IPN August 2024 by IPN Communications LTD

GROW STRONGER, PLAY LONGER

NEWS: Pharmacy welcomes Health Bill Page 4

REPORT: Pharmaceutical Society publishes Annual Report Page 8

INTERVIEW: Gwynne Morley on Ireland’s OTC Landscape Page 15

TOP 100: The annual IQVIA Top 100 OTC Products Page 24

CATEGORY MANAGEMENT: Digestive Health Page 30

CPD: DXA Reporting Page 41

TEAM TRAINING: Stress Page 74

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Page 5: Pharmacists call for urgent need to address underfunding

Page 8: Pharmacy Regulator publishes Annual Report

Page 12: Diversity and Inclusion at PHX Ireland

Page 14: New supports for Pharmacy

Page 15: Gwynne Morley talks through the latest IQVIA Top 100 OTC Products

Page 30: An overview of the Digestive Health Category

Page 63: New appointment for Professor Robson

PUBLISHER:

IPN Communications

Ireland Ltd.

Clifton House, Fitzwilliam Street Lower, Dublin 2 00353 (01) 6690562

MANAGING DIRECTOR

Natalie Maginnis n-maginnis@btconnect.com

EDITOR

Kelly Jo Eastwood: 00353 (87)737 6308 kelly-jo@ipn.ie

SALES MANAGER

Amy Evans | amy@ipn.ie 0872799317

EDITORIAL/ EVENTS & MARKETING EXECUTIVE

Aoife Hunter: aoife@ipn.ie

CONTRIBUTORS

Gwynne Morley

Laura Gilmartin

Mark McPhillips

Michelle O’Hagan

Emily Kelly

Fatimah Kara

Dr Cathal O’Connor Oonagh O’Hagan

DESIGN DIRECTOR

Ian Stoddart Design

Foreword

As the pre-budget submissions have been getting underway, community pharmacists across Ireland have emphasised the urgent need to address the chronic underfunding of Ireland’s community pharmacy sector. The Irish Pharmacy Union, in its submission, has highlighted that Community Pharmacists must be paid an economically viable dispensing fee. Pharmacists are being paid less than they were twenty years ago.

IPU President Tom Murray said that it has been outlined to the Department of Health that 10% of Community Pharmacists are operating at a loss and another 33% are perilously close to becoming unviable based on the inadequate margins they are currently achieving. “The current fee does not cover the costs and in fact because of the regressive and penal nature of the fee structure it does not even cover the labour element of the cost.”

You can read more about this on page 5.

Meanwhile, on page 8, we carry details on the publication of the Pharmacy Regulator Annual Report. This outlines the significant work undertaken by the pharmacy regulator to protect the health, safety, and wellbeing of patients and the public by regulating pharmacists and pharmacies in Ireland.

In further news identifying the growing and key role played by community pharmacists, a recent survey as shown that pharmacies in Ireland are providing higher levels of healthcare than ever before. The Pharmacy index 2024 was produced by Ipsos B&A and found close to universal public support for expanding pharmacy services into new treatment areas. Turn to page 10 to read more.

The IPN August issue carries our annual IQVIA Top 100 statistics. Irish Pharmacy News has been working with data analysts IQVIA for over nine years in compiling and bringing this information to our readers, pharmacy professionals of Ireland.

We spoke to General Manager of IQVIA, Gwynne Morley, to gain further insights into how these statistics are compiled and on the value of this market to pharmacy.

Turn to page 15 for a full interview with Gwynne, in which she highlights the value of the OTC market to community pharmacy and the key trends affecting the consumer health market.

12 Irish Pharmacy News is circulated to all independent, multiple Pharmacists and academics in Ireland. All rights reserved by Irish Pharmacy News. All material published in Irish Pharmacy News is copyright and no part of this magazine may be reproduced, stored in a retrieval system or transmitted in any form without written permission. IPN Communications Ltd. has taken every care in compiling the magazine to ensure that it is correct at the time of going to press, however the publishers assume no responsibility for any effects from omissions or errors.

She told us, “Albeit the OTC market in Ireland continues to grow, the growth has been significantly lower than previous years. Uncertainty is impacting consumer purchasing behaviour. In addition to the market’s susceptibility to seasonal variations, survival instincts reign supreme – consumers intend to spend more on essential categories, such as health & wellness, but concerns about inflation, resulting in higher prices, has been the subject top of mind across all consumers over the past 12 months.

We follow this interview with a series of in-depth category reports, including the Digestive Health market, Sports Health and Nutrition, Pain and much more.

I hope you enjoy the issue.

New Appointment for Denis

Congratulations to Denis O’Driscoll, Superintendent Pharmacist at LloydsPharmacy Ireland on his election as Vice President of the PSI–The Pharmacy Regulator Council of Ireland.

Vice President of the PSI, Denis O’Driscoll

Exploring Parkinson’s Progression

Denis said of his election, “It is a privilege to serve in this role during such an exciting and transformative time for our profession. I look forward to working closely with our President, Katherine Morrow, the PSI Council, and the PSI corporate team. Together, we will strive to achieve a busy, industrious, and productive year ahead.”

Pharmacy Welcomes Health Bill

Denis O’Driscoll has 26 years’ experience in pharmacy, including 22 years with HSE Addiction Services as Chief Pharmacist. After spending most of his career as an addiction expert, Denis moved to the role of superintendent pharmacist for LloydsPharmacy Ireland in 2018.

Denis is currently the clinical lead for one of the largest pharmacy chains in Ireland, with 85 pharmacies, and is responsible for the management and delivery of quality pharmacy services to the public. He is also the voluntary independent chair of the Naloxone Advisory Group for the HSE Strategy on Overdose Prevention. Denis is a graduate of pharmacy from Trinity College Dublin and has a PhD in Biopharmaceutics (TCD).

Community pharmacists have welcomed the passing of the Health (Miscellaneous Provisions) Bill 2024. The legislation will facilitate an enhanced role for pharmacists and will assist with the management of the ongoing global problem of medicine shortages.

The legislation will enable the Minister for Health to pass regulations allowing for patients to access certain medications directly from their pharmacy without the need for a GP visit or prescription. It is anticipated that this may include the contraceptive pill.

To address medicines shortages this legislation will empower Pharmacists to recommend clinically appropriate substitute medicines when a prescribed medication is unavailable. This will save healthcare professionals significant time and crucially ensure that patients receive medication in a timely manner.

Welcoming the legislation, the Irish Pharmacy Union calls for its rapid implementation to bring these benefits to patients as quickly as possible.

Brennans open Fourth Pharmacy

Pictured are the Brennans Pharmacy Team with Clare O Donnell - their very own Donegal Mary - after a great launch event in Brennans Letterkenny! Also pictured is Owner Fergus Brennan who said, “A huge thanks to everyone who called in to our new Pharmacy in the Retail Park- we really appreciate your support. Thanks also to John Breslin and the Highland Radio team - it was a blast having the show broadcast from Brennans!”

Brennans Pharmacies have been looking after patients and customers for the last 32 years since Fergus Brennan opened the first Brennans Pharmacy in Buncrana in 1992.

They now serve three communities in Donegal in Buncrana, Clonmany and Creeslough. Their newest Pharmacy is based at Letterkenny’s Retail Park, beside Dunnes Stores and Costa.

A new project led by researchers at RCSI University of Medicine and Health Sciences aims to uncover critical insights into the progression and potential treatment of Parkinson’s disease.

The ambitious ¤1.8 million study, known as the 4DPDOmics project, is coordinated by Professor Jochen Prehn, Chair of the RCSI Department of Physiology and Medical Physics and Principal Investigator at the SFI FutureNeuro research centre. It hopes to enhance understanding of the neurodegenerative disorder Parkinson’s disease through advanced analysis techniques.

Dr Niamh Connolly, Lecturer, RCSI Department of Physiology and Medical Physics is also a partner on the project.

The project will explore how specific genes and proteins behave across different cell types and disease stages. Focusing on the abnormal protein deposits known as α-synuclein that are characteristic of Parkinson’s, the researchers are aiming to find new targets for future treatments.

Funded by the EU Joint Programme for Neurodegenerative Diseases Research (JPND) through the Health Research Board (HRB), 4DPD-Omics is a collaboration with expert researchers in Ireland, Germany, France, the Netherlands, Sweden, Hungary and the Czech Republic. The project is further supported by the advanced single-cell and spatial analysis platforms funded through the Science Foundation Ireland (SFI) Research Infrastructure Programme.

Dr Niamh Connolly emphasised the collaborative effort involved:

“The 4DPD-Omics project brings together a diverse team of researchers and clinicians, united by a common goal to better understand and ultimately combat Parkinson’s disease. Our multidisciplinary approach, combined with cutting-edge technology, will enable us to delve deeper into the disease mechanisms.”

Patient and Public Involvement (PPI) has been embedded in the project from an early stage, with the Dutch Parkinson patient association, Parkinson’s Alliance Netherlands, and patient advisory panels at FutureNeuro research centre in RCSI and DZNE actively contributing.

Research on Bleeding Disorder

New research by RCSI University of Medicine and Health Sciences published in Blood journal has identified how a new medicine can help people living with the bleeding disorder von Willebrand disease. The discovery opens the way for more targeted treatments of the condition, which is the most common inherited bleeding disorder in humans.

“Because von Willebrand factor has an important role in blood to form clots, patients with von Willebrand disease experience abnormal bleeding episodes, such as heavy menstrual bleeding, nose bleeds, mouth bleeds and bleeding during surgery and childbirth,” explains Dr Alain Chan Kwo Chion, a senior post-doctoral fellow at RCSI’s School of Pharmacy and Biomolecular Sciences and the Irish Centre for Vascular Biology.

“At the moment, people with von Willebrand disease are treated by increasing von Willebrand factor in the bloodstream through either administering drugs to encourage the release of von Willebrand factor that is stored in cells near blood vessels or by injecting von Willebrand factor into their veins,” explains Dr Chion. “A new drug called Rondaptivon pegol - also known as BT200 - uses a very different approach to increase von Willebrand factor in the blood. BT200 increases the amount of von Willebrand factor by slowing the body from removing the factor from the blood.”

In a series of lab experiments, they showed that BT200 makes it more difficult for immune system cells called macrophages to bind to von Willebrand factor and remove it from the bloodstream.

They identified a section of von Willebrand factor where macrophages typically bind to remove it from the blood, and showed how BT200 partially interferes with this binding. This means the macrophages cannot remove the factor as quickly, and the factor stays in the bloodstream for longer.

Address Chronic Underfunding of Community Pharmacy

The Irish Pharmacy Union (IPU) in its pre-budget submission has emphasised the urgent need to address the chronic underfunding of Ireland’s community pharmacy sector and pay Community Pharmacists an economically viable dispensing fee. Pharmacists are being paid less than they were twenty years ago.

IPU President, Tom Murray

“Many pharmacists are at breaking point, and Community Pharmacy is at a tipping point. The Government needs to take note and immediately provide the necessary funding to set this right and pay the ¤6.50 flat fee the IPU has been seeking. All other healthcare professionals, workers and contractors have had their payments restored since the 2007 financial crisis ended. We need the Autumn Budget to address this situation and put Community Pharmacy back on a viable, safe and fair footing.

“The majority of pharmacies are small, family-owned, and operated healthcare businesses, Mr Murray explained. “We provide a vital service to the State and our communities by dispensing medicines under community drug schemes. This revenue accounts for approximately 60% of the average pharmacy’s income. It is no longer viable to administer these schemes without the fee increase. Over the last twenty years costs have increased significantly particularly in the past four to five years. Community Pharmacists effectively spend 82% of their time working on the Community Drugs Scheme and are doing so at a loss. Some pharmacies are having to reduce their opening hours while a lot of pharmacists are working extensive hours in order to make ends meet.

“The IPU is calling for the introduction of a core dispensing fee of ¤6.50 for each medication dispensed under the community drug schemes. The current

outdated structure of reducing fees based on the volume dispensed in each pharmacy must be discontinued. Our costs do not decrease with higher volumes, and neither should the payments we receive.”

Mr Murray also highlighted concerns about the increased administrative burden pharmacies face: “There has been a dramatic increase in the level of administration and compliance requirements over the years and this is eating into patient care time. Streamlining and rationalisation must happen as time spent on out-of-date administration schemes is not

adding value to the patient, the state or the pharmacist. Until such time as administrative burdens are removed from the pharmacists a ¤1.50 administration fee per item dispensed will be required to compensate the pharmacy.

Concluding, Mr Murray said, “There is a huge need for expanded pharmacy-based healthcare and Community Pharmacists have the expertise to deliver it, as evidenced by the Covid vaccine programmes and access to emergency contraception, but this expanded role will only be possible if and when pharmacy is put back on a sure financial footing.”

Disposing of Unused Medicines Scheme

Urgently Required

Ireland needs to take action to reduce the amount of medicines that are being inappropriately disposed of, according to the Irish Pharmacy Union (IPU). The IPU is calling for a nationwide national Disposal of Unused Medicines Properly (DUMP) scheme to be established and promoted, to limit what it describes as serious health and environmental risks.

Ireland is currently out of line with many developed health systems with no national programme to support the safe disposal of unused medicines.

IPU President, Tom Murray, explained the need for a national DUMP scheme, “There are significant environmental and health risks from improperly disposing medicines. This includes impacts on crops, biodiversity and contaminating our water system. One of the most pressing health challenges of our time is antimicrobial resistance and every antibiotic incorrectly disposed of adds to this problem. Worryingly, research conducted by Behaviour and Attitudes on behalf of the IPU in 2020 showed that a third of all unused medicines are incorrectly disposed of, with 6% dangerously flushed down sinks or toilets. The same research highlighted that over one third of medicines in Ireland are incorrectly discarded. We have no reason to believe that this situation has changed in the interim.”

National

“These risks are well understood globally and having a system of collection for expired medicines has been required under EU law since 2004. The Environmental Protection Agency too has set out the establishment of a nationwide system as a key recommendation in its National Hazardous Waste Management Plan, with implementation due last year.”

By encouraging patients to return their unused medicines to their local community pharmacy, thus restricting access to unused medicines, the introduction of a DUMP Scheme can also reduce the risk of suicide, deliberate selfharm and accidental poisoning in children and help prevent environmental pollution.

“For the pharmacies themselves disposal services are very expensive to operate. It has reached the stage where it is not viable for pharmacies to accept unused medicines from the public without the state covering the cost of disposing these medicines. A national scheme, therefore, is the

most viable option and would also assist in raising awareness and improving uptake.”

The IPU is calling for the introduction of a DUMP scheme which includes a national promotional campaign and covers the costs of disposing medicines.

“Our first challenge is to make sure everyone knows the risks. Then we need it to be easy to do the right thing. There are many successful models for the HSE to replicate including an initiative that has run very successfully in Cork and Kerry, which should immediately be rolledout to the rest of the country.”

Mr Murray concluded by explaining the role he feels pharmacies should play. “Pharmacies are the logical centre point for this national programme. There are over 1,800 nationwide and we already have a relationship with patients when it comes to managing their medications. With the correct funding mechanism in place pharmacies can implement a DUMP scheme without delay.”

Inclusion Health Framework

A public consultation process to inform the development of an Inclusion Health Framework for Ireland was launched in UCC recently.

The Department of Health has contracted the Inclusion Health Research Group (IHRG) in the College of Medicine and Health, University College Cork to undertake the public consultation process. The framework will ensure an inclusion health approach across all aspects of health policy and practice going forward.

Minister Colm Burke, Minister of State for Public Health, Wellbeing and the National Drugs Strategy today launched the consultation for this Inclusion Health Framework

in the Jennings Gallery, Brookfield Health Sciences Complex in UCC.

Focus on socially excluded groups

The focus of the framework will be on socially excluded groups who experience severe health inequalities eg people who are homeless, Travellers, Roma, exoffenders, people who use drugs and alcohol.

Professor Stephen Byrne, Deputy President and Registrar UCC congratulated all involved.

Hubs for COPD & Asthma Patients

Specialist HSE respiratory teams in Integrated Care Hubs are helping thousands of patients with COPD and asthma to be treated closer to home. Prevention, early detection, slowing of disease progression, and providing the best support for people to manage their COPD and Asthma is the aim of the hubs.

With 26 teams across the country, each team is based in an integrated care hub affiliated to an acute hospital. This allows patients to have their care needs met in a community setting, providing a better patient experience.

Associate Professor Stanley Miller, National Clinical Lead Respiratory, HSE, says: “Integrated Respiratory Teams deliver care closer to where people live, in line with the Sláintecare vision of ‘Right Care, Right Place, and Right Time’. Since January 2023, we have had 43,000 patient contacts to integrated respiratory services, shifting care away from hospitals. There have been 15,000 pulmonary rehabilitation patient contacts, helping to empower patients to manage their condition.”

There are significant benefits for patients, which aim to improve patient health and wellbeing, and support the patient to selfmanage their condition. These benefits include:

• integrated, holistic and personalised care to improve patient outcomes

• timely specialist access

• significant reduction in avoidable attendance and admission to hospital

• the promotion of patient selfcare.

“We are delighted the Inclusion Health Research Group led by Dr. Angela Flynn in the College of Medicine and Health in UCC have been successful in responding to the tender offer from the Department of Health to undertake a public consultation on the formation of an Inclusion Health Framework. University College Cork and the College of Medicine and Health have a strong track record in patient and public involvement and have established robust policies to enable respectful, rewarding and positive involvement.”

Care pathways for patients with asthma or COPD focus on the prevention, early detection, slowing of disease progression, and the provision of optimal management for people with COPD and asthma.

One of the services provided by the specialist respiratory teams is pulmonary rehabilitation.

New videos to support the management of COPD and asthma have been developed by the HSE and will provide further information for patients.

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Pharmacy Regulator Publishes 2023 Annual Report

The PSI has published its Annual Report and Financial Statements for 2023, outlining the significant work undertaken by the pharmacy regulator to protect the health, safety, and wellbeing of patients and the public by regulating pharmacists and pharmacies in Ireland.

Key activities for the PSI during 2023 included:

• Being invited to be a representative of the Expert Taskforce to Support the Expansion of the Role of Pharmacy in Ireland.

• Publishing the Workforce Intelligence Report, the first report of its kind for pharmacy in Ireland.

• Adding 524 pharmacists to the Register, bringing the total number to 7,483, representing the largest ever single-year increase in first-time registration numbers.

• Carrying out 143 risk-based pharmacy inspections.

• Reviewing 135 expressions of concern about pharmacists and pharmacies.

• Receiving 73 formal complaints, an increase of 36% versus 2022.

• Hosting five regional roadshows as part of our ongoing commitment to engaging with registrants on patient safety and quality initiatives.

• Launching a revised Core Competency Framework for Pharmacists.

• Publishing a review of the CPD model in place for pharmacists and a report setting out a recommended CPD model for pharmaceutical assistants.

• Launching the next phase of the PSI Business Transformation Project.

Commenting on the publication of the Annual Report, PSI Registrar and Chief Officer Joanne Kissane said, “The establishment of the Expert Taskforce by the Minister for Health to Support the Expansion of the Role of Pharmacy marked one of the most significant developments for pharmacy in Ireland in 2023. The expansion of the role of pharmacists in the public interest has been a strategic focus for the PSI Council and the Department of Health for some time. Our participation in the Expert Taskforce aligns with our objective to expand the role of pharmacy as part of an integrated healthcare system so that pharmacists can make an enhanced contribution to improving patient outcomes and accessibility.”

The first recommendation of the Taskforce was accepted by the Minister for Health in November 2023. Under the recommendation, pharmacists are enabled to extend the validity of a prescription from six months up to a maximum period of 12 months if, in their professional judgement, it is safe and appropriate to do so. Prescribers are also enabled to issue prescriptions for up to 12 months. This recommendation is the first step in expanding the role of pharmacists in Ireland with the aim of improving patient access, streamlining healthcare delivery at the lowest point of complexity, and contributing to better patient outcomes, in line with the principles of Sláintecare.

Registrar and Chief Officer Joanne Kissane, the PSI

September 2023 saw the publication of the Workforce Intelligence Report, providing a baseline view of the pharmacy workforce in Ireland. The report was commissioned to assess emerging risks to the continued availability of a professional pharmacy workforce in both community and hospital settings. It sheds light on the challenges experienced in relation to pharmacist recruitment and retention, incorporating insights from pharmacists and pharmacy students that will be used to support strategic workforce planning. The report identified six recommendations, each underpinned by a number of actions and a commitment from stakeholders, including the PSI, to implement these actions to secure a future sustainable pharmacist workforce.

“Implementing the recommendations and actions in the Workforce Intelligence Report will significantly impact pharmacy and the role of pharmacists in patient-facing settings. Achieving these recommendations will require extensive collaboration, and we remain committed to working with stakeholders across the system to advance this important work.”

The annual report highlights a continued year-on-year increase in the number of pharmacists registering with the PSI, with a total of 7,483 pharmacists on the register at the end of the year. In 2023, 524 pharmacists registered with the regulator for the first time, marking the highest single-year increase in registrations. Of those newly registered pharmacists, just over one-third received their qualification from Irish universities, with one-fifth graduating in the UK. Additionally, there was a 165% increase in pharmacists registering from EU countries compared to 2022. The total number of pharmacies registered was 1,985, an increase of four from 2022.

A robust and transparent process to facilitate the public and pharmacy profession to raise concerns and bring forward complaints is a key pillar of the pharmacy regulator’s work. During 2023, a total of 135 expressions of concern were received, a 14% increase from 2022. Of these, 39% related to pharmacy practice issues. The majority of concerns (78%) were raised by members of the public, while 16% were raised by other pharmacists. Additionally, 73 formal complaints about pharmacists or pharmacies were received, marking a 36% increase on the previous year. The PSI shares information and learning from complaints and the outcomes of inquiries. This is done in the interest of maintaining and upholding professional standards, raising awareness around patient and public safety matters, and promoting compliance with pharmacy and medicines legislation.

She added, “The public is entitled to a high standard of care from pharmacists, and pharmacies must operate at high standards of quality and safety. We continued to uphold these standards through significant registration, inspection and enforcement activities carried out throughout the year. These activities are at the core of what we do and are delivered by highly committed and skilled colleagues from across the organisation.”

As part of its remit to ensure pharmacists are engaging in continuing professional development (CPD), the PSI commissioned an independent review of the CPD model for pharmacists and developed a proposal for a CPD model for pharmaceutical assistants. A revised Core Competency Framework for Pharmacists was also published.

“This past year has seen the progression of several strategic projects which will continue to shape the future of pharmacy in Ireland. We are pleased that advances have been made under our strategic objectives to assure continued trust in pharmacy. We look forward to delivering on our commitments in 2024 and to engaging positively and constructively with all stakeholders.”

Pharmacy Usage at ‘All Time High’

Community pharmacies in Ireland are providing higher levels of healthcare than ever before, according to a new study commissioned by the Irish Pharmacy Union (IPU). The study also found close to universal public support for expanding pharmacy services into new treatment areas.

The Pharmacy Index 2024 was produced by Ipsos B&A and involved surveying 2,000 people in March and April. It found that with 2.1 million visits per week pharmacy usage is at an all-time high. This equates to 51% of the population visiting a pharmacy in the past week and 88% in the past month.

Continuing the trend of recent years, there has been a significant increase (7%) in the use of pharmacy consultation rooms to 440,000 per month.

With an Expert Taskforce expected, in the coming weeks, to make recommendations on the areas where pharmacy services should be expanded, this survey demonstrates the strong public desire for such an expansion. It found that the overwhelming majority either strongly or generally support new services such as:

• 96% in favour of a Common Clinical Condition scheme, allowing pharmacies to provide treatments for minor ailments

directly to patients without requiring a GP visit.

• 87% in favour of greater availability of vaccines in pharmacies.

• 87% would support oral contraception (the pill) being available directly from pharmacies without prescription.

Welcoming the findings IPU

President Tom Murray said, “Pharmacists have the trust of the public and we welcome that 96% of people agree that they get a good service in a convenient manner. This report shows that pharmacies remain the most accessed part of our healthcare system and it is essential to maximise this resource for the benefit of patients.

“We eagerly await the findings of the Expert Taskforce with a view to introducing new services. Where we have innovated and expanded in recent years this has been phenomenally successful and well received by patients. For

example, this survey shows high support for certain new services like blood pressure screening (93%), sore throat exams (91%) and cryotherapy (84%).

“Extended prescribing, where pharmacists can use clinical discretion to extend repeat prescriptions for up to 12 months, will be introduced in September. Supported by 95% of people this is an example of the type of quick wins the Department of Health can deliver for patients and the healthcare system.”

He added though, “New services need to come hand in hand with addressing the regressive pay structures that are now in place 16 years.”

Concluding, Mr Murray said, “With over 1,900 pharmacies they are at the centre of our communities and community care. The potential is there to revolutionise care within pharmacies. All that is required is sufficient ambition and the adequate resources and funding to fully realise this potential.”

Regional Pharmaceutical Forums

The five International Pharmaceutical Federation (FIP) regional pharmaceutical forums, which cover the African, Americas, Eastern Mediterranean, South-East Asian, and Western Pacific regions, are now officially part of FIP, the federation announced last month.

These forums were established over 20 years ago, to increase dialogue, understanding and activities to improve pharmacy services and health according to specific needs, and to be the liaising structures between the World Health Organization (WHO) Regional Offices and FIP.

“In recent years, both the forums and FIP expressed a desire for a closer relationship and a sense of belonging, and a need for greater support from and alignment with FIP, both institutional and strategic. Initial meetings between the forums and FIP were held in 2019 to explore options for integration, and following our consultations in 2023, I am pleased that the regional pharmaceutical forums are now fully integrated within FIP. This is an important step in our ‘One FIP’ approach,” said FIP president Paul Sinclair. The integration will facilitate FIP in consolidating its presence, visibility and influence across the WHO regions, including enhanced work with the WHO Regional Offices and partnerships with other regional stakeholders.

“The WHO Regional Officers are important stakeholders in the definition of health and pharmaceutical policies in regions, with significant influence on national policies. In addition to global WHO policies, the policy and technical documents of its regional offices are opportunities for collaboration. Furthermore, cooperation among FIP member organisations within a region — given their common geography, and often cultural, economic and political closeness — will be efficient and valuable,” he added.

The forums will act as the regional arm of FIP with the WHO, with speaking rights at the FIP Council, but no voting rights so as not to duplicate the votes of FIP member organisations.

PRIDE | Diversity & Inclusion at PHX Ireland

PHX Ireland has further developed the ourpeople strategy which forms the basis for Diversity & Inclusion, Charity Partnerships, Health & Wellbeing, Learning & Development and Engagement & Feedback across the business. One of the key strengths of each of the ourpeople pillars is the use of champions through the PHX Ireland business units of United Drug, LloydsPharmacy Ireland and TCP Homecare.

Throughout the month, the Pride flag has been flown throughout the business, both physically and digitally and prominently displayed at the front of the Magna Park building. As part of the Pride celebrations, Karina Murray from Pride at Work was invited to deliver an engaging, in-person masterclass on ‘How to be an Ally’ as a part of the ‘including you’ initiative. Teammates learned the significance of being LGBTQ+ ally and the impact of this, both in the workplace and everyday life. PHX Ireland is proud to be a Pride at

Work partner sharing a common belief and commitment that Pride is more than just a day.

D&I Champions were joined by colleagues from across the business units to participate in the 50th annual Dublin Pride Parade, an event that may have marked the end of Pride month but cemented the commitment of PHX Ireland to continuing to build a diverse and inclusive culture for all of the teammates.

PHX Ireland Group Limited, is Ireland’s leading fully integrated healthcare provider. PHX Ireland Group Limited comprises United Drug, Ireland’s leading pharmaceutical wholesaler and distributor; LloydsPharmacy Ireland and McCabes Pharmacy, who over the coming months will be joining to become Ireland’s largest pharmacy retail brand with 110 pharmacies across Ireland ; and TCP Homecare, innovators in clinical home nursing services and direct to patient delivery solutions.

PHX Ireland colleagues take part in annual Dublin

Pride flag flying at United Drug House

Pride Parade

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New Supports for Pharmacy

New supports and updated training for pharmacists on the IIOP website

The Irish Institute of Pharmacy (IIOP) is excited to announce new and updated online training programmes and resources available to pharmacists this Autumn through the IIOP website.

Expansion of the Role of Pharmacy: Resources for Pharmacists

A comprehensive set of resources will be available on the IIOP website to provide information to pharmacists relating to the Recommendations of the Expert Taskforce to Support the Expansion of the Role of Pharmacy.

IIOP Resource Hub

The IIOP Resource Hub has a dedicated section providing information on the Pharmacy Expert Taskforce Recommendations. Visit the IIOP Resource Hub, Expert Taskforce, or use the following link: https:// iiop.ie/content/expert-taskforce.

Resources for Phase 1 Recommendations: Empowering Pharmacists to Extend Prescriptions

Following recommendations from the Expert Taskforce to Support the Expansion of the Role of Pharmacy, new legislation effective September 1 allows pharmacists to extend and dispense certain prescriptions written on or after March 1, 2024, from six months to a maximum of 12 months where appropriate. The IIOP is providing resources including webinars, workshops and support materials to support pharmacists in implementing Recommendation 1 - Prescription Extension.

For further information on any of the training programmes and workshops, visit the dedicated ‘Expert Taskforce Information and Resources’ section of the Resource Hub on the IIOP Website.

Upcoming events this autumn include:

• ‘In Conversation With...’ Webinar: August 28, 2024, introducing the new suite of resources

• ‘In Conversation With...’ Webinar: September 11, 2024, discussing practical implementation of Phase 1 Recommendations

• Delivery of a Pharmacy-Based Vaccination Service

• Responding to an Emergency Situation including the Management of Anaphylaxis (RESMA)

• Administration of Influenza Vaccine 2024/2025

For more information on these training programmes you can visit the IIOP site and click on the dedicated Training for the Supply and Administration of Emergency Medicines and Vaccinations page, on the ‘Courses and Events’ dropdown menu.

Keeping up to date with IIOP

• Interactive Workshops: Three online workshops throughout autumn will provide practical application through case studies, directed at enhancing pharmacists’ skills and confidence

Pharmacists should log into the IIOP website, navigate to the ‘Courses and Events’ page, and select the ‘Vaccination Training’ tab to register.

• Newsletter Subscription: Subscribe to the IIOP newsletter; past newsletters are available on the IIOP website.

• Email Updates: Keep an eye on your emails for the latest updates.

Pharmacists should log into the IIOP website, navigate to the ‘Courses and Events’ page, and select the ‘Vaccination Training’ tab to register.

Seasonal Influenza Vaccines:

As the influenza season approaches pharmacists can enrol in the following courses on the IIOP website:

To administer the seasonal influenza vaccine to adults and children aged 6 months and older, pharmacists must complete the following five training programs, each with a specific validity period. Pharmacists should check their certificate dates and the validity of each program as outlined on the Pharmaceutical Society of Ireland (PSI) website.

• IIOP Website: Visit the ‘Resource Hub’ and ‘Latest News’ sections.

• Social Media: Follow us on X (formerly Twitter), LinkedIn, and Instagram.

• For any queries, contact info@iiop.ie.

Training Programme

CPR (Adults and Children)

Parenteral Medicines Administration Training (PAMT)

Responding to an Emergency Situation and Management Of Anaphylaxis (RESMA)

Delivery of a Pharmacy-Based Vaccination Service (DPBVS)

Administration of the Influenza Vaccination (2024/25)

EAHP Boost – Date for your Diary

Training Provider Where to complete

Cardiac First Response Community Level or Heartsaver® CPR AED AHA

Contact training provider directly for details.

Hibernian Healthcare Register on the Hibernian Healthcare website.

Hibernian Healthcare Register on the IIOP website.

The European Association of Hospital Pharmacists will hold EAHP BOOST! On 27th-28th September this year in Florence, Italy.

Keeping up to date with IIOP

The event is aimed at ‘Humanising the high-tech pharmacy’ and will feature a keynote on the management perspective of automatisation; Automation in Reconstitution and Production of Medicines: Explore cutting-edge technologies like robots in Total Parenteral Nutrition (TPN) production and cytotoxic reconstitution; Bedside Dispensing Services and Pharmaceutical Care: Dive into patient-centered pharmacy services with automated unit-dose production and AI-driven drug information management and Interactive Workshops: Engage in ‘world cafe’ style sessions tailored for beginners, advanced, and expert levels.

Visit www.eahp.eu for further details.

• Newsletter Subscription: Subscribe to the IIOP newsletter; past newsletters are available on the IIOP website.

• Email Updates: Keep an eye on your emails for the latest updates.

• IIOP Website: Visit the ‘Resource Hub’ and ‘Latest News’ sections.

• Social Media: Follow us on X (formerly Twitter), LinkedIn, and Instagram.

• For any queries, contact info@iiop.ie.

What is New within Ireland’s OTC Landscape?

Irish Pharmacy News has been working with human data science company, IQVIA, for the last nine years to comprise this annual report which highlights the Top 100 Over-theCounter (OTC) pharmacy brands in Ireland.

The information contained over the following pages is widely accepted as the industry standard from which brand performance is measured across the OTC sector.

We spoke to the General Manager of IQVIA, Gwynne Morley, to gain further insights into how these statistics are compiled and the value of this market to pharmacies.

The Top 100 OTC Market Report is based on the total value of wholesale sales for OTC products into retail pharmacy over the course of the previous 12 months to April 2024 (May 2023- April 2024).

It’s a rolling annual value which includes the 5 major OTC categories including Pain relief, Cough and Cold remedies, Vitamins and Minerals, Skin and Digestive Health.

About IQVIA

IQVIA is a leading global provider of clinical research services, commercial insights and healthcare intelligence to the life sciences and healthcare industries. IQVIA’s portfolio of solutions are powered by IQVIA Connected

Intelligence™ to deliver actionable insights and services built on highquality health data, Healthcare-grade AI™, advanced analytics, the latest technologies and extensive domain expertise. With approximately 87,000 employees in over 100 countries.

Present in Ireland since 1990, IQVIA pioneered the country as a hub for clinical research. In addition to supporting life sciences in their clinical efforts across Europe and the globe, IQVIA’s activity in Ireland includes supporting the life sciences industry from Research and Development through to commercialisation, as well as healthcare providers, to improving treatment outcomes and patient pathways.

1. Can you give our readers an overview as to how the Top 100 data is collated?

The Top 100 OTC Market Report is based on the total value of wholesale sales for OTC products into retail pharmacy over the course of the previous 12 months to April 2024 (May 2023- April 2024). It’s a rolling annual value which includes the five major OTC categories including pain relief, cough, cold and respiratory products,

Morley, General Manager, IQVIA Ireland

vitamins and minerals, digestive health, and habit treatment.

2. Can you give readers a brief overview as to the value of the OTC market to community pharmacy? And what are the key trends currently affecting/changing the consumer health market in Ireland?

The total value of the OTC market in Ireland based on IQVIA’s data for 12 months, from May 2023 to April 2024, was €571 million1. This market grew by 2.1% (value) and decreased by 3.1% (volume) when comparing year-on-year growth2. This was significantly lower than the forecasted growth as Ireland’s value sales growth for 2023 was expected to be 6%. The global OTC market also underperformed forecasts as a notably

Gwynne

Global OTC Performance – FY 2023

Global OTC Market Size ($ bn) & growth

Source: IQVIA Global OTC Insights plus estimates of e-Commerce & Mass-market (excluding Venezuela) The Consumer Health Brand Strategy Evolution – IQVIA Consumer Health – May 2024

weak cough and cold season restricted overall value sales growth to 3.9% for 2023, see Figure 1. As the largest market segment globally, the performance of the cough and cold category strongly influences the overall growth trajectory of the OTC market. With subdued seasonal activity globally, the market faced downward pressure, highlighting the sector’s susceptibility to seasonal variations.

The five major OTC categories (including Pain Relief, Cough, Cold and Respiratory products (CCR), Vitamins and Minerals, Digestive Health, and Habit Treatment) account for €450 million1 of the total value. See the Previous Period Growth (PPG) Moving Annual Total (MAT) April 20242 for each of these five categories: Unlike other markets, Cough, Cold and Respiratory Products (CCR) is the second largest category in the Irish OTC market - Pain Relief continues to be the most consumed category in Ireland, valued at €157 million MAT April 2024 versus €106 million MAT April 2024 for CCR1. This category declined by 2% in 2023 versus double digit growth of 10% in 20221,

contributing to Ireland’s significantly lower sales value growth versus global sales value growth levels.

Habit treatment was the only category that experienced double digit growth, with +11% Previous Period Growth (PPG) MAT April 20242. This increase in consumers seeking smoking cessation treatments in Ireland during 2023 can be attributed to increasing awareness about the health risks associated with smoking, more consumers are motivated to quit. The Smoking Prevalence Tracker data indicates an underlying downward trend in smoking prevalence in Ireland3. Recognised as crucial for tobacco control, cessation services play a vital role in helping people quit smoking. Nicotine

Replacement Therapy (NRT) products are part of evidence-based strategies to support individuals in their journey to quit4. Despite efforts, the goal of a TobaccoFree Ireland by 2025 remains challenging5.

Vitamins and Minerals, the third largest category in the OTC market, valued at €80 million MAT April 20241, grew at a modest rate of 3.2% PPG MAT April 20242. This is a category that is sensitive to price increases. Calming, sleep and mood enhancing products continue to grow faster than market value growth at 6% PPG MAT April 20242, which suggests that a significant number of the population continue to struggle with anxiety and insomnia.

Uncertainty means consumers are budgeting and trading down

This cautious behaviour in light of economic pressure could impact your brand

Saving motivators for consumers around the world

Source: IQVIA Secondary Research, NielsenIQ

The Consumer Health Brand Strategy Evolution – IQVIA Consumer Health – May 2024

The category that continues to decline quite significantly is Weight Loss, -19.6% sales value growth PPG MAT April 20242 Consumers are becoming more aware of evidence-based weight loss options and the availability of more effective prescription options. Recent innovations in the treatment of obesity in the prescription market has more than likely negatively impacted the OTC sector of this category.

3. It would be fair to say that Covid-19 resulted in more consumers taking control of their own health. Would you say that the era of greater ‘self-care’ awareness is evident in these Top 100 figure compared to previous years?

The COVID-19 pandemic certainly accelerated the trend to greater self-care and personal health management due to safety concerns and limited in-person medical consultations at that time. Selfcare is also the future, with consumers worldwide desiring more access to healthcare, and more control over their own care, while governments and payors look to reduce costs by encouraging people to adopt healthier lifestyles and self-manage more conditions when safe

to do so. Consumer health products are pivotal in facilitating efficient self-care. These products empower individuals to proactively manage their health, address minor health issues promptly, monitor chronic conditions, and help cultivate a health-conscious society and alleviate the burden on healthcare systems.

Albeit the OTC market in Ireland continues to grow, the growth has been significantly lower than previous years. Uncertainty is impacting consumer purchasing behaviour, as shown in Figure 2. In addition to the market’s susceptibility to seasonal variations, survival instincts reign supreme – consumers intend to spend more on essential categories, such as health & wellness, but concerns about inflation, resulting in higher prices, has been the subject top of mind across all consumers over the past 12 months, see Figure 3. As a consequence, choices are being made between ‘need to have’ healthcare products and ‘nice to-have’ aspirational products, altering the market dynamic across categories. This has obviously impacted on the lower sales value growth in the OTC market in Ireland in 2023.

of shoppers have changed how they shop for FMCG in order to manage expenses

of consumers are making changes to manage their financial situations

of global shoppers feel they only have enough to spend on food, shelter, and basics

of shoppers identify as “cautious spenders"

4. What do you think is currently driving medicine spending in Ireland? What do you envisage will be the driver for the next 5 years?

Our ageing population is certainly a contributing factor to the current and future medicine spend in Ireland, as it places additional demands on healthcare systems and medicine expenditure. Ireland’s population has grown by 9% over the past decade, reaching over 5 million people6; the first time it has surpassed this number since 1851. Approximately 14.8% of people in Ireland are aged 65 or older7. By 2051, it is projected that one in four people (26%) will be over the age of 65 in both the Republic of Ireland and Northern Ireland8. Among Irish individuals aged between 52-85 years, around 39% are living with multimorbidities9. Self-care is paramount in this instance. The National Framework for the Integrated Prevention and Management of Chronic Disease in Ireland 2020-2025 explicitly considers self-care as a critical component10. This framework focuses on shifting most of the chronic disease care into communitybased settings. It addresses four major chronic diseases: type 2 diabetes, asthma,

Figure 2

TOP 100

Global Consumer Outlook

Survival instincts reign supreme, consumers intend to spend more on essential categories

Source: IQVIA Secondary Research, NielsenIQ, IPSOS

Chronic Obstructive Pulmonary Disease (COPD), and cardiovascular disease10. By emphasising community care and empowering individuals, the framework recognises the importance of self-care in preventing and managing chronic conditions.

5. Do you agree with the idea that consumers are shifting from a ‘symptom’ model to a ‘prevention’ model when looking at OTC medicine needs? How is this apparent within the latest OTC figures?

This shift in consumers behaviour, from ‘symptom’ control to ‘prevention’, is evident in the above data showing the growth of Vitamins & Minerals, and the Habit Treatment categories. These products empower individuals to proactively manage their health. In today’s market, consumers are no longer passive recipients of healthcare - they are increasingly knowledgeable and technologically adept, seeking products that cater specifically to their needs and preferences. Consumers are also increasingly aware of preventive measures, nutrition, fitness, and mental well-being. This awareness drives selfcare behaviours.

Holistic self-care moving beyond symptom treatment is also being driven by the rise of digital health tools. Technology enables personalised health monitoring, telemedicine, and wellness apps. These tools empower individuals to manage their health proactively. A broad range of solutions - including consumer health apps and wearable devices such as smart watches and activity trackers — are well established in the market, see Figure 4. Biometric sensors can be included in such devices or used separately, as in connected glucose or heart rate monitors while even basic smartphone tools such as the camera and microphone can measure health related data. For example, stress levels can be tracked through fingertip photoplethysmography, a non-invasive approach using a light source and a photodetector at the skin’s surface to measure variations in blood circulation11

Smartphones can also detect the sound signature of coughing and snoring. Data gathered via these devices can then be analysed using diagnostic algorithms and AI/ML approaches, a development which is having an increasing impact on consumer health on both the consumer and manufacturer sides. In addition to consumer users, the HSE also recognise

the benefits of utilising digital heath technologies, with the introduction of the National Virtual Ward programme12 and the HSE Telemedicine Roadmap 2024202713. Possibly the biggest opportunity for the consumer health industry with the rise of digital health, is its ability to streamline clinical trials and openup new ways of generating evidence. The industry can use virtual tools to collect health data through digital channels, helping to make research less burdensome and more consumer centric, while improving adherence and outcomes, and gaining an improved understanding of the real-world efficacy and safety of products and services.

6. E-Commerce has grown over the last couple of years. What impact do you think this has had, if any, on the OTC medicines landscape?

The rise of E-Commerce has impacted the landscape of OTC medicines. In 2023, the sales value growth of OTC e-pharmacy was stronger than offline channels in most markets, see Figure 5. Consumers have not abandoned retail pharmacies, with advice and consultation still valued highly. However, there are benefits to e-commerce, such as the following:

Figure 3

‘Digital Health’ is already a Disruptive Force for Consumer Health

Emergence of digital therapeutics

AESGP - The Future of Self-care Is Bright | June 2024

1. Enhanced accessibility and convenience: E-Commerce platforms have made OTC medicines more accessible to consumers. People can now conveniently order medications online, eliminating the need for physical visits to stores14

2. Consumer empowerment: E-Commerce also allows consumers to research products, compare prices, and read reviews before making a purchase. This empowerment enables informed decisions about OTC medicines, promoting self-care and health literacy15

3. Wider range of choices: Online pharmacies offer a broader selection of OTC products, providing consumers with more options. This variety ensures that people can find the most suitable medications for their needs16

As technology continues to evolve, E-Commerce is likely to play an increasingly significant role in shaping how consumers interact with and purchase OTC healthcare products17

7. What do you think the OTC Medicines market in Ireland will look like for the remainder of 2024 going into 2025?

The Global OTC market is expected to grow at +6.8% CAGR during the next five years, 2024-2818. It is also forecasted that Europe’s OTC market will grow at 6.1% in 2024, see Figure 6. Growth within Ireland’s OTC market is not as optimistic based on the performance of the first half of the year – sales value growth is flat, 0.4% PPG 6-month April 20242. The two largest categories in the OTC market, Pain Relief and CCR, have declined quite significantly in the first half of the year, -6.3% PPG six months April 2024 and -2.5% PPG six months April 20242 respectively. The overall market pace slows down when these segments underperform. Unless there is a high incidence of flu later in the year, Ireland’s OTC market growth for 2024 is forecasted to be flat or low digits. Data from the Australian Respiratory Surveillance Report19 indicates the incidence of fever and cough for flu in 2024 is currently similar to the proportion observed in the same period in all previous years (excluding 2022) and the five-year mean (see Figure 7).

8. What are the current trends with regards to shopper behaviour within the OTC landscape?

In Ireland, the key consumer health trends driving shopper behaviour within the OTC landscape can be segmented into the following pillars:

1. Prioritising self-care and wellbeing: As highlighted in the OTC market data above, shoppers are prioritising preventive health measures. They are seeking OTC products related to immunity, vitamins, and supplements, and habit treatments. This has been caused by the pandemic which has heightened awareness of health and wellness.

2. Local and sustainable: There’s a growing interest in supporting local brands and sustainable products. Consumers appreciate transparency about ingredients, sourcing, and ethical practices.

3. Personalisation: Consumers are looking for products customised to their individual nutrition needs, such as DNA-based diets, personalised supplements, and smart devices.

Figure

OTC e-Pharmacy Share and Growth: Key Markets

growth stronger than offline channels in most of the markets

Source: IQVIA CH Global Database Audit, LC$ MNF

5 Figure 6

Source: IQVIA OTC Review; Missing channel with estimates (Updated in February 2024 as per MAT Q3 - 23) AESGP - The Future of Self-care Is Bright | June 2024

TIRED, DRY EYES?

Hypotonic solution that helps restore the natural balance of the tear film

LONGER RESIDENCE TIME(2) Tear HYPEROSMOLARITY > 350 mOsm/l Corneal and Conjunctival epithelial DAMAGE

OSMOTIC BALANCE RESTORATION (8) (hypotonic, 200 mOsm/L)

IMPROVEMENT OF CORNEA AND CONJUNCTIVA STAINING(7)

Ideal for mild to moderate symptoms of Dry Eyes

wearers

Age standardised percentage of FluTracking participants reporting new fever and cough symptoms compared with the five-year mean by year and week of report*, Australia, 2017 to 16 June 2024

* FluTracking has expanded the reporting period from 2020 onwards due to COVID-19. As such, five-year historical comparisons are not available for data reported before May and after October for any year before 2020. The years 2020 and 2021 are excluded when comparing the current season to historical periods when influenza virus has circulated without public health restrictions. As such, the five - year mean includes the years 2017 to 2019 and 2022 to 2023. Please refer to the Technical Supplement for interpretation of the five-year mean and for notes on impact of COVID-19 on FluTracking data.

Source: Australian Respiratory Surveillance Report, June 2024

4. Convenience: Busy lifestyles drive demand for convenient formats like single-dose sachets, travel-sized packs, and easy-to-use applications.

5. Digital shift: E-commerce platforms and mobile apps have become popular for ordering supplements, and personal care items.

6. Pharmacist recommendations: Shoppers trust pharmacists’ advice. According to the IPSOS Veracity Index 2023 edition20, healthcare professionals are again the three most trusted professions, with Pharmacists regaining the top spot. The IPSOS Veracity Index is the longest-running poll on trust in professions in Ireland, first measured in 2005. The 2023 edition, conducted via nationally representative telephone survey, tracked the latest movements in public trust in key professions. Pharmacies remain a key channel for OTC purchases, and consumers value professional guidance.

References:

1. IQVIA OTC Ireland Monthly Database, MAT April 2023

2. IQVIA OTC Ireland Monthly Database, Previous Period Growth April 2023

3. https://www.hse.ie/eng/about/who/ tobaccocontrol/research/smoking-inireland-2023.pdf

4. https://www.hse.ie/eng/about/who/ tobaccocontrol/cessation/

5. https://www.hse.ie/eng/about/who/ tobaccocontrol/research/state-of-tobaccocontrol-report-2022.pdf

6. People Statistical Yearbook of Ireland 2021: Part 1 People and Society - Central Statistics Office

7. Population aged 65+ Ageing Population Older Persons Information Hub - Central Statistics Office

8. https://publichealth.ie/sites/ default/files/2023-02/wp-content/ uploads/2020/04/20200416-AGEINGPUBLIC-HEALTH-MAIN.pdf

9. The Irish Longitudinal Study on Ageing (TILDA) - Trinity College Dublin (tcd.ie)

10. https://www.hse.ie/eng/about/who/cspd/ icp/chronic-disease/documents/the-chronicdisease-integrated-care-programme-10step-guide.pdf

11. IQVIA White Paper, The Next Wave of Self Care Digital Health, February 2023

12. https://www.hse.ie/eng/about/who/ strategic-programmes-office-overview/ national-virtual-ward-programme/

13. https://healthservice.hse.ie/staff/ procedures-guidelines/digital-health/hsetelehealth-roadmap-2024-2027/

14. The digital transformation in pharmacy: embracing online platforms and the cosmeceutical paradigm shift | Journal of Health, Population and Nutrition | Full Text (biomedcentral.com)

15. https://medium.com/@cookkelly219/ the-influence-of-e-commerce-on-the-otchealthcare-market-8738a17b8b7a

16. https://ispe.org/pharmaceuticalengineering/ispeak

17. https://medium.com/@cookkelly219/ the-influence-of-e-commerce-on-the-otchealthcare-market-8738a17b8b7a

18. IQVIA CH Global Database Audit

19. Australian Respiratory Surveillance Report, Report 6 2024

20. Ipsos (Ireland) Veracity Index 2023 – Who do we trust? | Ipsos

Figure 7

DOUBLE YOUR PATIENTS CHANCES OF QUITTING WITH NICORETTE

IRELAND’S NO.1 QUIT SMOKING BRAND

*Source: IMS Sales Value & Units MAT December 2023. For verification please contact 1800 22 00 44. ** Versus willpower alone. Nicorette Icy White 2mgMedicated Chewing Gums, Nicorette Cools 2mg Lozenges, Nicorette Quickmist 1mg/spray Spray: For the treatment of tobacco dependence by relieving nicotine craving and withdrawal symptoms, thereby facilitating smoking cessation in smokers motivated to quit. Helping smokers temporarily abstain from smoking (Gum and Inhaler only). In smokers currently unable or not ready to stop smoking abruptly. Gum, Inhaler QuickMist and Lozenges may also be used as part of a programme to reduce smoking prior to stopping completely. 2mg Gum or Inhaler may be used in combination with Invisi 10mg and 15mg Patch for the treatment of tobacco dependence as part of a stop smoking programme. Dosage: Smoking cessation: Gum: The gum should be used whenever there is an urge to smoke. Not more than 15 pieces of the chewing gum may be used each day. Nicorette Gum may be used for up to 3 months during which time the habits associated with smoking will be lost. If not successful after 12 weeks the patient should be encouraged to make a fresh attempt to stop smoking. Lozenges: 2mg lozenge is suitable for smokers with low nicotine dependency e.g. those smoking their first cigarette of the day more than 30 minutes after waking up or those who smoke fewer than 20 cigarettes per day. 4mg Lozenges are suitable for smokers with high nicotine dependency e.g. those smoking their first cigarette of the day 30 minutes after waking up or those who smoke more than 20 cigarettes per day. Should not be used for more than 9 months. One lozenge should be placed in the mouth and allowed to dissolve. Periodically, the lozenge should be moved from one side of the mouth to the other, and repeated, until the lozenge is completely dissolved. The lozenge should not be chewed or swallowed whole. Sufficient lozenges should be used each day and most smokers usually require 8 to 12, not to exceed 15 lozenges. The duration of treatment is individual, but up to six weeks treatment is recommended to break the habit of smoking. The nicotine dose should then be gradually reduced, by decreasing the total number of lozenges used per day. The treatment should be stopped, when the daily consumption is down to 1-2 lozenges. Quickmist: Step I: Weeks 1-6: Use 1 or 2 sprays when cigarettes normally would have been smoked or if cravings emerge. If after a single spray cravings are not controlled within a few minutes, a second spray should be used. If 2 sprays are required, future doses may be delivered as 2 consecutive sprays. Most smokers will require 1-2 sprays every 30 minutes to 1 hour. Step II: Weeks 7-9: Start reducing the number of sprays per day. By the end of week 9 subjects should be using half the average number of sprays per day that was used in Step I. Step III: Weeks 10-12: Continue reducing the number of sprays per day so that subjects are not using more than 4 sprays per day during week 12. When subjects have reduced to 2-4 sprays per day, the spray use should be discontinued. Temporary Abstinence: During periods of temporary abstinence, the patient should use Gum or Inhaler when required to relieve nicotine cravings and withdrawal symptoms. Gradual cessation: For smokers who are unwilling or unable to quit abruptly. Use the gum/inhaler/lozenge whenever there is a strong urge to smoke in order to reduce the number of cigarettes smoked as far as possible and to refrain from smoking as long as possible. The number of cartridges/gums/lozenges is variable and depends on the patient’s needs. Not more than 15 pieces of the gum, 6 cartridges, 15 lozenges should be used per day. If a reduction in number of cigarettes per day has not been achieved after 6 weeks, professional advice should be sought. Reduced tobacco consumption should lead to complete cessation of smoking. A quit attempt should be made as soon as the number of cigarettes has been reduced to a level whereby the smoker feels ready to quit completely, then start as outlined for “smoking cessation” as given above. Combination therapy: Step 1: The 15mg Patch would be applied daily on waking for 16 hours and removed just before bedtime for a total of 8 weeks. The 2mg gum or Inhaler would be used ad libitum when the smoker felt an urge to smoke or in situations where he/she feels that breakthrough cravings may occur, up to a maximum of 15 pieces of gum per day or 6 cartridges per day. Step 2: After the initial 8 weeks the lower dose Invisi 10mg Patch should be used for a total of 4 weeks. The 2mg gum or Inhaler would be used ad libitum when the smoker felt an urge to smoke or in situations where he/she feels that breakthrough cravings may occur, up to a maximum of 15 pieces of gum per day or 6 cartridges per day. Step 3: Use of the Invisi Patch should be stopped after the 12 week treatment program. The Nicorette 2 mg gum or Inhaler can continue to be used for a further 3 months during which time the habits associated with smoking will be lost. Contraindications: Use in non-smokers, Use in persons hypersensitive to nicotine or any ingredient in the formulation. Children under the age of 12 years (Lozenges) or under 18 years (Quickmist). Special Warnings and Precautions: The benefits of quitting smoking outweigh any risks associated with correctly administered nicotine replacement therapy (NRT). A risk-benefit assessment should be made by an appropriate healthcare professional for patients with the following conditions: - Cardiovascular disease: Dependent smokers with a recent myocardial infarction, unstable or worsening angina including Prinzmetal’s angina, severe cardiac arrhythmias, recent cerebrovascular accident, and/or who suffer with uncontrolled hypertension should be encouraged to stop smoking with non-pharmacological interventions (such as counselling). If this fails, Nicorette may be considered but as data on safety in this patient group are limited, initiation should only be under close medical supervision. Allergic reactions: Susceptibility to angioedema and urticaria. Renal and hepatic impairment: Use with caution in patients with moderate to severe hepatic impairment and/or severe renal impairment as the clearance of nicotine or its metabolites may be decreased with the potential for increased adverse effects. Gastrointestinal Disease: Nicotine may exacerbate symptoms in patients suffering from oesophagitis, gastric or peptic ulcers and NRT preparations should be used with caution in these conditions. Seizures: Use with caution in subjects taking anti-convulsant therapy or with a history of epilepsy as cases of convulsions have been reported in association with nicotine. Phaeochromocytoma and uncontrolled hyperthyroidism: Nicotine, both from NRT and smoking, causes the release of catecholamines from the adrenal medulla. Therefore, Nicorette should be used with caution in patients with uncontrolled hyperthyroidism or pheochromocytoma. - Diabetes Mellitus:. Patients with diabetes mellitus should be advised to monitor their blood sugar levels more closely than usual when smoking is stopped and NRT is initiated, as reductions in nicotine-induced catecholamine release can affect carbohydrate metabolism. Patients with diabetes mellitus may require lower doses of insulin as a result of smoking cessation. - Smokers who wear dentures may experience difficulties in chewing Nicorette Gum. The chewing gum may stick to, and may in rare cases damage dentures. Lozenge: Lozenges can represent a choking hazard. Use with caution in individuals with aspiration and swallowing problems Transferred dependence: Nicotine in any dose form is capable of inducing a dependence syndrome after chronic use and is highly toxic after acute use. However, dependence with Nicorette Gum is a rare side-effect and is both less harmful and easier to break than smoking dependence. Danger in children: Doses of nicotine tolerated by smokers can produce severe toxicity in children that may be fatal. Products containing nicotine should not be left where they may be handled or ingested by children. The spray contains small amounts of ethanol (alcohol), less than 100 mg per dose (1 or 2 sprays). This medicinal product contains less than 1 mmol sodium (23 mg) per spray, i.e. essentially ‘sodium- free’. This medicine contains 12 mg propylene glycol in each spray which is equivalent to 150 mg/mL. Due to the presence of butylated hydroxytoluene, Nicorette QuickMist may cause local skin reactions (e.g. contact dermatitis), or irritation to the eyes and mucous membranes. Care should be taken not to spray the eyes whilst administering the spray. Inhaler should be used with caution in smokers with chronic throat diseases and bronchospastic disease Invisi Patch should be removed prior to undergoing any Magnetic Resonance Imaging (MRI) procedures to prevent the risk of burns. Undesirable Effects: Regardless of the means used, a variety of symptoms are known to be associated with quitting habitual tobacco use. These include emotional or cognitive effects such as dysphoria or depressed mood; insomnia; irritability, frustration or anger; anxiety; difficulty concentrating, and restlessness or impatience. There may also be physical effects such as decreased heart rate; increased appetite or weight gain, dizziness or presyncopal symptoms, cough, constipation, gingival bleeding or aphthous ulceration or nasopharyngitis. In addition, and of clinical significance, nicotine cravings may result in profound urges to smoke. Adverse Drug Reactions: Nicorette may cause dose dependent adverse reactions similar to those associated with nicotine administered by other means and are dose dependent. Most of the undesirable effects reported by the subjects occur during the early phase of treatment. Gum: Immune System Disorders: HypersensitivityCommon Anaphylactic reaction - Not known. Psychiatric Disorders – Abnormal Dreams – Uncommon. Nervous System Disorders: Headache - Very Common, Burning sensation, Dysgeusia, Paraesthesia – Common, Seizure - Not known. Eye Disorders: Blurred Vision, Lacrimation increased – Common. Cardiac Disorders: Palpitations, Tachycardia - Not known. Vascular Disorders: Flushing, Hypertension – Uncommon. Respiratory, Thoracic and Mediastinal Disorders: Cough, Throat irritation - Very common. Bronchospasm, Dysphonia, Dyspnoea, Nasal Congestion, Sneezing, Throat tightness – Uncommon. Gastrointestinal Disorders: Hiccups, Nausea - Very common. Abdominal pain: Diarrhoea, Dry mouth, Dyspepsia, Flatulence, Salivary hypersecretion, Stomatitis, Vomiting – Common. Eructation Glossitis, Oral mucosal blistering and exfoliation, Paraesthesia oral – Uncommon. Dysphagia, Hypoaesthesia oral, Retching – Rare. Dry throat, Gastrointestinal discomfort Lip pain - Not known. Skin and Subcutaneous Tissue: Hyperhidrosis, Pruritus, Rash, Urticaria Disorders – Uncommon. Erythema - Not known. Musculoskeletal and Connective Tissue Disorders: Pain in jaw – Uncommon. Muscle tightness - Not known. General Disorders and Administration Site Conditions: Fatigue – Common. Asthenia, Chest discomfort and pain, Malaise – Uncommon. Allergic reactions including angioedema - Rare. Seizure - Unknown. Eye disorders: Not known – blurred vision, lacrimation increased. Cardiac Disorders: Uncommon - palpitations, tachycardia, atrial fibrillation. Vascular disorders: Uncommon – flushing, hypertension. Respiratory, thoracic and mediastinal disorders: Very common - cough, hiccups, throat irritation. Uncommon - Bronchospasm, dysphonia, dyspnoea, nasal congestion, oropharyngeal pain, sneezing, throat tightness. Gastrointestinal disorders: Very common - nausea, mouth/throat and tongue irritation Common - Abdominal pain, dry mouth, diarrhoea, dyspepsia, flatulence, salivary hypersecretion, stomatitis, vomiting, heartburn. Uncommon - Eructation, glossitis, oral mucosal blistering and exfoliation, paresthesia oral. Rare - Dysphagia, hypoaesthesia oral, retching. Not known - Dry throat, gastrointestinal discomfort, lip pain. Skin and Subcutaneous Tissue Disorders: Uncommon - Hyperhidrosis, pruritus, rash, urticaria. Not known – Erythema. General Disorders and Administration Site Conditions: Common – burning sensation, fatigue. Uncommon - Asthenia, chest discomfort and pain, malaise QuickMist: Immune system disorders Common Hypersensitivity Not known Allergic reactions including angioedema and anaphylaxis Psychiatric disorders Uncommon Abnormal dream Nervous

Irish Pharmacy News has been working with data analysts IQVIA for over nine years in compiling and bringing this information to our readers, pharmacy professionals of Ireland.

The Top 100 data is collated each year and summarises activity from May ‘23 to April ‘24. IQVIA uses data, technology, advanced analytics, and expertise to help customers across healthcare drive health forward. For many of these customers, having an accurate, timely view of product performance is critical to ensuring they are improving both business and patient outcomes.

The Top 100 Over the Counter (OTC) Market Report is based on the total value of wholesale sales for OTC products into retail pharmacy over the course of the previous 12 months to April 2024 (May 2023- April 2024).

In looking at this years’ data, General Manager of IQVIA, Gwynne Morley told us “The five major OTC categories (including Pain Relief, Cough, Cold and Respiratory products (CCR), Vitamins and Minerals, Digestive Health, and Habit Treatment) account for ¤450 million1 of the total value.

“Unlike other markets, Cough, Cold and Respiratory Products (CCR) is the second largest category in the Irish OTC market - Pain Relief continues to be the most consumed category in Ireland, valued at ¤157 million MAT April 2024 versus ¤106 million MAT April 2024 for CCR1. This category declined by 2% in

2023 versus double digit growth of 10% in 20221 , contributing to Ireland’s significantly lower sales value growth versus global sales value growth levels.”

PARALIEF DRIVING CASH SALES AND PROFIT IN YOUR PHARMACY

Reflecting on the growth of selfcare, she adds, “The COVID-19 pandemic certainly accelerated the trend to greater self-care and personal health management due to safety concerns and limited in-person medical consultations at that time.

PARALIEF DRIVING CASH SALES AND PROFIT IN YOUR PHARMACY

“Self-care is also the future, with consumers worldwide desiring more access to healthcare, and more control over their own care, while governments and payors look to reduce costs by encouraging people to adopt healthier lifestyles and selfmanage more conditions when safe to do so. Consumer health products are pivotal in facilitating efficient self-care. These products empower individuals to proactively manage their health, address minor health issues promptly, monitor chronic conditions, and help cultivate a health-conscious society and alleviate the burden on healthcare systems.”

Gwynne also highlights that as technology continues to evolve, “E-Commerce is likely to play an increasingly significant role in shaping how consumers interact with and purchase OTC healthcare products.”

*Disclaimer: Please note that the six year comparison listed opposite details a range from Jan-April for the years 2019-24 and from JanMay for 2024. These, along with other comparisons with previous years, may include brands and categories whose classification may have changed over that period. The IPN/IQVIA Top 100 OTC products and the method of its collation evolves with the pharmacy.

Size: 100*x75mm sheets: 50 Paper: White

IQVIA Top 100 Pharmacy Products

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BUSCOPAN

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Sports Nutrition – A Vital Category for Pharmacy Category Report: Sport Nutrition

Sports nutrition has become a significant category within the health and wellbeing industry. Pharmacy has seen a substantial demand for sports and nutrition products to cater for a growing demand from consumers. People are looking for a holistic approach to health, which includes striving to become fitter and to take the appropriate nutritional supplements. Pharmacies are in a unique position within retail, as they provide a trusted source for consumers who are looking to get fit and healthy. Consumers trust that a pharmacy will stock reputable sports nutritional products.

Is the category growing, declining or emerging?

Worldwide, the market is estimated at $22billion and is expected to grow to $37billion by 2027. Sports nutrition is the fastest growing consumer health category since the COVID-19 pandemic. Established consumers (consumers taking nutritional supplements for more than 12 months) have increased their spend on nutritional supplements over a 12-month period by 47% and the average spend per month in this category is ¤52.86. Consumer Behaviours and Shopper Trends

It is essential for pharmacies to understand consumer behaviour to be able to benefit from this growing category. The average age of consumers in this category are aged between 18-35, mostly

male but there is an increasing trend in women seeking benefits from sports nutrition products. Sports nutritional supplements offer many health benefits for active individuals such as muscle recovery, enhanced athletic performance and overall wellbeing. It is reported that one third of adults in Ireland are currently taking or considering taking performance nutrition products. This is a significant proportion of population that could potentially be sourcing these products from the pharmacy.

The most common products available in this category are protein products such as powder, bars and ready to drink servings. Shopper trends are showing that the most convenient options for a protein supplement are more popular.

It is not only serious athletes looking for sports nutritional supplements but also ‘active lifestyle consumers’ also. This

Written by Laura Gilmartin, Pharmacist, North Road Pharmacy, North Sports

has opened up this category for potential growth, as a greater variety of consumers are now looking for these products. The demand is also rising for nonprotein products to aid post workout recovery.

Technological Changes

Technological advances are reshaping the sports industry.

The most common products available in this category are protein products such as powder, bars, and ready to drink servings. Shopper trends are showing that the most convenient options for a protein supplement are more popular.

Many consumers are using wearable technology or mobile apps to track their fitness goals and eating habits. 31% of wearable technology users have stated that it has a ‘major influence on their activity. It is also reported that women are more likely to be motivated by targets, whilst men prefer to use the wearable technology to track their performance and progress.

Since the COVID-19 pandemic, many people are opting to exercise using online platforms. Social media influencers in the fitness industry, use social media to post short workout snippets for people to do at home with little or no exercise equipment needed. These strides in online fitness have made exercise more accessible for people who may not want to join a gym, attend fitness classes or struggle to fit exercise into their busy schedule.

Overall category value, price changes and major cost changes

The sports nutrition industry in Ireland is growing exponentially, giving pharmacies an

Figure 1: Protein Products that consumers would consider for ‘on the go’

Category Report: Sport Nutrition

opportunity to capitalise on this. The growth is driven by a greater emphasis on healthy lifestyles, increased exercise and social media influencers.

Prices in this category are increasing due to high inflation and a surge in raw material price for certain products. The sports nutrition industry seems to perform well with online sales. E-commerce sales for sports nutrition products are performing better than other categories such as OTC products and vitamins. This gives pharmacies an opportunity to grow this category in their own e-commerce site.

Innovations in the category, such as product improvements or extensions

More sports nutrition companies are developing plant-based products due to an increased demand due to increased veganism and environmental consciousness. There is also a demand for clean label products which are free from artificial additives or preservatives. Many brands are opting for more eco-friendly packaging including biodegradable or recyclable materials to reduce the environmental footprint. When sourcing products it is important to take these factors into consideration.

Risks to the Category

There are many risks to the category such as regulatory challenges, saturation in the market and any changes to the economy. Within the sports industry, there are lots of regulations for product labelling and health claims. Any changes could impact the products in this category. With an ever-growing market, this can then also lead to market saturation and increased competition with brands competing leading to reduced profit margins. If there are any negative changes to the economy, this category could be impacted as it would be considered as nonessential items.

Key influencers in the category

Social media influencers, fitness trainers and professional athletes are playing a considerable role in promoting sports nutrition. Many brands are using these influencers to promote their products on social media.

Sponsorships and collaborations are also another key factor that can influence consumers to buy specific products. Healthcare professionals such as pharmacists can recommend specific products personalised to each customer.

Strategies to improve revenue in the category

To improve revenue in this category, there are multiple strategies that can be implemented. Social media influencers are paving the way for growth in this industry and it is imperative that pharmacies use social media platforms to advertise the products that are trending. Market expansion within the category and knowing the target audience can also help to maximise sales. It is important to understand what health trends are shaping the industry and use that knowledge to grow this category. Brand awareness is also essential to help drive sales. Extensive training for new sports nutritional brands should help to sell and promote the products.

Benefits of Sports Nutrition within the Pharmacy

The sports and nutrition category is on an upward growth trajectory, which gives the pharmacy sector a huge opportunity to grow this category by increasing the choice of functional, sustainable and personalised products for the consumer.

It is essential to understand consumer behaviours and shopper trends to ensure the right products are being stocked within the pharmacy. Pharmacies need to stay attuned to any changes within the sports and nutrition industry to ensure they can effectively cater to the evolving needs of consumers within this category.

Social media and social media influencers are paving the way for marketing in this category. Understanding what products are trending online can then be used to increase social media engagement and to generate sales. This can therefore benefit the pharmacies growth and capitalise in this area. It is important to understand the audience and engagement on each of the businesses social media platforms as they can attract different age demographics. Whilst Instagram and Tik Tok attract a

younger demographic, Facebook offers the best opportunity to reach a middle-aged audience. Two thirds of users on Facebook report that they visit a local business Facebook page at least once per week.

Consumers who are using sports nutritional products are also potential customers for other pharmacy-based products such as pain relief, first aid and vitamins. When buying these products within a pharmacy setting, the consumer is also benefiting from the knowledge of the pharmacy staff. Pharmacy staff can advise on how to treat any sports related injuries and can advise on pain relief, appropriate first aid and any recovery supplements. Health care professionals such as a pharmacist, are trusted sources of advice within the community and can guide consumers towards the right products.

Examples of Sports Nutritional Products within the pharmacy:

• Protein Powder

• Protein Balls

• Protein Gels

• Protein Ready to Drink

• Creatine products

Opportunities for Link Selling

• Electrolytes will help to replace electrolytes lost during exercise

• Magnesium products for post workout recovery

• Pain relief for any injuries

• First aid products such as strapping, kinesiology tape, strapping, freeze gels

• Glucosamine and MSM products can be taken for joint pain

• Digestive enzymes will help breakdown protein

• Iron supplementation will help to give energy

• L-Glutamine - Amino acid protein building blocks which are good for a busy lifestyle and to take alongside protein products

• Omega 3 products will help aching or stiff muscles and help to lubricate joints

• CoQ10 can be taken for energy

• L arginine is good for heart health

References

BordBiaPerformance Nutrition

Communications Hub

Euromonitor International

Sports IrelandIrish Sports Monitor Statista.com

Kind and Effective Cough Relief & Immune Support*

Category Report: Gut Health

Mastering the Digestive Health Category

Gut instinct can help Pharmacists navigate professional challenges, build relationships with customers, which products to stock or promote and understand their customers needs and this is no less effective when it comes to Optimising the ‘digestive health shelf’ alongside current insights into the digestive health market.

The OTC Digestive remedy market is one of the most stable health categories in Ireland and is generally considered to be emerging and growing.

Of the OTC classes by value; Digestion has a 12.7% share. The latest IQVIA data shows the digestive market has grown by 2.3%.

Written by Michelle O’Hagan, Superintendent Pharmacist, Pharmacy Hub, Killinarden

sales of anti- diarrhoeal, motion sickness remedies and rehydration products.

 Sports enthusiasts - rehydration is becoming a buzz word and with a vast variety of products to choose from ORS to Electrosal.

 Pharmacists have noted an ever-increasing role in health maintenance of the gut as opposed to solely treatment.

Products in the Digestive Health Category

 Ageing population- as we have an ageing population and more experience health issues the demand for OTC products will continue to increase

Brands that provide clear reliable information tend to gain consumer trust e.g.: Nexium is the leading PPI on the market and one of the top OTC medicines by sales volume in Ireland. PPIs are perceived as better for acid suppression and have taken over substitutes like the H2 blockers. Gaviscon is also a market leader having a 5% share of the OTC market and as OTC Pharma market is experiencing a growing demand for natural and health remedies Reckitt have innovatively launched ‘Gaviscon Natura’ to enter this group.

expected to grow at a compound annual growth rate of 8.3% from 2024- 2030.

Several factors contributing to the emerging growth of the digestive market share;

 Increasing awareness of products and best treatment methods as people are more informed thanks to the internet

Of the OTC classes by value; Digestion has a 12.7% share. The latest IQVIA data shows the digestive market has grown by 2.3%.

Digestive Health is big business and one of consumers’ top health concerns. As of the latest available data the overall value of the digestive health market in Ireland is estimated to be growing reflecting global trends. The global digestive health market size was valued at $51.62 million USD in 2023 and is expected to grow at a compound annual growth rate of 8.3% from 2024- 2030.

 Dietary changes- due to our fast-paced lives, obesity, stress and fast-food intake, many people lack fibre and make poor food choices

Several factors contributing to the emerging growth of the digestive market share;

 Holistic health trends – digestion is the cornerstone of overall health and keeping the gut in good stead boosts the body’s immunity

 Probiotics popularity - Probiotics and other health supplements are growing in popularity and will continue to grow in the market as people become more health conscious and focus on wellbeing and gut microbiome

 Innovation and new products – continued innovation in the field and development of new products and formulation will drive market growth and maintain customer interest.

 E- commerce – online Pharmacy is driving growth and consumers can access a wide range of digestive health products.

 Digital influencers- social media is becoming significant

 Resurgence of travel- leading to an increase in impulse

Products in the digestive health OTC market – PPIs, H2 blockers Anti-diarrhoeals, antispasmodics Laxatives, fibre supplements, Digestive enzymes, probiotics

Shopper trends in the digestive health market highlight a growing interest in proactive health management and natural remedies. Focus on healthier lifestyles and well-being and Gut Health has resulted in Probiotics leading the way and helping the digestive health market to innovate and accelerate.

Probiotics are part of the wider digestive category which is the 4th largest OTC category as measured by IQVIA Consumer Health with sales of $18 billion globally. This category is expected to outperform the OTC market as a whole, with a forecasted CAGR of 7% from 2022-2025.

Probiotics are defined by IQVIA as OTC products that contain

Category Report: Gut Health

live micro-organisms either alone or in combination with other Ingredients. Probiotic is the most recognisable digestive Health supplement term, say New Nutrition Business, however there is vast variation within the probiotic sub-category that can make things about them hard to understand, including variations in strains, dosages and formats.

No health claims have been granted for ‘probiotics’ by the European Commission after evaluation by the European Food and Safety Agency. In most recent developments January 2023 France authorised the use of the word ‘probiotic’ on food supplement labels under specific conditions allowing the claim that they “contribute to the balance of the intestinal flora” if they contain a certain amount of live microorganisms.

A growing understanding of the importance of gut microbiome is expected to further boost product demand over the coming forecast period.

Probiotics do have limitations and the health microbiome market will be challenged by a balancing act between innovation and regulation.

Develop a Health Digestive Category smart.

Regulation and disrupter’s; Regulation always restricts new products coming to the market and ever rising costs and inflation will also play a part. The last OTC

product that was launched from Pom to P was Buscopan in 2021.

As the European market at large embraces a new wave of healthy lifestyles and gut health holistically, food products containing probiotics and prebiotics are widely accessible on supermarket shelves and as consumers are more adept with knowledge a cohort will focus on health prevention and maintenance via daily diet.

Negating this is the growing number of the elderly population and their health concerns and an increased demand for supply of digestive OTC products.

Prevalence of obesity will drive sales of digestive OTC remedies. Despite the growing adoption of healthier dietary and lifestyle habits, Ireland has the not-so proud distinction of having the second highest rate of obesity in the EU.

As we see a continued shift of consumers eating in restaurants more frequently and breakfast and lunch to go, combined with urban lifestyles, we will inevitably experience an increased prevalence of symptoms of acid, gastrointestinal oesophageal reflux and this will support retail volume and current value of PPIs.

Influencers and media are indeed influencing the market by bringing ‘microbiome’ to the forefront and delivering gut health as

playing a major role in chronic disease, boosting immunity and mood management.

These products are not always science based and with no proven records or regulation consumers will always search for reliability. Retailers are in a sweet spot to point toward the solutions that can help address specific issues but success hinges on being able to effectively communicate with customers.

Strengths of Pharmacy and keys to sale success;

Education and transparency. Pharmacists are-well regarded and trusted healthcare professionals are ideally placed to become influencers in their communities.

There is a real opportunity in educating your public, highlight the science consumers are interested in.

Marketing must convey the direct benefit to the consumer such as reduced gas, less discomfort, better stool regularity etc There is a gap for better and consistent outreach to consumers in terms of education.

Ensuring staff are knowledgeable on the products you stock is key. Staff potentially could become one of your most valuable assets and allies especially in the face of AI generation.

Staff training can take the form of simple webinars and bite sized nuggets of information.

Companies are also very supportive in this respect. Fact is consumers are motivated to learn more about their health and now the resources exist to do so.

Sales strategies:

Customer surveys are effective in learning about your local market and which products to stock as trends change. Expand and diversify your digestive health in store category to meet consumer needs. e.g. Offer a range of rehydration products they appeal to seasonal shoppers, runners and active families.

Christmas time maybe consider focusing on Gut-health and treatments for over-indulgence rather than gifts with low margins. Consider offering personalised consultations either in store or virtually where customers can discuss their digestive health concerns and receive tailored product recommendations.

Stock only well branded high quality products. OTC will always offer stability so merchandise well market leaders’, consumers know and trust these brands. Create window displays and present in-store offers. Loyalty cards are also an option to attract repeat customers especially for food supplements and Probiotics e.g. 6th purchase discounted for example.

CUSTOMER

DECISION MAKING

PREOFESSIONAL CHALLENGES

DEFINITION

Intuitive understanding of patient needs and health issues

Decide which products to stock based on market trends and experience

Build solid relationships with customers and provide personalised recommendations

Making effective decisions in complex situations and find solutions

Keep abreast of regulatory changes and sale analysis in store

EXAMPLES

Engage with your customers about their symptoms and refer for regular check ups

Increase stock of popular digestive health products

Suggesting products based on observed customer preferences

Prioritising medications during a supply shortage

Merchandise your digestive health section accordingly to meet customer needs

The future will be interesting in the overall Digestive category market as it is likely the food sector will be the winners due to the ever-evolving Probiotic industry and their ever-increasing options for consumers.

Nonetheless Pharmacy holds a stable share and OTC trade cannot be threatened.

Future microbiome research and advancement in digestive supplements which will better address the underlying cause of digestive health issues is promising and will bring new products to the market.

E-Pharmacy promises robust growth prospects over the coming years. By combining the fruits of our labour with the strategic use of gut instinct, Pharmacists can continue to drive growth and maintain strong revenue streams in the competitive digestive health market.

References: Euromonitor | Others on request

Category Report: Pain

The Pain Market in Ireland

The pain category continues to have the greatest share of the OTC market. Community pharmacies are often the first port of call for patients experiencing mild to moderate pain. Pharmacists and their trained teams are experts at triaging pain and recommending appropriate action for patients.

It is essential that all pharmacy team members know the medicines in your pharmacy that contain paracetamol and are familiar with the dosage.

Using the WWHAM model, pharmacy colleagues can recommend appropriate products to alleviate pain or refer further if necessary. There are three main molecules that are most often requested for pain in pharmacy – paracetamol, ibuprofen, and codeine. It is important that the WWHAM technique is used appropriately as these are important drugs and effective counselling on side effects and usage is essential. They can also interact with many prescription medications so knowing what other medications the patient is taking is necessary too.

The main reasons patients visit community pharmacies for pain advice are:

• Migraine

• Tension Headache

• Back pain

• Muscle and joint pain

• Dental pain

• and Sports Injuries.

Paracetamol and Ibuprofen are still the main molecules in the category. Paracetamol is an analgesic and antipyretic.

Written by Emily Kelly, Community Pharmacist McCauley Pharmacy

Ibuprofen is an anti-pyretic, analgesic, and anti-inflammatory. It should not be used with other NSAIDs and can interact with medications and conditions. It is important to know if the patient has GI problems or is taking other medication e.g. blood thinners.

There are restrictions on the sales of these products that all pharmacy staff must know and follow.

It is essential that all pharmacy team members know the medicines in your pharmacy that contain paracetamol and are familiar with the dosage. Good counselling is essential for all pain products. It is important the patient is aware of the dosage and form e.g. cough cold flu remedies that customers may not realise contain paracetamol or that have a single dose with 1g paracetamol. Paediatric counselling of pain medication is essential and ensuring the correct dosage is known to the patient for the age of the child and the form e.g. suppositories.

Paracetamol containing products are the drugs most often used for self-harm and can also be associated with suicide. Approximately 500 people die by suicide every year in Ireland. There were almost 11,000 intentional paracetamol containing overdoses recorded between 2007 and 2018 by people under the age of twenty-five. More than one pack of paracetamol containing medication should not be sold to a customer at any one time. Exceptions to this include when the total combined dosage of multiple packs does not exceed 24 x 500mg units or the

pharmacist is satisfied that it is safe following direct consultation with the customers. The HSE have a current campaign targeted at staff in pharmacy, to remind them of the restrictions on the sales of paracetamol-containing medications that they should always know and follow. It has been developed to promote the safe sales of paracetamol, from a self-harm and suicide prevention perspective – and to reduce the incidence of paracetamolrelated intentional drug overdose in Ireland. Supports such as posters and patient cards are available to order at https:// www.hse.ie/eng/services/ list/4/mental-health-services/ connecting-for-life/publications/ safe-sales-of-paracetamol.html If you are concerned about a customer who is trying to buy excessive amounts of paracetamol containing mediation always refer to the pharmacist. Pharmacists can refer patients to supports, many are available 24/7 and you can make contact in different ways, for example: on the phone – Samaritans – freephone 116 123, by text message - Text About It – text HELLO to 50808, online – MyMind, face-to-face – Pieta –freephone 1800 247 247. You can also call the HSE YourMentalHealth Information Line, anytime day or night, for information on mental health, and what other services and supports are available near you. Freephone 1800 111 888 or visit www.yourmentalhealth.ie.

Overall, the pain category has settled after the pandemic and is now in sustainable continued growth. Like all medications in Ireland, shortages have impacted the category this year. This has seen patients try alternative products to ones they were more familiar with and seen movement across products in the category. Products that have been around for a while are becoming more popular like Solpa Extra (paracetamol /caffeine), Panadol Extra (paracetamol/ caffeine)

TOP 100: Pain

Excedrin (Aspirin/paracetamol/ caffeine) for migraine and dual molecule product Easolief Duo (paracetamol / ibuprofen)

Topical application products are seeing a lot of growth either as a rub or gel applied directly to the area of pain or a patch. Side effects particularly GI disturbances are reduced by this form of application. Voltarol Emugel Extra Strength 2% gel and Diclac Relief 1% gel that contain diclofenac as the active ingredient are the leaders. Patches have become more popular with patients and products like Nurofen Durance 200mg plaster, and Voltarol Heat patch are seeing growth.

Patients are looking for holistic solutions to there symptoms. Along with traditional pain relief molecules, customers are looking for complimentary products to alleviate pain. Heat patches are number one in this category with Deep Heat and Thermacare Patches the market leaders. VMS products containing turmeric or products like Revive Joint active are used by customers for inflammation and prevention of ongoing pain. Cool and Soothe patches can complement migraine pain relief. There are little to no requests for products like Tens machines that in the past were very popular with patients.

The category can be very price driven and patients are price sensitive. We are seeing growth in single molecule generics particularly. Branded products are growing with product extensions and offering targeted products that patients want. For example, those with dental pain are likely to request products like Nurofen rapid release maximum strength 400mg capsule or Nurofen long lasting prolonged release 300mg capsule.

We cannot review the OTC Pain category without discussing Codeine which has featured in media articles and TV programmes this year. Codeine is a mild to moderate opioid (narcotic) analgesic and has weak cough suppressant activity; when supplied as a nonprescription medicinal product

for the relief of pain codeine is used in combination with other analgesics such as paracetamol or ibuprofen. It should only be supplied when the pharmacist deems a supply is necessary and only when a non-opioid analgesic, e.g., paracetamol, aspirin, or ibuprofen, has not effectively relieved the patient’s symptoms. Consumption of quantities more than the recommended dose, or consumption over a prolonged period, may cause tolerance and dependence and may result in withdrawal symptoms such as restlessness and irritability upon stopping the medicine. Regular or prolonged use of codeinecontaining products may produce psychological and physical dependence. For combination products, use of higher doses and/or for a longer duration than that recommended, can also lead to serious adverse clinical outcomes arising from exposure to the analgesic component (e.g. paracetamol or ibuprofen). These include hepatotoxicity, gastrointestinal and renal toxicities, such as gastrointestinal haemorrhage and perforation and renal failure.

The PSI Non-Prescription Medicinal Products Containing Codeine: Guidance for Pharmacists on Safe Supply to Patients gives pharmacists information on necessary counselling for codeine products. Pharmacists should outline to the patient that the lowest effective dose for the shortest period should be used, with a maximum of 3 days use. When it is not appropriate to supply a codeine product. The pharmacist should discuss the reason the medication is not suitable with the patient and offer alternative treatments/ supports. If dependence is suspected the pharmacist on duty should engage with the patient and make all reasonable attempts to ensure that the patient is facilitated and encouraged in accessing services which will assist in the management of that dependence. The Irish pharmacy union have great supports for pharmacists and their teams on supplying codeine. They have a codeine checklist, patient information card, guidance on spotting signs of abuse or misuse and what to do if abuse is suspected.

One solution for muscle and joint pain

Reduces pain and inflammation to improve physical function

Diclofenac gel provides superior pain relief compared with ibuprofen gel*

Available in 100g and 50g pack sizes. Always read the label. Suitable for 14+ years.

Indicated for mild to moderate pain from acute strains, sprains or contusions following blunt trauma.

*Wade AG, Crawford GM, Young D, et al. Comparison of diclofenac gel, ibuprofen gel, and ibuprofen gel with levomenthol for the topical treatment of pain associated with musculoskeletal injuries. J Int. Med Res. 2019;47(9):4454-4468.

DICLOMEL MAX STRENGTH 2% w/w GEL. 1 g of gel contains diclofenac as 23.2 mg diclofenac diethylamine corresponding to 20 mg of diclofenac sodium. Presentation: Tube containing white, homogeneous gel. Indications: For short-term local symptomatic treatment of mild to moderate pain in acute strains, sprains or contusions following blunt trauma. Dosage: Adults and adolescents aged 14 years and over: Diclomel Max Strength is used 2 times a day (preferably morning and evening). Depending on the size of the affected site to be treated, cherry to walnut size quantity is required, corresponding to 1-4 g of gel corresponding to 20-80 mg diclofenac sodium. This is sufficient to treat an area of 400-800 cm2. The maximum daily dose is 8 g of gel corresponding to 160 mg diclofenac sodium. Method of administration: For cutaneous use. Contraindications: Hypersensitivity to the active substance or any of the excipients, patients with a history of hypersensitivity reactions, such as asthma, bronchospasm, urticaria, acute rhinitis or angioedema in response to acetylsalicylic acid or NSAIDs, on open injuries, inflammations or infections of the skin as well as on eczema or mucous membranes, in the last trimester of pregnancy, in children and adolescents under 14 years of age. Warnings and precautions: The possibility of systemic undesirable effects from application of topical diclofenac cannot be excluded if the preparation is used on large areas of skin and over a prolonged period. The gel should therefore be used with caution by patients with reduced renal function, reduced heart function or reduced liver function as well as patients with active peptic ulcers in the stomach or duodenum. Diclomel Max Strength must only be applied to intact, not diseased or injured skin. Eyes and oral mucous membranes must not come into contact with the gel and it must not be taken orally. Topical diclofenac may be used with a non-occlusive bandage but not with an airtight occlusive dressing. If symptoms worsen or do not improve after 3-5 days, a doctor should be consulted. Patients suffering from asthma, hay fever, swelling of nasal mucous membranes (nasal polyps) or chronic obstructive pulmonary disease, chronic respiratory infections (particularly hay fever-like symptoms), and patients with hypersensitivity to painkillers and anti-rheumatic medicinal products of all kinds are rather at risk to asthma attacks, to local skin or mucous membrane swelling (Quincke oedema) or to urticaria than other patients when treated with Diclomel Max Strength. In these patients, Diclomel Max Strength may only be used under certain precautions (emergency preparedness) and direct medical supervision. The same applies for patients who are also allergic to other substances, e.g. with skin reactions, itching or urticaria. If a skin rash occurs with Diclomel Max Strength the treatment should be stopped. Direct sunlight or artificial sun should be avoided during treatment and two weeks after treatment to avoid the risk of photosensitivity. Preventive measures should be taken so that children do not contact the skin areas to which the gel has been applied. Diclomel Max Strength contains butylhydroxytoluene (E321) which may cause local skin reactions (e.g. contact dermatitis) or irritation to the eyes and mucous membranes. Diclomel Max Strength contains fragrance with eugenol and citral which may cause allergic reactions. Interactions: Since the systemic absorption of diclofenac is very low with topical application, such interactions are very unlikely in use as intended. Fertility, pregnancy and lactation: During the first and second trimester of pregnancy, diclofenac should not be used unless clearly necessary. If diclofenac is used by a woman attempting to conceive, or during the first and second trimester of pregnancy, the dose should be kept as low and duration of treatment as short as possible. Diclofenac is contraindicated during the third trimester of pregnancy. Diclofenac passes into breast milk in small amounts. However, at therapeutic doses of Diclomel Max Strength no effects on the breast-fed child are anticipated. Because of a lack of controlled studies in breast-feeding women, the medicinal product should only be used during breast-feeding under advice from a healthcare professional. Under this circumstance, Diclomel Max Strength should not be applied on the breasts of breast-feeding mothers, nor elsewhere on large areas of skin or for a prolonged period of time. Driving and operation of machinery: The topical use of diclofenac has no or negligible influence on the ability to drive and use machines. Undesirable effects: Dermatitis (including contact dermatitis), skin rash, erythema, eczema, pruritus. Refer to Summary of Product Characteristics for other adverse effects. Adverse reactions should be reported via HPRA Pharmacovigilance, website: www.hpra.ie Pack size: 50 and 100 mg tubes. A copy of the Summary of Product Characteristics is available upon request or go to www.clonmelhealthcare.ie Marketing authorisation holder: Clonmel Healthcare Ltd, Waterford Road, Clonmel, Co. Tipperary, Ireland. Marketing authorisation number: PA0126/372/001. Medicinal product not subject to medical prescription. Date last revised: March 2024. Date prepared: June 2024. 2024/ADV/DIC/122H.

Category Report: Hair

Hair Care – Value to Pharmacy

Hair care can be defined as the practices and products used to maintain the health, appearance, and vitality of the hair and scalp. It is a category that we have seen growing due to it’s ever evolving and dynamic nature with the emergence of different trends and advice from influencers and hair care professionals.

Although we see a huge commitment and loyalty of consumers to their favourite brands and products, we have noticed that there is also a willingness to try new products and brands which could potentially help them achieve the care and results they are desiring. We see a lot of consumers coming in to buy their usual hair care products and also browse and take interest in new products we highlight and have on our counters such as hair masks and in particular styling products such as sleek hair sticks which help to smoothen flyaway hairs. There has also been an increase in interest of vitamins and products to help hair from within and contribute to hair growth and strength such as hair gummies and capsules containing ingredients such a biotin.

Social media and ‘viral’ products have contributed significantly to consumer interest and increased value on the hair care category. We have noticed that any products which are heavily advertised or endorsed by social media accounts gain heavy attraction and demand from consumers. The owner of the brand ‘Sleek N Easy’ came to our pharmacy one day uninvited and was delighted to see that we stocked her new ‘Hair Finishing Stick’ and asked if she could film a video which she since uploaded onto her Tik Tok account announcing that our pharmacy stocked it. As a result, we sold out of the product within

Written by Fatimah Kara, Supervising Pharmacist, Reidy’s Pharmacy Rathcoole

a day and had to restock twice over within the same week due to the increase in demand especially from pupils in the local secondary school and word of mouth that we stocked the product.

Shopper trends as with other categories are ever changing and never static. We have seen an increased awareness and demand for more natural based hair colours which do not contain harsh chemicals, and these have overtaken other brands at the moment. Also new, novel ways of applying hair colour such as those which are like a hair mask rather than being brushed on have increased in demand. Trends change also, based on the time of year so in Autumn and Winter we see a surge in products which help dryness and provide protection from the harsh elements

so hair masks, oils and vitamin sales increase. In the Spring and Summer, we see a demand for sun protection and moisture surge products for coarseness as well as styling products to help with humidity and frizz. We have also seen an increase in sales in men’s hair care products but in particular stylers and shavers.

There is no denying that the hair care category adds significant value to the pharmacy and is one that we do not neglect. There does not seem to be a noticeable price changes as there are many brands in the category which cater to all price ranges from ¤2 shampoo and conditioners, mid-range brands all the way up to luxury brands, the vastness of choice means that consumers have many options to suit their needs. We also notice the banded products such as shampoo and conditioner packs for ¤4 are still as popular as ever and provide hair care without compromising on quality. Some hair care treatments such as conditioning masks or vitamins have seen an increase in price but consumer loyalty to these products and brands has meant that this is rarely a concern for consumers, however we do try to offer alternatives at all price levels.

New formulations of products especially in hair colour has seen certain products gain popularity such as colour which can be applied like a hair mask as previously mentioned saw a surge in interest and sales from consumers. We have seen demand for styling products such as hair dryers, straighteners and heatless curl sets all year round and not only over the Christmas period which means we have to ensure we have them in stock to cope with demands.

Sustainability could be improved in evolving the category, I feel we need more brands and products which have a strong ethos regarding ingredients which are not harmful to the environment. Although there are some emerging brands, I feel these are relatively lesser known and are not getting an opportunity to attract new consumers due to loyalty to more well-known brands who I feel could do more with regards to sustainability in both their ingredients and packaging.

There is no doubt that consumers are the drivers in this category, their loyalty to products ensures that brands do not need to worry about sales wavering. Also, consumers are behind the popularity and success of new products, and we see this when influencers and advertising for certain products are very high that this correlates to increase in sales and demand.

Variety and innovation are the key I believe to improve revenue in the category. Ever since we invested more in the category to keep all the leading products but also keeping a constant eye on new products and brands and doing research into them and highlighting and increasing awareness to consumers has significantly increased revenue in the category. It has gone beyond just shampoo and conditioner and this acknowledgement and investment in the category is highly recommended to cater to the ever-growing consumer needs and demands.

• Contains a combination of Silica, Biotin, Zinc Picolinate, Copper Citrate, Vitamin C and Vitamin E.

• We also use silica derived from bamboo shoot, which contains various compounds that provide antioxidant, skin-soothing and astringent properties. Silica is included as a higher silica content in the hair results in a lower rate of hair loss and increased brightness.

• Biotin plays a role in keratin production, which is the protein that makes up your hair.

• Zinc is vital for cell growth and collagen formation.

• Vitamin C provides antioxidant protection while Vitamin E acts as an ant-inflammatory agent in the skin.

HAIR, SKIN & NAILS

60 Second Summary

The recent Irish DXA Meeting themed - “Collaboration Matters” - took place at the University of Galway on May 10th and 11th with a variety of speakers from government, university staff, HIQA, China, Ireland, Taiwan, Singapore, UK, and the USA'.

The meeting was opened by Ms. Catherine Connolly. She acknowledged that Ireland has one of the highest prevalences of osteoporosis in the world and admitted that she was both startled by some of the recent figures and surprised that a national osteoporosis programme has yet to be put in place.

Mr. Fergal Lynch gave an excellent presentation on "Why Health Policy Matters" and how health policy is formed. He noted the theme of the meeting and agreed it is a critical part of the journey. He noted the Irish figures, and gave an outline of the journey for a national cancer programme and how it now delivers much better outcomes for patients but is not perfect.

Professor Gerard Boron, Tallaght University Hospital provided a brief but excellent overview of the biochemical basis of bone mineral density. He outlined the structure of bone and bone biochemistry, the factors which affect it and finished with a couple of unusual cases to highlight the clinical and biochemical assessment and some of the factors involved.

The last session of the day commenced with a presentation on the importance of the “Least significant change” (LSC) by Nurse Susan van der Kamp and what it means. In essence it is a measure of consistent, also known as the coefficient of variation with a 95% confidence interval and an important scientific step to understanding the consistency of measurements.

AUTHOR: Professor John J Carey & Dr Attracta Brennan, University of Galway

Professor John J Carey is a consultant physician in Medicine and Rheumatology, and Clinical lead in DXA, osteoporosis and fracture liaison services, at Galway University Hospitals, and Professor in Medicine at the University of Galway, Galway, Ireland.

Dr. Attracta Brennan is a lecturer in the School of Computer Science at the University of Galway. Her research interests span a number of areas, including: healthcare analytics, adaptive learning systems, game based learning, socio-technical systems to support older people, AR/VR and medical informatics.

1. REFLECT - Before reading this module, consider the following: Will this clinical area be relevant to my practice?

2. IDENTIFY - If the answer is no, I may still be interested in the area but the article may not contribute towards my continuing professional development (CPD). If the answer is yes, I should identify any knowledge gaps in the clinical area.

3. PLAN - If I have identified a

knowledge gap - will this article satisfy those needs - or will more reading be required?

4. EVALUATE - Did this article meet my learning needs - and how has my practise changed as a result? Have I identified further learning needs?

5. WHAT NEXT - At this time you may like to record your learning for future use or assessment. Follow the

4 previous steps, log and record your findings.

Published by IPN.

Copies can be downloaded from www.irishpharmacytraining.ie

Disclaimer: All material published is copyright, no part of this can be used in any other publication without permission of the publishers and author.

Collaboration Matters: Irish DXA Annual Meeting

The meeting was opened by Ms. Catherine Connolly, Leas Ceann Comhairle for the Dail. In a beautiful confluence of Gaeilge and English, she gave attendees a ‘céad mile failte go Gaillimh’. She acknowledged that Ireland has one of the highest prevalences of osteoporosis in the world and admitted that she was both startled by some of the recent figures and surprised that a national osteoporosis programme has yet to be put in place. She noted this disease affects around 1 in 3 women and 1 in 4 men aged 60 years and older, resulting in approximately 50,000 fractures annually. She emphasised that if we are to impact waiting times, trolley numbers and the lives of patients with this disease, then a national programme has to be a priority.

Following the address by Ms. Connolly, a patient shared her personal experience of having osteoporosis; she gave an eloquent but heart-breaking presentation titled “my story”. She recalled how she was sent to the emergency room with fractures in her back, only to be sent home

‘because there was nothing we could do’. All she was given for the pain was Panadol! She suffered needlessly for several months, and today is no longer the person she once was. She spoke about how osteoporosis doesn’t just shatter bones, it shatters lives. Despite having other illnesses, being familiar with the healthcare system and adhering very strictly to a healthy diet, regular exercise and her prescribed medication, she still ended up with eight spinal fractures. She saw an expert who noted that it was one of the worst cases that he had ever seen. She has since listened regularly to

podcasts and, as a patient finds it difficult to accept that four things which could have benefitted her are not available in Galway for public patients:

1. Shorter waiting times for MRI and DXA scans with modern technology;

2. Access to bone turnover markers to monitor her treatment;

3. Access to a team of experts to manage her acute fracture pain;

4. Access to Romosozumab which is an excellent option for those who need it.

Saturday session: Ms. Nicola Crabtree’s Presentation on Pediatric Densitometry and Professor John J Carey

Dr Attracta Brennan

Professor John J Carey

Opening speakers: Professor Bobo Tanner, Vanderbilt University, Tennessee, USA. Past President ISCD, Committee member for Osteoporosis Essentials writing group; Mr. Lee O’Hora, Health Information and Quality Authority, Ireland; Professor Manju Chandran, Singapore General Hospital, Board Member International Osteoporosis Foundation; Professor Andrea Singer, Georgetown University, D.C., USA. Chief Medical Officer, National Bone Health Alliance, USA; Professor Wing Chan, Taipei Medical University, Taiwan, Chair Scientific Advisory Committee, ISCD; Professor John J Carey

This speaker’s eloquent presentation had a profound impact on all present.

Next, Mr. Fergal Lynch gave an excellent presentation on “Why Health Policy Matters” and how health policy is formed. He noted the theme of the meeting, agreeing that it is a critical part of the journey. He discussed the Irish statistics, and outlined the journey in the development of a national cancer programme, which now delivers much better outcomes for patients, although it is not perfect. He emphasised the importance of working together, speaking to politicians and understanding their priorities, in addition to involving patients, researchers as well as expert clinicians and health professionals. He highlighted the critical role of the patient voice in driving changes and the value of international expertise and experience in leading to change.

Mr. Lee O’Hora from HIQA followed, outlining the role of HIQA in ensuring compliance with regulations for the use of ionizing medical radiation. He gave a very clear and concise overview of the regulations, the responsibilities of those undertaking procedures and the role of HIQA He explained to the audience that he was not there to punish people but to ensure that inspected organisations had clear policies and practices in place in order to adhere to the legislation thereby protecting patients and with respect to DXA, the staff and members of the public, although this would fall under the E.P.A. in many instances. He stressed that he was very impressed overall

with the processes and the level of dedication he encountered, praising many of the excellent services which are in place. He also highlighted some concerns where further clarity is desirable with regard to legislation, policy and practice. He provided an excellent overview of what they look for during inspections, and how to prepare for one should one be forthcoming. He also stressed how they welcome active engagement, feedback and discussion to protect patients and promote safe practice.

The next session featured four international panellists answering questions about the process and significance of the Position Development Conference (PDC) of the International Society for Clinical Densitometry (ISCD). The panellists were:

1. Prof. Andrea Singer, USA, 2023 ISCD PDC Expert Panellist and medical director of the National Bone Health Alliance, USA;

2. Prof. Bobo Tanner, USA, Past-President ISCD, Writing Committee member for The ISCD Osteoporosis Essentials / Bone Densitometry Course;

3. Prof. Manju Chandram, Singapore, 2023 ISCD PDC Expert Panellist and board member of the International Osteoporosis Foundation.

4. Prof. Wing Chan, Taiwan, Chair of the ISCD Scientific Advisory Committee, dual trained as an osteoporosis physician and musculoskeletal radiologist.

These experts reviewed the PDC process from the selection of topics to be considered, the extensive reviews of the literature, the work of each team on their individual sections, the voting system to either accept, reject or reconsider the proposed position and the final day of ‘word-smithing’ to use the most appropriate language to ensure that the positions were useful to a global audience. Prof. Carey chaired the session and pointed out that most Irish people would never attend an ISCD PDC and so thanked the panellists for their insights. He also noted that some Irish people perceive these to be “American” guidelines and wondered whether the expert panel agreed or not. The panel emphasised that the teams were composed of experts from around

the world, including; Australia, Brazil, Canada, Ireland, Israel, Lebanon, Singapore and of course the USA. They also noted that the positions are as relevant globally as they are in the USA, despite differences in the availability and quality of services across the globe. Prof. Chandran highlighted that Pakistan, a country which is larger than any European country, has only one DXA centre. The experts agreed that local applicability must be considered for all official positions and that in some cases, where there is limited evidence to support or refute a position, a consensus of experts can be very helpful.

Following a short break, Mr. O’Hora again returned to the stage and gave an overview of national audit guidelines published by HIQA in the past year. While these guidelines are new and at the moment are not mandatory, they will be enforced by the end of the year with HIQA requiring every centre to actively perform audits and engage at all levels of their corporation or institution. Mr. O’Hora pointed out that further details are available on the HIQA website, which also offers an excellent overview of what auditing

entails and how it promotes and supports safe practice.

Prof. Gerard Boron from Tallaght University Hospital then delivered a brief but excellent overview of the biochemical basis of bone mineral density. He explained the structure and biochemistry of bone and the factors which affect it. He also presented a number of unusual cases to highlight the clinical and biochemical assessment in addition to some of the other factors involved. His review was welcomed by many engaged in clinical practice for a long time, who might not frequently think about some of the more fundamental biochemical and structural aspects of bone disease.

Prof. Wing Chan gave a fantastic overview of vertebral fractures, their importance and their diagnosis. He pointed out that all diagnostic methods have limitations but highlighted how a combined approach could help close the diagnostic gap. He reviewed methods such as the Genant deformity scale and the Yoshida criteria in addition to some cutting edge artificial intelligence driven solutions which are currently attracting a lot of interest.

Following this, Prof. Bobo Tanner took the audience on a journey through the diagnostic approaches used for diagnosing osteoporosis or assessing bone strength. Prof. Tanner covered everything from pre-DXA non-invasive methods,

to bone biopsy, engineering laboratories testing mechanical strength and resistance to indentation to state of the art imaging such as virtual bone biopsy and the use of CT and MRI for opportunistic screening. He discussed some of the strengths and limitations of these methods, providing a comprehensive overview of a very complex field with a brief synopsis of each method. Although DXA remains the primary tool in the Republic of Ireland for osteoporosis diagnosis, it is clear there are other options, some of which may have distinct advantages in specific situations although no one solution or alternative is ideal to date.

The session closed with two brief presentations from Irish researchers. First, Dr. Louise Horrigan from the University of Galway presented her findings on using bioimpedance to assess bone strength, noting that future work is needed to correlate these results with DXA or some other gold standard. Prof. Carey then presented the results of the HRB funded DXA-MAP project demonstrating how a new screening tool has the ability to identity healthy men and women most likely to benefit from a DXA test. This tool has the potential to reduce waste by eliminating unnecessary testing in healthy people less likely to benefit, while also identifying those most likely to have osteoporosis who should be tested.

Afternoon session: Ms. Catherine Armstrong, CNS in Osteoporosis, Galway University Hospital; Professor Sansin Tuzun, Istanbul University, Turkey, Board Member European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases; Professor Andrea Singer; Professor Manju Chandran; Dr Carmel Silke, Consultant Rheumatologist, SAOLTA Hospital Group, University of Galway Rheumatology Lead, Session Chair

The afternoon session commenced with an excellent overview of the need for, and principles of modern treatment algorithms by Prof. Andrea Singer. She highlighted a paradigm shift whereby it is now clear that those deemed at very high or imminent risk of fracture are most likely to benefit from osteoanabolic therapy. Importantly, she also pointed out that evidence now shows that such therapy has a greater impact if used before rather than after anti-resorptive therapy. Prof. Singer concluded by stating that all osteoporosis medications are effective, and that individual treatment decisions should be made in consultation with the patient taking into account their concerns, wishes and abilities.

Findings from our most recent 2022 census reveal that almost 1 in 5 residents of Ireland were born abroad. This raises the complexity of understanding medical care and assessment. Professor Manju Chandran reviewed the differences between social constructs such as ‘race’ and ‘ethnicity’ and societal norms and cultural issues. She highlighted their importance for understanding both bone mineral density and fracture risk and gave examples of where she works and resides i.e. “The little Red Dot” Singapore, which has a complex multi-ethnic society. She noted there is an ‘Irish’ community there (a ‘little green dot’) who likely differ in bone content and fracture risk compared to indigenous Asian citizens. Despite some clear scientific data, she pointed out the scientific controversies and complexities that arise, especially when considering people of ‘mixed race’ and those who are immigrants in other countries.

Professor Sansin Tuzun reviewed the principles behind the

rehabilitation of osteoporotic patients, both with and without fractures. She highlighted key elements which are often not available for Irish patients, including counselling on nutrition, core strengthening and correct posture maintenance, weightbearing exercises, adequate pain control and when needed, osteoporotic medications. She also discussed the limited evidence supporting the use of certain back braces, noting that while some may be helpful in specific circumstances, many are not and/or are too cumbersome for patients to utilise. She reviewed many of these areas which are covered in detail in a recent paper of the Rehabilitation Working Group of the International Osteoporosis Foundation.

Nurse Catherine Armstrong from Galway University Hospital emphasised the importance of DXA in fracture liaison services for patients and healthcare professionals looking after them. She explained how once patients have sustained a fracture, osteoporosis is the likely, diagnosis and DXA measurement of BMD is crucial for assessing prognosis and monitoring treatment. She pointed out that there was much more to DXA than measuring BMD; it includes vertebral fracture assessment technology which can impact management decisions. Also, it serves as another healthcare visit for patients to receive education and discuss their concerns, often helping to bridge the gap between ’what the doctor said’ and what the patient understands. The final session of the day began with a presentation by Nurse Susan van der Kamp on the importance of the “Least significant change” (LSC) and what it means. She explained that LSC is a measure of consistency, also known as the coefficient of variation with a 95% confidence interval; it is an important scientific step to understanding the consistency of measurements. She emphasised that using the manufacturer’s LSC is not recommended as it is only one of four factors that affect the true value. Random error, patient factors and the scanning health professional factors also affect the measurement, underscoring the need for a scientific approach. She pointed out that repeat DXA scans have no proven value in the absence of a known LSC for that DXA machine in that centre, and

ideally for each individual involved in scanning patients.

Ms. Ciera O’Reilly followed with a review of their experience in establishing the LSC for their centre, which is a new DXA facility for their institution. She detailed their protocol and how they used the ISCD calculation tool to generate their values. She reiterated that this metric is essential if patients are to have a follow-up scan.

Dr. Eithne Murphy then reviewed the risk of systemic and periarticular bone loss in rheumatic diseases, in particular rheumatoid arthritis. She highlighted that all rheumatic illnesses are associated with a substantially higher risk of fracture compared to the general population. She also noted that not only are these patients at greater risk of losing bone strength but they are also are at greater risk of losing muscle strength and balance due to their underlying arthritis or concomitant use of some medications such as corticosteroids. Dr. Murphy made some general recommendations to assess the bone health and fall risk of all patients with rheumatic diseases and advised consideration of whether risky treatments like corticosteroids are necessary when assessing them.

Finally, the evening finished on a lighter note when Dr. Attracta Brennan showcased Tik Tok videos created by her university students to explain why Humpty Dumpty had osteoporosis and how it affected him. Given the excellent presentations earlier in the day, which highlighted the need for clear and appropriate communication, the use of Tik Tok videos created by non-medical 20-21 year old undergraduate students was seen as an excellent way to help nonmedical individuals understand the significance of bone health. Although it was difficult to choose a winner from several outstanding videos, conference attendees awarded the top prize to a student who not only provided an excellent story outlining why poor old Humpty Dumpty ‘with bones like that never stood a chance’ accompanied by amazing graphics. Other students unpicked the biases in the nursery rhyme questioning why people thought Humpty Dumpty was an egg when he was in fact, a man with osteoporosis. A number of Tik Tok videos featured fantastic rhyming stories and graphical illustrations comparing the difference between falling with healthy bones (or egg-shells) to falling with osteoporosis

Day two commenced with a brief review of all the society’s activities and some challenging clinical cases that built on some of the principles discussed on the first day. This session prompted pertinent questions and lively discussions. Dr. Erjiang E, from China, then presented his study on the sensitivity, specificity and accuracy of DXA for diagnosing osteoporosis in Irish adults. His extensive analysis showed that there is a considerable range in these values depending on : age, gender, site of BMD measurement and site of skeletal fracture. These factors must always need to be considered when performing any test. For the first time, we have some robust Irish data from thousands of people both with and without fractures.

Next, Dr. Emerald House, Medical physics, Galway University Hospital provided an excellent pre-recorded review of ‘Diagnostic Related Levels’ (DRLs). This presentation helped attendees understand the various ionizing radiation exposures associated with DXA, how these exposures compare to the general environment and other imaging modalities, and the purpose of DRLs. Dr. House clearly explained how DLRs are

calculated, their significance and how, like LSC, they are important for understanding the ALARA principle and best practice when it comes to justification for medical ionizing radiation.

Dr. Nicola Crabtree (a lecturer in the first ISCD paediatric course 16 years ago) then reviewed some of the complexities of scanning paediatric patients. She provided some updates on current ISCD positions and practices and reviewed the complexities with some case examples. She emphasised that DXA in children is complex and should not be undertaken by those unfamiliar with the field. The performance and interpretation of these scans is more challenging than in adults in many situations, but can be extremely helpful when performed and interpreted correctly by the right people for the right reasons. She noted that some complex issues in paediatric DXA remain evolving and, similar to adult cases, have certain limitations.

The conference concluded with several workshops and discussion groups. These focussed on manufacturer specific considerations for GE and Hologic DXA systems – the two most common DXA systems in use in Ireland. Led by Irish experts: Ms. Bridie Rooney and Ms. Catherine Corry for G.E. Lunar and Ms. Susan van der Kamp for Hologic, these sessions featured lively discussions with plenty of questions and answers. They provided DXA users, who often operate in remote or single person locations, a chance to discuss any concerns or ask necessary questions. Following these, workshops run by GP and Hospital units that have already undergone HIQA inspections, helped attendees understand the inspection process, how to organise and present their working practices and standard operating procedures to help them prepare for future inspections.

Note: A booklet was provided to the attendees courtesy of the Irish DXA MAP team highlighting several key statistics related to DXA and Osteoporosis in Ireland:

References: https://www.dxasoc.ie/nextmeeting

https://dxa-map.com

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Category Report: VMS

Notable Growth for VMS Sector

The vitamins, minerals, and supplements (VMS) category is experiencing notable growth in 2024, driven by increasing consumer awareness and interest in personal health and wellness. According to the Fitzgerald Power Pharmacy Pulse Report Q1 2024, the overall industry growth is marked at 2.2%.

This upward trend is even more pronounced within specific franchises; for instance, the Navi Group, which includes the StayWell Pharmacy franchise, of which Mark Philips is a member, has reported a robust 5% growth. Particularly, the gut health category within the Navi Franchise has shown a significant 6% increase in volume, with a growing consumer preference for probiotic supplements. This surge in demand reflects broader purchasing behaviors as customers prioritize products that support overall health and wellbeing, making the VMS category a dynamic and essential part of the pharmacy retail landscape.

Consumer Behaviour & Buying Habits

Interestingly, the surge in volume sales within the vitamins category can be intricately linked to a significant 17% growth in the cold and flu category. This increase, likely influenced by unpredictable weather patterns, has persisted throughout the summer months. As customers flock to pharmacies to buy cold and flu medications, pharmacy teams have seen a compelling trend: many of these customers are also opting to buy vitamins. This behaviour suggests an initiative-taking approach to

Written by Mark McPhillips, Superintendent Pharmacist, Staywell Pharmacy

health, as individuals look to bolster their immunity and prevent future illnesses.

Vitamins and supplements, particularly vitamin C and probiotics, are becoming popular choices for their proven benefits in supporting general immunity. These products are not just quick fixes but are increasingly viewed as essential preventative measures. Customers are recognizing the value of supporting their health even after recovering from an initial bout of cold or flu, leading to a more health-conscious consumer base. This shift in buying habits underscores a broader trend towards holistic wellness and the role of pharmacies in guiding and supporting these proactive health decisions.

At a time of year when allergy sales would typically be soaring, the lack of sunny weather has dampened these figures, pushing vitamins to the forefront as a preventative measure against colds and flus. This year’s gloomy weather has not only affected allergies but has also spurred an increase in vitamin D purchases. With natural sunlight scarce, many Irish consumers are turning to supplements to meet their vitamin D needs. In fact, the

Department of Health’s January 2024 recommendation for all Irish adults and children to take vitamin D supplements through winter—at least until St. Patrick’s Day—has likely extended well beyond the typical season due to continued poor weather conditions.

Additionally, the Fitzgerald Power Pharmacy Pulse Report Q1 2024 highlights a notable increase in the habit treatment category, including smoking cessation products. This trend suggests a growing public concern for overall health. As individuals embark on their health journeys, starting with smoking cessation, it’s common to see a simultaneous rise in the purchase of vitamins to support their wellness goals.

Moreover, a significant 6% drop in pain category sales, coupled with the rise in vitamin sales, indicates a shift in consumer behaviour towards maintaining health proactively with vitamins and supplements. Rather than treating pain after it occurs, consumers are increasingly focused on staying well, reducing their reliance on pain medications. This proactive approach underscores a broader trend in health-conscious buying habits, with pharmacies playing a pivotal role in guiding and supporting these consumer choices.

Technological Changes

Technological advancements are significantly shaping the vitamins, minerals, and supplements (VMS) category, enhancing both the consumer experience and pharmacy operations. The integration of AI-driven health apps and wearable devices is revolutionizing how consumers track their nutritional intake and health metrics, providing personalized supplement recommendations based on realtime data. Pharmacies are using advanced inventory management systems and automated dispensing technologies to ensure optimal stock levels and streamline operations. Additionally, e-commerce platforms and telehealth services have expanded

access to VMS products, allowing customers to conveniently buy supplements online and receive professional guidance remotely. These technological innovations are not only boosting efficiency but also fostering a more informed and health-conscious consumer base.

Shopper Trends

Shopper trends in the pharmacy sector are evolving, with consumers becoming more priceconscious yet equally more healthconscious, a shift accelerated by the aftermath of the COVID-19 pandemic. This dual awareness is clear in the increased purchase of vitamins and supplements, ranging from multivitamins to probiotics, as people prioritize maintaining their health and building immunity against potential illnesses.

The demand for personalized nutrition is rising, with customers seeking tailored supplement plans supported by advancements like DNA testing kits and health tracking apps. Additionally, there is a strong preference for natural and organic supplements, driven by a desire for transparency and safer, cleaner products. Sustainability also plays a significant role, with shoppers favouring brands that practice eco-friendly sourcing and packaging.

Price points in the vitamins and supplements category vary widely, from low-end to high-end products. Interestingly, consumers are now more willing to invest in higher-priced items to support their health and potentially avoid the need for pain medication or antibiotics in the future. This willingness to spend on preventive health measures highlights a broader shift towards proactive wellness.

The convenience of e-commerce has also reshaped shopping behaviours, making it easier for consumers to order supplements online and subscribe to regular deliveries, ensuring their health routines still are uninterrupted. Additionally, the influence of health and fitness influencers on social media has significantly affected consumer choices, guiding

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Category Report: VMS

purchasing decisions and shaping general health practices.

Lastly, the demand for immuneboosting supplements has surged, particularly for products like vitamin C, vitamin D, and probiotics. This trend underscores a growing emphasis on immunity in the wake of global health concerns, reflecting a more informed and proactive approach to personal health.

Overall Category Value, Price Changes, and Major Cost Changes

The vitamins, minerals, and supplements (VMS) category is experiencing significant growth in 2024, driven by increased consumer demand and a focus on health and wellness. This expansion is clear across personalized nutrition, natural and organic products, and immuneboosting supplements.

Price changes within the VMS category have been influenced by several factors. The rising demand for high-quality, natural, and organic supplements has led to a wider range of price points. Consumers are increasingly willing to invest in premium products, recognizing the long-term health benefits of preventive measures.

Major cost changes, including higher raw material costs, supply chain disruptions, and increased transportation expenses, have contributed to price increases. Technological advancements, such as AI-driven health apps and wearable devices, add value but also incur added costs for manufacturers and retailers.

To manage these costs, brands are improving operational efficiencies and leveraging economies of scale. Pharmacies are adopting advanced inventory management and automated dispensing technologies to streamline operations and reduce expenses.

Overall, the VMS category’s growth, combined with strategic price adjustments and cost management, reflects a robust market driven by health-conscious consumers willing to invest in their wellness.

Factors Holding the Category Back, Significant Opportunities, and Potential Risks

The vitamins, minerals, and supplements (VMS) category faces several challenges. Increased online competition and reduced disposable income are potential risks. Rising retail prices are driving consumers towards generics over brand-name products, impacting margins and sales. The Navi Franchise has observed a 40% drop in sales of high-value items (over ¤50) compared to 2023, particularly in skincare, cosmetics, and fragrance categories. This trend could extend to higher-priced vitamin and probiotic supplements.

Key Influencers in the Category

Social media influencers play a crucial role in shaping consumer behaviour within the VMS

category. These influencers can significantly change purchasing decisions by promoting specific products and sharing their health and wellness journeys.

Strategies to Improve Revenue in the Category

The Navi Franchise, including Mark’s Pharmacy in Ardee, is focusing on margin-boosting products and pharmacy-specific lines in their promotional strategies. They emphasize complementary product ranges to encourage link-selling and highlight categories with significant growth opportunities, such as children’s vitamins.

A key initiative is the Back-toSchool promotional campaign in Navi franchise pharmacies (CarePlus & StayWell). This campaign focuses on supporting children’s health as they return to school and throughout the autumn and winter months. The campaign features a dedicated gondola end with essential products for parents, including children’s multivitamins and probiotic supplements for immunity and gut health.

Additionally, Navi provides franchise stores with point-ofsale materials for their year-round

Advice & Treatment campaign. This initiative focuses on various categories at various times, based on the specific pharmacy’s needs and consumer trends. For example, a current focus on gut health and its benefits to immunity and overall health is highlighted ahead of the autumn and winter seasons, encouraging continued consumer behaviour of buying preventive vitamin and supplement products for themselves and their families.

Conclusion

Despite the challenges of increased competition, price sensitivity, and shifting consumer preferences, the VMS category holds significant potential. By using technological advancements, understanding shopper trends, and implementing strategic promotional activities, pharmacies can continue to drive growth. Focusing on highdemand areas such as children’s health and gut health, and using the influence of social media, can help navigate the market dynamics and secure a robust position in the evolving landscape of vitamins, minerals, and supplements.

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Composition: Each tablet contains 20 mg esomeprazole (as magnesium dihydrate).

Description: Light pink oval lm coated tablet.

Indication(s): Proton Pump Inhibitor (PPI): Short-term treatment of re ux symptoms (e.g. heartburn and acid regurgitation) in adults. Dosage: Swallow tablets whole with liquid, do not chew or crush. Disperse in half a glass of non-carbonated water if di culty in swallowing. Stir until tablets disintegrate, drink liquid with pellets immediately or within 15 min, or administer through a gastric tube. Do not chew or crush pellets. Adults: Recommended dose is 20 mg esomeprazole (one tablet) per day. It might be necessary to take the tablets for 2-3 consecutive days to achieve improvement of symptoms. Duration of treatment is up to 2 weeks. Once complete relief of symptoms has occurred, treatment should be discontinued. If no symptom relief is obtained within 2 weeks of continuous treatment, the patient should be instructed to consult a doctor. Elderly (≥ 65 years old): As per adults. Paediatric population (< 18 years): Not recommended. No relevant use in this group in the indication: “short-term treatment of re ux symptoms (e.g., heartburn and acid regurgitation)”. Severe impaired renal function: Caution. Severe liver impairment: 20 mg max daily dose. Contraindications: Hypersensitivity to esomeprazole, substituted benzimidazoles or any of the excipients. Not with nel navir. Warnings and Precautions for Use: On demand treatment: Contact a physician if symptoms change in character. In the presence of any alarm symptom (e.g. signi cant unintentional weight loss, recurrent vomiting, dysphagia, haematemesis or melaena) and when gastric ulcer is suspected or present, malignancy should be excluded, as treatment with esomeprazole may alleviate symptoms and delay diagnosis. Treatment with proton pump inhibitors (PPIs) may lead to a slightly increased risk of gastrointestinal infections such as Salmonella and Campylobacter and in hospitalised patients, also possibly Clostridium di cile. Patients should consult their doctor before taking this medicinal product if they are due to have an endoscopy or urea breath test. Absorption of vitamin B12 may be reduced due to hypo- or achlorhydria. Not recommended for long-term use as the following may also occur: Hypomagnesaemia; Risk of fracture. Consider stopping Emazole Control in cases of subacute cutaneous lupus erythematosus (SCLE) accompanied by arthralgia. Serious cutaneous adverse reactions (SCARs) such as erythema multiforme (EM), Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN) and drug reaction with eosinophilia and systemic symptoms (DRESS), which can be life-threatening, have been reported very rarely. Patients should be advised of the signs and symptoms of the severe skin reaction EM/SJS/TEN/DRESS. Discontinue and seek medical advice immediately when observing any indicative signs or symptoms. Do not re-challenge. Interference with laboratory tests: Increased Chromogranin A (CgA) level may interfere with investigations for neuroendocrine tumours. To avoid this interference, Emazole Control treatment should be stopped for at least 5 days before CgA measurements. If CgA and gastrin levels have not returned to reference range after initial measurement, measurements should be repeated 14 days after cessation of PPI treatment. Contains glucose and sucrose.

Interactions: E ect of esomeprazole on other drugs: Co-administration with atazanavir is not recommended. If the combination of atazanavir with a PPI is judged unavoidable, close clinical monitoring is recommended in combination with an increase in the dose of atazanavir to 400 mg with 100 mg of ritonavir; esomeprazole 20 mg should not be exceeded. Esomeprazole is a CYP2C19 inhibitor. When starting or ending treatment with esomeprazole, the potential for interactions with drugs metabolised through CYP2C19 should be considered. Serum levels of cilostazol, cisapride, tacrolimus, methotrexate may be increased. An interaction is observed between clopidogrel and esomeprazole, but the clinical relevance is uncertain. As a precaution, concomitant use of esomeprazole and clopidogrel should be discouraged. Gastric acid suppression by PPIs increase or decrease absorption of drugs with pH dependent absorption (decreased absorption of ketoconazole, itraconazole); esomeprazole inhibits CYP2C19 metabolising enzyme and could increase plasma concentrations of diazepam, citalopram, imipramine, clomipramine, phenytoin (monitor plasma levels of phenytoin), etc. resulting in need of a dose reduction; monitor INR when given with warfarin or similar. Caution as absorption of digoxin can increase. E ect of other drugs on esomeprazole: CYP2C19 and CYP3A4 inhibitors (clarithromycin, voriconazole) may increase the esomeprazole exposure. Dose adjustment not regularly required, except in severe hepatic impairment and long-term use. CYP2C19 and/or CYP3A4 inducers (rifampicin and St. John’s wort) may lead to decreased esomeprazole serum levels by increasing the esomeprazole metabolism.

Pregnancy and Lactation: Caution in pregnancy due to lack of clinical data. No studies in lactating women, therefore, not recommended during breast-feeding. Ability to Drive and Use

Machinery: Minor in uence on the ability to drive or use machines. Adverse reactions such as dizziness (uncommon) and blurred vision (rare) have been reported. If a ected, patients should not drive or use machines. Undesirable E ects: Common: Headache, abdominal pain, constipation, diarrhoea, atulence, nausea/vomiting, fundic gland polyps (benign). Uncommon: Peripheral oedema, insomnia, dizziness, paraesthesia, somnolence, vertigo, dry mouth, increased liver enzymes, dermatitis, pruritis, rash, urticaria, fracture of the hip, wrist or spine. For other side e ects refer to the SPC.

Marketing Authorisation Holder: Rowa Pharmaceuticals Ltd., Newtown, Bantry, Co. Cork. Marketing Authorisation Number: PA 0074/100/001. Further information and SPC are available from: Rowex Ltd, Bantry, Co. Cork. Freephone: 1800 304 400 Fax: 027 50417. E-mail rowex@rowa-pharma.ie

Legal Category: Not subject to medical prescription. Date of Preparation: July 2024 CCF for API: 26593

Category Report: Eczema in Children

Treating Eczema in Babies

Atopic dermatitis (AD), also known as eczema, is the most common skin condition in children, affecting 30% of Irish babies in the first 2 years of life. AD has a significant impact on quality of life (QOL) for infants and their parents. The main burdensome symptoms are itch and sleep disruption (Image 1). AD is associated with other atopic conditions such as food allergy, asthma, and allergic rhinitis. These associations often lead to babies with AD being treated with ineffective and inappropriate treatments, such as dietary restriction, which have no role in AD. AD is also associated with neuropsychiatric diseases such as anxiety, depression, and attention-deficit hyperactivity disorder. There is growing evidence that developing eczema in early life might increase the risk of autism. Immunologically, there may be a window of opportunity to intervene in early life to prevent progression to more chronic and severe AD. For all these reasons, effective is the treatment of eczema in babies is extremely important.

Cause of AD

The cause of AD relates to a combination of the triad of skin barrier dysfunction, skin dysbiosis, and dysfunctional inflammation. Skin barrier dysfunction is genetically inherited, with filaggrin mutations significantly increasing the risk of developing AD. Filaggrin plays an important role in the skin’s barrier function. It brings together structural proteins in the outermost skin cells to form tight bundles, flattening and strengthening the cells to create a strong barrier. In AD, skin is heavily colonised with Staphylococcus aureus (S. aureus) in lesional and non-lesional skin. A rising proportion of S. aureus in skin microbiome samples predicts a flare, and diversity of nonstaphylococcal species returns once a flare has been treated. A hallmark of AD is Th2-mediated inflammation, with high levels of IL-4 and IL-13 that promote dysfunctional allergic inflammation. With chronic or untreated AD, other immune pathways can become activated. Each component of the triad interacts with the others in a vicious cycle, for example filaggrin deficiency allows antigens to penetrate the stratum corneum

Written by Dr Cathal O’Connor, Clinical Research Fellow in

Paediatric Dermatology, Irish Clinical Academic Training Programme, Royal College of Physicians of Ireland

Anti-inflammation

and stimulate inflammation, and subsequently IL-4 and IL-13 production leads to reduced filaggrin production. It has recently been shown that dupilumab (a biologic targeting IL-4 and IL-13) not only reduces inflammation but enhances skin barrier function, highlighting the importance of adequately treating inflammation in AD. It is essential to treat each component of the causes of AD adequately to optimise outcomes.

Treatment of AD

To deal with the three intertwining causes of AD, a three-pronged approach is necessary: emollients to replenish the skin barrier, topical steroids or calcineurin inhibitors to reduce inflammation, and antiseptic bleach baths to reduce cutaneous dysbiosis. In special scenarios oral antibacterial or antiviral agents may be required.

Parents of babies with AD should NOT be told to use topical steroids ‘sparingly’ or ‘thinly’ and should be advised to treat for an adequate duration. Babies with AD should NOT be treated with oral steroids (outside of expert centres with a therapeutic exit strategy in place) due to the severe side effects and lack of disease modification. Parents of babies with AD should NOT be told to change their washing powder or reduce/ eliminate foods from their diet, as AD is not caused by detergents or food allergy, and this can lead to nutritional deficiencies.

The use of anti-inflammatory steroid creams/ointments is essential to reduce inflammation in AD. Early and aggressive use of topical steroids can reduce the duration of disease, and may also reduce the risk of developing associated problems. The dermatology team in Crumlin have recently shown that reducing inflammation in the skin using steroid creams also reduces systemic inflammation, suggesting that topical steroids can correct the systemic immune dysregulation in AD. For mild AD, hydrocortisone 1% can be dispensed over the counter. However, hydrocortisone 1% is a very weak antiinflammatory agent, and is not sufficient to treat more severe eczema. For moderate AD, agents such as clobetasone butyrate (Eumovate) or betamethasone valerate 0.025% (Betnovate RD) can be used. For severe AD, potent agents such as betamethasone valerate 0.1% (Betnovate 0.1%)

or mometasone furoate (Elocon) should be used. In general it is better to use a more potent topical steroid less frequently than a weaker topical steroid more frequently, for two reasons: systemic absorption is related to the frequency of application, and the burden of treatment with daily topical steroid application is much higher than twice weekly. Topical steroids should be applied liberally (not sparingly!) so that the affected skin is left glistening afterwards. Ointments are preferable to creams as the higher lipid content makes the vehicle more effective. There is no benefit to using topical steroids more than once daily - more frequent use increases the risk of systemic absorption and reduces adherence. In general, therapy should be continued once daily for two weeks, then weaned to alternate days for two weeks, then maintained twice weekly (weekend therapy on Saturdays and Sundays is a good option for busy parents) until the skin has been clear for several months.

From fever to blocked noses, Calpol has got you covered.

120 mg/5 ml Sugar Free Infant Oral Suspension, Calpol Six Plus Sugar / Colour Free Oral Suspension. Composition:

colds. Dosage: Calpol Infant:

Pharmaceutical Form: Oral Suspension, Indications: Calpol is indicated for the symptomatic relief of headache, migraine, neuralgia, toothache and teething pains, sore

Six Plus Oral Suspension:

and

Children under 6 years: Calpol Six Plus Suspension is not suitable for administration to children under 6 years of age. Renal impairment: It is recommended, when giving paracetamol to patients with renal impairment, to reduce the dose and to increase the minimum interval between each administration to at least 6 hours unless directed otherwise by a physician. Patients should be advised to contact their healthcare professional before use. Recommended Dose for Adults with Renal Impairment:

Hepatic impairment: In patients with hepatic impairment or Gilbert’s Syndrome, the dose should be reduced or the dosing interval prolonged. Patients should be advised to contact their healthcare professional before use. The Elderly: Experience has indicated that normal adult dosage is usually appropriate. However, in frail, immobile, elderly subjects or in elderly patients with renal or hepatic impairment, a reduction in the amount or frequency of dosing may be appropriate. For certain patient groups, a reduced maximum daily dose should be considered: Patients who are underweight (for adults, those under 50kg), Chronic alcoholism, Dehydration, Chronic malnutrition. These patients should be advised to contact their healthcare professional before use. Contraindications: Hypersensitivity to the active substance or to any of the excipients. Special warnings and precautions for use: Paracetamol should be administered with caution under the following circumstances: Hepatic impairment, Chronic alcoholism, Renal impairment (GFR≤50ml/min), Gilbert’s Syndrome (familial non-haemolytic jaundice), Concomitant treatment with medicinal products affecting hepatic function, Glucose-6-phosphate dehydrogenase deficiency, Haemolytic anaemia, Glutathione deficiency, Dehydration, Chronic malnutrition, Patients who are underweight (for adults, those under 50 kg), Elderly. In general, medicinal products containing paracetamol should be taken for only a few days without the advice of a physician or dentist and not at high doses. If high fever or signs of secondary infection occur or if symptoms persist for longer than 3 days, a physician should be consulted. Prolonged or frequent use is discouraged. Patients should be advised not to take other paracetamol containing products concurrently. Taking multiple daily doses in one administration can severely damage the liver; in such cases medical assistance should be sought immediately. Serious skin reactions such as acute generalized exanthematous pustulosis (AGEP), Stevens - Johnson syndrome (SJS), and toxic epidermal necrolysis (TEN), have been reported very rarely in patients receiving paracetamol. Patients should be informed about the signs of serious skin reactions and use of the drug should be discontinued at the first appearance of skin rash or any other sign of hypersensitivity. Caution is advised if paracetamol is administered concomitantly with flucloxacillin due to increased risk of high anion gap metabolic acidosis (HAGMA), particularly in patients with severe renal impairment, sepsis, malnutrition and other sources of glutathione deficiency (e.g. chronic alcoholism), as well as those using maximum daily doses of paracetamol. Close monitoring, including measurement of urinary 5-oxoproline, is recommended. Calpol Infant Sugar Free: Carmoisine (E122) which may cause allergic reactions.-Methyl parahydroxybenzoate (E218),Propyl parahydroxybenzoate (E216), Ethyl parahydroxybenzoate (E214) which may cause allergic reactions (possibly delayed).This medicine contains less than 1 mmol sodium (23 mg) per 5ml, that is to say essentially ‘sodium-free’. This medicine contains 14.32mg propylene glycol (E1520) in each 5ml dose, which is equivalent to 2.86mg/ml. This medicine contains 0.16mg benzyl alcohol in each tablet. High volumes should be used with caution and only if necessary, especially in subjects who are pregnant or breastfeeding, or subjects with liver or kidney impairment because of the risk of accumulation and toxicity (metabolic acidosis).This medicine contains 0.00071mg of alcohol (ethanol) in each 5ml which is equivalent to 0.000142 mg/ml. The amount in 5 ml is equivalent to less than 1ml beer or 1 ml wine. The small amount of alcohol in this medicine will not have any noticeable effects. Due to the sorbitol (E420) and maltitol (E965) content of this product, patients with rare hereditary problems of fructose intolerance should not take this medicine. Sorbitol and maltitol may cause gastrointestinal discomfort and have a mild laxative effect. Calorific value 2.3kcal/g maltitol. Calpol Six Plus Sugar/Colour Free: Contains 2.04g Maltitol and 1.4g Sorbitol per 5ml.Sorbitol and maltitol may cause gastrointestinal discomfort and have a mild laxative effect. Patients with hereditary problems of fructose intolerance (HFI) should not take/be given this medicine. Calorific value 2.3kcal/g maltitol. Methyl and propyl parahydroxybenzoates may cause allergic reactions (possibly delayed). This medicine contains less than 1 mmol sodium (23 mg) per 5ml, that is to say essentially ‘sodium-free’. This medicine contains 20.92mg propylene glycol (E1520) in each 5ml dose, which is equivalent to 4.18mg/ml. This medicine contains 0.05mg benzyl alcohol in each tablet. High volumes should be used with caution and only if necessary, especially in subjects who are pregnant or breastfeeding, or subjects

Calpol

Calpol Infant Oral Suspension contains - Paracetamol 120 mg per 5 ml. Calpol Six Plus Oral Suspension contains Paracetamol 250 mg per 5 ml.

throat, influenza, feverishness

feverish

Calpol

CALPOL® Vapour Plug & Nightlight is an electrical device and non-medicine. CALPOL® Saline Nasal Spray is a medical device for congestion relief. ALWAYS READ THE LABEL.

Myth 1 Topical steroids should be applied sparingly/thinly and only for short bursts

Topical steroids are a very elegant way to deliver local antiinflammatory therapy, without the potential side effects that systemic therapy can produce. Skin that is inflamed with AD is on fire immunologically. This immune dysregulation needs to be extinguished appropriately to prevent worsening or chronic AD. If topical steroids are stopped too quickly the inflammation can return rapidly. Parents are almost always counselled by pharmacists and non-dermatology doctors about the risk of skin thinning, but this is generally limited to prolonged use of extremely potent topical steroids such as Dermovate (which should only be prescribed for palmoplantar AD). We have recently performed qualitative research interviewing parents of children with severe eczema, and the ‘mixed messages’ about the safety of topical steroids can cause significant upset.

Myth 2 Topical steroids can never be used on broken skin in AD

When skin inflammation is so severe that it has caused skin breakdown, either directly or indirectly from scratching, it is essential to reduce inflammation to avoid further damage. It is safe to apply topical steroids to broken skin.

Topical tacrolimus, a calcineurin inhibitor, is an alternative to topical steroids. It is a useful antiinflammatory adjunct, particularly in the maintenance phase of AD (rather than the treatment of flares, when it is less effective than potent topical steroids). The only side effect is mild stinging with the first few applications, which usually settles down with ongoing use. Given the lack of steroid, it is particularly useful for sensitive areas such as the eyelids. Topical tacrolimus is much more expensive than topical steroids.

Myth 3 Topical tacrolimus can never be used in babies and only 0.03% can be used in older children

Topical tacrolimus (Protopic) has been used in dermatology for decades, with an overwhelming volume of reassuring safety data. Protopic 0.1% is licensed for patients over 16 years, and Protopic 0.03% is licensed from two to 16 years. Dermatologists usually prescribe the 0.1%

Category Report: Eczema in Children

formulation for all ages, because of the extensive safety data and the enhanced efficacy. There is extensive anecdotal evidence of safety of Protopic in younger infants, so Protopic 0.1% is often prescribed off-license for infants under two years.

Skin barrier replenishment

Moisturisers (also known as emollients) should be used twice daily or more, and moisturising after a bath (‘soak and seal’) is an excellent way to hydrate the skin. Moisturisers should be applied downwards to avoid blocking or irritating hair follicles. A pump dispenser is useful for preventing bacterial colonisation of the moisturiser container. Alternatively, a large spoon can be sterilised (using boiling water) and dipped into a tub to avoid transfer of bugs from the parent’s hand to the container. Appropriate bathing advice for babies with AD is to avoid soaps or irritant products that produce bubbles, use an emollient (that does not contain sodium laureth sulfate) as a wash, keep the temperature of the bath tepid, and limit the duration of the bath/shower to 10 minutes or less. The skin should be gently patted dry afterwards.

Myth 4 There is a number one brand of emollient for treating AD

There is no particular brand of emollient that is significantly superior than any other for treating AD. One of the key causes of AD is an impaired skin barrier, and every individual has differing levels of various proteins in their skin that retain moisture and protect us from external threats. Every moisturiser has a different mixture of ingredients, so it best for parents to try several brands to see which leaves the skin most hydrated.

Antimicrobial strategies

For infection-driven flares, the addition of sodium hypochlorite (eg Milton) bleach baths is an effective strategy for reducing microbial colonisation, without causing antibiotic resistance. Two capfuls (60mL) can be added to a baby bath (50L) and four capfuls (120mL) can be added to a full bath (100L) once or twice weekly. Topical fusidic acid (Fucidin) is frequently prescribed by non-dermatologists for AD and other skin infections. S. aureus resistance to fusidic acid has reached crisis point, driven by inappropriate use of topical antibiotics, and topical fusidic

acid should no longer be routinely prescribed for AD. Moreover, the selection for fusidic acid resistant strains also selects for methicillin resistance, creating even more problems with MRSA. If antibiotics are required for infected AD, then oral antibiotics should usually be prescribed, in conjunction with topical antiseptics (eg Milton).

Myth 5 Topical antibiotics are better than oral antibiotics because they do not cause antimicrobial resistance

Topical antibiotics are known to cause localised antimicrobial resistance in the area being treated, but also in cutaneous sites distant to application. One recent study even showed antimicrobial resistance on the skin of close contacts. While oral antibiotics have scope to cause more antimicrobial resistance in an individual patient due to exposure to other flora such as in the gastrointestinal tract, topical antibiotics are usually washed off ‘as is’, compared to oral antibiotics which are excreted in urine or egested in faeces as less active or inactive by-products. The introduction of topical antibiotics directly to waste water is a major contributor to antimicrobial resistance globally.

Special scenarios

Bacterial superinfection

As mentioned, S. Aureus is a major contributor to pathogenesis and flares of AD. While patients with AD are almost always colonised with S. aureus, some babies will develop bacterial superinfection. This manifests as weeping of clear or purulent fluid, honey-coloured crust, folliculitis, abscess, or cellulitis. If there is evidence of bacterial superinfection then oral antibiotics should be prescribed, guided by microbiological cultures (predominantly for resistance information) and local antimicrobial practices. These should be prescribed in conjunction with topical antiseptic measures, which should be instituted as a preventative measure.

Eczema herpeticum

Eczema herpeticum occurs due to infection with herpes simplex virus, and is more common in children. It manifests as clusters of painful and itchy blisters which evolve into punched-out erosions, sometimes associated with fever. Children can have inactive AD, so it does not represent a sign of treatment failure. It is helpful to

take viral PCR swabs to confirm the diagnosis. Treatment should be immediately started with oral acyclovir/valaciclovir. Intravenous therapy may be required if there is concern for ophthalmic or central nervous involvement, or if the patient is unwell. Children with recurrent eczema herpeticum should consider prophylactic antiviral treatment.

Eczema coxsackium

Eczema coxsackium is a recently described entity caused by coxsackie A6 or A16 in babies with AD. Clusters usually occur in springtime. It looks very similar to eczema herpeticum but it is not itchy and there is a slightly purpuric hue to the background skin. Respiratory viral panels can be sent to confirm enterovirus infection as the PCR testing is difficult to access. Given the similarities to eczema herpeticum it is very reasonable to start treatment with acyclovir or valaciclovir but enteroviruses do not express viral thymidine kinase and therefore do not respond to antiviral treatment.

When to refer

Babies with persistent or severe AD despite the use of appropriate potent topical therapy should be referred to dermatology for consideration of advanced therapies. Use of 1% hydrocortisone for a few days does not represent a trial of topical steroids: an adequately potent steroid should be prescribed for at least two weeks to assess response. Dermatologists now have access to dupilumab, a biologic drug targeting IL-4 and IL-13 which is now licensed from 6 months and can be life-changing. In addition, other biologic drugs and oral janus kinase (JAK) inhibitors are also available. JAK inhibitors have a more rapid onset of action and quickly reduce itch, but there are still some concerns about longterm use, based on studies in other conditions such as rheumatoid arthritis, with patients who represent a very different population to babies with AD. Topical JAK inhibitors have been licensed in some countries with significant benefit seen in AD, although cost is currently prohibitive.

Overall it is a very positive time for dermatologists and patients with AD, with effective treatments already available and many more in the pipeline.

Category Report: Skincare

Skincare Market in Irish Pharmacy

Skincare is the fastest growing category in the Irish Health & Beauty market with the category seeing 9% growth this year in pharmacies. This growth is driven by increased consumer awareness about skincare, a rising focus on personal health and wellness and the influence of social media and celebrity endorsements.

There was significant growth in the skincare category during the Covid-19 lockdowns in 2020 and the growth has continued. Consumers became more focused on self-care and wellness during this period and skincare became a priority for many consumers. Many consumers were opting for make-up free skin and focused on the importance of a good skincare regime.

Derma skincare has continuously seen the most engaged shoppers in the skincare category in pharmacies with consumers looking at clinical studies and key ingredients. La RochePosay and CeraVe are the market leaders in this category in pharmacies and continue to go from strength to strength. Constant innovation, along with Dermatologist endorsements and recommendations are key to the success of these brands. La Roche-Posay continues to offer fantastic solutions to many common skin concerns and consumers remain loyal to brands when they see results.

The body suncare category has been struggling due to poor weather in June and July this year

Written by Oonagh O’Hagan, Managing Director & Pharmacist, Meaghers Pharmacy Group

and it is forecasted to reach 37% by 2027. Over half of those online sales now take place on mobile devices.

Overall, online search for ‘skincare’ is +83% YoY in 2024. Growth was consistant from 2020, through to 2023, but growth exploded in July 2023, seeing much higher volumes of search YoY up to June 2024.

Consumer behaviour and buying habits

Innovations in the Category

but the face suncare category is continuing to grow all year round as consumers are more aware of the need to wear sun protection 365 days a year. Within skincare, the highest predicted rate of revenue growth is within the ‘sun protection’ category, estimated to grow by 7.5% in 2024 and 1.8% in 2025.

Females represent over 80% of skincare sales on the Irish market currently but there is a notable rise in demand for gender-neutral skincare, as well as increasing popularity of skincare routines among men. Many brands are developing gender-neutral products to appeal to a broader audience. There is a growing trend of men investing in skincare which is driven by the normalisation of male grooming.

While the skincare e-commerce is growing, many consumers still value the in-store experience. A hybrid shopping model, where consumers research products online but purchase in-store, is very common and is a trend that is set to continue. This trend highlights the importance of an omnichannel approach, where pharmacies integrate their online and offline channels to provide the best possible shopping experience for the consumer.

Online Sales

Online sales are forecasted to account for 27% of all retail skincare sales in Ireland in 2024. That is up from 10% in 2018

Personalisation is emerging as a theme in customer habits & expectations in 2024, with consumers exhibiting higher levels of brand loyalty when a brand or retailer is able to offer them a personalised experience. Skincare bundles are becoming increasingly popular where consumers want to buy a skincare routine for their skin type such as cleanser, serum, moisturiser and SPF.

Different age groups have varying skincare needs and preferences. Younger consumers, particularly millennials and Gen Z, are more inclined to look for preventative skincare and focus on products such as sunscreens and antipollution creams. Older consumers, on the other hand, prioritise antiaging products, such as serums and creams designed to reduce wrinkles and improve skin elasticity. We have also seen increased demand for additional skincare products such as neck creams. The trend towards a holistic approach to health has led consumers to view skincare as part of their overall wellness routine. This has increased the demand for products which promote skin health from the inside out. We have seen significant growth in the skin supplements category with collagen, omegas, vitamin c and probiotics now regularly purchased along with topical skincare products.

Consumers are moving away from being loyal to brands and are more inclined to shop by ingredients. Hyaluronic acid, vitamin c, retinol and ceramides are all now wellknown ingredients that customers regularly ask for in pharmacies.

Innovation is key to driving the skincare category and continuous improvements and product extensions are shaping the market. The introduction of ingredients such as probiotics, peptides and plant stem cells are transforming skincare formulations. These ingredients offer targeted benefits to the consumer including improving skin barrier function and promoting collagen production. Brands are expanding their product lines to cater to specific skin concerns and demographic groups. There is a growing range of products targeting sensitive skin, acne-prone skin and mature skin.

Innovations in sustainability are becoming more important in the skincare market. Brands are focusing on eco-friendly packaging, sustainable sourcing of ingredients and reducing their carbon footprint. Some brands are using biodegradable or recyclable packaging materials and implementing waterless formulations to reduce environmental impact.

The integration of technology into skincare products is an emerging trend in the skincare market. Beauty tech is an emerging category where smart skincare devices analyse skin conditions and deliver customised treatments. These devices often use technologies like LED light therapy, microcurrents, and ultrasonic waves to enhance skincare routines. German beauty tech brand Geske has created a buzz in the market and we expect this category to further expand in the next few years.

Despite its growth, the skincare category within Irish pharmacies faces several challenges and risks. The skincare market is highly competitive, with numerous brands competing for consumer attention. This can make it difficult for new entrants to successfully launch in Ireland.

We have seen some incredible Irish brands successfully launch and

achieve continuous growth, some great examples of Irish innovative brands are Skingredients, Ella & Jo and Pestle & Mortar. Each of these female founded brands continue to innovate and compete with well known international brands.

Opportunities for the future

We expect to see an increased demand for high quality, active, problem-solving body products this year. The demand for the Inky List Glycolic Body Stick was an unprecedented sell out in Ireland and globally.

Tik-tok trending products and brands will continue to grow.

Caudalie is having a resurgence in Irish pharmacies due to viral tik-tok reviews leading to a huge demand for the brand from all age groups.

Beauty tech is becoming much more affordable and accessible to skincare customers and the continued innovation by Geske will result in the integration of personalised beauty into skincare routines as standard.

With Dermatologist’s waiting lists getting longer and longer, customers are turning to their pharmacy for advice on treating skin conditions. Continued training and education for front of counter staff is key to offering customers

effective skincare solutions to treat common skin conditions such as eczema, atopic dermatitis, psoriasis etc.

Scalp care is an emerging category with many consumers now aware that the skin on their scalp needs to be cared for as much as the skin on their face. There is plenty of opportunity for new brands to enter the market in this space as consumers are looking for advice from pharmacies.

Merchandising is becoming increasingly challenging in pharmacies where many brands and products benefit from dual citing within numerous categories.

When Eyelid Care Meets Skin Care!

Adding more skincare products to the men’s section creates opportunity to grow skincare sales as research shows men shop differently to women and prefer to have relevant products in one section rather than shopping skincare by brand.

Overall, skincare is a buoyant category in Irish pharmacies with lots of exciting innovation and notable growth. Many pharmacies have chosen to move away from supermarket skincare brands and focus on problem solving, effective solutions for customers which is key to continued growth in the category.

Did you know that 8 out of 10 adults suffering from dry eye or eyelid disorders also suffer from skin disorders in the eye area? 1 in 3 dry eye / eyelid sufferers are affected by skin irritation, itching or sensitivity in the eye area. Théa Pharma, Ireland’s No 1 choice for Eye Care, is offering a new pioneering solution: Blephaderm®!

Blephaderm® is a 100% preservative free, repairing, soothing and hydrating eyelid & eye contour cream for sensitive, dry, irritated and atopy-prone skin, which can also be used on the face.

Its unique formulation consists of a synergistic action of an innovative trio of natural-origin ingredients: Trehalose to repair and protect the skin barrier, Hyaluronic Acid to regenerate and hydrate the skin and Ophiopogon Japonicus to enhance the skin barrier and respect the skin microbiota.

Blephaderm® is clinically proven to provide 5 immediate actions:

- Repair the skin barrier

- Significant and immediate soothing effect

- Hydrate the skin after a single application

- Reduce puffiness

- Reduce size of the bags and improve eye contour skin colour

Blephaderm® is Ophthalmologist & Dermatologist Tested with confirmed, immediate soothing effect after just 28 days:

100% of patients found stinging, redness and itching sensations reduced just after application.

100% found the skin hydrated, protected and soothed just after application.

Anti-itching effect: -94 %

Anti-irritant effect: -95%

The 5 actions of BLEPHADERM® are confirmed by users (just after application):

Repairs: 91% of users

Soothes, hydrates, protects: 100% of users

Reduces puffiness: for 85% of users

Approved by 95% of users.

Blephaderm® is ideal for people who:

Need efficient and fast relief of their eyelid skin.

Need to be reassured to use the right product for their eyes.

Prefer to pay on a cream that provides multiple actions instead of spending money by buying several creams for the same effect.

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Guidelines and practice of breastfeeding in women living with HIV—Results from the European INSURE survey

Written

by A. Keane1, F. Lyons1, K. Aebi-Popp2, C. Feiterna-Sperling3, H. Lyall4, A. Martínez Hoffart5, H. Scherpbier6, C. Thorne7, H. Albayrak Ucak8, A. Haberl9

1Department of Infectious Disease and Genitourinary Medicine, St James Hospital Dublin

2Department of Infectious Diseases, University Hospital Bern, University of Bern, Switzerland

3Charité Universitätsmedizin Berlin, Klinik für Pädiatrie m. S. Pneumologie, Immunologie und Intensivmedizin, Berlin, Germany

4Department of Paediatric Infectious Diseases, Imperial College Healthcare NHS Trust, London, UK

5Posithiva Gruppen, Knowledge Network for Women Living with HIV, Stockholm, Sweden

6Department of Paediatrics, Amsterdam University Medical Centre, Amsterdam, The Netherlands

7University College London, Great Ormond Street Institute of Child Health, London, UK

8CPL Life Science, Vaccine Research and Development, Reading, UK

9Department of Internal Medicine, Infectious Diseases, HIVCENTER, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany

The high effectiveness of antiretroviral therapy (ART) has transformed the lives of people living with HIV. In addition, ART is the most important measure of HIV prevention, including prevention of vertical HIV transmission. However, there is still controversy regarding the small risk of HIV transmission in the setting of effective maternal ART, where there is access to safe, affordable alternatives to breast milk.1

The World Health Organization (WHO) reports the rate of vertical transmission without ART, or other specific interventions, as ranging from 15% to 25% in Europe and the USA, and from 25% to 45% in low-resource settings, where breastfeeding is the norm.2,3 In low-resource settings, the estimated risk of HIV transmission attributable to breastfeeding, in the absence of maternal or infant ART, is 25%–48%.4

Rates of vertical transmission in high-resource settings, where mothers living with HIV are advised not to breastfeed, are reported as less than 0.5%.5,6 There is increasing data, primarily from low-resource settings, on breastfeeding-associated transmission in the setting of maternal ART.7 A large randomized controlled trial comparing the efficacy of maternal

ART and prolonged infant ART (PROMISE IMPACT), conducted in Sub-Saharan Africa and India, reported a breastfeedingassociated HIV transmission rate of 0.3% and 0.7% at 6 and 12 months of breastfeeding, respectively, in 1 219 mother–infant pairs where mothers were taking combination ART. There was no increased risk of toxicity reported in these infants.8 Of note, in the maternal ART group, only 41% of women had a viral load below the limit of detection at delivery or at their study entry visit 1 week post-partum.

The WHO recommends that women living with HIV breastfeed for at least 12 months but may continue breastfeeding up to 24 months or longer (similar to the general population) while being supported with adherence to ART.9 The WHO recommends exclusive breastfeeding but states that mixed feeding is not an indication to stop breastfeeding in the presence of ART. These guidelines are recommended as global guidance regardless of HIV prevalence.1

We know that, in high-resource settings, most guidelines recommend against breastfeeding for women living with HIV, and there is a paucity of data on breastfeeding-associated transmission in areas where there is continuous access to maternal ART and maternal and infant monitoring. In addition, there are reports of increased intention to breastfeed or actual breastfeeding in women living with HIV5, 10 and documented wish to breastfeed and fear of stigma in women living with HIV who do not breastfeed.11

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Research and collaboration is needed to inform guidance and best practice in these settings to provide best medical care during this period.

Women Against Viruses in Europe (WAVE), part of the European AIDS Clinical Society (EACS), is an initiative established in 2014 to promote the welfare of women living with HIV in Europe. WAVE sought to gather information on breastfeeding recommendations and practices for women living with HIV across Europe and to develop a collaborative network to share experience, bridge data gaps, and provide research opportunities to improve our understanding and to inform guidelines for healthcare providers.

This survey, conducted by the WAVE breastfeeding group, aims to review similarities and differences in breastfeeding recommendations for women living with HIV in Europe and create a conversation and supportive network for providers caring for women living with HIV who wish to breastfeed.

Methods

A steering group consisting of healthcare providers, nongovernmental organization representatives and researchers was established to develop a survey (Appendix A1) to review national guideline recommendations and country practices in relation to breastfeeding for women living with HIV. In addition, each country was asked about the trends in breastfeeding, current breastfeeding-related research, and willingness to participate in

a network for collaboration and research. The survey, INSURE (HIV aNd BreaStfeeding in EURopE), consisted of 38 questions, including multiple choice and free text for descriptive answers. Not all of the questions were mandatory. The survey was developed and distributed via Jotform, which was also used to collate results. The steering group identified a contact person in each country across Europe to whom the survey link was sent. These contacts were mostly identified through EACS and WAVE networks. Thus, 31 contacts were emailed a link to the survey on 30 March 2022, requesting one response per country. Contacts were asked to link in with colleagues as needed to provide the most appropriate response for their country. The survey was closed on 9 May 2022, after a series of reminders were sent alerting respondents of the closing date.

Results

In total, 25 responses were included in the final analysis. Some respondents omitted some questions, leading to different denominators throughout the results. The survey took a minimum of 12 min and a maximum of 43 min to complete, as recorded by Jotform. Respondents were encouraged to attach links to or files of referenced guidelines.

A flowchart of country responses in relation to HIV and pregnancy guidelines is shown in Figure 1. Where countries did not have national guidelines, responses were provided around country practices, which are included in the results. This is clearly indicated in Table 1.

Of the 23 countries with national guidelines, 12/23 (52%) reported that their guidelines recommend

Figure 1: Country responses: HIV and pregnancy guidelines

and practice of breastfeeding in women living with HIV Results from the European INSURE survey

S U I T A B L E F O R

D I A B E T I C S

U p t o 1 0 0 % p r o v e n e ﬀ e c t i v e

S t o p s t h e d e v e l o p m e n t o f f u n g i t h a t c a u s e f u n g a l n a i l

P r e c i s i o n b r u s h : f o r a t a r g e t e d a p p l i c a t i o n o n h a r d - t o - r e a c h a r e a s

N a i l ﬁ l e s i n c l u d e d : i m p r o v e s e ﬃ c a c y T h e H o m e T r e a t m e n t K i t f o r F u n

62 INSURE Study

against breastfeeding, 11/23 (48%) offer an option to breastfeed if certain clinical criteria are met, and no countries offer an option to all women to breastfeed.

Although not specifically asked in the survey, three countries independently advised that, although their guidelines recommended against breastfeeding, if a woman wishes to breastfeed, she would be supported to do so where medically appropriate.

In total, 12/25 (48%) respondents reported that the number of women living with HIV who breastfeed in their country is increasing, 12/25 (48%) felt it was stable, and 1/25 (4%) felt it was decreasing.

Maternal viral load, duration/type of breastfeeding, and neonatal post-exposure prophylaxis

The survey asked a range of questions around conditions for breastfeeding:

Seventeen respondents (17/17 [100%]) reported that a suppressed maternal HIV viral load (within 4 weeks of estimated delivery date) was required to support breastfeeding.

Ten respondents (10/11 [91%]) reported that a suppressed viral load needs to be maintained for a minimum period of time during pregnancy.

One respondent (1/11 [9%]) reported that a suppressed viral load prior to conception is required for breastfeeding.

Five respondents (5/12 [42%]) reported that their guidelines include a recommendation on duration of breastfeeding.

Eleven respondents (11/20 [55%]) have a recommendation on the minimum age of introduction of solids.

Sixteen respondents (16/19 [84%]) reported that all infants born to women living with HIV (including breastfed and non-breastfed infants) receive post-exposure prophylaxis (PEP).

Twelve respondents (12/16 [75%]) reported that PEP is not extended in infants who are breastfed.

Three respondents (3/16 [19%]) reported that PEP is extended in some breastfed infants.

One respondent (1/16 [6%]) reported that PEP is extended in all breastfed infants.

Information on breastfeeding

Six respondents (6/20 [30%]) have dedicated healthcare workers to educate women living with HIV on breastfeeding.

Thirteen respondents (13/20 [65%]) have a multidisciplinary approach for management of women living with HIV who wish to breastfeed.

Countries reported a variety of different healthcare workers in their multidisciplinary team, including midwives, paediatricians, gynaecologists, infectious disease specialists, clinical nurse specialists, social workers, and case manager/peer workers from an non-governmental organization.

Laws surrounding HIV and breastfeeding

Twenty-two respondents (22/25 [88%]) reported that there were no known cases of women living with HIV breastfeeding who had been reported to the police or social services or been prosecuted or convicted due to breastfeeding. Three respondents (3/25 [12%]) reported that this has occurred in their country, and two respondents stated that social services had been informed.

Ten respondents (10/25 [40%]) said breastfeeding is exempt from laws concerning HIV exposure and/or transmission, and 15 respondents (15/25 [60%]) reported that breastfeeding is not exempt from laws concerning HIV exposure and/or transmission.

Research on HIV and breastfeeding

Eight countries (8/25 [32%]) have research studies on breastfeeding in women living with HIV, and some reported multiple studies. At a national level, five research studies (5/9 [56%]) are ongoing, two (2/9 [22%]) have been published [10-13], and two research studies (2/9 [22%]) have been completed. At the local level, three research studies (3/4 [75%]) are ongoing, and one respondent reported that their research studies (1/4 [25%]) have been published.14, 15

One respondent (1/6 [17%]) reported having a breastmilk biobank.

Twenty-four (24/25 [96%]) respondents would like to collaborate in data collection around breastfeeding in women living with HIV coordinated by WAVE.

Discussion

Through this survey, we sought

to better understand the current situation and transition of guidelines and practice in Europe in regard to breastfeeding in women living with HIV. Our results demonstrate that countries report an increasing number of women who decide to breastfeed and heterogeneity in guidelines and practice across respondents. There is adequate data in HIV serodifferent sexual couples to support the statement ‘undetectable = untransmissible’ (U = U) regarding the ability of effective ART to prevent sexual transmission of HIV.16, 17 We do not have the same level of evidence to apply U = U to the breastfeeding situation. The risk is lower when the mother’s viral load is not detectable, but breastfeedingassociated transmissions in the setting of effective maternal ART have been reported.13, 18, 19

Despite many guidelines recommending against breastfeeding, some women will choose to breastfeed. Comments in the survey revealed that clinical practice differs from what is recommended in guidelines. To minimize risk in a supported way, many countries offer support to women who choose to breastfeed despite their national guidelines recommending against breastfeeding. Freeman-Romilly et al. describe providing a ‘managed risk’ plan for women living with HIV who want to breastfeed their infants, including ‘Ten safer breastfeeding rules’ and ‘The Safer Triangle’.13

We need to recognize the complexities of breastfeeding in women living with HIV who wish to breastfeed. It must be noted that formula feeding is the only method of feeding that has zero risk of HIV transmission to the infant, and this needs to be discussed with the mother. However, taking a hard-line approach to counselling against breastfeeding may result in a mother breastfeeding in secret and a lost opportunity for education, adherence support, and close monitoring. Open conversation leading to shared decision making is important in understanding a mother’s and parents’ values, discussing risks and benefits, and providing education to ensure the best outcome for the infant [20]. We believe it is our duty to encourage and support an open discussion around breastfeeding in women living with HIV.

NOURISH-UK, an ongoing study exploring how new mothers/ birthing parents living with HIV

make decisions around feeding their babies in the UK, will help better inform guidelines and supports for parents by sharing experiences and offering peer support.21

One-third of countries are already conducting research on breastfeeding in women living with HIV in their country. The vast majority of respondents would like to join a European network to bring together expertise in this area. Since the total number of breastfeeding women living with HIV is increasing but still small in most European countries, collaboration to increase our understanding is essential.

This survey is the first to review practices and guidelines in relation to breastfeeding in women living with HIV in Europe. Although guidelines themselves were not independently reviewed, the survey was sent to an informed group of clinicians, non-governmental organization representatives, and researchers, and—where national guidelines were available— verbatim fragments of the guidelines were gathered. This article has led to the development of a working group to review and translate guidelines across Europe. We received a broad range of responses but did not reach every country in Europe.

The establishment of the INSURE WAVE breastfeeding network will help fill the data gap and start a discussion in Europe around breastfeeding in women living with HIV.

Conclusions

Breastfeeding recommendations for women living with HIV vary across Europe. Many national guidelines recommend against breastfeeding, but some include management recommendations if women choose to breastfeed. Around half of the countries report an increase in the number of women living with HIV who are breastfeeding. Almost all of the respondents express a keen interest in joining a network supported by EACS/WAVE to expand our knowledge and research opportunities. This survey and the differences and similarities across countries will help bring respondents together to create a European platform for discussion and collaboration so that more data can be collected and a consensus reached on how best to support women living with HIV who want to breastfeed to do so safely.

New Appointment for Professor Robson

RCSI University of Medicine and Health Sciences has announced the appointment of Professor Tracy Robson as Deputy Vice Chancellor for Academic Affairs (DVCAA).

Professor Robson follows Professor Hannah McGee who was the foundation DVCAA at RCSI. She will lead RCSI’s academic community in delivering a transformative and innovative education which prepares its students to make a difference for patients worldwide.

She will have a particular focus on addressing healthcare workforce demands through the development of a highly skilled workforce that can meet the evolving needs of a growing and aging population.

A cancer biologist, Professor Robson joined RCSI in 2016 as Head of Department of Molecular and Cellular Therapeutics. She became the foundation Head of the School of Pharmacy and Biomolecular Sciences following its establishment in 2019. She has previously held academic appointments at Ulster University and Queen’s University Belfast where she was appointed

Professor Tracy Robson, Deputy Vice Chancellor for Academic Affairs (DVCAA)

Professor in Experimental Therapeutics in 2010.

Professor Robson is a highly successful researcher, with over ¤15 million in competitive research grant awards and a sustained track record of high-quality publications in leading journals. Her research is focused on the development of biotherapeutics, based on a novel protein, which have been patented and licensed. Under her leadership, the School of Pharmacy and Biomolecular Sciences secured ¤11.3 million in educational funding, including a ¤7.8 million award from the Higher Education Authority under the Human Capital Initiative, Pillar 3.

Professor Robson said: “I feel immensely privileged to take on

the role of Deputy Vice Chancellor of Academic Affairs at RCSI, following in the footsteps of Professor Hannah McGee whose legacy at RCSI is immense. I share our community’s deep commitment to promoting better health and wellbeing and to ensuring our students emerge

as healthcare professionals and scientists with the skills and attributes to thrive in complex clinical and research settings around the world. I look forward to progressing our ambitious agenda which is wholly focussed on driving improvements in health in Ireland and around the world.”

Product Name: Brupro 200mg & Brupro Max 400mg Film-coated tablets. Composition: Each tablet contains 200mg or 400 mg of ibuprofen respectively. Description: Biconvex film-coated tablets. 200mg: White, round . 400mg: White, oblong, with a score notch on both sides. Can be divided into equal doses. Indication(s): 200mg: Short-term management of mild to moderate pain such as headache, dental pain, period pain, muscular strain and backache , for the management of feverishness and the symptoms of colds and influenza. 400mg: Management of muscular pain, backache, dental pain and dysmenorrhoea. Dosage: Adults and children over the age of 12 years only: 200mg: Initial dose is 400mg and subsequently if necessary 200mg – 400mg every four hours. 400mg: The usual dose is 400mg and subsequently if necessary 400mg every 4-6 hours For both: Maximum dose of 1200mg in a 24-hour period. Children under the age of 12 years : Not recommended. Elderly: Assess dosage individually in impaired renal or hepatic function The lowest dose compatible with adequate safe clinical control should be employed Treatment should be reviewed at regular intervals and discontinued if no benefit is seen, or intolerance occurs. Take with a glass of water with or after food Swallow whole and do not chew, break, crush or suck to avoid oral discomfort and throat irritation. Contraindications: Third trimester of pregnancy. Known hypersensitivity to the active substance or to any of the excipients; A history of gastrointestinal bleeding or perforation, related to previous NSAIDs therapy Active, or history of recurrent peptic ulcer/haemorrhage (two or more distinct episodes of proven ulceration or bleeding); Sev ere heart, liver or renal (glomerular filtration below 30ml/min) failure; Conditions involving an increased tendency to bleeding; Patients with known hypersensitivity or who have experienced asthma, urticaria, or allergic-type reactions after taking ibuprofen, aspirin or other NSAIDs. Warnings and Precautions for Use: See SPCs for detailed information. General: Caution in patients with bronchial asthma, renal, hepatic or cardiac impairment, history of heart failure and/or hypertension. Elderly have an increased frequency of adverse reactions especially GI bleeding and perforation that may be fatal. Should report any unusual abdominal symptoms particularly in initial stages of treatment. Ibuprofen may mask signs of infections. Not to be used concomitantly with other NSAIDs due to risk of ulceration and bleeding. Monitor patients using ibuprofen on long term. GI bleeding, ulceration and perforation : Can be fatal. Risk is increased with higher doses. Take care in patients with history of GI diseases. Consider combination therapy with protective agents (e.g. misoprostol or proton pump inhibitors) for these patients, and also for patients requiring concomitant low dose aspirin or other drugs likely to increase gastrointestinal risk. See Interactions section Cardiovascular and cerebrovascular effects: Monitoring required for patients with history of hypertension and/or mild to moderate congestive heart failure. High doses (2400 mg/day) and long-term use may be associated with small increased risk of arterial thrombotic events. Overall, epidemiological studies do not suggest that low dose ibuprofen (e.g. ≤ 1200mg day) is associated with an increased risk of myocardial infarction. Patients with uncontrolled hypertension, congestive heart failure (NYHA II-III), established ischaemic heart disease, peripher al arterial disease, and/or cerebrovascular disease should only be treated with ibuprofen after careful consideration and high doses (2400mg/day) should be avoided. Careful consideration for use in patients with risk factors for cardiovascular events (hypertension, hyperlipidaemia, diabetes mellitus, smoking). Cases of Kounis syndrome have been reported with unknown frequency. Renal: Caution in dehydrated patients Renal toxicity Long term use resulted in renal pathological changes and renal papillary necrosis Patients at risk are those with impaired renal function, heart failure, liver dysfunction. Haematological effects: Caution in patients with intracranial haemorrhage and bleeding diathesis. Dermatological effects: Skin reactions, some fatal, severe cutaneous adverse reactions (SCARs), including exfoliative dermatitis, Stevens-Johnson syndrome, and toxic epidermal necrolysis (TEN), drug reaction with eosinophilia and systemic symptoms (DRESS) and acute generalised exanthematous pustulosis (AGEP) have been reported with the use of ibuprofen. Withdraw ibuprofen and consider alternative treatment. Exceptionally, varicella can be at the origin of serious cutaneous and soft tissue infectious complications To date, the contributing role of NSAIDs in the worsening of these infections cannot be ruled out. Avoid use in case of varicella. Aseptic meningitis: Observed in rare occasions Interactions: Unsafe with warfarin or heparin unless under direct medical supervision See the SPCs for more detailed information on taking concomitant medicines . Care with concomitant use of: Antihypertensives, beta-blockers and diuretics, cardiac glycosides, lithium, methotrexate, ciclosporin, other analgesics including cyclooxygenase-2 selective inhibitors: avoid concomitant use of two or more NSAIDs (including aspirin), corticosteroids, anticoagulants, aspirin, antiplatelet agents and selective serotonin reuptake inhibitors (SSRIs), aminoglycosides, cholestyramine, quinolone antibiotics (patients taking NSAIDs and quinolones may have increased risk of developing convulsions ), sulfonylureas, probenecid, oral hypoglycaemic agents, mifepristone, tacrolimus, zidovudine, CYP2C9 Inhibitors (voriconazole and fluconazole), ginkgo biloba (may potentiate the risk of bleeding). Fertility, Pregnancy and Lactation: Not for use in first and second trimester if not clearly necessary Monitor for oligohydramnios and ductus arteriosus after exposure to ibuprofen for several days from gestational week 20 onward Contraindicated in third trimester. Not recommended during breast-feeding or in woman attempting to conceive Ability to Drive and Use Machinery: Dizziness, drowsiness, fatigue and visual disturbances are possible after taking NSAIDs If affected, patients should not drive or operate machinery. Undesirable Effects: Very common : Gastro-intestinal disorders Common: Peptic ulcers, headache, somnolence, vertigo, fatigue, dizziness, insomnia. Refer to the SPC for other undesirable effects.

Marketing Authorisation Holder: Rowa Pharmaceuticals Ltd., Bantry, Co. Cork.

Marketing Authorisation Number: PA 0074/067/001-002. Further information and SPC are available from: Rowex Ltd., Bantry, Co. Cork. Freephone: 1800 304 400 Fax: 027 50417 E-mail rowex@rowa-pharma.ie

Legal Category: Not Subject to medical prescription Date of Preparation: January 2024

CCF No.: 26272 ABBREVIATED

Adverse events should be reported. Reporting forms and information can be found on the HPRA website (www.hpra.ie) or by emailing Rowex pv@rowa-pharma.ie

‘Changed landscape’ for couples with fertility challenges

Fertility investigations and treatments are available to public patients for the first time through the development of regional hubs such as the new Mid West service based at Nenagh Hospital, writes Dr Lucia Hartigan, Consultant Obstetrician and Gynaecologist and Clinical Lead for the UL Hospitals Group Regional Fertility Hub.

Approximately one in six heterosexual couples in Ireland have fertility problems. Infertility can be a devastating diagnosis for men and women alike. It can be socially isolating, lead to low self-esteem and have a negative impact on the couple’s relationship.

Up until recently, Ireland was one of the few countries in Europe that did not offer any publicly-funded assisted human reproduction (AHR) treatments like in vitro fertilisation (IVF).

Dr Lucia Hartigan, Consultant

Obstetrician and Gynaecologist and Clinical Lead for Fertility services based in the Regional Hub for Women’s Health at Nenagh Hospital

Thankfully, in recent times, the landscape has changed for couples who are challenged with their fertility with the rollout of six fertility hubs nationwide and the provision of public-funding for AHR treatments for eligible couples.

Fertility services in the Mid West Region

The regional Fertility Hub services of the UL Hospitals Group launched in September 2023. We provide comprehensive fertility investigations for couples across

the Mid West. Assessment and treatment requires specialised, skilled care by a team of doctors, an andrologist, specialist nurses and clinical specialist radiographer sonographers.

Ultrasound scans, phlebotomy, consultations, outpatient hysteroscopy and HyCosy (test of fallopian tube patency) all take place in the recently-renovated ambulatory gynaecology unit at Nenagh Hospital. Semen analysis is currently performed at Waterstone’s clinic in Limerick although soon this investigation will also be available in Nenagh hospital.

Our hub currently receives approximately 60 new referrals per month.

Referral pathway

In order to be investigated for infertility, patients must be referred by the female partner’s GP. They must be less than 41 (women) or 59 or under (men) and have a BMI between 18.5 and 35.

To be eligible for referral for AHR treatments such as IUI (intrauterine insemination), IVF and ICSI (intracytoplasmic sperm injection), the female partner must be aged 41 or under and have a

European Pharmacists and Doctors Unite

BMI of between 18.5 and 30. Both partners must be non-smokers. Further information is available at www.hse.ie/fertility

What patients can expect when they are referred to our hub

When couples are seen in our Regional Fertility Hub, they can expect to avail of a wide range of investigations and interventions including relevant blood tests, semen analysis, fertility-related surgeries and medical management of ovulatory problems eg. ovulation induction with follicle tracking.

If further more advanced treatment is recommended by a Reproductive Medical Consultant and the patients meet the access criteria, the hubs will refer patients to HSE-approved private provider of their choosing. There is no cost to patients for the recommended treatment through the private providers.

This service is initially being provided by approved private clinics on behalf of the HSE, while the HSE builds up the capacity to, in due course, deliver the service directly within the public health system.

The Standing Committee of European Doctors (CPME) and the Pharmaceutical Group of the European Union (PGEU) have exchanged views on solutions for shortages of medicines, medical devices and healthcare professionals in a joint event with policy-makers, academics and professionals.

Pharmacists and doctors are concerned about the rise of medicine shortages across Europe, affecting the quality of care of patients.

PGEU President Aris Prins said “Doctors and pharmacists need earlier notifications of shortages. The security of supply could be further improved by ensuring that pharmaceutical companies have robust shortages prevention and mitigation plans in place and introducing progressive requirements for rolling buffer stocks. In the next EU mandate,

the ongoing revision of the general pharmaceutical legislation and a possible Critical Medicines Act provide opportunities to offer solutions.”

Professionals are also concerned about shortages of some essential medical devices becoming increasingly common, with no alternatives available in many cases. CPME President Dr Christiaan Keijzer said “We need long-term solutions that address the inadequate implementation of the new medical device and in-vitro diagnostics regulations and notified bodies capacity, to ensure that patient safety is preserved.”

“Special attention should be paid the availability of orphan medical devices and there should be a prudent system of incentives that avoids the artificial ‘orphanisation’ of devices to exploit the system.”

Finally, pharmacists and doctors reaffirm how the shortages of healthcare professionals are threatening the foundations of the entire health sector. CPME and PGEU urge member states and the European Commission to implement a coordinated EU Health Workforce strategy that prioritises retention and recruitment by safeguarding minimum training requirements and lawful practice conditions, as well as investing in workforce planning.

PGEU President Aris Prins

Pharmacy Strategic Partnership

St Patrick’s Mental Health Services and University College Cork announce strategic partnership to enhance pharmacy-related research and clinical collaborations

A newly announced strategic partnership between the Pharmacy Department at St Patrick’s Mental Health Services and the School of Pharmacy at University College Cork (UCC) will see the two organisations come together over the coming five years to advance research and clinical training in mental health pharmacy.

Through a wide range of collaborative activities, the partnership aims to foster innovation and enhance collegiality.

Central to this partnership are the facilitation of clinical teaching for pharmacy students at UCC and the advancement of evidencebased research into mental health difficulties, with the goal of improving service user outcomes and informing best practices in mental healthcare.

Speaking about the partnership, Ciara Ni Dhubhlaing, Chief Pharmacist at St Patrick’s Mental Health Services, said: “In our most recent organisational strategy, The Future in Mind 2023 – 2027, St Patrick’s Mental Health Services reaffirmed its commitment to enhancing evidence-based understandings of mental health difficulties through research, and to supporting individuals and organisations committing to work in mental healthcare in their training and education. This partnership with UCC signifies a significant step forward in a shared vision of improving education, training and research.

“By working together, we will leverage our collective strengths to drive innovation in clinical

Ciara Ni Dhubhlaing, Chief Pharmacist at St Patrick’s Mental Health Services

training and to pioneer new research as we strive to improve outcomes for service users and inform best practice in mental health services. We look forward to the opportunities this partnership brings and the positive impact we envisage it will have on advancing pharmacy practices in mental health.”

The partnership between St Patrick’s Mental Health Services and University College Cork will enable a wide range of activities including:

• Research: The partnership will support research into mental health and enhance evidencebased knowledge.

• Clinical teaching: Dedicated administrative links will be established to oversee integrated clinical teaching and research between both organisations.

• Professional development: Both organisations will facilitate mutual professional development, ensuring continuous learning opportunities and growth for staff members within St Patrick’s Mental Health Services and UCC, and pharmacy students.

• Sharing expertise: There will be active exchange of information and consultation on matters of mutual interest, fostering informed decision-making and collaboration. Staff from both organisations will establish and strengthen collaborative links, sharing expertise and resources to enhance capabilities.

collaborations. This endeavour will yield substantial benefits, improving patient care and health outcomes across hospitals, primary care and the community, while contributing to the creation of a more inclusive and compassionate world.”

Professor Helen Whelton, Head of the College of Medicine and Health, UCC

Professor Helen Whelton, Head of the College of Medicine and Health, UCC said: “This new partnership with the innovative St Patrick’s Mental Health Services perfectly aligns with our UCC strategy to strengthen our collaboration with the health sector through an academic health sciences model. It embodies the vision of University College Cork by connecting and empowering individuals across academia and healthcare services to create and share knowledge. By focusing on those facing mental health difficulties, we are confident that this strategic alliance will significantly enhance pharmacyrelated research and clinical

Professor Laura Sahm, Vice Dean of School of Pharmacy, UCC said: “I am thrilled to be part of this exciting new partnership, which will form part of the transformation of UCC’s research culture. This will be achieved through the implementation of engaged research and open research with clinicians at St Patrick’s Mental Health Services. I would welcome other UCC colleagues to join in this collaboration and see how we can effect positive change with personcentred research and learning.”

This partnership announcement comes as St Patrick’s Mental Health Services continues to progress its Academic Institute, which, established in 2022, will be progressed into an international research centre, pioneering research in the field of mental health. The Academic Institute of St Patrick’s Mental Health Services will play a crucial role in investigating and enhancing mental health treatments and evidencebased practices by collaborating with key partner organisations.

Milestone for Life Pharmacy

Life Pharmacy, part of the Uniphar Group, is celebrating welcoming its 100th Pharmacy in Killeagh, Co. Cork with a nationwide fundraising campaign to raise vital funds for the Jack and Jill Children’s Foundation.

As part of the Life100 campaign, Life Pharmacy teams from all corners of the country will participate in sponsored activities within their local communities, from now until the end of August with the aim of raising the equivalent of 10,000 hours of support for families caring for children, up to the age of six, with severe learning disabilities associated with complex medical needs.

Life Pharmacy is calling on its loyal customers and community members to show their support by making a donation to their local Life Pharmacy either in

store or online, which will directly contribute to the essential services provided by the Jack and Jill Children’s Foundation. Just ¤18 will provide one hour of in-home nursing care and respite support –a lifeline for Jack and Jill families.

Speaking about the campaign, Mairead Reen, Chairperson, Life Pharmacy, said, “We are delighted to welcome our 100th Life Pharmacy with a campaign that involves our entire store network

Pictured is Mairead Reen, Chairperson, Life Pharmacy, and Deirdre Walsh, CEO Jack and Jill Children’s Foundation

as well as our customers. Through the support of our local Life Pharmacy teams and generous donations from the public, we have the opportunity to give the gift of time to families supported by the Jack and Jill Children’s Foundation. This campaign is not just about celebrating our growth, but also about making a tangible difference in the lives of those who need it most.”

Deirdre Walsh, CEO of the Jack and Jill Children’s Foundation added, “This is a remarkable community fundraising initiative to celebrate Life Pharmacy reaching this significant milestone of 100 member pharmacies across Ireland. Like Life Pharmacy, we are all about family and community, and with 416 families currently under our care across the country, the ambition of raising 100 hours of in-home nursing and respite care hours across each of the 100 pharmacies is substantial.

“10,000 hours of care would make a truly meaningful difference in the lives of the families under our care for whom Jack and Jill is a lifeline..”

HSE Annual Report

The HSE has recently published its 2023 Annual Report and Annual Financial Statements highlighting the broad scope of work and activity carried out during the year and includes information about HSE reforms, operations, budget, key challenges, governance and performance.

In the context of population increase of over 97,000 people in 2023, the HSE delivered health and social care services to an ageing population (increase of 37% for people aged 65 years and over since 2014) and with life expectancy now at 84.3 years for women and 80.5 for men.

2023 was a challenging year also due to budgetary, recruitment and digital transformation requirements needed to bring about the reform of the health service. The HSE will

continue to work with staff, patients and service users to build on the improvements made last year.

Highlights

It is estimated 5.3 million people live in Ireland, this is an increase of over 97,000 people in 12 months:

• there were 54,493 births in 2023

• the most recent estimate of life expectancy in Ireland is 80.5 years for males and 84.3 years for females

• according to the Healthy Ireland Survey 2023, 86% of the population said that their quality of life is good or very good with just 5% of the population saying that their quality of life is poor or very poor

Community Healthcare

• 1.61 million persons covered by medical cards as at 31 December - this is 3% above 2022 activity and 1% below 2023 target

• 95,962 total Community Intervention Teams referrals - this is 14.5% above 2022 activity and 18% above 2023 target

• 45,424 day only respite sessions accessed by people with a disability - this is 60% above 2022 activity and 86% above 2023 target

• 89.4% of children aged 24 months received measles, mumps, rubella (MMR) vaccine - in line with 2022 performance but 6% below 2023 target

Pictured is Michael Murphy, General Manager of Life Pharmacy, Killeagh, Co. Cork

NEW TO

Neostrata Ireland - Hosts International Training Day for

Pharmacy and Clinic Professionals, Providing Opportunities for Networking and Deepening Brand Knowledge

Neostrata recently hosted their International Training Day which took place on Tuesday the 17th of June. The event brought together pharmacies and clinics at the stunning Sky room in the Radisson Blu where they were joined by the Neostrata team from the US.

The event featured a training session led by Global trainer Kim Sarros and Director of International Sales, Catherine Mueller, who provided valuable insights into the world of Neostrata. The event was thoughtfully tailored into two segments, with one focused on pharmacy training and the other on clinical peels.

The pharmacy training commenced with a drinks and canapes reception, where all attendees had the opportunity to mingle with the team. This was followed by an engaging session where tables were set up with individual testing kits, mirrors, and training materials. Nuala Anne Curley, Head of Marketing for Pharmed, warmly welcomed Neostrata US to Ireland and shared the latest updates on what Pharmed has in store for

The effects

Neostrata. She also announced the much-anticipated return of the Neostrata Ambassador programme, which aims to create neostrata brand champions and promote “best practice” in pharmacies when it comes to selling and promoting Neostrata products.

Notably, the afternoon also featured an update on the latest technologies in Neostrata, including the introduction of the groundbreaking MicroDipeptide229 into the Skin Active range –Microdipeptide229 is a unique scientific development by Neostrata labs that boasts a 229 Dalton size. Dalton is the scientific name given to the size of a molecule. Most topical peptide cosmetics offer a Dalton size of over 500 when the skin needs less than 500 dalton size to effectively penetrate the skin. MicroDipeptide229 technology

Neostrata’s Global Trainer, Kim Sarros & Neostrata Ireland’s Trainer, Gillian MacMahon presenting a live demonstration

vastly increases the ability for the product to absorb into the skins barrier. The technology features in our new Rebound Sculpting Cream – the latest addition to Skin Active range which is quickly becoming a “hero product”.

The highlight of the afternoon was the unveiling of Neostrata’s Clarify’s latest product – the new Post Acne Mark Correcting Serum. This potent serum, containing a mix of Tranexamic acid, Niacinamide, and Vitamin C, has been proven to effectively reduce the appearance of dark marks from acne scarring. The training session was further enhanced by a hands-on practical session led by Kim, where all attendees received a customised a skincare regime tailored to their individual skin types. Neostrata’s Lead Trainer, Gillian MacMahon also performed a live demonstration of how to get the best results from your regime.

The afternoon drew to a close with an engaging Q&A session about the brand and its products and an opportunity for everyone to discuss the training session before parting ways.

Following the afternoon training, the focus shifted to the evening ProSystem Professional Peels training. The setup was rearranged to suit a clinical bed, setting the stage for an informative and interactive session. This was followed by a comprehensive overview of the brand and its products, setting the stage for an in-depth exploration of the peels offered by Neostrata. Kim expertly

outlined the different types of peels and the products best suited for various skin types. Importantly, she addressed common concerns, side effects, and the transformative effects of consistent product use. One of the most cherished parts of the evening was the practical session, where attendees had the unique opportunity to experience the peels under Kim’s expert guidance. This hands-on demonstration provided valuable insights into the application and effects of the peels, offering attendees practical knowledge that they could apply in their professional settings.

Overall, the Neostrata International Training Day was a resounding success and served as a testament to Neostrata’s commitment to excellence and innovation.

Neostrata team (USA and Ireland) from left: Katherine Mueller, Nuala Anne Curley, Elaine McKale, Kim Sarros, Soraya Blazquez, Gillian MacMahon, Ger Fitzgerald, Daisy Cleary, Amy Rossiter

of using Neostrata Enlighten Vitamin C serum demonstrated on a split apple

Katherine Mueller, International Sales Director Presenting Neostrata

Kim Sarros, Global Trainer, Neostrata demonstrating peels on Marleide Santana, Bahia Beauty

Effectively Reduces the Appearance of Dark Marks from Acne Scarring.

CONTAINS

• Tranexamic Acid

• Niacinamide

• Vitamin C

BACKED BY 40 YEARS OF DERM SCIENCE

Topic Team Training – Stress

A community pharmacy environment that fosters teamwork ensured high levels of consumer satisfaction. This series of articles is designed for you to use as guide to assist your team in focusing on meeting ongoing CPD targets and to identify any training needs in order to keep the knowledge and skills of you and your team up to date.

The below information, considerations and checklist provides support to enable you to run a team training session and identify opportunities for learning within the topic of Stress.

Stress is one of the most common conditions in Ireland. Recent research shows that Ireland ranks among Europe’s ‘most stressful’ countries. Pharmacy customers often choose to self-treat stress using over-the-counter (OTC) products and are likely to rely on the advice of the pharmacist and pharmacy teams.

Going back to school can trigger feelings of worry and anxiety in some children. In the pharmacy you may meet several parents of children who are concerned about their children experiencing stress during this period. Understanding the causes of common worries can help you to support parents and children during this time. Some of the more common concerns are discussed here.

While a small amount of stress around exams is common, if the levels of stress are affecting sleep and daily tasks it is time to encourage parents to take action. Schools can offer support to students who are worried about exams. If additional help is needed the GP is the first port of call for children who are experiencing

Consider:

high levels of anxiety. In a small number of cases children can be diagnosed with anxiety disorders requiring medical intervention or counselling.

Pharmacists can play a crucial role in managing exam stress by providing various services and advice to students and individuals experiencing stress and anxiety during exam periods. Their role extends beyond just dispensing medications to offering comprehensive support that can contribute to overall well-being. Here’s how pharmacists can help manage exam stress:

Education and Awareness

• Understanding Stress and Anxiety: Pharmacists can educate students about the physiological and psychological aspects of stress and anxiety, helping them understand their symptoms better.

• Identifying Symptoms: They can assist in identifying symptoms of stress and anxiety, such as insomnia, fatigue, irritability, and difficulty concentrating, and differentiate between normal stress and more severe anxiety disorders.

Lifestyle and Behavioural Advice

• Sleep Hygiene: Provide tips on improving sleep hygiene, such

 The signs and symptoms of stress amongst younger people

 How to identify those who need to be referred to further mental health support

 The benefits of appropriate nutrition and lifestyle factors

 Appropriate treatment and advice

as maintaining a regular sleep schedule, creating a restful environment, and avoiding stimulants before bed.

• Nutrition and Hydration: Advise on a balanced diet rich in fruits, vegetables, whole grains, and adequate hydration, emphasising the importance of maintaining energy levels and concentration.

• Exercise: Recommend regular physical activity as a means to reduce stress and improve mood, suggesting activities like yoga, walking, or sports that students can easily integrate into their schedules.

• Relaxation Techniques: Teach relaxation techniques such as deep breathing exercises, mindfulness, and meditation, which can help manage stress levels.

Pharmacological Support

• Over-the-Counter Products: Suggest over-the-counter products that can help with mild symptoms of stress and anxiety

• Sleep Aids: Recommend appropriate non-prescription sleep aids if insomnia is an issue, while advising on the importance of not becoming reliant on these for long-term use

• Medication Management: For students already on prescription medications for anxiety or depression, pharmacists can ensure proper medication adherence and manage any potential side effects or interactions

Counselling and Support

• Emotional Support: Provide a listening ear and emotional support to students who may feel overwhelmed, creating a safe space for them to express their concerns.

• Referral to Mental Health Services: Recognise when a student may need more specialised mental health support and refer them to counsellors, psychologists, or psychiatrists as appropriate.

Individualized Care

• Personalised Advice: Tailor advice to the individual’s specific situation, taking into account their lifestyle, academic pressures, and personal stressors.

• Follow-Up Care: Provide follow-up consultations to assess progress and make any necessary adjustments to their stress management plan.

Pharmacists are well-positioned to contribute significantly to the management of exam stress by combining their expertise in medication with a holistic approach to health and wellbeing. By offering education, support, and personalised care, pharmacists and their teams can help students develop effective coping strategies, improve their academic performance, and enhance their overall quality of life.

Actions:

 Ensure the team can meet the needs of younger patients who are experiencing stress

Key Points:

Check your pharmacy team are aware and understand the following key points:

 The pharmacy team knows to understand the importance of maintaining good mental health

 The team are able to initiative conversations with parents and care-givers

 The team are aware of the OTC treatments available

 My pharmacy assistants can meet the points in this training checklist.

 Ensure that I and the team are aware of the treatments and appropriate counselling

 Do we understand the reasons why some people may be at greater risk of stress? What are these?

 Are we able to provide confidential and discreet consultation rooms?

 Can we provide good advice on the different types of OTC treatments and their suitability for each patient

 Train the team to meet all the above considerations

Ask yourself, where is your nearest AED?

When I first started working in the medical device industry almost 30 years ago in 1995, it was a time before AEDs as we know them really existed in Ireland. The small medical company I worked for then provided a wide range of equipment mostly in the area of resuscitation with the salesperson at that time selling defibrillators to Ambulance Services around the country. In many cases, this was the first time ambulances were getting to carry and use defibrillators, thanks to the ECG analysis programme within which it could determine whether the patient needed a shock or not. Even hospitals only had defibrillators in acute areas such as theatres, coronary care and the accident and emergency departments, but not on the wards.

I was fascinated with the machines and what they could do and soon I started learning that the ones we were supplying were saving lives in the hands of the Ambulance personnel. This was a first and especially important step towards improving outcomes from heart attacks and cardiac arrest.

What ambulance personnel see when they arrive on scene today has greatly evolved from what they saw even as recently as in the midnineties. When a person suffered a cardiac arrest, 999 was called and people waited for the ambulance to arrive. Nowadays, CPR is given by a by-stander and sometimes an AED is used, often just grabbed from the nearest hotel or shop, which is something we have come to expect them to have.

Working in the industry I knew that early CPR was important and that defibrillators could save lives.

AEDs could be used by anyone but little knowledge of how they worked or how safe they were was known, even amongst medical professionals. Along with this lack of understanding of how safe this

Written by Conrad Wynne, Senior Product Specialist, OxygenCare

new technology was, there were many barriers to their introduction of these lifesaving devices. There was limited choice for those wishing to buy an AED, which was uncommon and expensive. In 1996 one of the earlier AEDs introduced was priced at almost ¤5000. People were also afraid of being sued if they attempted to save someone’s life. Organisations such as Croí (The West of Ireland Heart and Stroke Charity), the Irish Heart Foundation, and more recently, PHECC (The Pre-Hospital Emergency Care Council), worked diligently over the years to raise awareness about the importance of CPR, early defibrillation, and appropriate responses in cardiac emergencies. In the past, even when an ambulance arrived, it might not have been equipped with a defibrillator, so people were coached to specifically request a ‘Cardiac Ambulance’.

One day in 1997 a small box arrived at my workplace which changed things. In the box was a new style AED but it was not immediately clear to me what it was and who would use it. This device was so much smaller and simpler than previous models, it did not have a printer like the ambulance model and its battery was not rechargeable. I wondered what could you do with that data card? This was in fact the dawning of the modern AED.

When it comes to treating cardiac arrest there simply is not enough time to rely on even the quickest ambulance responses or time to travel to a hospital and then find the right people with the right equipment and training – we know this now. Every minute that passes is a 10% reduction in the possibility of saving a cardiac arrest victims life. But what is acceptable? Is a 5-minute delay ok so we only save half of the people? Back then so much awareness was needed. It was not just AEDs that were needed, in order to save more lives, the symptoms of cardiac arrest needed to be

Pictured left to right: Maurice Moran, Managing Director, OxygenCare; Etáin Moran, Corporate Affairs & Brand, OxygenCare; Conrad Wynne, Senior Product Specialist, OxygenCare with the Defibtech LifeLine AED and LifeLine View AED

recognised more quickly, help needed to be called for more quickly and CPR needed to be given more quickly.

Fast forward to the early 2000s and I am now working directly for a large manufacturer. Having sold just four AEDs in the year 2000 and 25% growth to five AEDs in 2001, the opportunity arose to develop a plan to support charities helping to create awareness.

In 2002 Croí reported that of some 6000 victims of cardiac arrest in Ireland in that year 99% would in fact die. This was announced at a breakfast meeting and press launch for the Community First Responder (CFR) Schemes in Connemara, amongst the very first CFR groups in the country. With heavy rains forecast and in anticipation of a potential bog slide, the country’s media who were waiting for this event had fortuitously booked into the same hotel. They took the initiative of attending the CFR launch and filled the room to hear presentations from the local Ambulance Chief, a Cardiologist and also the Chief of the Fire Service at Dublin Airport, one of the country’s most successful Public Access Defibrillator schemes –even at that stage of development of AED programmes.

In modern terms, the press launch went ‘viral’ with hourly references on most radio news programmes, TV news and print

media followed the next day. It did not take long before I started getting calls and orders for AEDs from Government Departments. The interest from Government was key to the success of driving sales and growth of AEDs. The first National Conference in 2004 run by the Irish Heart Foundation in the Helix followed, with over 1000 delegates present. At this event, the Department of Health sent a delegation which formed the Sudden Cardiac Death Task force. This led to important statistical and supporting work to encourage growth of placement of AED programmes. Again, this received extensive positive media coverage.

In 2011, Government enacted The Good Samaritan Act to protect providers from being sued for attempting to assist another human being, which removed a further barrier to CFR programmes being created.

In 2016 the Health and Safety Act advised large and medium sized employers that they should protect their employees by providing and maintaining AEDs at the workplace. Fortunately, many organisations are motivated by social conscience i.e. having an AED is the right thing to do, they are maintained properly, accessible and there is staff training about how easy they are to use. These AED programmes at workplaces are saving lives. Workplaces take fire prevention

Richard Smith, engineer at OxygenCare, calibrating a Corpuls AED

and protection seriously, but how often do companies conduct Fire Drills for example vs CPR and AED training? We test our fire alarms every week and even do fire drills and evacuations – but how often do we do cardiac arrest emergency scenario training, so we are ready when the unthinkable happens.

It has happened to me on more than one occasion where an AED I have provided has been used successfully within weeks. It always gives me a chill to think what if they had delayed their purchase. Thankfully, it is becoming more common to hear of cardiac arrest survival but there is still a long way to go. Every year sees improvements with more AEDs being placed in more industries and in more public places. The numbers of voluntary Cardiac First Responder schemes are growing annually with support from the CFR Ireland Charity and the National Ambulance Services CFR engagement officers.

And it has delivered results. Today when the Ambulance turns up to a cardiac event CPR is very likely to be ongoing. The latest statistics from the Republic of Ireland’s Out of Hospital Cardiac Arrest Registrar showed that in 2022, CPR was in progress more than 84% of the time and an AED was in use 31% of the time. 1Survival rates to hospital discharge is 7.3%, which is a massive step forward from of 1% in 2003 and every life

counts, but we can still do better. Our rural landscape and distances to advanced care present a challenge too.

To do better we need more AEDs placed, more awareness and more CPR being taught across all walks of life. It is encouraging to see the Irish Heart Foundation’s ‘CPR 4 Schools’ Programme teaching transition year students these important lifesaving skills. Dental Guidelines state that dentists now need to have an AED on-site. In the 2023 Budget, the Irish Government reclassified AEDs to remove them from the 23% VAT rate band, meaning 0% VAT is now applicable on all AEDs, cabinets, and training equipment, which is a huge step forward in making AEDs more affordable.

The importance of checking and maintaining AEDs was highlighted by HIQA (Health Information and Quality Authority) in 2014 who reported that more than 20% of AEDs were not rescue ready. A single AED is often considered sufficient, but for many large workplaces, schools and buildings, realistically it is not enough.

The gold standard employed by Airports for example is a oneminute fast walk in either direction from the nearest AED. Remember the 10% per minute rule? Let us surmise, it takes a minute to realise what has happened to that person who has slumped in their chair, one more minute to get to the AED and another minute back, another minute to power it on, open the pads packet and attach them to the patient before a lifesaving shock is delivered. So now we are at 4 minutes, maybe 5 and already half the opportunity to save that person’s life is gone. What if the AED is located a five-minute fast walk away? That is a 10-minute round trip, and the clock does not stop.

So, ask yourself, where is your nearest AED?

Reference

1Out of Hospital Cardiac Arrest Register Annual Report publishedNational Ambulance Service

New Approaches in Overcoming Obesity and Cancer

Cancer patients with the condition of obesity could see more positive outcomes from immunotherapy treatment

Scientists, funded by Breakthrough Cancer Research, have discovered revolutionary new approaches to overcome key challenges presented by obesity in the treatment of Oesophageal cancer through the redirection of Natural Killer Cells.

Principal Investigator Dr Melissa Conroy, alongside Dr Eimear Mylod and Professor Joanne Lysaght

There is no one-size-fitsall treatment for cancer and some forms of the disease, like the ones linked to obesity such as Oesophagogastric adenocarcinomas (a type of oesophageal cancer which affects the lower part of the food pipe), can be especially difficult to treat and currently have very low survival rates.

In a ground-breaking development, a team of scientists in Trinity College Dublin, funded by Ireland’s leading cancer research charity Breakthrough Cancer Research, have discovered an innovative approach to making immunotherapy treatment more effective for these cancer patients. The findings, published recently in Nature-Scientific Reports show how a category of cancer-killing immune cells are profoundly and negatively impacted by ‘abdominal fat’ but can be redirected to the tumour by a new drug called E6130.

Oesophageal cancer has long posed a significant challenge in the medical field, with only one in four patients surviving past the critical five-year mark post-diagnosis.

Recognising the urgent need for transformative therapies, Principal Investigator Dr. Melissa Conroy, alongside Dr. Eimear Mylod and Professor Joanne Lysaght, have identified vast potential for novel immunotherapeutic approaches. Their research explores innovative strategies targeting the immune system, particularly Natural Killer (NK) cells. NK cells are the body’s own first-line defence against cancer and play a crucial role in directly recognising and eliminating cancer cells.

One of the key findings of the research, conducted by Dr. Eimear Mylod under Dr. Conroy and Prof. Lysaght’s mentorship, is the profound impact of obesity on oesophageal cancer progression. Notably, individuals with higher levels of visceral fat characterised by excessive abdominal fat, exhibit

lower levels of NK cells within their tumours. Through rigorous investigation, the team identified a molecule known as Fractalkine, responsible for drawing NK cells into fat deposits, thus diverting them away from the tumour site where they are needed most.

Building upon this initial discovery, the team introduced an innovative intervention. By utilising a drug named E6130, they successfully redirected NK cells from fat deposits towards the tumour, marking a significant breakthrough in cancer immunotherapy. However, the journey towards effective treatment doesn’t end there.

Dr. Conroy and her collaborators encountered a subsequent challenge: upon reaching the tumour site, NK cells were suppressed in patients with the condition of obesity, hindering their anti-cancer activity. Undeterred, the researchers are now focused on overcoming the suppression of NK cells within such tumours. Whether through the introduction of fortified NK cells from healthy donors or through innovative strategies to counteract

suppression within the tumour microenvironment, the team believes that they can enhance efficacy of immunotherapies for oesophageal cancer patients.

“This research not only offers hope for oesophageal cancer patients but also holds promise for advancing immunotherapy across various cancer types,” stated Dr. Conroy. “By addressing the intricate interplay between the immune system, obesity and cancer, we are paving the way for more effective and personalised treatment approaches.”

The findings from this study represent a significant milestone in cancer research, with farreaching implications beyond oesophageal cancer. As many as 13 cancers are currently strongly linked to obesity. As the medical community continues to unravel the complexities of cancer immunity, Dr. Conroy’s team stands at the forefront, driving innovation and delivering hope to patients worldwide.

The research is being funded by Breakthrough Cancer Research

through their award-winning partnership with Qualtrics through their campaign called five for the Fight. Orla Dolan CEO of Breakthrough Cancer Research said, “We are thrilled to see the publication of these powerful new findings. This team have not only unlocked how visceral or belly fat can impede a patient’s immune system reaching their tumour but they have gone a step further and found a way to overcome that. The immune system is a powerful tool in treating cancer but its complexity is still being unravelled. This research is a huge step in unleashing that tool for more patients.”

Breakthrough Cancer Research is Ireland’s leading cancer research charity. They work with researchers and scientists throughout Ireland and fund exceptional patent focused translational research throughout Ireland and beyond. They particularly focus on poor prognosis or low survival cancers which are often diagnosed at an advanced stage and are poorly served by current treatments.

Breakthroughcancerresearch.ie

80 Clinical Profiles

NATIONAL ROLLOUT OF HEALTHY AGE FRIENDLY HOMES PROGRAMME

Healthy Age Friendly Homes (HAFH), a first-of-its-kind programme to enable older adults to continue living independently, launches nationwide today (10 July). This joint Health and Local Government programme, recognised globally as a best practice example of coordinated support services, will assist up to 10,500 older adults each year through timely interventions. It is estimated that the programme will result in an annual saving of ¤41.5 million to the State through the prevention of hospitalisation and early or unnecessary admission to long-term residential care.

The programme’s key partners include the Department of Health; Health Service Executive (HSE); Department of Housing, Local Government and Heritage; Age Friendly Ireland, and the Sustainable Energy Authority of Ireland (SEAI).

Following a two-year pilot across nine sites, the programme is now expanding to all 31 local authorities. Local Healthy Age Friendly Homes Coordinators will manage support packages — across Housing, Health, Technology, Finance, Energy Efficiency and Social/Community — for each person referred. Home-based assessments will identify a diverse range of supports to enable the older person to continue living independently –whether in their own home or in more suitable housing. These supports could include housing adaptations, rightsizing to a more appropriate home, and assistive technology such as age-friendly tablets or wearable PanPan. It will also provide connections to services such as occupational therapists, social and community groups like Meals on Wheels and transportation to hospital appointments.

An evaluation conducted by Maynooth University involving over 2,130 participants during the pilot phase revealed significant improvements in self-reported health status, quality of life, social support, and functional ability. The Healthy Age Friendly Homes - Pilot Evaluation released today, underscores the programme’s success in enhancing the wellbeing of older adults. In total there were 6,908 supports delivered between May 2021 and December 2023. Of the participants surveyed, over 3,270 people received home visits; over 1,400 participants live in urban areas; 963 participants indicated housing adaptations were required in their home, with 347 having been assisted in

making a housing adaptation grant application and 376 were provided information on housing adaptation grants for consideration and followup. The report also found that 74% of programme participants own their home; 51% live alone; 37% live with a significant other; and 11% live in their own home with a family member.

More than 50% of research participants now feel they have strong levels of social support, a 9% increase, with almost 4 out of 5 research participants reporting having greater self-belief in their ability to respond to new or difficult situations.

Mark Harrington, National Manager of Healthy Age Friendly Homes added: “International evidence shows that the environment — Housing, Health, Technology, Finance, Energy Efficiency and Social/Community— greatly influences how older adults manage at home. The HAFH initiative is poised to support up to 10,500 older adults across Ireland each year, ensuring they receive the right support, at the right time, in the right place. There are currently 44 Local Healthy Age Friendly Homes Coordinators across Ireland, meaning from Dublin to Limerick; from Galway to Waterford, there is a coordinator — or even in some regions two coordinators — in your local authority.”

“Residential care homes are essential when needed, but this service aims to prevent early admission by ensuring timely interventions. While there is an estimated annual saving of ¤41.5 million to the State, HAFH focuses on enhancing quality of life and supporting independent living, rather than solely on cost-effectiveness. Our goal is to provide alternatives to older people, reducing the risk of hospitalisation, premature entry into long-term care, and social isolation through a well-rounded model of care. This person-centred approach ensures that the older person is at all times the decision maker in the supports required.”

STUDENTS EMBARK ON CANCER JOURNEY

This summer, seven promising third-level students will embark on a significant journey to help advance Ireland’s understanding and treatment of cancer. Their innovative research into poor prognosis cancer is being funded by Breakthrough Cancer Research’s Summer Scholarship Programme. This year’s scholarships are kindly supported by the annual AIB Community Fund.

This initiative connects students with top research teams to cultivate the next generation of

leaders in cancer research. The charity is dedicated to ensuring that patients have access to the best possible cancer treatments and never have to hear that there is ‘no hope’. Each student has been awarded a scholarship of ¤3,000 to conduct their research over a 6-10 week period this summer.

The funded projects include:

1. Assessing the impact of palliative and ablative radiotherapy on poor prognosis cancers.

2. Improving the treatment of seizures associated with brain tumours

3. Exploring the information and communication needs of lung cancer patients.

4. Examining drug treatments that could improve survival rates and minimise side effects in ovarian cancer patients.

5. Studying the effects of physical activity and nutritional health on ovarian cancer patients before and after surgery.

6. Identifying how certain proteins and molecules affect drug resistance and cell behaviour in ovarian cancer.

7. Investigating potential new treatments for pancreatic cancer. Amongst the students awarded scholarships is Kimya Ghaffarian from University College Cork, who is exploring the impact of qualityof-life palliative radiotherapy may have in patients with poor prognosis cancers. Kimya says “Unfortunately, many patients with incurable cancer don’t know the potential benefits of radiotherapy. It is a safe and effective treatment option for pain and other debilitating symptoms. There is currently no quality-of-life data on Irish patients with incurable disease receiving radiotherapy as it is difficult to ask patients who are often near the end of life to return to hospital for additional appointments to complete questionnaires.” This study will use easy-to-access mobile phone electronic applications to collect the important information which will help healthcare practitioners identify patients who may benefit most from treatment. It is hoped that the electronic application will encourage more patients to be assessed in a cost-effective and less disruptive way.

Meanwhile, medical student Nazia Rafiq from Trinity College Dublin is looking at whether treatments for seizures associated with brain tumours can be improved. Around the tumour is an area of brain tissue called the peritumoral region. Using cell lines from

donated brain tissue, in-vivo models and novel clinically relevant drugs, this project will assess if the AMPA receptors contribute to generating seizures and the growth of the tumour. The project aims to improve treatment options for patients using drugs that target the AMPA receptor. Speaking about the importance of the Breakthrough Cancer Research’s Summer Scholarship Programme, Nazia added “This scholarship really highlights the importance of facilitating research opportunities for students at my stage. It helps us decide whether an academicclinician pathway is really for us. It allows us to make connections with researchers and clinicians at later stages of their career who can provide us with valuable guidance and advice.”

Breakthrough Cancer Research is Ireland’s leading cancer research charity. They work with researchers and scientists throughout Ireland and fund exceptional patient-focused translational research throughout Ireland and beyond. They particularly focus on poor prognosis or low survival cancers which are often diagnosed at an advanced stage and are poorly served by current treatments.

Over the past 20 years, Breakthrough has helped bring 9 new treatments to the clinic and delivered over 300 novel discoveries in cancer prevention, diagnosis and treatment.

Now in its fourth year the Summer Scholarship Programme promotes and drives more patient-focused cancer research within Ireland, through the education of the next generation of cancer researchers.

For more on the Summer Scholarship Programme, see breakthroughcancerresearch.ie or email research@breakcancer.ie

GOVERNMENT URGED TO INVEST ¤5.5 MILLION IN DEMENTIA SERVICES TO TACKLE INEQUITY ACROSS IRELAND

The Alzheimer Society of Ireland (The ASI) is calling on the Government to invest ¤5.5 million in dementia supports and services to address inequity of access across the country.

The organisation is highlighting the vital need for increased care services, social protection, research resources and workforce planning to meet the growing needs of thousands of people across the country.

The recommendations are contained in The ASI’s Pre-Budget Submission 2025; Equal Dementia Supports, Building on Momentum

in 2025, which was launched today at Buswell’s Hotel in Dublin – and calls for additional State investment to address a rising demand for dementia services.

The submission asks Government to build on the momentum of the past four years with an investment of ¤5.5m, alongside tangible policy solutions to address:

• Ongoing geographical inequity in dementia services and supports (including Day Care, Day Care at Home, Weekend Activity Clubs, Dementia Advisers, Clinical Nurse Specialists in Dementia)

• Financial struggles of family carers

• Mental health needs of people living with dementia and those who care and support them

• A sustainable dementia workforce

• Support for Irish dementia research.

The ASI’s Head of Advocacy, Research and Public Affairs, Cormac Cahill said there are 29 Dementia Advisers working across Ireland who are consistently in demand.

“In 2023, the service worked with 4,607 new clients, a 12% increase on 2022. In 2024, demand for the first four months of the year for the service is already 6% ahead of 2023 – showing an 18% increase since the start of 2023.

“Providing greater access to the Dementia Adviser Service will support more people living with dementia and their families to navigate services and supports and receive personalised and timely information about dementia, which has been identified as a significant challenge.

“Our services throughout the country such as Day Care and Day Care at home have waiting lists and ongoing capacity challenges. We are ambitious for the lives of people with dementia, and those who care for, and support them. The actions in this submission have the power to be lifeenhancing and life-changing.

“We appreciate the support from this Government, particularly Minister Mary Butler and her continued understanding and funding of much-needed dementia services. This support has led to considerable improvement in the level of dementia supports in Ireland. Given the rising need and the immense challenges faced by people impacted by dementia, what we are proposing in Budget 2025 can build on the investment in recent years and help to address these challenges.”

This inequity in services was highlighted by Kathleen Farrell, who lives with Lewy Body Dementia, and said: “We should be able to stay in our own homes if that is what we want. Everybody should be entitled to the same support no matter where they live in the country. Time is not our friend; we cannot wait for a service sometime in the future”.

The ASI has highlighted the urgent need for a Dementia Registry to quantify the number of people diagnosed with dementia in Ireland and where they live.

Dr Laura O’Philbin, Research and Policy Manager with The Alzheimer Society of Ireland said: “The lack of hard data on the number of people living with dementia in Ireland and where they live makes our estimations just that, estimations on prevalence rather than evidence-based facts. A Dementia Registry is essential for planning equitable and responsive service provision, ensuring that limited resources are used in the most optimal was possible.”

The organisation has also outlined the need for investment in Dementia Research. Quality research and innovation lead to better outcomes for people with dementia and their families. Ireland has developed a solid foundation in dementia research. Continued investment is vital to capitalise on expertise and knowledge while facilitating a more cohesive research focus across all disciplines.

INVACARE UNVEILS LATEST INNOVATIONS AND RE-BRAND OF MATRX AT DUBLIN ESS CONFERENCE

Leading healthcare manufacturer Invacare unveils its latest innovations and fresh new concepts under its Matrx brand at the prestigious European Seating Symposium in Dublin this week.

Matrx is an award-winning range of clinician-led seating and

positioning solutions specifically designed for the health and wellbeing of wheelchair users around the world.

This week’s symposium brings therapists and clinicians from all over the world together for threedays of research, insights and education within the field.

Invacare’s Matrx range has seen significant global growth over the last number of years and is fast becoming a respected name in the industry.

Sofie Vercaemer, Occupational Therapist and Head of Seating and Mobility at Invacare, expressed her excitement about the European Seating Symposium 2024. She shared, “We are thrilled to be here for this year’s ESS and unveil our latest developments from our Matrx brand. There is a science behind our seating and a truly unique concept that we want to share with delegates during the event.

Over 600 delegates are gathering at the symposium and Invacare welcomed them into their Matrx M-Lab, a space dedicated to expert insight, and seating innovation. Sofie added: “At Invacare, we believe in the power of collaboration and knowledgesharing to drive positive change. Our clinical education team from Motion Concepts in Canada are also joining us to lead on several speaker presentations at the symposium.

“By supporting these events, we aim to enhance education for clinicians, and improve the well-being of individuals with disabilities worldwide.”

Invacare’s Global Head of Communications, Leisa Evans, added, “We continue to strengthen relationships and meet with clinicians, customers and industry colleagues. Our gold sponsorship of the symposium reflects our ongoing commitment to advancing in the field of seating and mobility in Europe and beyond.”

ST PATRICK’S MENTAL HEALTH SERVICES’ ANNUAL REPORT

The recently published 2023 Annual Report for Ireland’s largest independent, not-for-profit mental healthcare provider, St Patrick’s Mental Health Services, has revealed consistent demand for remote care, with approximately 20% of its service users accessing comprehensive, multidisciplinary team-led care through online channels during 2023.

Grounded in a human rights-based ethos, St Patrick’s Mental Health Services introduced homecare and remote services in 2020, which offers choice and empowerment by removing barriers and providing care within the person’s home environment.

A human rights-based approach to care seeks to ensure that the rights of people using services are protected, promoted and supported by the services they’re engaged with. Through the provision of rights-based care, St Patrick’s Mental Health Services strives to ensure that its practices and policies uphold and safeguard the dignity, autonomy and fundamental rights of each service user.

Remote care services are now a core part of St Patrick’s Mental Health Services’ overall service delivery model, with 881 people receiving treatment through this service in 2023 alone. Since its introduction, the Homecare service, which offers inpatient level care to both adults and adolescents in their own home via online channels, has represented an average of 23% of all admissions to the service over the last four years.

The report also showed that during 2023, inpatient care was delivered to 2,341 service users while there were 15,466 Dean Clinic appointments and 18,769 attendances at day programmes.

Speaking about remote care and its role in enhancing human rights-based approaches to mental health treatment, Paul Gilligan, CEO at St Patrick’s Mental Health Services said: “The world is evolving at a rapid pace and how we respond to mental health difficulties must evolve with it. What we are witnessing is not only a shift in technology available, but also a new level of ease and comfort in implementing and using digital healthcare for both mental healthcare professionals and service users.

Nearly one-quarter of service users now choose to access care remotely and the provision of technology-enabled care has become integral to ensuring

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a sustainable and adaptable mental healthcare service. While inpatient services remain at the heart of St Patrick’s Mental Health Services’ operations, remote care has the potential to become a cornerstone of our human rightsbased ethos by providing choice and empowerment and removing barriers to mental healthcare.”

St Patrick’s Mental Health Services’ 2023 Annual Report also showed significant digital growth in other areas, including the development of a new Digital Transformation Strategy and significantly increased usage of its service user online portal, Your Portal.

By the end of 2023, there were over 2,500 service users registered to use Your Portal, an online portal that empowers service users to play a more active role in their recovery by providing them with greater access to their healthcare records and enabling them to contribute to and monitor their care plans.

Since its launch in 2020, Your Portal, which is Ireland’s first service user portal, has seen a 51% increase in the number of service users using the portal, with 490 additional users recorded in 2023.

The publication of the 2023 Annual Report comes after, earlier this year, St Patrick’s Mental Health Services also published its first Digital Health Transformation Strategy. This strategy outlines how, over the next five years, St Patrick’s Mental Health Services will use digital technologies to promote positive mental health; to educate people in managing their own mental health; to provide service users with recovery and self-management tools; to enable the delivery of the highest quality care and treatment to more people; and to further empower service users as partners in their care.

The 2023 Annual Report, which is available to view here, also outlined significant progress and achievements in a number of other key pillars of activity that are central to St Patrick’s Mental Health Services’ mission and vision, including service user partnership, advocacy and education and research and training.

MUNSTER TECHNOLOGICAL UNIVERSITY HOSTS RARE DISEASES SYMPOSIUM

Munster Technological University (MTU) hosted the All-Ireland Rare Disease Interdisciplinary Research Network (RAiN) symposium on the 10th of June 2024 at its Kerry campus. This symposium was open to anyone living with or interested in rare diseases.

Catherine Carty (UNESCO Chair Manager), Daniel Mikula (Rare Disease Research Catalyst Consortium) Bernadette Sheehan Gilroy (MTU) Associate Professor Suja Somanadhan (UCD) Dr Maria Caple (UCC) and Professor Josephine Hegarty (UCC)

Rare diseases, though individually rare, collectively present a formidable challenge to the global population, impacting approximately 350 million people worldwide. In Ireland, the situation is particularly alarming, with an estimated 410,000 individuals grappling with rare diseases, a staggering 70% of whom are children and young people. RAiN, in direct response to this urgent research gap, provides a platform for the voices of individuals and families to be heard and actively contribute to research that directly affects them.

RAiN is funded by the Department of the Taoiseach’s office through the Shared Island New Foundations Awards and University College Dublin (UCD) Strategy funding. This network promotes and extends excellent North-South connections to increase knowledge, influence practice, develop policy, and improve patient outcomes on the island of Ireland.

RAiN, a testament to the power of collaboration, represents a united effort to address the unique needs of families affected by rare diseases. By amplifying their voices, we are driving meaningful change and making a real difference in their lives.

The network involves University College Dublin (UCD), Queen’s University Belfast (QUB) and 33 partner organisations across the Republic and Northern Ireland, including Munster Technological University. RAiN is co-led by Associate Professor Suja Somanadhan (UCD) and Professor Amy Jane McKnight (QUB).

The symposium brought together approximately 50 attendees, including researchers, health

and social care professionals, academics, policymakers, and advocates in the rare disease field. It showcased the power of collective action in promoting equality, diversity, and inclusion for rare diseases.

The symposium was opened by Associate Professor Suja Somanadhan (UCD), and Professor Maggie Cusack (President of MTU) welcomed everyone to the symposium and highlighted the challenges faced by those living with a rare disease across Ireland and the role of RAiN.

Bernadette Sheehan Gilroy from the Dept of Health and Leisure Studies (MTU) spoke about low-protein dietary therapy in the context of inborn errors of metabolism expressing concerns including the lack of research to support the recent implementation of the ‘hot school meals programme’ for those adhering to lifelong low-protein dietary therapy. As part of Bernadette’s presentation, attendees heard from a young man living with tyrosinemia, from the parent of a child with homocystinuria and the perspective of the Irish PKU (Phenylketonuria) community through research Bernadette conducted in collaboration with Associate Professor Somanadhan in the RAiN network.

Thereafter, the work of RAiN’s Children’s Research Advisory Group (CRAG) was presented by two members of the CRAG - Ethan Gilroy and Aaryan Mahesh. The two young members emphasised the importance of amplifying the voices of young people in rare disease research. CRAG member Lucy Gallagher shared a powerful message, virtually, reminding other young people living with rare diseases to “Be the voice, not the Echo”.

After lunch, the symposium heard from Ian Fallon, who presented on the work of BUMBLEance, the first non-governmental funded child ambulance service in Ireland. Catherine Carty (UNESCO Chair

MTU) spoke about rare diseases in relation to Principle Two of the United Nations Sustainable Developmental Goals Declaration to “Leaving No One Behind”. Rosie Dempsey (MTU) described the process of designing a cartoon video which raises awareness of haemophilia. This video was developed in collaboration with Children’s Health Ireland (CHI). Professor Josephine Hegarty and Maria Caples University College Cork (UCC) presented their work on developing a competency framework on genomic education.

The day concluded with a panel conversation led by Associate Professor Somanadhan. The panelists included Anne Lawlor (22q11), Mary Vasseghi (TSC Ireland), Cassandra Dinius and Daniel Mikula (Rare Disease Clinical Trial Network), and Triona Seery (Patient Advocate). The discussion was highly engaging, focusing on the importance of partnership through patient and public involvement and engagement (PPIE) in rare disease research. The key message was that it is imperative to place the voices of people living with rare diseases and their families at the very core of research. The day was an immense success, and RAiN and MTU would like to thank all who attended, participated or supported the day. Stay tuned for many more RAiN events in the future.

For more information on RAiN, see the network’s website - https:// www.rainrareresearch.org/

SPINAL INJURIES IRELAND (SII) MARKS 30TH ANNIVERSARY

Ireland’s only spinal cord injury charity reflects on milestone anniversary to urge public to continue supporting 2400 people across Ireland living with spinal cord injury

Spinal Injuries Ireland (SII) is celebrating their 30th anniversary this year and have called on businesses across the country to help them make their annual flagship fundraiser – A Day in My Wheels - their most successful fundraising and awareness event to date.

SII is Ireland’s only support agency dedicated to providing a nationwide person-centred service to assist people to engage fully in society following spinal cord injury which is described by the World Health Organisation and one of the move devastating & life changing injuries a person can sustain.

During this time, the charity has provided services and support to over 5000 people with a spinal cord injury and over 20,000 family members and carers. On average,

three people a week sustain a SCI every week in Ireland.

In conjunction with celebrating their 30th anniversary as a charity, SII is calling on businesses across Ireland to declare their expressions of interest for their biggest fundraising and awareness campaign of the year, ‘A Day In My Wheels 2024.’

‘A Day in my Wheels’ provides companies with the chance to engage in an interactive educational experience and provides a holistic understanding of the challenges wheelchair users face when it comes to inclusivity, diversity and employability in the workplace.

SII CEO Fiona Bolger said the annual fundraiser was a key part of SII’s mission in Ireland to create a more accessible and supportive environment for wheelchair users and people with spinal cord injury.

She said: “Inclusivity and accessibility is crucial in aiding people with SCI to return to the workplace, and companies need to ensure they are doing all they can to help wheelchair users thrive and feel accepted in the workplace.

“I would urge CEOs across Ireland to sign up to our expression of interest for A Day in my Wheels and join us in raising awareness of the issues faced by those with SCI and be part of the solution.”

The most recent ‘A Day In My Wheels’ workshops raised over ¤30,000 for the charity last year, with the charity hoping to better that for 2024.

To date since the fundraiser began, A Day in My Wheels has raised almost ¤200,000 over the last 3 years. SII has to fundraise over a ¤1 million annually to cover their costs.

Founded in 1994, SII has grown from a small community initiative set up by a group of former patients to a nationally recognized organisation based in a state-ofthe-art resource centre beside the National Rehabilitation Hospital in Dún Laoghaire.

With a mission to empower individuals with spinal cord injuries to live full and independent lives, the charity has made significant strides in raising awareness, funding research, and delivering critical services.

Reflecting on how far the charity has come since its inception 30 years ago, SII Events Manager Philip Quinlan said: “I remember starting in SII in a tiny, cold portacabin just beside the entrance to the old hospital. We only had four full-time permanent staff then – now, we have 17 staff working for our charity.

“We had no fundraising staff, so I initiated that role – the main aim was to get one outreach officer on the road visiting our service users because that’s where they indicated to us that they had the biggest challenge, having left the hospital and all its support. We’re immensely proud to now have a full Services team of 8 people providing a fantastic service for our service users and families.”

Ms Bolger added: “It is amazing to reflect on how far the organisation has come since then, beginning as a small group with the common purpose of supporting people with a spinal cord injury in Ireland

“It is thanks to our incredibly generous donors, supporters and dedicated volunteers that we are still here today, continuing to provide people living with spinal cord injury with much-needed care and support.

Express your interest for ‘A Day In My Wheels’ by emailing info@spinalinjuries.ie or by phoning 01 653 2180.

For more on Spinal Injuries Ireland and the services it provides, see www.spinalinjuries.ie

THE VISION VAN - COMBATTING PREVENTABLE BLINDNESS ACROSS IRELAND

Every day in Ireland, 18 people begin to lose their eyesight, yet 70% of blindness is preventable

Elaine Crossan, Vision Ireland; Fundraiser and Former Paralympian Peter Ryan, Campion Insurance; Denise Harris, CEO of the Harris Group; Jim Campion, CEO of Campion Insurance with the Vision Van

through early detection and treatment. To tackle this worrying trend and raise awareness about the importance of good eye health, Vision Ireland has proudly launched the Vision Van service.

In order to facilitate early screening for various eye conditions, Harris Group, Ireland’s pre-eminent distributor of commercial vehicles, generously donated a state-of-theart mobile unit, which provides vital public education and awareness.

A staple vehicle from Harris Group’s range of electric vehicles, the Maxus eDeliver 9 is equipped with screens and tools for detecting eye conditions, including an Amsler grid for recognising the early stages of AMD (Age-related Macular Degeneration), the most common cause of blindness in Ireland in people over the age of 50. The Vision Van will also provide simulation services through virtual reality and information to the public on various other eye conditions.

Former Irish Paralympian Peter Ryan officially launched the Vision Van today along with sponsor Denise Harris, CEO of the Harris Group, at their headquarters on the Naas Road in Dublin. The donation was also significantly helped by Peter Ryan’s fundraising run from Malin to Mizen Head, along with the support of partners such as Campion Insurance, Bayer and Abbvie, with Circle K covering EV charging costs.

Speaking at today’s launch, Denise Harris commented “We are delighted to support Vision Ireland as they travel across the country promoting good eye health to the public, to safeguard against avoidable vision impairment and blindness. It is important that we

mind our eyes. Of all the faculties that people depend on, I consider that eyesight is one of the most important; education, awareness, and screening are critical for independent living.

Vision Ireland’s Vision Van will benefit many communities across Ireland, and I hope that everyone will appreciate the foresight and effort of Vision Ireland in pioneering this service. It will, I am sure, support many people to better manage their vision and ensure they can live the fullest possible life.”

Former Paralympian Peter Ryan said, “I’m delighted to see the Vision Van get on the road. I feel that people underestimate how many people in Ireland are affected by eye conditions. It is essential that people have access to services like those offered on the Vision Van. I know it will have a massive impact in communities around Ireland.”

Vision Ireland Chief Services Officer Aaron Mullaniff said, “With our Vision Van setting off around the country, we hope to start important conversations about eye health. Our team will be travelling around Ireland informing the public about various sight-loss conditions that can often be difficult to pick up or can be age related. Our aim is to make the public aware of these conditions and equip everyone with the lifestyle information required to manage their eye health. Be sure to pay the Vision Van a visit to learn about how you can look out for your eye health.”

The Vision Van will be coming soon to locations around the country to start much-needed conversations about eye health.