development, multidisciplinary training, and expanded patient and public involvement initiatives.

RESEARCHERS UNLOCK SECRETS OF SPINAL DISC DEGENERATION New research into the arrangement of sugar chains or ‘glycans’ in the cells of the spine has shed light on the critical role it plays in the complex process of disc degeneration.

Researchers at CÚRAM, the Research Ireland Centre for Medical Devices at University of Galway, together with a team of international colleagues, carried out a comprehensive investigation into the different characteristics of glycans in healthy and degenerated intervertebral discs.

It is the first time that the whole human disc glycome in the spine – the entire set of sugar chains that modify human proteins and lipids – have been analysed in this way.

Intervertebral disc (IVD) degeneration is a major cause of low back pain, a significant global health issue. While glycosylation is critical for cellular signalling and inflammation, its malfunction can lead to diseases and its role in IVD degeneration has remained poorly understood until the research was conducted.

Dr Kieran Joyce, first author of the paper, said: “From this research, we now know which sugars are expressed in the degenerated or diseased disc states, so we can design therapies to target this.

“We observed distinct alterations in glycan expression, notably an overabundance of sialic acid on the surface of the cells in degenerated discs and decreased branching, which are associated with IVD degeneration. These observed differences have implications for regulating inflammatory responses and other cellular activities.”

Prof Abhay Pandit, Scientific Director of CÚRAM and senior author of the research paper, said: “Our findings suggest that there is therapeutic potential in using biomaterial systems to intervene and alter the way proteins and glycans attach to each other to reduce inflammation associated with IVD degeneration. This research significantly advances our knowledge of the glycomic mechanisms underlying IVD degeneration and opens new avenues for developing therapies to restore disc physiology.”

The research has been published in Advanced Science and can be accessed at https://advanced.onlinelibrary. wiley.com/doi/10.1002/advs.202506669?af=R The project was carried out by CÚRAM researchers at University of Galway in collaboration with colleagues at Maynooth University, University College Dublin, the National Institute for Bioprocessing Research and Training, the Medical University of South Carolina, US, and the Institute of Chemical Technologies and Analytics, Austria.

MEDMARK ACQUIRES BLACKWELL ASSOCIATES Medmark recently announced its entrance into the Northern Irish market with the acquisition of Blackwell Associates.

The deal brings together two long-standing leaders in the sector, with a combined turnover of more than €20 million and over 160 employees. The announcement also marked the opening of Medmark’s new purpose-built clinic in Dublin city centre, increasing the number of Medmark offices from seven to nine across the island.

Founded in 1987, Medmark delivers workplace medical assessments, employee wellbeing services, and specialist clinical support to public and private sector organisations, assisting over half a million employees nationwide.

As part of Medmark, the Blackwell Associates team will continue to provide occupational health, medical screening, and workplace assessment services to people based in Northern Ireland.

Commenting on the acquisition, Dr Robert Ryan, Managing Partner, Medmark, said: “Today’s announcement is a landmark moment for Medmark. Building on our acquisition of Blackwell Associates, one of Northern Ireland’s most respected occupational health providers, we are proud to create Ireland’s largest all-island occupational health service.”

Blackwell Associates, based in Belfast, has delivered

occupational health, medical screening, and workplace assessment services for more than 25 years. It serves over 70 public and private sector clients, including some of the region’s largest employers. Under the leadership of Managing Director Dr Richard Black, Blackwell has been well-positioned for its next phase of growth under Medmark ownership.

Dr Black commented: “We are delighted to be joining Medmark, a provider whose values and clinical standards mirror our own. This partnership gives our clients access to greater resources, innovation, and expertise while preserving the trusted relationships we’ve built over 25 years.

Together, we are well positioned to deliver even more value to employers across Northern Ireland and beyond. We look forward to shaping the next chapter of occupational health as part of Medmark.”

MINISTER HIGHLIGHTS EXPANSION OF VIRTUAL CARE INITIATIVES Minister for Health Jennifer Carroll MacNeill has highlighted significant progress in the implementation and expansion of virtual care across Ireland.

Since the commencement of two pilot acute virtual wards at St Vincent's University Hospital, Dublin, and University Hospital Limerick, over 1,500 patients have been admitted, equating to more than 13,800 virtual bed days.

Four new virtual wards have now opened in Our Lady of Lourdes, Drogheda; Midland Regional Hospital, Tullamore; Mercy Hospital, Cork; and St Luke’s Hospital, Kilkenny, with plans to launch another acute virtual ward in Galway University Hospital early this year.

According to the Department of Health, virtual care is becoming an increasingly vital approach to the delivery of acute care at home to patients who would otherwise need to be hospitalised. Community virtual wards have also been established, which, along with a variety of seedling projects, are harnessing digital technology to deliver clinically-led healthcare to patients across the country.

Minister Carroll MacNeill said: “The implementation and expansion of virtual wards across Ireland is a wonderful success story that illustrates how technology can deliver effective, efficient, and sustainable healthcare, leading to measurably better outcomes.

“These innovative models are not only improving patient outcomes and supporting recovery at home, but also helping to alleviate pressure on our hospitals. I commend the dedication of healthcare professionals and local teams who are making this transformation possible and remain committed to ensuring that all regions benefit from such advancements in care.”

The HSE is expanding all types of virtual ward models nationwide. Letterkenny has been at the forefront of virtual care and was one of the first areas to adopt the virtual ward concept. Focusing initially on respiratory disease, the Letterkenny virtual ward has demonstrated impressive results, including an 18 per cent reduction in acute admissions to the hospital in 2025. Other initiatives include the community virtual ward in Cherry Orchard, which primarily serves older adults who would otherwise require hospital care, allowing patients to receive high-quality care at home while protecting them from hospital-acquired infections.

Chief Nursing Officer Ms Rachel Kenna noted: “The rollout of virtual wards represents a significant step forward for patient-centred care in Ireland. By harnessing technology and innovation, we are empowering people to receive vital treatment at home while strengthening our health service for everyone.”

According to the Department, expanding the delivery of virtual care is central to its mission to improve the health and wellbeing of people in Ireland. Digital for Care: A Digital Health Framework for Ireland 2024–2030 sets out a roadmap to digitally transform health services and improve access for patients. Establishing and scaling virtual wards is part of wider efforts to revolutionise and modernise the health service, while ensuring high quality services and getting the best value from health system resources.

THE MEDICAL INDEPENDENT | 13 JANUARY 2026

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THE MEDICAL INDEPENDENT |13 JANUARY 2026

40

The Dorsal View

If you have anything you would like to share, please email: info@mindo.ie

A round-up of news and oddities from left field by Dr Doug Witherspoon

Vocation and avocation: A research perspective on being the best physician you can be

H

appy New Year to all our readers and contributors – we hope you had a chance to unwind a little over the Christmas holiday period. In previous Dorsal Views, we have touched on the need to help patients to manage their New Year’s resolutions and keep them re-

alistic, measurable, and achievable. In this piece, we will look at how doctors can instead take care of themselves.

It might be reasonable to say now that burnout is fi rmly on everybody’s radar – or at least it should be. While it’s easy enough to advise a patient to ‘get a hobby’, what if doctors are given the same advice?

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Self-care through leisure is not a new concept at all, even for medical professionals. Indeed, it was addressed by none other than Sir William Osler, whom many consider to be the ‘father of modern medicine’, as far back as 1899.

Osler was a vigorous proponent of doctors integrating healthy leisure activities to offset the stresses and strains of their vocations – this work-life balance was termed ‘avocation’ by Osler. Having a passion or an interest outside of medicine is important for professional longevity and even to help maintain empathy, he posited.

Much more recently, a 2011 paper in BMC Medicine touched on the area and provided some interesting data.

The authors recruited 4,457 UK-qualified doctors and got a 63.8 per cent response from the participants. It was a follow-up questionnaire, as they were included in four previous studies of medical school selection and training from the eighties and early nineties. The questions were targeted and focused on career satisfaction, work engagement, personal vocational achievements, stress, emotional exhaustion, burnout, and depersonalisation.

The questionnaire also included 29 different leisure activities, as well as questions around empathy, personality, and demography.

Regarding the results, they wrote: “Doctors reporting more avocation/leisure activities tended to be women, to have older children, to be less surface-rational, more extrovert, more open to experience, less agreeable, and to fantasise more. Doctors who were more burned-out tended to be men, to be more sleep-deprived, to report a greater workload, and less choice and independence in their work, to have higher neuroticism, lower extroversion and lower agreeableness scores, and to have lower self-esteem.”

Doctors with a greater “sense of vocation/engagement” saw more patients, had greater independence at work, were more extrovert and conscientious and had better self-esteem, they continued. Avocation and leisure activities correlated highly with vocation/engagement, they pointed out, even after taking into account 25 variables.

“In this cross-sectional study there is evidence, even after taking into account a wide range of individual difference measures, that doctors with greater avocation/ leisure activities also have a greater sense of vocation/engagement,” the researchers concluded. “In contrast, being burned-out did not relate to avocation/leisure activities (but did relate to many other measures).”

Of course, burnout is a complex phenomenon and highly individualistic. But more research is showing that a major cause is related to the institutions in which doctors and other healthcare professionals work. As the data accumulates, it’s not a bad idea to glance back at Osler’s advice, which is just as relevant now as it was back then.

Perhaps even more so.

History, the humanities and literature were just a few of Osler’s suggestions for avocation, although the doctors of our era have an enormous range of options.

As an aside, a 2014 survey by the American Medical Association showed that doctors’ top avocations of choice were predominantly running for under-40s, while doctors over 40 also enjoyed jogging, hiking, cycling or camping, with more than 50 per cent of those over 60 saying they enjoy walking. As you might expect, most doctors were keen readers, and other perhaps predictable avocations included golf, aerobics and cardio, skiing, tennis, and fishing.

Get in touch with us on social media or get in contact by email to let us know what your avocation is, and how it helps you to live your best life and avoid burnout.

And the last word to William Osler: “While medicine is to be your vocation, or calling, see to it that you also have an avocation... some intellectual pastime which may serve to keep you in touch with the world of art, of science, or of letters.”