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February 2024 Volume 16  Issue 2 PHARMACYNEWSIRELAND.COM

THE INDEPENDENT VOICE OF PHARMACY

In this issue: NEWS: Pharmacy role in Blood Pressure Awareness Page 5

REPORT: Polypharmacy Project improves Patient Safety Page 8

MENTORING:

Keep fully charged with

Utilising your Skill Set Page 10

FEATURE: Age Related Macular Degeneration Page 18

CPD: VITALITY11

Chronic Kidney Disease Page 41

AWARDS: ENERGY SUPPORT

IMMUNITY SUPPORT

MENTAL PERFORMANCE

HIGH in 11 vitamins & minerals each contributing to support energy release + Ginseng Vitamins C, B1, B2, B3, B5, B6, B7, B12, iron, copper and manganese, each contributing to normal energy yielding metabolism Pharmacy only. Suitable for Adults over 18 years. Food supplements are not intended to be a substitute for a balanced and varied diet and / or a healthy lifestyle. Always read the label. Distributed in Ireland by Clonmel Healthcare Ltd. 2023/ADV/PHA/001H

This Publication is for Healthcare Professionals Only

OTC & Retail Pharmacy Product Awards Page 45

TEAM TRAINING: Dandruff Page 83

FINANCE: Minding the Financial Gap Page 88

Content for Pharmacists Only

Helps Patients Breathe Their Best

Trust Otrivine to relieve congestion

Up to 6x faster than decongestant tablets* 1

Nasal congestion can leave your patient’s nose feeling restricted.

Extra Dual Relief 0.5mg/ml + 0.6mg/ml Nasal Spray Xylometazoline hydrochloride/ Ipratropium bromide

Learn more about the Otrivine range.

Relief from cold symptoms blocked and runny nose Metered-Dose

Nasal Spray

Xylometazoline Hydrochloride / Ipratropium Bromide *Vs pseudoephedrine and phenylephrine tablets. Reference: 1. Eccles R. Over the counter medicines for colds. In: Common Cold. Eccles R & Weber O, eds. Basel, Switzerland: Birkhäuser Verlag: 2009. Product Information: Otrivine Extra Dual Relief 0.5mg/ml + 0.6mg/ml nasal spray, solution (xylometazoline hydrochloride and ipratropium bromide). Indications: Symptomatic treatment of nasal congestion and rhinorrhea in connection with common colds. Dosage and method of administration: Adults: 1 puff in each nostril up to 3 times daily. 6 hours min. between 2 doses. Max. 3 puffs daily into each nostril. Max. 7 days use. Do not exceed the stated dose. Paediatric population: Not for use under 18 years of age. Geriatrics: Limited experience of use in patients above 70 years of age. Contraindications: Hypersensitivity to ingredients, atropine or atropine like substances. After surgical operations where dura mater may have been penetrated. Patients with glaucoma, rhinitis sicca or atrophic rhinitis. Precautions: Use with caution in patients with hypertension, cardiovascular diseases, long QT syndrome, hyperthyroidism, diabetes mellitus, hypertrophy of the prostate, stenosis of the bladder bar, pheochromocytoma, cystic fibrosis, on monoamine oxidase inhibitors treatment, on tri/tetra cyclic antidepressants (or have been on either within the last two weeks), on beata 2-agonist treatment and a sensitivity to adrenergic substances. Use with caution in patients predisposed to angle closure glaucoma, epistaxis and paralytic ileus. Immediate hypersensitivity – may occur. Avoid spraying in or around the eye. Side effects: Very Common: Epistaxis. Common: nasal dryness, dysgeusia, headache, nasal discomfort, nasal congestion, dry throat, throat irritation, rhinalgia, dry mouth, dizziness, nausea, application site burn. Uncommon: insomnia, parosmia, tremor, eye irritation, dry eye, palpitations, tachycardia, nasal ulcer, dysphonia, orophyaryngeal pain, sneezing, dyspepsia, fatigue, corneal oedema, conjunctival hyperaemia, cough. See SPC for full list. Legal category: Pharmacy Only. Product Licence Number: PA 0678/131/001. MAH: GlaxoSmithKline Consumer Healthcare (Ireland) Limited, 12 Riverwalk, Citywest Business Campus, Dublin 24, Ireland. Full product information is available in the SPC. Additional information is available upon request. Text prepared: November 2023. Ask your pharmacist for advice. Always read the label/leaflet. Trade marks are owned by or licensed to the Haleon group of companies. PM-IE-OTRI-23-00004.

Contents

Foreword

Page 4: Chemist Warehouse opens 9th Store

In one of our lead news stories this month, as Irish Pharmacy News was going to print, Health Minister Stephen Donnelly brought proposals before the Cabinet which mean patients will soon be able to access certain medications directly from their pharmacy without the need for a GP visit or prescription. This will include the contraceptive pill. In addition, to combat the growing problem of medicines shortages, pharmacists will be permitted to recommend clinically appropriate substitute medicines, when a prescribed medication is unavailable.

Page 8: Study results show polypharmacy improves patient safety Page 12: Operation Transformation for Woods HealthPoint Pharmacy

Page 14: Three Awards for DispenSense

The Irish Pharmacy Union (IPU) has said that the proposed legislation for an enhanced role for pharmacists will be good news for patients when the changes facilitated by legislative changes are actually implemented in pharmacies. These new measures will represent a positive step in patient care.

Page 22: What pharmacists need to know about Medicines in Winter

Page 26: Health Insights released for 2024

Page 45: OTC & Retail Pharmacy product Awards – The Finalists

PUBLISHER: IPN Communications Ireland Ltd. Clifton House, Fitzwilliam Street Lower, Dublin 2 00353 (01) 6690562 MANAGING DIRECTOR Natalie Maginnis n-maginnis@btconnect.com

ADVERTISING EXECUTIVE Esther Elliott-Coulter: 00353 (87) 062 2025 Esther@ipn.ie EDITORIAL/ EVENTS & MARKETING EXECUTIVE Aoife Hunter: aoife@ipn.ie CONTRIBUTORS Dr Bart Kuczera Dr Colm Rowan Professor Austin Stack Colm Moore DESIGN DIRECTOR Ian Stoddart Design

PHARMACYNEWSIRELAND.COM @Irish_PharmNews IrishPharmacyNews

Minister Donnelly says, “We know that pharmacists can do more for patients and I have been clear that I want to further enhance the contribution that pharmacists make to our health services, and this will be an important step forward. “The Bill will also prepare the way for some much-needed changes around the oversight of medicines supplies and access to medicines. Shortages of medicinal products has unfortunately become a reality across many countries in recent years. This Bill will allow us to be more agile in our response to these occurrences. Secondary legislation will be needed for these changes to take effect, and this is currently being developed in my department.”

Page 38: Fertility Advice in Pharmacy

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

Turn to page 4 to read more. Elsewhere, the February marks the shortlisting for the annual OTC & Retail Pharmacy Product Awards 2024. Showcased across pages 45-77 you can see who has made it as finalist across categories including Best Baby Skincare Product, Best Cough, Cold & Flu Product, Best Women’s Product and Best Eyecare Product. The OTC and Retail Pharmacy Product Awards act as a celebration and showcase of product innovation, marketing and value to its customer.

2024 45

In other news we have some excellent clinical content on chronic kidney disease, fertility in pharmacy, Vitamins, Minerals and Supplements and financial planning. I hope you enjoy the issue.

& Retail Pharmacy Regulars Product Awards

Irish Pharmacy IRISH News is PHARMACY circulated to all NEWS 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.

FEATURE: MANAGING WOUND CARE

P32

CPD: CHRONIC KIDNEY DISEASE

P41

TEAM TRAINING: DANDRUFF

P83

FINANCE: MIND THE GAP

P88

FEATURE: IRON DEFICIENCY

P91

CLINICAL PR:

P96

PHARMACYNEWSIRELAND.COM

News

9th Store Opening for Chemist Warehouse Chemist Warehouse, a global pharmacy retail chain, has opened its ninth store in Ireland at Westend Shopping Park in Blanchardstown, just three years after opening its first Irish store at the same venue. Chemist Warehouse, Westend Shopping Park, Blanchardstown expanding the original store at Westend to a more prominent 10,000 square feet space at the former NIKE store in the shopping park.

As part of its expansion plans, Chemist Warehouse will open two more stores in early 2024 in Artane, Dublin and in Cork city centre. In total, the company is seeking to open an additional 6-8 stores across various Irish locations next year.

The company said its expansion reflected the brand’s growing popularity and commitment to providing accessible healthcare and pharmaceutical products at competitive prices. As part of the moves, Chemist Warehouse is relocating and

Colin Galligan, CEO of Chemist Warehouse Ireland, comments, “Our expansion within Ireland reflects our commitment to bringing quality healthcare and affordable pharmaceutical products to more Irish customers. The new Blanchardstown store, with its increased space and central location, allows us to enhance our product offering, onboard new suppliers and elevate categories such as fragrance and beauty. With 40 dedicated staff members and three pharmacists on duty seven days a week, we are wellequipped to meet the healthcare needs of our community.”

Welcome for Expansion of Pharmacy Services The Irish Pharmacy Union (IPU) has said that the proposed legislation for an enhanced role for pharmacists will be good news for patients when the changes facilitated by legislative changes are actually implemented in pharmacies. These new measures will represent a positive step in patient care. The IPU emphasised that these developments will mean significant additional work for pharmacists and will require adequate and appropriate resources to be tabled during the ongoing pay talks with the Department of Health. Unless significant progress in relation to the 16 year pay freeze, tiered fee structure and administrative burden is made it will not be possible to implement any changes enabled by this legislation. Under proposals brought to cabinet at the end of last month by Health Minister Stephen Donnelly, patients will soon be able to access certain medications directly from their pharmacy without the need for a GP visit or prescription. This will include the contraceptive pill. In addition, to combat the growing problem of medicines shortages, pharmacists will be permitted to recommend clinically appropriate substitute medicines, when a prescribed medication is unavailable.

The legislation will strengthen joint actions by the Health Products Regulatory Authority (HPRA), the Health Service Executive (HSE), the PSI (the Pharmacy Regulator) and the Department of Health and will enable pharmacists to make therapeutic substitutions of products that are in shortage, in line with an approved clinical protocol. The IPU has tirelessly advocated on behalf of patients for the introduction of these measures for many years. The full expertise of Ireland’s community pharmacists has long been an untapped resource. These service expansions will support patients to access treatments quicker and easier. Community pharmacies provide a range of services to the state through the community drug scheme and other mechanisms. Where pharmacies are providing an essential healthcare service it is essential that the funding for doing so is fair. However, the fees pharmacies paid have not increased in 16 years. This is

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unsustainable and unacceptable and must be addressed in line with any expansion of services and should be reflected in any ongoing discussions with the Department of Health. Minister Donnelly says, “We know that pharmacists can do more for patients and I have been clear that I want to further enhance the contribution that pharmacists make to our health services, and this will be an important step forward. “The Bill will also prepare the way for some much-needed changes around the oversight of medicines supplies and access to medicines. Shortages of medicinal products has unfortunately become a reality across many countries in recent years. This Bill will allow us to be more agile in our response to these occurrences. Secondary legislation will be needed for these changes to take effect, and this is currently being developed in my department.” It is intended to progress the legislation through the Houses of the Oireachtas in the coming months.

Pharmacy Symposium The School of Pharmacy at University College Cork recently hosted the second annual ‘Pharmaceutical Quality and Regulatory Science Symposium’ in the Pharmacy Building, UCC. The theme of this years meeting was ‘Beyond Compliance: Decision Driven Pharmaceutical Quality and Regulation’. Over 60 delegates, representing local and national pharmaceutical manufacturing industry were addressed by a range of speakers, focusing on science led and riskbased decision making in pharmaceutical quality and regulation. Catherina O’Keeffe, QP and QA Team Lead in Janssen, and MSc PTQS alumnus, outlined her experience of ‘The Early Days in a QPs Career’, outlining the change of dynamics on moving into a batch release role. Valerie Mulholland from GMP Services and TU Dublin presented an analysis of ‘Risk Based Decision Making - a game of chance or skill?’ and discussed the opprtunities and challenges associated with the revised ICH Q9 guidelines. She emphasized the importance of proactive decision-making by preparing for challenging, but foreseeable quality decisions in before they occur. Orla McCarthy, External Site Quality Lead and Associate Director/QP with MSD, and graduate of the MSc PTQS in the School, provided an outline of factors to consider in ‘Ensuring Quality Oversight in the External Manufacturing Space’. Orla specifically addressed the challenges which exist in decision making due to the remote nature of the manufacturing process. Finally, John Henchion of CAI outlined means of ‘Building a Mature Decision-Making Framework’ – focusing on effective communication, factual, science-based decision making and stakeholder management. The event also showcased poster presentations from the recent graduates of the MSc in Pharmaceutical Technology and Quality Systems. These posters outlined the work carried out during their dissertations and highlighted the potential impact of these research projects to industry representatives. The symposium, led by Drs Joseph O’Shea and Patrick O’Dwyer, and Ms Linda McGuire, was established in 2022.

News Proof of Concept Award The European Research Council (ERC) has announced 102 new proof-of-concept (POC) grants for European researchers, bringing the total number of awardees from last year’s competition rounds to 240. Professor Conor Buckley, principal investigator in AMBER, the SFI Centre for Advanced Materials and BioEngineering Research, and Professor in Biomedical Engineering in Trinity’s School of Engineering, has secured the ¤150,000 funding for iDISC. Professor Buckley is also affiliated with the Trinity Centre for Biomedical Engineering, and the Trinity Biomedical Sciences Institute, and is an Honorary Associate Professor in RCSI. He will develop injectable biomimetic hydrogel systems for the lower back that aim to halt degeneration and restore natural biomechanical function through minimally invasive spine treatment strategies. Speaking following the announcement of iDISC’s ERC Proof of Concept Award Professor Buckley said, “The ERC POC award is a fantastic opportunity to accelerate my lab’s research in developing new strategies in treating disc degeneration, offering new hope and insights for patients suffering from back pain. “This research opens new horizons in minimally invasive spine treatment strategies but also has the potential to enhance patient quality of life, reduce healthcare expenses, and minimise lost productivity throughout the European Union.” iDISC will receive the funding over an 18-month period to progress biomechanical testing, pre-clinical evaluation, and marketing and commercialisation evaluation. This ERC POC builds on previous research funding to Prof Buckley’s lab from the ERC, Science Foundation Ireland and the Irish Research Council, and provides a continuation of the development of next-generation injectable biomaterials for tissue repair. Professor Buckley added, “This Proof of Concept award provides the necessary funding to pioneer innovative solutions in treating back pain, which affects over 600 million people worldwide and is the single leading cause of disability in people under 45 years of age.”

Pharmacy Highlights Blood Pressure Awareness Community pharmacies across Ireland played their part in highlighting the importance of high blood pressure awareness recently. The Irish Pharmacy Union (IPU) are teaming up with RTÉ’s Operation Transformation to support National Blood Pressure Day 2024. The partnership saw over 600 participating pharmacies nationwide, offering once-off free blood pressure checks. High blood pressure affects approximately two out of three over 50s, but it is symptomless. Once detected, high blood pressure is one of the few conditions that can be successfully managed, but only if you know you have it. Following a quick, easy, and non-invasive blood pressure check, your community pharmacist can provide you with a detailed results card and any necessary health advice or referral. Encouraging people to avail of the service Clare Fitzell, Head of Strategic Policy, at the IPU said, “Hypertension, or high blood pressure, is a serious health problem in Ireland, and many people are unaware that they suffer from it. Adults should take steps to inform themselves of their blood pressure levels. Those aged over 40 should have an annual check and under 40s should have a check at least every five years.”

Risks of allowing high blood pressure to go untreated include higher likelihood of developing a number of conditions including: • Heart disease • Stroke • Dementia • Problems with eyesight or kidneys “This year Irish pharmacies are delighted to partner with Operation Transformation to raise awareness of the risks of high blood pressure, and to encourage people to take a few minutes to get checked.

“Thankfully, many people who have slightly raised blood pressure may be able to successfully manage this through straightforward lifestyle changes. The key is knowing what your level is and taking appropriate action. However, experience tells us that some people who undergo this week’s tests will be advised to seek further medical attention. This is not something to be feared, as its far better to treat high blood pressure before complications arise than after.”

Community-based Care for Stroke Patients A new study from RCSI’s School of Population Health has found that future developments to Irish stroke services, according to those who are most impacted, must prioritise specialist community-based rehabilitation, ongoing support for life after stroke and better information and support for navigating services. The study, published in PLOS ONE, is the first in Ireland to feature the opinions of those directly affected by stroke; including survivors, their family carers and healthcare professionals. The researchers made a concerted effort to ensure that survivors with communication and cognitive difficulties were included. As well as the three main priorities identified, the need for improved staffing was emphasised, along with access to specialist acute care and support for mental health. Dr Eithne Sexton, Lecturer, RCSI School of Population Health and research lead commented “These findings point to a need for stroke services that are more consistent nationally and better resourced

based on an understanding of the diverse needs of stroke survivors and their families. This type of population-based service planning a key part of the Sláintecare strategy. “We hope this study can contribute to the broader discussion on stroke care, informing policy and practice not only in Ireland but other countries with similar healthcare challenges.” Stroke survivors and carers related many positive experiences of stroke care through interviews, surveys and a stakeholder meeting, but also revealed significant difficulties in accessing needed services and supports. This included problems accessing

rehabilitation, home care hours, equipment to support stroke recovery, and support for mental health. A major challenge identified by stroke survivors and their families was the difficulty of navigating the care system, compounded by inadequate communication and information dissemination. “Priorities for developing stroke care in Ireland from the perspectives of stroke survivors, family carers and professionals involved in stroke care: A mixed methods study.” was carried out in collaboration with The Irish Heart Foundation and researchers from UCC and Beaumont Hospital. It was funded by the Health Research Board.

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News

DispenSense take home 3 PharmaceuticalTechnology Excellence Awards Navi Group has been honoured for their dispenSense PMR system, a cloud-based pharmacy management solution that is the first of its kind in Ireland. John Carroll, Chief Executive Officer at Navi Group, said, “We are thrilled to win these highly regarded awards. This recognition motivates us to continue our mission of overcoming everyday hurdles pharmacists encounter in the dispensary.”

They are Category Award Winners in three areas in the 2023 Pharmaceutical-Technology Excellence Awards:

market, with a significant number of pharmacies signed up for the dispensary management system in 2024.

• Business Expansion: IT Solutions

The development team of pharmacists and technicians are at the forefront of their innovative features, including the First-to-Market Contraception Scheme – dispenSense have developed software to facilitate the dispensing and claiming process associated with this new scheme. Other features include:

• Innovation: Dispensary Management • Product Launches: Dispensary Software These accolades are a testament to the company’s dedication and innovative approach across the categories. Designed to enhance the efficiency of pharmacy operations while simultaneously improving patient care, the system’s robust architecture ensures that dispenSense is not just a software solution, it is a catalyst for positive change within the pharmacy landscape, setting a new standard for resilience and efficiency in pharmacy management. This cutting-edge software strives to make dispensing reliable, safe and efficient, empowering teams to overcome everyday challenges. Since its introduction, the dispenSense PMR system has generated huge interest in the

Leeanne Duignan-Higgins, Newtown Pharmacy Maynooth says “dispenSense is a very intuitive software that doesn’t require much training. The software makes processing prescriptions so quick. There is an excellent support team in the background so if any questions or issues arise, they are rectified immediately. There are fantastic features like the contraceptive claim being done directly from dispenSense, adhoc ordering function, uploading prescriptions directly from the computer etc. Also being able to log in from home if I need to check something or send the claim is great. I would recommend dispenSense and am delighted I made the move.”

• Elevating Information Security Standards (ISO 27001)

Ryan Casey, Avenue Pharmacy, Clones, Co. Monaghan says, “At long last, a new software system that is compatible with modern pharmacy. I genuinely cannot speak highly enough of this. Installation very straightforward, back up is first class, and response within seconds via WhatsApp or call if any problems. Highly recommend for anyone on the fence.”

Positioned as the system for the present and the future, dispenSense anticipates and embraces upcoming challenges in the Irish pharmacy market, with features in development such as real-time claims issue detection, patient app and medication safety scanning.

If you have any questions regarding dispenSense or are interested to find out more, please contact hello@dispensense.ie, +353 1 4433884 or visit our website dispensense.ie. dispenSense is not just a solution, it’s a partner in navigating the evolving landscape of pharmacy services.

• Seamless handling of both Healthmail and paper prescriptions • Integration with the IPU web service • Kanban workflow management tool

Research and Pharmacy Practice Mark your calendars for 25-26 April 2024, at University College Cork, for the 30th Health Services Research and Pharmacy Practice (HSRPP) Conference, which will be commemorating its ‘pearl’ anniversary. Attendees will have the opportunity to hear from a variety of experts on the topic of “Sustainable Development in Healthcare” through guest lectures, seminars, and presentations. For more information and to register, visit the HSRPP conference page at www.ucc.ie/en/hsrpp2024

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Health Research Board Funding Two RCSI researchers have been awarded funding totalling more than ¤5 million by the Health Research Board (HRB) under the Applied Programme Awards scheme. The funding is part of an overall investment of ¤20m by the HRB divided across eight new projects to support high-quality, team-based applied research that will lead to a step-change in practice and policy to deliver outcomes for the health system, population health, or for service users and carers. The successful RCSI lead applicants were: Dr Michelle Flood, Senior Lecturer, RCSI School of Pharmacy and Biomolecular Sciences for ‘Sjögren’s beyond dry eye: Advancing policy and practice through co-creation of integrated care journeys and education for health professionals – The SYNERG-IE Programme’. SYNERG-IE is a multidisciplinary research programme designed in partnership with Sjögren’s Ireland that aims to address longstanding challenges in the recognition, diagnosis, and management of Sjögren’s. This programme will adopt a collaborative and inclusive approach, combining the skills of multidisciplinary researchers, the insights of patients, and the needs of healthcare professionals and policymakers to bring about transformative change in Sjögren’s care and research. Professor David Cotter, Professor of Molecular Psychiatry, Department of Psychiatry RCSI for ‘VISTA: Vision To Action for promoting mental health and recovery. An Implementation Science approach to “Sharing the Vision” – Ireland’s national mental health policy’. The VISTA programme aims to implement Sharing the Vision’s recommendations. The multidisciplinary team, comprising clinician researchers, non-clinical researchers, policy experts, sociology, health economics, public and patient involvement (PPI) and implementation science for knowledge translation, is a first for mental-health research in Ireland. It aims to produce research that will ultimately result in improved outcomes in mental health in Ireland.

Don’t get left in the dark

Since 1st September 2023, the EU has banned the sale of fluorescent lighting. This may directly affect your business. With a fully funded lighting upgrade from Energia, you can get your old fluorescent lighting replaced, while also reducing your lighting consumption by up to 80%. We’ll make it easy by managing the entire process from start to finish.

Find out more at energia.ie/lighting

News

Polypharmacy Project improves Patient Safety A cross-border project reviewing patients’ use of multiple medicines (polypharmacy) has improved the safety of patients by reducing adverse drug reactions. Launched recently, the evaluation report for the iSIMPATHY project found that: • 77% of interventions by HSE clinical pharmacists led to improved patient care • 4% of interventions prevented major organ failure or serious adverse reaction • saved over €1.2m due to fewer adverse drug reactions and admissions to hospital. Ciara Kirke, Clinical Lead of the HSE’s National Medication Safety Programme and HSE iSIMPATHY

said, “This is the best thing to come into my life in a while. It is absolutely great, I was floundering as I’m on so many medications and I was lost.”

Ciara Kirke, Clinical Lead of the HSE’s National Medication Safety Programme and HSE iSIMPATHY project lead, explained, “Over 2,500 comprehensive medicines reviews were carried out by pharmacists in GP practices in border counties as part of the iSIMPATHY project. This work resulted in people taking fewer and more appropriate medicines. An average of 11.4 interventions were made per patient, including drug changes and education, leading to a reduction of 1.2 medicines per patient.” Patients reported significant improvements in their understanding of their medicines, increased ability to engage in daily activities and reduced side effects, following the reviews. Bernadette from Co. Cavan

The collaborative project between health services in Ireland, Northern Ireland and Scotland saw pharmacists working within multidisciplinary teams and engaging with healthcare professionals across care settings. In Ireland, pharmacists and GPs worked in partnership with patients to enable shared decision-making regarding medication and improve outcomes for patients.

all factors into consideration may identify it’s not as beneficial. 8.6 million unplanned hospital admissions across Europe each year are due to adverse drug events, of which approximately 50% are potentially preventable. The iSIMPATHY project was also well received by GPs, with all participating GPs supporting the continuation of the service. Dr Majella Grealish, Co. Donegal, said, “This is the single most important change in our practice since we were established over 20 years ago”.

The World Health Organisation (WHO) has recognised polypharmacy as a priority area for patient safety. Taking multiple medicines can be problematic if they are not achieving their intended benefits, or if the risk of harm outweighs the intended benefits. Many of these medicines are appropriate at the time of prescribing, and may be prescribed by different healthcare professionals (GP or consultant). A review at a later time that takes

Pharma Summit 2024 The Pharmaceutical Managers’ Institute will host the 2024 Pharma Summit on Thursday April 18th, 2024 at Croke Park Conference Centre Dublin. The PMI team are looking forward to welcoming all members and guests to what promises to be a day packed with insights and information that you can bring back to your teams and apply in your day-to-day work. The agenda for the day will examine the diverse values in healthcare across patients and payors. Speakers include Bernard Duggan, Chief Pharmacist – Medicines Management Programme (HSE); Neil Grubert, Independent pharmaceutical consultant, trainer and writer; Professor Orla Hardiman – Professor of Neurology, Head of the Academic Unit of Neurology and Academic Director of Trinity Biomedical Sciences Institute, and Consultant Neurologist at Beaumont Hospital and Dr Lesley Tilson, Chief I Pharmacist – National Centre for Pharmacoeconomics (NCPE) among many others. Visit www.thepmi.com for more information.

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Welcoming the report findings and positive outcomes for patients, Bernard Gloster, HSE CEO, said, “I’m pleased to see the impact on patients and service users who have taken part in iSIMPATHY. This project has played a major role in the delivery of effective and efficient health services in the border regions. It addresses challenges we face with polypharmacy, improving care and safety for people with multiple long-term conditions. I am delighted to see just how effective this project has been in making a difference in the lives of people in the region.”

EW N

COLD & FLU SYMPTOMS

ONLY TRIPLE ACTIVE FORMULATION Solpa Cold & Flu Multi Relief Max Powder for Oral Solution, Paracetamol 1000 mg, Guaifenesin 200 mg, Phenylephrine Hydrochloride 12.2 mg. For the relief of symptoms of colds and flu and the pain and congestion of sinusitis, including aches and pains, headache, blocked nose and sore throat, chills, lowering of temperature, and to loosen stubborn mucus and provide relief from chesty coughs. Adults, the elderly and adolescents aged 16 years and over: One sachet every 4-6 hours as required to a maximum of 4 sachets (4 doses) in a 24-hour period. Do not give to children and adolescents under 16 years. Not to be continued for over 3 days without consulting a doctor. Contraindications: Hypersensitivity to any of the ingredients, severe hepatic impairment, hyperthyroidism, hypertension, diabetes, cardiovascular disease, those taking tricyclic anti-depressants or beta-blockers or other antihypertensive agents, patients who are taking or have taken monoamine oxidase inhibitors within the last two weeks or those currently receiving other sympathomimetics, phaeochromocytoma, closed angle glaucoma, and porphyria. Precautions: circulatory disorders, chronic alcoholism, urinary retention or prostatic hypertrophy, gilbert’s syndrome, concomitant treatment with flucloxacillin and medicinal products affecting hepatic function, glucose-6-phosphate dehydrogenase deficiency, haemolytic anaemia, glutathione deficiency, dehydration, chronic malnutrition, elderly, adults and adolescents weighing less than 50kg, may act as a cerebral stimulant. Use with paracetamol-containing products. Do not take with alcohol. Pregnancy and lactation: Not to be taken during pregnancy or whilst breast feeding without medical advice. Side effects: Thrombocytopenia, agranulocytosis, anaphylaxis, severe cutaneous hypersensitivity, bronchospasm, hepatic dysfunction, acute pancreatitis, angioedema, angle glaucoma. See SmPC for full list of side effects and further information. Product not subject to medical prescription. PA1186/021/003. MAH: Chefaro Ireland DAC, The Sharp Building, Hogan Place, Dublin 2, Ireland. Date of preparation: Feb 2023. SPC: https://www.medicines.ie/medicines/solpa-cold-flu-multi-relief-max-powder-for-oral-solution-35312/spc#tabs IRE SCF 2023 09

Mentoring

Utilising mentoring skills to advance Staff abilities from a supervising/managing pharmacist point of view (community setting) What is mentoring: According to EMCC (European Mentoring and Coaching Council), mentoring is “A learning relationship, involving the sharing of skills, knowledge, and expertise between a mentor and mentee through developmental conversations, experience sharing, and role modelling. The relationship may cover a wide variety of contexts and is an inclusive two-way partnership for mutual learning that values differences.” In a mentoring relationship, the mentor is an expert in their field and has the answers ready for the mentee. Because of that, mentor can be more prescriptive in the questioning than f.e. a coach. After initial enquiring ‘What have you tried before?’ they will have a full picture and be able to suggest ‘Have you tried (…) yet?’ or ‘What about this solution?’ or give advice ‘This is what you need to do’. Written by Anna Cotter, MPSI

Diploma vs IIOP programme

IIOP mentoring programme I stumbled upon the concept of mentoring by receiving an email from IIOP about enrolment in 2022/2023 edition of the IIOP peer mentoring programme. Having worked as a supervising pharmacist mostly in community pharmacies where there is only ever one pharmacist on duty, I had a sense of ‘loneliness’ in a profession. And so, to see what another pharmacist might think about my experiences with managing the pharmacy, contacts with Head Office, etc. I decided to enrol as a mentee. Kingstown College Diploma in Coaching and Mentoring During the IIOP mentoring programme, I got really interested in the power of mentoring in a context of advancing Staff abilities. Having recently taken on a supervising/managing role in a pharmacy with mostly new and/ or untrained Staff, I could see that a huge part of my role is to build a team of Staff confident in their duties. I decided to undergo Kingstown College Diploma in order to get the theoretical basis and learn practical strategies to implement in the workplace.

Getting familiar with stages of a mentoring relationship, mentoring activities, its consequences, and reasons for mentoring was particularly interesting to me as a reflection on the 2022 edition of IIOP Mentoring Programme. This programme was actually prepared by IIOP in partnership with the Kingstown College. It was very encouraging to see all the bricks of creating a good mentoring relationship from the article being reflected in the IIOP programme, such as: • providing a manual and training for mentees and also mentors before the launch of the programme, • encouraging to establish frequency and length of meeting in a form of contract during the first meeting, • checking in by IIOP during the programme (via email), • informing about a possibility to get paired with another person if there is some sort of conflict between the mentor and the mentee or there is any misconduct. The IIOP mentoring programme was designed for any Irish registered pharmacists and so it definitely facilitated the feeling of ‘similarity’ between the participants – which helped to create relationships where both mentor and mentee can learn from one another and there is equality and respect between the participating pharmacists. Informal mentoring in the workplace However, mentoring doesn’t always have to be formal – and

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this more informal approach is what I would like to suggest for any managing or supervising pharmacist to start utilizing in their daily practice. When I was set before a task of building and training a team in my most recent workplace, I decided to always have the time for my Staff to answer any doubts or questions they have. A good mentor should be able to set the boundaries (f.e. I don’t want to be disturbed while checking a prescription), but also to get the point ‘I am here to help you always’ across. I think we can all agree that working any job in a community pharmacy requires high levels of precision and knowledge of many many processes, specific to the pharmacy group we work for (‘the way we do things here’) or even individual pharmacies within the group. It can be very challenging for a new Staff member to take it all in at once. Knowing that they have a safe space to ask questions, can greatly decrease anxiety in the initial period of employment. Personally, I found having a nurturing and patient approach to my Staff very rewarding – they weren’t afraid to come and ask again if in doubt, which ensured good communication outcome. Once trained, they were more prone to take charge. Many a time, due to a good relationship with Staff, I was able to learn from them as well – they weren’t afraid to share their opinions on how to improve processes in the pharmacy. That openness flowing both ways is very refreshing as it can be beneficial to question the ‘status quo’ in the workplace. Conclusions Mentoring outcomes can be sometimes hard to quantify (higher work confidence – how much higher? Better future leadership outcomes – how can you know you would not get there

anyway without your mentor or how much quicker did you get there thanks to the mentor?), as they are to an extent subjective. What is absolutely paramount is that at it’s core lie confidentiality, trust between participants, setting goals and commitment to create mutually respectful relationships, where both mentor and mentee can help each other grow and gain perspective. Staff who are more confident in their duties that have a good, trusting and nurturing relationship with their supervising pharmacist, could potentially be more open to take on more tasks and thus develop themselves further. This is also beneficial for the pharmacist, freeing up their time to perform tasks only they can do (i.e. checking prescriptions). Creating mentoring relationships requires changing the priorities in the initial team-building stage and always having time to listen to Staff members learning needs. This can be challenging for the pharmacist in the initial months in a new workplace/working with a new Staff member. However, it pays off tremendously in the long-run. Bibliography IPU pharmacist mentoring course materials 2022/2023 edition Kingstown College course materials – Professional Diploma in Coaching and Mentoring 2022/2023 edition Mentoring Research and Best Practices White Paper; The Plank Center for Leadership in Public Relations Anna Cotter – Kingstown College Professional Diploma in Coaching and Mentoring course submissions EMCC Global website – definition of mentoring

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Operation Transformation for Woods HealthPoint Pharmacy The community of Mullingar is buzzing with excitement as Woods HealthPoint Pharmacy is set to feature on RTE’s renowned show, Operation Transformation, scheduled for Thursday, 18th January 2024. Pharmacist John O’Shaughnessy

The lead pharmacist at Woods HealthPoint, John O’Shaughnessy, shared his enthusiasm about the upcoming episode. “We were delighted to hear from RTE that our pharmacy will be part of Operation Transformation. This is a fantastic opportunity to highlight the health services we proudly offer to our community,” he remarked.

A special feature of the show will include O’Shaughnessy conducting a blood pressure check on a patient, showcasing one of the many health checks available at the pharmacy. Samantha Jones, the dispensary supervisor, highlighted the broader initiative, “In line with Operation Transformation’s goals, we, along with pharmacies across Ireland, will be offering free blood pressure checks on the day. It’s an important health measure that everyone should be aware of.” The Woods HealthPoint Pharmacy team is looking forward to the national spotlight, ready to demonstrate their commitment to health and wellness. “We’re all incredibly excited for this opportunity to showcase what Woods HealthPoint Pharmacy stands for and the difference we make in our community,” added Eithne.

Cardiovascular Disease Report A radical new approach to preventing chronic disease would save thousands of lives each year and protect our stretched health service, a new report by the Irish Heart Foundation and University College Cork insists. Mandatory limits on the salt content of processed foods and a political culture that tackles vested interests in public health are recommended in a bid to confront cardiovascular disease (CVD) – Ireland’s second biggest killer. And the Government must invest in brave policy measures to prevent people dying from it – rather than solely focussing on those already ill. CVD remains one of the top causes of premature death and disability in Ireland, accounting for 8,753 or 26.5% of all deaths in 2021. The paper proposes mandatory limits on the salt content of bread and processed foods, a complete online ban on marketing of high fat, sugar and salt food and drinks and an increase in the legal age of tobacco sales from 18 to 21. A new national cardiovascular policy is also needed after the last one expired four years ago.

Filming took place at Woods Pharmacy

The pharmacy team welcomed Dr Sui and team Operation Tranformation

Date for your Diary The International Conference on Antibiotics and Industrial Pharmacy (ICAIP - 24) is taking place in Dublin, Ireland on 7th - 8th February 2024 . Hosted by one of the most trusted organisations, SAIRAP, the conference provides a premier global platform for exchanging ideas and insights on the latest developments across various fields. Our goal is to offer a competitive venue for industry professionals and academic researchers to showcase and discuss cutting-edge advancements in their respective fields. The primary objective of this conference is to provide attendees with a unique opportunity to share their experiences, knowledge, and ideas on a global stage. The program features a blend of industry presentations, expert panels, and international keynote speakers. The theme and objective of the conference is centered around addressing the key challenges faced by various industries, including engineering, medicine, social science, applied science, management, and others. The aim is to bring together organisations and professionals from these fields to identify bottlenecks and collaborate on finding solutions. Visit www.sairap.org for more information.

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The five core risk factors for CVD and many chronic diseases, he said, are smoking, physical inactivity, poor diet, obesity and alcohol consumption. Prof Perry’s findings are being supported by the Irish Health Promotion Alliance (IHPA) – a new coalition launched at the same event to highlight the devastating impact CVD, cancer and diabetes are having on the nation. Members include the Irish Heart Foundation, Irish College of General Practitioners, Irish Medical Organisation, Royal College of Surgeons of Ireland, Irish Cancer Society, Alcohol Action Ireland and many other organisations. They support the paper’s call for greater political will to implement population-based strategies to prevent the onset of disease – aimed at the entire population, regardless of their risk status.

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Pharmacies Mark Blood Pressure Day Operation Transformation in partnership with the Irish Pharmacy Union recently hosted National Blood Pressure Day. Participating pharmacies across Ireland provided free blood pressure checks. High blood pressure affects two out of three over 50s, but it is symptomless. Once detected, high blood pressure is one of the few conditions that can be successfully managed, but only if you know you have it. Following a quick, easy, and non-invasive blood pressure check, your community pharmacist can provide you with a detailed results card and any necessary health advice or referral.

The Adrian Dunne Pharmacy Group participated in Operation Transformation’s National Blood Pressure Day

To help manage patients and communities heart health, LloydsPharmacy Ireland teams were delighted to provide this vital health screening service

Pictured are some of those who took part.

¤15m to Support TILDA Research The Minister for Health, Stephen Donnelly has announced ¤15 million in funding to progress new rounds of data collection for The Irish Longitudinal Study on Ageing (TILDA) to support research on ageing well in Ireland. The Health Research Board (HRB) will manage the funding to progress the new rounds of data collection for TILDA up to 2030. This follows a thorough international peer review process and a positive independent review of outcomes and impacts from TILDA to-date. The Principal Investigator of TILDA, Regius Professor RoseAnne Kenny, Chair of Medical Gerontology at Trinity College Dublin and Director of the Mercer Institute of Successful Ageing, said, “Utilisation of continuous longitudinal data, such as TILDA, provides a solid evidence base for healthcare policy, informs new policy and evaluates the impact of new models of care delivery. TILDA data is harmonised to 26 international longitudinal studies on ageing, enabling cross-country comparisons.

The pharmacy team at Hickey’s Pharmacy on hand to check blood pressure

“TILDA will work closely with funders and policy makers to build more resilient and efficient health and social care policies, programmes and services, thereby improving health and well-being for all.”

School of Pharmacy marks 20th Anniversary

Some key deliverables for the next phase of the study will include:

The School of Pharmacy at University College Cork marked its 20th anniversary, celebrating two decades of success and impact in pharmacy education and research to coincide with the launch of the new ‘School of Pharmacy Vision and Strategic Implementation Plan 2023 - 2028’. On the same day, the School of Pharmacy hosted a Research “Impact” Away Day, offering a chance for staff to gather, gain insights into ongoing research, and explore potential collaborations. The morning featured presentations and engaging discussions, highlighting the School’s research and talent. “Since its establishment 20 years ago, the School has grown from strength to strength,” says Professor Brendan Griffin, Head of the School. “Through the academic excellence of our degree programmes and

pioneering research of our staff, we work collaboratively with our healthcare partners in community pharmacy, hospitals and the pharmaceutical industry, to prepare graduates who provide skilled, compassionate and evidencebased pharmaceutical care.

needs of our society. This latest implementation plan will be important for sustaining our trajectory of providing ‘best-inclass’ academic programmes and pioneering research within a dynamic global university.

“UCC recently moved into the ‘Top 100’ of QS World University Subject Rankings in ‘Pharmacy and Pharmacology’, demonstrating the excellence of our research and education in pharmacy related disciplines, which is critical to addressing future healthcare

“The plan sets our collective priorities, and will guide decisions on future resourcing. I believe this will strengthen our capacity to address the emerging needs in pharmacy-led patient care but also advance pharmacy-led innovation in education, research and policy.”

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• Collect data on a nationally representative sample of people aged 45 and older in Ireland, and to examine factors that influence healthy ageing. • Inform future service planning and delivery, and help realise the goals of national policies, programmes, and services in Ireland such as those envisaged in Sláintecare. • Provide a platform and infrastructure to support research and innovation activities, providing education and training for the next generation of researchers. • Continuation of Public and Patient Involvement (PPI) in codesign and engagement, and widening engagement with community groups and representative organisations.

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Supply of Key Medicines During Winter As you will know, medicine shortages continue to be a feature of both the global and the Irish markets. The Pharmaceutical Society of Ireland recognises that medicine shortages can be challenging for patients, healthcare professionals and their teams, and that shortages can be particularly evident during the winter months. They also acknowledge pharmacy’s commitment to maintaining high standards of patient care and recognise the efforts being made to ensure continuity of supply for patients. This message from the PSI aims to provide reassurance about the availability of key medicines used during the winter season, and the efforts being taken to monitor this availability on an ongoing basis: What efforts are being taken to minimise medicine shortages for the winter season? At a European level, the Health Products Regulatory Authority (HPRA) has been working closely with other EU Member States, the European Medicines Agency (EMA), and the European Commission to prepare for the winter season. HPRA are monitoring the supply situation and taking appropriate actions to minimise shortages. Specifically, the pharmaceutical industry has been requested to review the estimated supplies of medicines, including antibiotics, for the winter season. Based on analysis of data from previous years, the pharmaceutical industry expects that the supply of key medicines used during the winter season will meet the anticipated demand. What other efforts are being taken in Ireland to mitigate the impact of medicine shortages? The Department of Health (DoH), the Health Service Executive (HSE) and the HPRA are committed to working with other stakeholders, including the pharmaceutical industry, wholesalers and pharmacists together with medical and pharmacy regulators to monitor the supply of medicines to Ireland to anticipate and respond to, in so far as is possible, any potential vulnerabilities in medicines supply. At a national level, the HPRA oversees a multistakeholder Medicine Shortages Framework intended to address the issue of human medicine shortages in Ireland. The aim of the framework is to: • Help avoid potential shortages from occurring in the first place. • Reduce the impact on patients when shortages do occur Actions to avoid disruption to the supply of medicines Continuity of supply and protection of public health must be everyone’s priority. Therefore, to

help reduce supply disruptions and prevent shortages this winter, we remind pharmacists not to order extra quantities of medicines, and only order stock required to meet current patient need. Healthcare professionals also have an important role to play in educating and informing patients on the safe and rational use of medicines. Patients should be informed:

Where can we find further information on medicine shortages?

• To use antibiotics only when needed. In addition to contributing to shortages, inappropriate or overuse of antibiotics contributes to antimicrobial resistance.

The continued support and assistance of healthcare professionals in relaying clear and accurate information to the public to avoid disruption to the supply of medicines is recognised and appreciated.

• Many everyday illnesses like colds, coughs or sore throats don’t need an antibiotic, and appropriate products and advice can be recommended to manage symptoms. • Vaccines help boost protection and reduce the risk of serious illness. Information about COVID-19, flu and other vaccines available to adults and children is available on the HSE website.

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The HPRA publish and maintains an up-to date list of medicines shortages impacting the Irish market on its website. The information aims to help keep patients and healthcare professionals informed of current and resolved shortages.

I am concerned about the availability of common medicines this winter Pharmaceutical companies and wholesalers in Europe are responsible for ensuring a consistent supply of the medicines they sell. The supply of medicines is dynamic, and companies aim to predict demand, accounting for seasonal

fluctuations. Based on analysis of data from previous years, the pharmaceutical industry expects that the supply of key medicines used during the winter season will meet the anticipated demand. Using information provided by industry, the HPRA will continue monitoring the availability of key medicines throughout this Winter period. Should any issues be identified as a result, the potential shortage and mitigating actions will be coordinated through the Medicine Shortages Framework. How can I confirm if a medicine is in short supply nationally? Pharmaceutical companies are required to report potential shortages notifications to the HPRA. The HPRA publishes and maintains an up-to date list of medicines shortages impacting the Irish market on its website The supply of ‘Over the Counter’ medicines can be obtained from online pharmacies which are registered with the Pharmaceutical Society of Ireland.

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Awareness Month: Age-Related Macular Degeneration Pharmacists cannot stop the progressive loss in central vision that comes with age-related macular degeneration, but they can help patients understand the treatment options. leaking may slow the progression of wet macular degeneration. What are the symptoms? • Gaps or dark spots (like a smudge on glasses) may appear in their vision, especially first thing in the morning. Objects in front of them might change shape, size or colour or seem to move or disappear. • Colours can fade. • Sufferers may find bright light glaring and uncomfortable or find it difficult to adapt when moving from dark to light environments. • Words might disappear when they are reading. • Straight lines such as door frames and lampposts may appear distorted or bent. Age-related macular degeneration (AMD) is a chronic disease leading to progressive central vision loss. The symptom of central vision loss is due to the fact that the damaged macula is in the centre of the retina. Patients with AMD may be unable to recognise faces, read, or drive a vehicle. AMD is the most common cause of sight loss in people over the age of 50 in Ireland and it’s estimated that 7% of Irish people over 50 years of age are living with AMD. On account of our ageing population, the number of people in Ireland affected by this condition is expected to increase. Symptoms of AMD include decreased central vision, central scotoma, and metamorphopsia. Scotoma is an area of partially diminished vision surrounded by a field of normal or well-preserved vision. Metamorphopsia is a visual defect that causes people to see objects in a distorted manner; straight objects appear wavy or curvy. Patients will complain of distorted vision, lack of bright colours, or blurred vision. There are 2 types of macular degeneration: dry and wet. All AMD begins as “dry.” In some cases, it progresses to “wet,” which is a more severe form characterised by abnormal blood vessel growth that produces fluid in the retina. Wet age-related macular degeneration (wet AMD) is the leading cause of severe vision loss and legal blindness in people over the age of 65 in North America, Europe, Australia and Asia.

Dry macular degeneration, also known as the nonexudative form, is more common and found in approximately 90% of AMD patients. The onset of dry AMD is subacute. Management of dry AMD includes attempts to prevent progression to and frequent monitoring for the development of wet macular degeneration Wet (also known as exudative or neovascular) macular degeneration occurs in about 10% of AMD patients. It is the more acute form and more likely to cause vision loss.

Amsler Grid An Amsler Grid (shown below) is a simple test designed to pick up symptoms of Wet AMD. However, it is not a substitute for an eye examination. The patient checks each eye separately with reading glasses on. If they notice new blurring or distortion of the lines on the grid this could indicate the presence of Wet AMD and they should be examined promptly by their eye doctor. Causes The exact cause of AMD is unknown. However, extensive research efforts over the last decade are playing an important role in uncovering some of the clues as to what may be causing the disease.

Researchers know that certain In Dry AMD symptoms are often genes can cause AMD, but they mild, such as needing stronger don’t know what triggers the glasses or better lighting for gene. While AMD can be inherited, reading. When progression to many lifestyle choices can make Wet AMD occurs, the patient progression of the disease worse. may notice the onset of blurring of reading vision with distortion Some risk factors that are (due to fluid or blood under the believed to increase the chances macula). Sometimes patients of developing AMD include being are unaware until they take a over the age of 50 and having a moment to cover or close one family history of AMD. Having high eye at a time. At this stage, https://www.fightingblindness.ie/living-with-sight-loss/eye-conditions/age-related-macularblood pressure, a poor diet or the progression can be rapid degeneration-amd/ Please note that even if the grid looks normal, people should still being overweight are also thought and patients should seek help attend regular eye exams for early detection of AMD. promptly from their eye doctor. to be risk factors for this condition.

Wet AMD (age-related macular degeneration) is a chronic, degenerative condition characterised by abnormal blood vessels that grow underneath the retina. The condition gets worse as these faulty blood vessels leak fluid in the back of the eye. This may lead to swelling and damage of the macula, the part of the retina that lets you see colour and maintain sharp vision. A healthy retina is a dry retina. If this fluid isn’t controlled, central vision will gradually get worse, leading to difficulty doing everyday activities such as reading, recognising faces and driving. The leaky blood vessels are caused by an excess of a tiny protein called vascular endothelial growth factor (VEGF). Most eye doctors agree that the best way to control these tiny proteins is with an anti-VEGF treatment. Treatments that help control fluid and stop blood vessels from Amsler Grid (Image Source: American Macular Degeneration Foundation)

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Also, frequent self-check-ups can catch the progression of the eye condition while in the early stages of AMD. People can monitor their sight and do a self-check up by closing one eye and

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AMD

Because the exact causes of AMD are not yet known, some people may develop AMD even in the absence of these risk factors. Age-Related Studies (AREDS1 and AREDS2) have shown that a combination of vitamins and antioxidants may help reduce the risk of progression of Early AMD to late-stage AMD. The recommendations include supplements containing vitamins C and E, zinc, copper, lutein and zeaxanthin. Treatment for Wet AMD is most often through a series of injections into the eye using a drug called anti-VEGF (anti-vascular endothelial growth factor). This treatment works by reducing the growth of new blood vessels. Response to this treatment is usually better in the early stages of Wet AMD, although even later stages can be stabilised. In some cases, individuals may notice improvements in their vision. It is important to remind patients at risk for AMD to have regular eye exams, even when they are symptom-free. Patients complaining of a recent or chronic loss or change of vision should be urged to see an ophthalmologist immediately. A healthy lifestyle may help prevent AMD. This includes not smoking, eating a healthy diet, and being physically active. Following the recommended guidelines and the use of

appropriate pharmacologic agents may help patients with AMD slow vision loss progression, increase visual acuity, and experience a greater quality of life. Knowing the symptoms and signs to be aware of: 1. Symptoms: look out for straight lines appearing wavy or distorted, e.g. a doorframe. If you see a smudge, gaps or dark spots appearing in your field of vision, or have difficulties in reading small print, even with glasses, or difficulty in recognising faces, it is recommended to make an appointment with an eye doctor, optometrist or GP as soon as possible. 2. Risk groups: People over 50 should have a regular eye exam (every 2 years or as directed by the doctor). If you have fair skin, light eyes, high blood pressure, or have been exposed to prolonged periods of sunlight, then you should also have regular check-ups. 3. Healthy diet: eat a diet low in saturated fats and rich in omega 3 fatty acids (oily fish and walnuts). Green, leafy vegetables (spinach and kale) contain antioxidants, eggs and yellow/orange-based fruit contain nutrients such as lutein, zeaxanthin and beta-carotene – all work to protect the macula.

4. Vitamin supplements: certain nutritional supplements containing vitamins C and E, zinc, copper, lutein and zeaxanthin can slow down the progression of AMD in people already showing signs of the condition. 5. Get moving and stop smoking: every week we should engage in 150 minutes of medium-level activity such as brisk walking, swimming and light jogging. Smoking poses a significant risk for AMD especially in women. Further information resources: • The Irish College of Ophthalmologists www.eyedoctors.ie • The Macular Society www.macularsociety.org • Retina International also has an international AMD toolkit on their website Latest Research Life stressors, such as obesity reprogram immune system cells, could cause age-related macular degeneration (AMD), according to the results of a study published in Science. “We wanted to know why some [individuals] with a genetic predisposition develop AMD, while others are spared,” Przemyslaw (Mike) Sapieha, PhD, an ophthalmology professor at the

Université de Montréal, said in a statement. “Although considerable effort has been invested in understanding the genes responsible for AMD, variations and mutations in susceptibility genes only increase the risk of developing the disease but do not cause it.” In the study, investigators used obesity as a model to accelerate and exaggerate the stressor experienced in the body throughout life. They found that a history of obesity or transient obesity leads to changes in the DNA structure within immune cells, which causes them to produce more inflammatory molecules. Previous research results have shown that the immune system in the eye of someone with AMD can become aggressive and dysregulated. The immune cells protect the eye from bacteria and viruses but can also be activated when the body is exposed to stressors, including excess fat in obesity. Being overweight is 1 of the biggest non-genetic risk factors for developing AMD, after smoking. Investigators hope that the results will lead to more research beyond obesity-related diseases and focus on other diseases characterized by increased neuroinflammation, including Alzheimer disease and multiple sclerosis.

Retina International World Congress Dublin Fighting Blindness has announced that they will be hosting the Retina International World Congress (RIWC24) in Dublin, from June 5-8, 2024. Fighting Blindness looks forward to hosting the congress at the Dublin Royal Convention Centre, Radisson Blu Royal Hotel, Dublin, and continuing to nurture and develop the great hope and optimism that emerged out of the last Congress. They will be bringing together the world’s foremost retinal scientists and clinicians alongside leaders in the fields of advocacy, patient representatives, health research and support organisations. On Friday, June 7, 2024, the Scientific Programme of RIWC24 is taking place and Fighting Blindness are now accepting abstracts to be considered for poster display as well as short talk presentations (more information on each of these below). Accepting submissions until March 1, 5pm GMT. • Poster- online PDF of poster uploaded to the RIWC24 website and viewable by all attendees both in person the day of the event and online on the website • Short talk presentations- approx. 10-minute oral presentations on the day. Please note if not selected for a talk you will still be considered for a poster More information will be shared over the coming months on the Fighting Blindness website and their event LinkedIn page! Visit www.fightingblindness.ie

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Views on e-labelling in Pharmacy Views on the benefits and challenges of e-labelling in pharmacy are shared in a new International Pharmaceutical Federation (FIP) insight board report.

The insight board discussion, held in September 2023, highlighted the value of e-labelling and its impact on pharmacy. Advantages included improving environmental sustainability and patient health literacy through access to relevant information. Additionally, e-labelling enables tailored information delivery, promoting improved self-care and sustainability of the healthcare system. During the discussion, experts highlighted barriers to e-labelling in their respective regions and countries, and the challenges in immediate implementation.

Barriers encompassed digital literacy gaps, access disparities, security concerns and implementation complexity. Pharmacists are expected to take bigger roles in patient education and guidance on e-labels, as well as in empowerment and collaboration with other stakeholders, the report says. The current approach to providing patient information leaflets (PILs) with over-the-counter (OTC) products bring challenges as consumers often find the information irrelevant or not tailored to their needs. Current

approaches in the use of PILs suggests that the information may not always be relevant, not tailored to patient’s needs, not formulated to address patients’ specific questions and may have adverse environmental impact.

formats for individuals with visual impairments. This could in return improve self-care and lead to better allocation of resources where they are most needed, supporting the sustainability of the overall healthcare system.

Studies show that the majority of the respondents (52%) in recent studies occasionally read the patient information leaflet, 37% always read it, and 11% never read it.4 PILs could be seen as an inappropriate use resource with environmental repercussions, while, at the same time, falling short of their core purpose, which is to provide comprehensible information enabling individuals to effectively manage their health.

Alongside the benefits e-labelling brings, several challenges include potential exclusion and inequity for those who cannot access digital systems for many reasons. It also relies on digital platforms and possibly the internet for access to health information, potentially exacerbating the existing inequities due to disparities in access to both. In addition, participants discussed privacy and security concerns, the complexity of the transitioning process from paper leaflets, regulatory challenges, and the possible challenges with regard to patient health and digital literacy.

For that reason, it is important that pharmacy finds alternative systems that will improve consumer health literacy, make available relevant updated, easily usable patient information and at the same time help contribute to a sustainable environmental future. Alternative approaches, such as e-labelling, have been explored in some regions. E-labelling, such as using QR codes, could offer many benefits, some of which include improving environmental sustainability and improving consumer health literacy through access to trustworthy and relevant information. It could also allow for customising information, whether in terms of content or delivery, such as utilising audio

At the 81st FIP World Congress of Pharmacy and Pharmaceutical Sciences in Brisbane, Australia, which took place in September 2023, pharmacists from around the world joined an insight board hosted by FIP for a discussion and insight gathering on the advantages and disadvantages of e-labelling as well as the impact it can have on pharmacy and the equity of healthcare services. This report provides a summary of the insight board discussion as well as the key insights that were shared. Read more by visiting www.fip.org

New Reimbursement for Diabetes Abbott has announced that its revolutionary glucose-sensing technology for diabetes management, the FreeStyle Libre 2 system, is available through the Health and Safety Executive’s (HSE) reimbursement programme for all people in Ireland living with Type 1 diabetes. The decision by the HSE comes after the publication of a rapid health technology assessment by HIQA. This found that using continuous glucose monitoring (CGM) systems over finger prick tests can improve glycaemic outcomes, particularly time in range, for people with Type 1 diabetes. Abbott’s FreeStyle Libre portfolio is the world’s most widely used glucose sensing system, now helping more than five million people across more than 60 countries to easily monitor their glucose levels. The system replaces the need for routine finger prick tests through the use of a

sensor worn on the back of the upper arm, which allows the user to view their real-time glucose readings through the FreeStyle LibreLink smartphone app. The FreeStyle Libre system was launched in Ireland in 2016 and since 2018 has been available free of charge through the HSE, prescribed for those under the age of 21. With this expanded reimbursement, now all people living with Type 1 diabetes in Ireland will have access to the system without costs, regardless of their age. Users will also now be able to access the FreeStyle Libre 2 system, providing them with minute-by-minute glucose

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readings and customisable realtime glucose alarms. “At Abbott, ensuring people have access to life-changing FreeStyle Libre technology is a priority,” said Neil Harris, general manager of Abbott’s diabetes care business in Ireland and the UK. “ And now with expanded reimbursement for the FreeStyle Libre 2 system, people with Type 1 diabetes have access to a sensor with one of the longest wear times on the market, real-time glucose measurements and optional alarms on their smartphone – significant steps towards reducing the burden of diabetes management.”

Welcoming the news, Kieran O’Leary, CEO of Diabetes Ireland said, “Since 2016, Diabetes Ireland and the diabetes community have been advocating for the removal of the age restriction for the FreeStyle Libre system as, unfortunately, the cost of self-funding the system has been a barrier and has left some people unable to access the technology and its benefits. Today, we warmly welcome the expansion of the reimbursement scheme to make the FreeStyle Libre 2 system available to all people with Type 1 diabetes at no cost to them. This will allow more people to access CGM and is a major step forward in the delivery and management of diabetes care in Ireland.”

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Real-time glucose readings sent right to your patients’ smartphones1,2 With the FreeStyle Libre 2 system, your patients get minute-to-minute glucose readings to help them manage diabetes more confidently3.

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Images are for illustrative purposes only. Not real patient or data. 1. The FreeStyle LibreLink app is only compatible with certain mobile devices and operating systems. Please check the website for more information about device compatibility before using the app. Use of FreeStyle LibreLink may require registration with LibreView. 2. Glucose readings are automatically displayed in the FreeStyle LibreLink app only when the smartphone and sensor are connected and in range. 3. Fokkert M. BMJ Open Diab Res Care (2019): http://dx.doi.org/10.1136/bmjdrc-2019-000809. © 2024 Abbott. The sensor housing, FreeStyle, Libre, and related brand marks are marks of Abbott. ADC-86633 v1.0 01/24.

Immunity

The Value of Immunity to Pharmacy It is well know that many consumers struggle to ensure they are eating a healthy, balanced diet and the result can be low immunity and a general lack of energy, which will leave them prone to picking up viruses and infections. Mineral

EU RDA

Calcium

800 mg

Refer to the pharmacist anyone with any medically significant conditions.

Iodine

150 mcg

Zinc

Iron

14 mg

Magnesium

375 mg

Phosphorus

700 mg

Zinc

10 mg

Zinc is a trace element that is essential for normal growth. The mineral has been promoted for many years as being able to boost the immune system. Customers purchasing zinc must keep to the recommended dosages. The correct dose is important and there may be side effects including nausea and an unpleasant taste in the mouth, or more serious events such as vomiting, diarrhoea and abdominal pain.

Certain vitamins are important for certain people, these are: Vitamin D Vitamin D is recommended for all pregnant and breastfeeding women. Older people also require additional vitamin D and it is recommended for children aged from six months to five years, together with vitamins A and C. Vitamin B9

Millions take vitamins and dietary supplements hoping to achieve good health, ease illnesses or defy ageing. Recent years have seen a massive boom in supplement use as products that were once the preserve of specialist health food stores have become more widely available, especially in pharmacies. However, the huge range of dietary supplements now available makes the area something of a minefield for consumers. It should be explained that vitamins and minerals are two completely different things, and that minerals help the vitamins work. Customers will take supplements for all kinds of reasons, usually relating to their health. They hope these will boost vitality, limit the signs of ageing, extend life, cut the risk of chronic disease such as cancer and treat specific ailments such as arthritis. Pharmacy staff should understand the evidence regarding the efficacy of supplements and be able to explain this to patients. They must also be up-to-date on any new products and formulations and be familiar with the benefits of each item. It is essential that customers feel that they are being recommended the correct VMS for them, not just whichever product is on special offer that particular day.

Buyer Categories Supplements are products that contain vitamins, minerals, herbs or plant material and come in pill, capsule, tablet or liquid form. Women are more likely to purchase VMS products than men, as will older people with poor health. Over 50% of children are given vitamins regularly and/or a mineral supplement. The Department of Health & Children recommend specific vitamins for specific groups of people, and the EU has daily recommended allowances for vitamins and minerals these are: Vitamin

EU RDA

Vitamin A

800 mcg

Vitamin B1

1.1 mg

Vitamin B2

1.4 mg

Vitamin B6

1.4 mg

Vitamin B12

2.5 mcg

Vitamin C

80 mg

Vitamin D

5 mcg

Vitamin E

10 mg

Folic acid

200 mcg

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More commonly known as folic acid, vitamin B9 is recommended for women who are trying to conceive and who are in the first 12 weeks of pregnancy – 400mcg daily is recommended for women at low risk of conceiving a child with neural tube defects and 5mg daily for those at high risk. Some pregnant women might require additional calcium or iron. Vitamin C Vitamin C is the most popular single vitamin supplement. Other supplements that people often turn to when they have a cold include zinc and echinacea. All of these have been found to have antiviral properties in animal or laboratory studies. Researchers have been interested in using vitamin C to prevent and treat colds for more than 60 years. Some animal studies have found that vitamin C strengthens resistance to infections. One theory for this is that the vitamin protects cells against oxidative stress. Vitamin C is not suitable for everyone. It can cause dangerous rises in the blood sugar levels of people with diabetes. It can also be dangerous for people with genetic conditions that cause an excessive build-up of iron in their body, such as haemochromatosis. Large doses may cause nausea, diarrhoea and stomach cramps.

Combination Products Combination products are also growing in popularity, such as combined fish oils and garlic for heart health. In fact, along with multivitamin formulations, products containing fish oils are amongst the highest top-selling supplements in recent years in Ireland. Magnesium Magnesium keeps the immune system strong, helps strengthen muscles and bones, and supports many body functions from cardiac functions to brain functions. The amount of magnesium recommended is 270mg a day for women (19 to 64 years). Care should be taken as high doses (more than 400mg) for a short time has been shown to cause diarrhoea. Having 400mg or less a day of magnesium from supplements is unlikely to cause any harm. Magnesium is available in tablet form at varying strengths and also in sachet form as a soluble powder for consumption. All the above vitamins and minerals are commonly contained in multivitamins, and it is crucial to check with the patient if they are taking any vitamins and minerals before recommending products to ensure that they do not exceed the recommended dose. There is an array of multivitamins available in various formulations for all ages and even gender specific for male and females containing tailored vitamins and minerals required for certain functions of the body e.g. increased iron for women.

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News

Pharmacy Remains Top Influencer in VMS LloydsPharmacy have recently released key Health Insights for 2024, based on a recent study conducted by Empathy Research. The study revealed a range of trends and preferences among Irish adults regarding their health and wellness habits, including a strong preference for seeking guidance from healthcare professionals and personal recommendations rather than online sources when making decisions about supplements and vitamins. This research comes as LloydsPharmacy begins their Buy One Get One-Half Price offers on a range of vitamins and supplements available in over 80 LloydsPharmacy stores nationwide, online from lloydspharmacy.ie or through their app. Denis O’Driscoll, Superintendent Pharmacist, LloydsPharmacy

GPs & Pharmacists Remain Top Influencers in Supplement and Vitamin Purchase Decisions The study found healthcare professionals, particularly general practitioners (GPs) and pharmacists, continue to hold significant influence over Irish adults’ supplement and vitamin purchase decisions, while the impact of social media influencers remains relatively small. Nearly half of all adults (47%) are influenced by their GP when it comes to buying vitamins and supplements, followed closely by pharmacists (46%). Social media influencers, on the other hand, hold less sway, with only 10% citing them as a significant influence. Majority of Adults Plan to Incorporate Dietary Supplements in 2024 75% of adults across the nation intend to regularly take vitamins or supplements in 2024. This trend is particularly evident among women, with 82% expressing their intention, compared to 69% of men. However this trend is dependent on age with those aged 65 and above, showing the least enthusiasm for supplements, with only 53% planning to take them. The primary driving force behind this surge in supplementation is a desire to boost immunity (57%) by enhancing energy levels and

overall performance (37%) and supporting joint, bone, and muscle health (35%) are other top reasons cited. Only 36% of all adults claim to take Vitamin D every day. Due to Ireland’s limited sunlight during the autumn and winter months, studies have revealed that many adults experience a deficiency in vitamin D. Vitamin D is recommended as it is an essential nutrient that plays a vital role in maintaining overall health. This growing interest in dietary supplements highlights a rising awareness among individuals about the importance of maintaining optimal health and well-being. As the population ages and longevity increases, the need to support overall health and combat age-related ailments becomes more pressing. Sleep Wins Out Over Exercise in Health Priorities The research uncovered a striking preference for prioritising sleep over exercise, with a resounding 70% of adults opting for the restorative power of sleep. This sentiment was particularly strong among women (77%) compared to men (64%). Intriguingly, older adults (80% of 65+) demonstrated an even stronger inclination towards sleep prioritisation, seemingly recognising its immense value in maintaining overall wellbeing as we age. In contrast, younger adults (18-34) seemed

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less inclined to prioritise sleep, with only 60% choosing it over exercise. This data suggests a growing awareness among individuals of the profound impact of sleep on both physical and mental health. Sleep deprivation has been linked to many health issues, including impaired cognitive function, increased risk of obesity and cardiovascular disease, and heightened stress levels. The findings also highlight the gender difference when it comes to sleep prioritisation, with women placing a higher value on this essential health practice. Digestive Woes affect over 80% of Adults A vast majority of adults, 81%, experience digestive issues at least some of the time, with over 25% reporting such issues regularly. This pervasiveness is particularly concerning among younger adults (25-44) and women. The digestive system plays a central role in the breakdown of food and the absorption of nutrients, providing the essential fuel for our bodies to function properly. When this intricate system malfunctions, it can lead to a range of uncomfortable and potentially serious health issues. The high prevalence of digestive issues among adults is a cause for concern, especially in the younger population. The survey findings indicate that just under 50% of 18–24-year-olds experience digestive issues regularly. This may indicate that digestive problems may be developing earlier in life and becoming more common among younger generations. In recent years, there has been a growing awareness of the importance of gut health and the role it plays in maintaining overall health. Research has shown that a healthy gut microbiome, the community of bacteria that reside in the digestive system, may influence a wide range of factors, including mood, immunity, and metabolism.

Stress Levels Heightened Among Younger Adults and Females Thirty percent of all adults rated their stress levels quite high in their daily lives, rising to 45% among 25-34-year-olds. Females were more stressed than males. Those living in Leinster reported higher stress levels compared to other parts of the country. Those aged 65+ were the least stressed overall. Bone Health Promotion Varies by Age and Location Fifty-eight percent of all adults reported participating in activities that promote bone health, with 66% among those aged 18-24. Those aged 55-65 were most likely to intermittently partake in such activities, while those living in the Rest of Leinster (outside of Dublin) 34% were least likely to participate in such activities. Speaking on the research findings, LloydsPharmacy Superintendent Pharmacist Denis O’Driscoll said, “Our LloydsPharmacy research into the consumer health and wellness priorities of Irish adults in 2024 provides invaluable perspectives. By understanding these trends, our pharmacists and colleagues can effectively serve our customers and provide tailored support for their health needs. There has been a shift in Irish people’s attitudes towards their health in recent years. People are more aware of the importance of prevention of illness through supplementation and vaccination, and they’re more willing to take proactive steps to manage their health. This is reflected in the increasing number of people seeking advice from pharmacists about healthy lifestyle choices, self-care, and preventive measures.” The LloydsPharmacy Health Insight for 2024 highlights the importance of seeking guidance from Pharmacists and considering personal recommendations when making decisions about supplements and vitamins. It also underscores the need for continued efforts to promote healthy lifestyle habits, such as prioritising sleep and exercise.

News

Prioritising Breastfeeding as a Health Issue A major University College Cork (UCC) study to prioritise breastfeeding as a public health issue has been awarded €2.5 million funding from the Health Research Board (HRB). The first-of-its-kind study will investigate and influence a cultural shift towards valuing breastfeeding as one of the most effective ways to ensure child and maternal health. Dr Aoife Fleming, UCC School of Pharmacy with Dr Helen Mulcahy, Professor Patricia Leahy-Warren (PI), Dr Elaine Lehane, Dr Margaret Murphy from UCC School of Nursing and Midwifery

The study aims to elevate the importance of breastfeeding a public health issue and influence sustainable changes to protect, promote, and support breastfeeding. Led by Professor Patricia Leahy-Warren, Head of School of Nursing & Midwifery UCC, it will investigate the barriers practical, societal and cultural – that prevent women from breastfeeding.

has received funding to investigate problems children experience with language and communication and Professor Deirdre Bennett, Professor in Medical Education and Head, Medical Education Unit UCC, has received funding for research exploring the skills healthcare professionals need to develop in relation to climate change and sustainability.

The study is one of three UCC projects awarded a combined ¤7.5 million funding under the Applied Programme Awards from the Health Research Board.

The Applied Programme Awards are designed to support highquality, team-based applied research which will lead to a step change in practice and policy to deliver outcomes for the health system, population health, or for service users and carers.

Dr Pauline Frizelle, Senior Lecturer, School of Clinical Therapies UCC,

Professor Leahy-Warren has received ¤2,445,580 for her project entitled ‘Maximise support for breastfeeding for sustainable population health and wellbeing: Integrated knowledge translation approach, MaxSBF’. This interdisciplinary programme of research is the first of its kind in Ireland to prioritise breastfeeding as an important societal health need. Despite well-established evidence on the value of breastfeeding in enhancing the health and wellbeing of current and future generations, breastfeeding rates in Ireland are the lowest of OECD countries.

Professor Leahy-Warren said: “Breastfeeding is not the sole responsibility of women, but society’s collective responsibility. We are delighted that the Health Research Board acknowledges the value of our research. It will enable our team to adopt a 3600 approach to shift the focus away from pressure on individual women and towards addressing government policy, legal protections, health systems, communities, and workplaces. It will also explore the social and cultural attitudes, familial support, health professional education and skilled breastfeeding support needed for women.” The project aims to elevate the importance of breastfeeding as a key public health issue and influence sustainable populationlevel change to benefit the health and wellbeing of the nation. It has the potential to have wide-reaching impact not just across the island of Ireland but beyond, through sharing and translating knowledge on how to tackle a public health issue of global importance.

Updates in Epilepsy Epilepsy Ireland has welcomed the announcement that Budget 24 has allocated funding “to provide free travel for people medically certified unfit to drive.” The matter was further discussed in the Dáil recently, which has provided further information on the amended scheme, as well as the reasons behind why the changes will not be implemented until July 2024. The changes to the Free Travel scheme was discussed in the Dáil by Minister Heather Humphreys and Deputy Pauline Tully, as part of a wider question on Free Travel eligibility. Deputy Colm Burke asked the Minister for Social Protection the changes she is making to her Department’s free travel scheme to support people with epilepsy and other medical conditions who

cannot drive but are not in receipt of a social welfare payment.

• People who have never been able to drive due to a disability.

Minister Heather Humphreys said, “The Free Travel scheme provides free travel on the main public and private transport services for those eligible under the scheme. There are over one million customers with direct eligibility. The estimated expenditure on free travel in 2023 is ¤95 million.

• Drivers who have a license and have been deemed medically unfit to drive for a period of one year or longer. In some cases these drivers will only need the Travel Pass until they are medically certified to drive again.

“As part of Budget 2024 I was particularly pleased to extend my Department’s Free Travel Pass to support people who are medically certified as unable to drive including those with Epilepsy.” The measure will expand access to the Free Travel scheme to:

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schemes, and lose their free travel entitlement after 5 years. If they are deemed medically unfit to drive for a period of one year or longer, they too may qualify for the medical grounds free travel pass.

“In addition, there will be no requirement that the person be in receipt of a Social Welfare payment to qualify for the medical free travel pass; however they must meet the other qualifying criteria.

“This measure is a significant expansion of the free travel scheme and will require my Department to develop a new administrative process, engage with outside agencies and transport providers and update the Department’s I.T. systems.

“The measure could also benefit people who return to work, from certain long-term disability

“It is for this reason that the implementation date for the measure is July 2024.”

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LEVETIRACETAM

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PRESCRIBING INFORMATION Leveriracetam Thame 100mg/ml Oral Solution Presentation: Each ml of oral solution contains 100mg Levetiracetam. Indication: Monotherapy in the treatment of partial onset seizures in adults and adolescents from 16 years of age with newly diagnosed epilepsy. As adjunctive therapy: In the treatment of partial onset seizures in adults, adolescents, children and infants from 1 month of age with epilepsy, in the treatment of myoclonic seizures in adults and adolescents from 12 years of age with Juvenile Myoclonic Epilepsy and in the treatment of primary generalised tonic-clonic seizures in adults and adolescents from 12 years of age with Idiopathic Generalised Epilepsy. Dosage and administration: Route of administration: Oral. Adults: monotherapy: Initially 250mg to 500mg twice daily. If 250mg given twice daily initially increase to 500mg twice daily after 2 weeks. Dose can be increased to 1500mg twice daily Dose can be increased by 250mg or 500mg twice daily every two weeks depending upon the clinical response Add-on therapy: 500mg twice daily. Can be increased up to 1500mg twice daily. Paediatric population: monotherapy: The safety and efficacy have not been established. Add-on therapy 6 months to 17 years (weighing less than 50kg): 10mg/kg twice daily, can be increased up to 30mg/kg twice daily. Dose changes should not exceed increases or decreases of 10mg/kg twice daily every two weeks. The lowest effective dose should be used Add on therapy infants aged 1 month to less than 6 months; Initial dose 7mg/kg twice daily. Dose can be increased by 7mg/kg twice daily every two weeks to max dose 21mg/kg twice daily. Elderly: Adjustment of the

dose is recommended in patients with compromised renal function. Renal impairment: daily dose must be individualized See SmPC. Hepatic impairment: 50% reduction of the daily maintenance dose is recommended when the creatinine clearance is <60ml/min/1.73m2. Contraindications: Hypersensitivity to the active substance or other pyrrolidone derivatives or to any of the excipients. Precautions and warnings: Renal impairment. Complete blood cells counts if weakness, pyrexia, infections or coagulation disorders reported. Monitor patients for signs of depression and / or suicidal ideation and behaviours. Monitor for psychotic symptoms, irritability and aggressiveness. Monitor for aggravation of epilepsy. Caution in patients with QTc prolongation, concomitantly treated with drugs affecting QTc interval or in patients with pre-existing cardiac disease or electrolyte disturbance. Interactions: Methotrexate, macrogol. SmPC for detailed information.

See

Pregnancy and lactation: can be used during pregnancy, if after careful assessment it is considered clinically needed. Breast-feeding is not recommended. Driving / using machines: Patients are advised not to drive or use machines until it is established that their ability to perform such activities is not affected. Undesirable effects: Nasopharyngitis, somnolence, headache, anorexia, depression, hostility/aggression, anxiety, insomnia, nervousness/irritability, convulsion, balance disorder, dizziness, lethargy, tremor, vertigo, cough, abdominal pain, diarrhoea, dyspepsia,

vomiting, nausea, rash, asthenia/fatigue, thrombocytopenia, leukopenia, suicide attempt, suicidal ideation, psychotic disorder hallucination, confusional state, amnesia, vision disturbance, pancreatitis, hepatic failure, acute kidney injury. , infection, pancytopenia, neutropenia, agranulocytosis DRESS, ECG QT prolonged, encephalopathy, Neuroleptic malignant syndrome, hepatic failure, Toxic epidermal necrolysis, Stevens -Johnson Syndrome, erythema multiforme, rhabdomyolysis. (Please refer to the Summary of Product Characteristics for detailed information) Legal category: POM Marketing Authorisation PA22697/012/001

Price: Number:

Marketing Authorisation Holder: Syri Pharma Limited t/a Thame Laboratories Floor 0, 1 WML, 1 Windmill Lane, Dublin 2, D02 F206, Ireland. (Distributed by Advanz Pharma Ltd in Ireland) Date of preparation: Sept 2022 Adverse events should be reported. Reporting forms and information can be found at www.hpra.ie. Adverse events should also be reported to Syri Pharma Medical Information via telephone on 00 44 330 1359 422 or via e-mail at medinfo@syripharma.com Reference: 1. Data on file Levetiracetam 100mg/ml oral solution January 2024 (v2.0) - savings (p.1) IE/LVI/PM/0006 Date of Preparation - January 2024

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Boost Online Growth with Effective Fulfilment How do I increase online sales and at the same time control costs is a common challenge facing online pharmacy retailers. You have invested in your online offering, dedicated budgets to paid advertising, converted sales and built a loyal customer base but now you don’t have the capacity to increase your daily orders due to inefficient order fulfilment capabilities. Written by Orla Cooney, COO Magico

inventory. Instead, they partner with suppliers or manufacturers who ship products directly to customers when orders are placed. Hybrid Models: Some online stores opt for a combination of fulfilment models. For example, they might use in-house fulfilment for their most popular products and partner with a 3PL for overflow or seasonal items. In-house and hybrid are the most common ecommerce fulfilment models for Irish retailers and increasingly online stores who wish to scale and improve overall efficiency are looking to automate their ecommerce fulfilment. Why Automate Ecommerce Fulfilment? Speed and Efficiency: Time is money! Automation can significantly speed up the fulfilment process, this is crucial for meeting todays customers fast shipping expectations. Research shows that offering slow shipping is one of the top reasons for customers to abandon the shopping cart.

Together with increasing expectations from your customers for fast delivery and spiralling costs of sales, now it’s more important then ever to look at your order fulfilment process What is Ecommerce Fulfilment? Ecommerce fulfilment is the backbone of every online store, from collecting orders and controlling stock to picking, packaging, and shipping items. Customers expect fast and dependable delivery, putting pressure on businesses to get items out the door promptly and properly. Customer satisfaction and loyalty will be influenced by the speed of delivery, how the product is packaged, the accuracy of shipping information, and the condition in which products reach the customer’s doorstep.

Common e-commerce fulfilment models In-House Fulfilment: In this model, the online store manages its own fulfilment operations. They typically own or lease warehouse space or dedicate space in their bricks and mortar store, hire and train their own staff, and handle all aspects of order processing, packing, and shipping. This is the most common model amongst Irish online retailers. Third-Party Logistics (3PL) Providers: E-commerce companies can outsource their fulfilment operations to third-party logistics providers. These companies specialise in handling warehousing, packing, and shipping of products on behalf of the online store. Dropshipping: In the dropshipping model, online stores don’t hold

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Reduce Errors: An error in the fulfilment process could turn a loyal customer into one that will never shop with you again, coupled with potential for poor reviews and the cost of returns and compensation, errors can be very costly. Automated ecommerce fulfilment, however, allows you to minimize the risk of mistakes by reducing manual data entry. Scalability: Automated ecommerce fulfilment will help you scale to handle increased order volumes without the need to hire and train more staff. This scalability is crucial during busy periods like holidays or sales events. Focus on Value-Added Tasks: By automating routine tasks, employees can focus on more value-added activities, such as customer service, marketing and product mix. Customer Satisfaction: Faster and more accurate order fulfilment leads to improved customer satisfaction. Happy

customers will convert into loyal customers and more likely to provide positive reviews. At Magico we are delighted to have partnered with Irish owned Wave OMS to provide automated ecommerce fulfilment services to our clients. Wave Order Management System fulfils online orders with maximum speed and minimum cost per order, supercharging Pack, Pick & Ship capabilities for online Retailers of all shapes and sizes. Both Magico and Wave OMS have developed specific functionality that uniquely caters for the Irish Pharmacy Industry and this partnership offers Irish Pharmacy Retailers a solution that provides for the statutory record trail obligations of Irish online pharmacies. Leading Irish Pharmacy Retailer, CH Tralee are enjoying significant benefits after integrating their Magico AB Commerce online store, www.chtralee.com , with Wave OMS. The speed and accuracy of their online deliveries is having a hugely positive impact on their reviews and hence their customer retention. A streamlined organised order fulfilment process has allowed resources to be redeployed to more value adding tasks . The shipping accuracy produced by Wave OMS is also delivering substantial savings in costs of returns and replacement products. According to Kevin Reardon, General Manager CH Chemist, the integration of Wave OMS with their Magico AB Commerce Online Store has brought immense benefits to the business and has allowed CH Chemist to continue to grow their online business with confidence. Improving your ecommerce fulfilment process is crucial to achieve online growth. You can boost order fulfilment speed and accuracy, customer happiness, and ultimately online sales by choosing the appropriate ecommerce fulfilment model, putting effective procedures in place, and utilizing technology and data. This will eventually lead to more satisfied customers and less workload, unlocking the possibility for rapid and long-term online growth.

The Management of Wound Care in Ireland

Wounds have a major personal, social, and economic impact. Wounds not only impact on the individual and their quality of life, they also have a significant impact on our health service and our society as a whole. Studies in the UK indicate that up to 4% of total health care expenditure is spent on the provision of wound management while in Ireland it is estimated that two thirds of community nursing time is spent on the provision of wound management. It is estimated that 1.5% of the population is affected by a wound at any one point in time. Patients will regularly present to the pharmacy to treat minor wounds rather than attending a GP clinic. Most wounds can be treated cheaply and effectively with over the counter products. Wound care management in the pharmacy could potentially be a service that pharmacists offer in the consultation room. This is a practice that other jurisdictions offer such as Australia and US and has been successful. In these situations it is utilising the skills of community pharmacists to provide enhanced first aid and wound management services and freeing up other highly skilled health professionals to perform health interventions requiring specialised skills. The Pharmacy Guild of Australia report that the introduction of this service gives greater recognition of the role of community pharmacists as a member of

the primary health care team and allows community pharmacy the opportunity to develop a viable business involving service provision as an adjunct to product supply. The Irish Pharmacy Union (IPU) have asked for a greater expansion of pharmacy services as part of the HSE Health Ireland initiative. Wound care is valued at €4.3 million in Ireland. Many pharmacy counter assistants and pharmacists are trained in first aid and are familiar with the appropriate equipment and advice for certain ailments and this can encourage loyal and repeat customers. Skin Wounds are a common health concern, which can vary from abrasions, lacerations, rupture injuries, punctures, to penetrating wounds. Treating pressure sores in bedridden or elderly patients is a large part of wound care. Addressing wounds appropriately and timely with dressings and wound closures will minimise cosmetic scaring and infection while making the patient more comfortable. When offering patients advice on wound care it is essential to ask the patient about their lifestyle and general health so the dressing and healing process is appropriate for the patient. The pharmacist should ask the patient about the duration of the wound, and if a patient who has had a wound for longer than one week then they should be referred to their doctor.

32 | PHARMACYNEWSIRELAND.COM

HSE Wound Care Guidelines The development of HSE national guidelines for wound management are designed to support the standardisation of care and encourage best clinical practice. These guidelines constitute a general guide to be followed, subject to the medical practitioner’s judgement in each individual case. These guidelines are based upon up to date scientific evidence and expert opinion and will serve to support consistency of treatment and contribute to improved patient outcomes.

Background It is estimated that 1.5% of the population worldwide develop a wound at any one time (Gottrup, 2004). The growing prevalence and incidence of non-healing wounds (acute and chronic) are a major source of morbidity to patients and a major cost to hospital and community healthcare providers globally (Posnett et al., 2009). Changing population demographics, increased prevalence and incidence of multiple comorbidities are challenging health care providers to provide ever more complex interventions with fewer resources (Moore et al., 2014). It is estimated that between 25% and 50% of acute hospital beds are occupied by patients with a wound. Of these wounds between 55%-60% are non-healing wounds, infected surgical wounds, pressure ulcers and leg/foot ulcers (Posnett et al., 2009).

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quality of service delivery at an affordable cost. A key focus of The Patient Charter, You and your health service (2014) is committed to ‘supporting quality improvement throughout the health system to improve outcomes and reduce patient harm’. The complexity of wounds requires practitioners who are skilled in wound assessment, diagnosis, treatment and evaluation of outcomes (Harding et al., 2013). Continuing Professional Development (CPD) is essential to ensure optimal delivery of patient care (An Bord Altranais, 2000).

Additionally, it is estimated that more than 23% of all hospital in-patients have a pressure ulcer, many of which are acquired during hospitalisation for an acute episode of illness or injury and therefore are avoidable (EPUAP, 2002). Ireland in the past decade has experienced an unprecedented rise of 16% in population growth. Evidence indicates that the number of people over 65 years of age is expected to triple in the next 30 years (DoHC, 2010b). Consequently, the prevalence and incidence of wounds is likely to continue to increase due to the ageing population and the ongoing increase in theprevalence of obesity, diabetes and lower extremity arterial disease (Chandan et al., 2009; HSE, 2009). Chronic wounds are associated with comorbidities such as hypertension, diabetes, cardiovascular and neurological illness (DoHC 2007a; DoHC 2007b). The costs associated with wound care are substantial; four per cent of the United Kingdom’s (UK) health care budget is spent on wound care (Posnett and Franks, 2007). Chronic wounds of all aetiologies cost the Irish Health Service Executive an estimated at €285.5 million per annum (Mc DermottScales et al., 2009). The epidemiology of wounds section discusses these issues in greater depth. Furthermore, wound therapeutics are continuously evolving requiring the clinician to keep abreast of the research evidence that will inform and underpin their practice to ensure that patients receive the evidence-based assessment and treatment options at the appropriate time. Wound healing is a dynamic process and normal wound healing occurs in a precise and timely manner. Wound management is also dynamic and is dependent on the clinician’s ability and skill in assessing, planning care and evaluating outcomes. The duration of wounds is directly related to prolonged healing rates (Bosanquet and Harding 2014). Early focused treatment of wounds that fail to respond to standard care may reduce the burden of wounds that become chronic. One of the objectives of the HSE Corporate Plan (2008-2011) was to ensure that sufficient healthcare professionals have the appropriate competencies to deliver its objectives in maximising the level and

Whilst no single healthcare discipline can completely meet the complex needs of those presenting with challenging wounds, it is essential that healthcare professionals from all disciplines are aware of the standards and prevention strategies, knowing when and how to refer the patient with a challenging wound.

General Wound Care Acute wounds will generally proceed through an orderly and timely process to produce a healed wound which has anatomic and functional integrity. However, there are physiological factors which may enhance or impede wound healing (Table 1). Chronic wounds are defined as those whose healing is impaired. The inflammatory phase is dysfunctional due to intrinsic and extrinsic factors that impact on the person, the wound or the healing environment (Swanson et al., 2015). Chronic wounds include a variety of aetiologies, yet they share a number of characteristics such as a persistent state of inflammation due to high levels of pro-inflammatory cytokines and unregulated proteolytic activity as a result of the high levels of active proteases and defective neutrophils, with an imbalanced expression of tissue inhibitors i.e. metalloproteinases. There is also a denaturing of growth factors (Moore, 2010). It is more recently accepted that biofilm may be responsible for this persistent inflammatory state (Swanson et al., 2016). Wound healing in children generally follows the same process as adults; however, there is an increased production of collagen and elastin. Granulation tissue is created at a faster rate than in adults, resulting in a faster healing process (Byrant and Nix, 2016). There is a paucity of evidence examining the treatment of paediatric wounds, with most evidence being anecdotal, opinion based or extrapolated from adult research (Baharestani, 2007; Byrant and Nix, 2016). Accurate and timely wound assessment within a holistic patient assessment, underpins effective clinical decisionmaking. It is pivotal to good wound management and should form the basis for wound care practice (Baharestani, 2007). Assessment enables appropriate clinical diagnosis and goal setting for the management of the wound in order to improve patient outcomes and reduce morbidity and costs (Posnett et al., 2009).

34 | PHARMACYNEWSIRELAND.COM

In the treatment of wounds endeavour to facilitate the following objectives of wound healing: 1. The wound should be allowed to heal in a moist wound environment unless the clinical goal is to maintain a dry wound bed, e.g. ischaemic foot 2. To address the issues observed in the assessment process 3. To promote wound healing Due to the complexity and challenging nature of wound healing, a systematic and standardised approach to the assessment process is desirable to provide baseline information against which progress can be measured. Recording of wound size is a useful baseline indicator. Assessment should include identification of all factors that may delay healing. Other factors to assess include current care and local wound environment (Peate and Glencross, 2015). The principles of wound assessment are central to all wound types, although some aetiologies such as leg ulceration, pressure ulceration, diabetic foot ulceration and malignant fungating wounds require additional considerations.

Practice point: Assess and observe for the following: • Primary/ secondary dressings used in relation to type, wear time, frequency of dressing changes, strikethrough (wet or dry), visible leakage and how saturated the dressing is on removal • Wound moisture (e.g. visibly dry, moist/ glossy; wet; saturated; bathed in fluid). The volume of exudate should be recorded in all wound assessments and at each dressing change • Peri-wound skin • Documentation should include a description of the type, colour and consistency of exudate at each dressing change Trigger factors have been identified (WUWHS, 2008b) to aid the clinician in suspecting infection in the acute wound. These include; inflammation, new or increasing pain, local heat, swelling, advancing redness, increases in serious or purulent discharge, abscess or malodour. Some of these indicators also mimic the markers of inflammation. Therefore it is vital that you are able to determine whether a change in these indicators is predictive of wound infection. Immuno-comprised patients, older adults or patients taking anti-inflammatory medication may not present with these classical signs. It is important to emphasise that the presence of slough, pus and/or necrotic tissue is not evidence of infection, but these non-viable substances do support bacterial growth (Ennis, 2010; Cutting et al., 2005). When present in conjunction with other outlined indicators, the suspicion index for infection is increased. Early diagnosis of wound infection and early treatment are essential to minimise the risk

of more serious complications and systemic illness (Cutting and White, 2004). Diagnosis is made on clinical manifestations, yet infection may produce different signs and symptoms in wounds of different types and aetiologies (WUWHS, 2008a). The WUWHS (2008b) identified additional criteria to assist in identifying wound infection in such patient cohorts. These include: • loss of appetite • general lethargy, malaise • inability to undertake normal activities • a deterioration in glycaemic control in patients with diabetes • there may be other subtle changes in the wound bed; e.g., wound bed colour may appear darker, less vascular and there may be an increase in slough (Jones, 2012a) Clinical judgement, a detailed patient history and a comprehensive assessment of the wound are the pivotal tools to recognise infection in the wound. The aim of effective management of the patient with a wound infection is to restore balance to the interaction between the patient and the infecting microorganism. A multidisciplinary approach and if necessary, referral to a specialised wound expert should be considered (WUWHS, 2008a). Simultaneous maximising of the host response, treatment of the wound bed and the general wellbeing of the patient all form part of the management of the patient with a wound infection. Treatment of the wound to reduce bacterial load includes; facilitating wound drainage, managing excessive exudate, debridement and removal of devitalised necrotic tissue and prevention of further or super infection by the adoption of relevant infection control principles. The judicious use of topical / antiseptic/antimicrobial agents may also be employed.

living with a wound (Mudge and Orsted, 2010). Dressing changes are a major contributor to wound pain. In patients with a wound infection whose nervous system has become sensitised, dressing removal, wound cleansing and dressing application may prove particularly painful. Analgesia may need to be timed for maximum efficacy during dressing changes and the patient may find music or some other form of distraction helpful. Even when a dressing change is managed well and the choice of dressing minimises pain, the patient’s past experience of painful dressing removal may lead to increased anxiety at dressing change (Mudge and Orsted, 2010). Non-steroidal anti-inflammatory drugs (NSAIDs) work peripherally by inhibiting the enzyme cyclooxygenase (COX). It is this enzyme, which converts arachidonic acid, released from the walls of the damaged cells, into inflammatory prostaglandins. Nonsteroidal anti-inflammatory drugs provide good pain relief, but can lead to gastric ulceration, renal failure and prolonged bleeding time due to impaired coagulation.

be expected to be available as stock in residential settings. According to the circular, these products will not be approved under Discretionary Hardship Arrangements; however, dressings of a more complex nature can be approved under this arrangement. Pharmacists were reminded that while dressings are not available to patients on GMS prescriptions, certain dressings are provided on the reimbursement list for GP Stock Orders. A more comprehensive list of wound management products available for GP Stock Orders was published on the reimbursement list effective 1 November 2017. Where there are no local arrangements in place to make supplies through the public health nurse at local level, applications can be submitted under Discretionary Hardship Arrangements for approval supported by a GP prescription. “In order to further reduce the administrative burden to Pharmacists, Compression Hosiery products have been provided with administrative codes effective 1st January 2018,” the circular states.

Dressing Codes Compression hosiery products have been provided with new administrative codes, according to a new circular from the HSE. The Expert Group for Wound Management Products recently carried out a national review of dressings and aids for wound management. The circular sent by the HSE’s Primary Care Reimbursement Service enclosed a list of wound management products considered as “Normal Nursing Needs” that would

“This will mean that where such products are prescribed, they can be dispensed and claimed for electronically. Compression Hosiery will no longer require individual authorisation by the Local Health Office under Discretionary Hardship Arrangements. Reimbursement support is provided for two pairs per calendar year. Claims submitted outside the approved yearly threshold will not be reimbursed. This arrangement applies to medical card holders under the GMS scheme only.”

The general wellbeing of the patient is the most important factor in the effective treatment of wound infection. Elimination of stressors such as pain and sleep deprivation are essential. The education of the patient and the family and the active participation of the patient in their plan of care are also necessary.

Wound Pain Wound pain can be categorised as: • Background pain – continuous or intermittent pain that is felt even at rest • Incident pain – pain that occurs during day-to-day activities such as mobilisation or coughing • Procedural pain – pain that results from routine procedures such as dressing changes or wound cleansing • Operative pain – pain associated with significant wound intervention, e.g. debridement or wound biopsy. Tissue damage often occurs during the dressing change procedure and has been described by patients as the worst part of

PHARMACYNEWSIRELAND.COM | 35

Report

Core Planning for Cancer Control The latest Annual Statistical Report from the National Cancer Registry (NCRI) focuses on the impact of age and stage at diagnosis on cancer outcomes. The report titled: Cancer in Ireland 1994 – 2021 is an analysis of nationally collated data revealing the status of cancer in Ireland including statistics on cancer incidence, mortality, and survival. NCRI Director, Professor Deirdre Murray

REPORT AT A GLANCE Cancers with a population screening programme also Who are we, and what doexperience we do? high 5-year net survival when detected in early stages. However, late The National Cancer Registry of Ireland (NCRI) presentation (stage IV) remains common for of some other cancers works on behalf of the Department Health (e.g. head and neck, pancreatic and collects information from all hospitals and lung cancers) within consequent poorer outcomes. Ireland on the number of persons diagnosed

• Older people they experience with cancer and the types of cancer have.higher cancer incidence and lower NCRI also follows up the numbers dying fromto survival rates compared Key findings include: other age groups. 5-year their cancer or from other causes. All patient net survival for those aged 75+ • Early diagnosis is associated personal and private information are removed is 46%, compared with 86% with better cancer outcomes, for those in theprepared 15 - 44 year reduced complexity of carecancer statistics are before summary age group. Internationally, it for patients and lower cost of and made available public health beenand shown that many cancer care. A high proportion to of the has factors underlie these findings someprofessionals cancers (e.g. melanoma, through our annual cancer including delayed diagnosis uterine and prostate cancers) report and other as our older website. people may present present at early stage with reports on consequent 5-year net survival of up to 100% in many cases.

later for medical attention of symptoms, patients having

other serious illnesses which limit treatment options, poorer treatment tolerance, reduced physiological reserve and lack of representation in clinical trials.

NCRI Director Professor Deirdre Murray said, “This year, the NCRI report emphasises some major themes that are core to planning for cancer control. Life expectancy in Ireland is among the highest • The number of invasive cancers in Europe and we present the (excluding non-melanoma outcomes for cancer in older skin cancers) presenting as an people, which will hopefully form How are the numbers emergency was estimated at reported? a benchmark for policy makers 14% during 2016-2019, down and service planners in their work. almost 6% since 2002. This fall Equally, we highlight the benefits of Collecting and was checking information is from 20% to 14% observedall this early diagnosis on cancer outcomes between 2002 by anda2009, after performed combination manual andfinally we byofcancer type and which no further reduction report on cancers presenting as an electronic processes. Our staff collect cancer was evident. Unfortunately, emergency, both key indicators of emergency presentation is and then cancer control.” diagnosis information use an agreed associated with more advanced system coding (The International Classification Chair of the NCRI Board Dr Jerome stage andof therefore limited Coffey, welcomed the report and treatment options poorerthe cancers of Diseases) toand group into different said: “The Annual Statistical Report survival outcomes. is the most important Registry types. • More complete data on the output for everybody involved in impact of the COVID-19 organising and delivering cancer pandemic on cancerof diagnoses care. In addition to the key findings After a process collating diverse information in 2021 indicates that the and themes listed above it is from Irish hospitals for accuracy, pandemic resulted in a 4%and validation important to focus on the increase reduction in cancer diagnoses in total cancer cases over time, the annual cancer report is published following compared to what was expected reflecting changes in the size and analysis of de-identified data. that year. Early indicators suggest age profile of the population, and a return to expected rates of to ensure adequate healthcare cancer diagnoses in 2022. capacity to meet this challenge.”

What have we found? Over the years 2019-2021 the average number of ‘registered tumours’ in males and females is estimated at 41,767 per year. Just over 1 in 2 (24,424 excluding non-invasive tumours and non-melanoma skin cancers) are life-changing invasive cancers which often require extensive treatment. Cancer cases: Annual average 2019-2021 Percentages represent the proportion of all registered cancers. For example, nonmelanoma skin cancer made up 21% (about 1 in 5) of all registered tumours in females and 27% (almost 1 in 3) in males

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Fertility

Fertility Advice in the Pharmacy It is well known that fertility drugs can play a crucial role in assisting individuals and couples to achieve a successful outcome during Fertility Treatment. Dr Bart Kuczera, Fertility Consultant, Beacon CARE Fertility

support endometrial maturation after oocyte collection and facilitate maintenance of a conducive environment for early pregnancy, or suppress the menstrual cycle for a few months in women with endometriosis.

importance of remaining adequately hydrated (above normal levels) when taking fertility medication, as the ovaries will utilise an increased volume of water compared to that of a normal cycle.

2. What Are Common Side Effects Of Medication?

Proper hydration or haemodilution is a strategy that helps prevent clots that can occasionally be caused due to the higher estradiol levels.

Fertility medications are generally well tolerated, but they may present some potential side effects, albeit rarely and typically of a mild nature.

We asked Dr Bart Kuczera, Fertility Consultant at Beacon CARE Fertility, to provide an overview of the different types of fertility drugs available, their function, possible side effects and advice he has for pharmacists. 1. What Are The Different Types Of Fertility Drugs? There are three main categories of Fertility Drugs, each serving a specific purpose. A) Ovarian Stimulation: One category of Fertility Drugs is designed for ovarian stimulation. Medications such as Gonadotropins (hCG, LH and FSH) stimulate the ovaries to produce multiple eggs during a single menstrual cycle. Both FSH alone and in combination with LH are used for this purpose. Different variants of highly purified menopausal or recombinant FSH are currently available. The hCG is used in females to trigger oocyte maturation and ovulation. Occasionally, hCG is used for luteal phase support after fresh embryo transfer, or in cases of male hypogonadism, to stimulate sperm production (either alone or in addition to FSH). B) Ovulation Inhibitors: Another class of fertility drugs focuses on preventing spontaneous ovulation. By carefully controlling the timing of ovulation, these drugs

help optimise the chances for successful egg retrieval and reduce the risk of untimely ovulation. Medications such as GnRH agonists (e.g. buserelin, nafarelin) and antagonists (cetorelix, ganirelix) are used to suppress the release of eggs prematurely by preventing LH surge. The agonist class works through selective pituitary flare-andexhaustion action in repeated doses and either requires pre-treatment before stimulation (hence the term “long protocol”) or, indeed flare protocols when they are commenced alongside the stimulation to take the benefit of the surplus FSH release. The flare effect after the first/ single dose of GnRH agonist is often used to trigger ovulation safely as a means of prevention from OHSS in both IVF and egg freezing cycles. The GnRH antagonists are of pure inhibitory action. Interestingly, recent advances in stimulation protocols employ progestogens in this role too, following their successful use in the progestogenonly-pill. They are, however suited only for treatments where no fresh embryo transfer is planned (e.g. egg freezing, elective embryo freezing). C) Enhance Environment for Conceiving: In addition to drugs that stimulate and regulate ovulation, sex hormones are also utilised in various roles. Progesterone and progestogens are used to plan the onset of menstrual bleeding (i.e., in cycle programming), control the endometrial growth in sequential hormonal replacement therapy for a frozen embryo replacement, or

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Historically, ovarian hyperstimulation syndrome (OHSS) was a relatively frequent complication associated with IVF and fertility medication (hCG). However, advancements in protocols and strategies have significantly reduced its occurrence, which is now very rare. One common side effect associated with fertility treatments involves the method of administration, particularly with injectable medications. Bruising at the injection site is a somewhat common and generally minor side effect, resulting from the use of needles for subcutaneous or intramuscular injections. Some people also occasionally experience a rash due to an allergic reaction to the medication. This is typically a benign side effect that requires little to no intervention. Lactose intolerant patients may experience some side effects due to the composition of the drug (and not the main substance of the drug itself). Lastly, some individuals may experience mild symptoms such as headaches, bloating, swelling (water retention) or mood swings during the course of fertility treatments. 3. What Advice Would You Give Pharmacists regarding Fertility Medication? From a supply perspective, I would suggest having some extra medication in stock (if possible). Oftentimes, a patient will need a “top up” of their fertility medication. If Pharmacies don’t have more than the initial prescribed dose in stock, it may cause an issue for the patient, especially if she requires the extra dosage over the weekend. When counselling patients, I suggest emphasising the

Lastly, provide guidance on proper storage of the medication to ensure they maintain their efficacy, and suggest that the patient takes the medication around the same time each day. 4. What OTC Should Patients Avoid When Taking Fertility Medication? Vitamin A, Retinoids and nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen are generally discouraged during fertility medication regimens, due to potential interactions and adverse effects on reproductive health. Excessive intake of vitamin A, can lead to toxicity and negatively impact embryonic development. NSAIDs may interfere with or prevent ovulation and could compromise the effectiveness of ovulation induction. NSAIDs used regularly may also hinder implantation. It should be noted that patients typically “over supplement” when undergoing fertility treatment, and an excess of vitamins and herbs should equally be avoided. 5. Are there supplements that pharmacists can recommend that are OTC? On the male side, multivitamins are available specifically for male fertility. Their role is well established for enhancing IVF outcomes by helping to improve semen parameters and reduce oxidative stress in seminal plasma, thus lowering sperm DNA damage. For women aiming to conceive, folic acid is commonly advised. The role of vitamin D in female fertility is currently under extensive investigations and studies. It’s important to note that eggs are formed before birth and this limits the impact of any “enhancers”. By contrast, the production of sperm is continuous since puberty and prone to changes triggered by deficiencies, life style and supplementation.

The end of erectile problems? Touch wood.

Sidena. Your new firm favourite. Sidena 50mg Tablets are now available over the counter in a 4 and 8 pack. ABBREVIATED PRESCRIBING INFORMATION Product Name: Sidena 50 mg Tablets. Composition: Each tablet contains, 50 mg sildenafil (as citrate) . Description: Light blue, round, slightly dotted tablets. Cross breaking notch on one side and marked ‘50’ on the other side. Can be divided into equal quarters. (Only two quarters of the 50 mg is covered by posology). Indication(s): Treatment of men with erectile dysfunction, which is the inability to achieve or maintain a penile erection sufficient for satisfactory sexual performance. Dosage: Adults and elderly: 50 mg taken as needed approximately one hour before sexual activity. Dose may be decreased to 25 mg. Max dose: 50mg once daily. Impaired renal and hepatic function: Sildenafil clearance is reduced in hepatic and severe renal impairment. Consider a dose of 25 mg. Dose may be increased step-wise to 50 mg if tolerated. Children and adolescents below 18 years of age: Contraindicated. Use in patients using other medicines: Starting dose of 25 mg with CYP3A4 inhibitors (not advised to use with ritonavir). To minimise postural hypotension in patients receiving and alpha-blocker, stabilise patient first on the alpha blocker and use a starting dose of 25 mg sildenafil. Contraindications: Hypersensitivity to sildenafil or any of the excipients. Concomitant with ritonavir, nitric oxide donors or nitrates in any form, guanylate cyclase stimulators e.g. riociguat. In patients that sexual activity is inadvisable (e.g. severe cardiovascular disorders such as a recent (6 months) acute myocardial infarction (AMI) or stroke, unstable angina or severe cardiac failure). Refer these patients to a doctor. Patients with loss of vision in one eye due to NAION. Known hereditary degenerative retinal disorders. Severe hepatic impairment. Hypotension. Anatomical deformation of the penis. Women. Not intended if no erectile dysfunction. Warnings and Precautions for Use: First diagnose erectile dysfunction and determine potential underlying causes (e.g. hypertension, diabetes mellitus, hypercholesterolaemia or cardiovascular disease), before considering pharmacological treatment. Consider the cardiovascular status of patients, since there is a degree of cardiac risk associated with sexual activity. Serious cardiovascular events, including myocardial infarction, unstable angina, sudden cardiac death, ventricular arrhythmia, cerebrovascular haemorrhage, transient ischaemic attack, hypertension and hypotension have been reported post-marketing in temporal association with the use of sildenafil. Most, but not all, of these patients had pre-existing cardiovascular risk factors. Sildenafil has vasodilator properties, resulting in mild and transient decreases in blood pressure. Caution: Patients with anatomical deformation of the penis (such as angulation, cavernosal fibrosis or Peyronie’s disease), or in patients who have conditions which may predispose them to priapism (such as sickle cell anaemia, multiple myeloma or leukaemia). Advise patients that in case of priapism, prolonged erections (longer than 4 hours) or sudden visual defect, they should stop taking sildenafil and consult a physician immediately. Administer to patients with bleeding disorders or active peptic ulceration only after careful benefit-risk assessment, as there is no safety information available. Interactions: Inhibitors of the cytochrome P450 (CYP) isoforms 3A4 (major route) and 2C9 (minor route) isoenzymes such as CYP3A4 inhibitors: Itraconazole, ketoconazole, erythromycin, cimetidine, HIV protease inhibitor saquinavir: May reduce sildenafil clearance and increase sildenafil plasma levels. Consider a starting dose of 25 mg. Strong CYP3A4 inducers e.g. rifampicin may increase sildenafil clearance and decrease sildenafil plasma concentrations. Grapefruit juice: May give rise to modest increases in plasma levels of sildenafil. Nicorandil (Hybrid of potassium channel activator and nitrate): Due to the nitrate component it has the potential to have serious interaction with sildenafil. Sildenafil potentiates the hypotensive effect of nitrates. Alpha blocker: Concomitant administration of sildenafil may lead to symptomatic hypotension in a few susceptible individuals. Patients should be hemodynamically stable on alpha-blocker therapy prior to initiating sildenafil treatment. Sildenafil potentiates the antiaggregatory effect of sodium nitroprusside in vitro. Not recommended in patients with a history of bleeding disorders or active peptic ulceration. Not recommended to use with other pulmonary arterial hypertension treatment containing sildenafil. Ability to Drive and Use Machinery: Minor influence, dizziness and altered vision were reported. Patients should be aware of how they react to sildenafil before driving or using machinery. Undesirable Effects: Very common: Headache. Common: Dizziness, visual disorders, visual colour distortion, vision blurred, flushing, hot flush, nasal congestion, nausea, dyspepsia. See SPC for more adverse effects. Marketing Authorisation Holder: Rowex Ltd, Bantry, Co. Cork. Marketing Authorisation Number: PA 0711/170/002. 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 Adverse events should be reported. Reporting forms and information can be found on the Legal Category: Not subject to medical prescription. HPRA website (www.hpra.ie) or by emailing Rowex pv@rowa-pharma.ie Date of Preparation: Aug 2022 Date of preparation: (10-22) CCF: 25156

Supply status: Supply through pharmacies only.

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CPD: Chronic Kidney Disease Continuing Professional Development

CPD

AUTHORS: Dr Colm Rowan, Specialist Registrar Nephrology, University Hospital Limerick Professor Austin Stack, Professor of Medicine, Consultant Nephrologist, University Hospital Limerick and School of Medicine, University of Limerick

60 Second Summary Chronic kidney disease (CKD) is a leading cause of morbidity and mortality affecting more than 1 in 10 adults globally. It is projected to become the fifth leading cause of death worldwide by 2040, a trend that mirrors the global rise in major CKD risk factors including diabetes, hypertension and obesity. Given the adverse outcomes associated with advancing CKD, early diagnosis of kidney disease is crucial and optimal control of risk factors is central to management and better patient outcomes. According to the Global Burden of Disease (GBD) study, the prevalence of CKD globally was estimated at 9.1% (8.5-9.8) of the world’s population in 2017. The global incidence of CKD has nearly doubled from 1990 to 2016. The prevalence of CKD in Ireland follows international trends. The National Kidney Surveillance System (NKDSS) [https://www. nkdss.ie/ ]reported a prevalence of 11.8 % (11.8-12.1) among adults aged 18 years and over in the health system, with this figure rising to 55.7% in patients over the age of 80 years. A diagnosis of CKD is associated with increased risk of morbidity and mortality. Several studies have found independent and inverse correlation between the level of kidney function and the risks of mortality. With progression of CKD, there is a progressive decline in kidney function with the development of several metabolic, nutritional, and volume-related complications including anaemia, hyperkalaemia, metabolic acidosis, mineral bone dysregulation, malnutrition, volume overload, and worsening hypertension. Ireland lacks a comprehensive national chronic disease surveillance system and thus the capability to generate robust estimates of disease burden, risk factors, levels of preventive care, and clinical outcomes. National health policy initiatives, Slaintecare and emerging Integrated Care Programmes for Chronic Disease have provided an important road map for improved coordination and delivery of chronic disease in Ireland.

Dr Colm Rowan

Professor Austin Stack

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

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

4 previous steps, log and record your findings.

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.

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

3. PLAN - If I have identified a

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

Published by HPN. 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.

Chronic Kidney Disease in the 21st Century New opportunities to stop a Silent disease Introduction Chronic kidney disease (CKD) is a leading cause of morbidity and mortality affecting more than 1 in 10 adults globally.1 It is projected to become the fifth leading cause of death worldwide by 2040, a trend that mirrors the global rise in major CKD risk factors including diabetes, hypertension and obesity.2 There is substantial variation in the prevalence of CKD internationally with large differences reported among ethnic minorities and across vulnerable socioeconomic groups.3-4 CKD is classified according to stages from 1 to 5, according to the level of kidney function, estimated using a mathematical equation (estimated glomerular filtration rate), with each increasing stage representing a worsening degree of kidney function.5 [Figure 1] The stage of CKD is further subclassified a 41And didn›t swap anythingccording to the presence or absence of albuminuria- the earliest sign of kidney damage. Patients with CKD experience substantial levels of morbidity and mortality compared to the

general population.6 These risks develop at the earliest stages of chronic kidney disease, and are present well before the onset of end-stage kidney disease (ESKD). Cardiovascular disease is the leading contributor to excess mortality in this population and the majority of patients succumb from sudden death rather than progress to kidney failure.6-7 The complexity of care increases enormously for patients with advancing stage of chronic kidney disease requiring the support of multidisciplinary clinical teams to manage complications and transition to renal replacement therapy.8 Given the adverse outcomes associated with advancing CKD, early diagnosis of kidney disease is crucial, and optimal control of risk factors is central to management and better patient outcomes.9 Over the past decade, there has been substantial scientific advancement in the diagnosis and treatment of CKD, which has laid the foundation for consolidated international guidelines and personalised treatment strategies.10-13 International organisations and societies primarily focused on the protection of kidney health

and prevention of kidney disease, have translated scientific evidence into practical clinical guidelines for use in day-to-day practice. Professional bodies such as the Kidney Disease Improving Global Outcomes (KDIGO) group and the International Society of Nephrology (ISN) have provided clear guidance on the screening, diagnosis, treatment and monitoring of kidney disease with the goals of optimising disease management and ensuring effective implementation.13-16 The global landscape of CKD The global prevalence of chronic kidney disease has increased over the past three decades.17 According to the Global Burden of Disease (GBD) study, the prevalence of CKD globally was estimated at 9.1% (8.5-9.8) of the world’s population in 2017. The global incidence of CKD has nearly doubled from 1990 to 2016.17 A key driver of emergent trends is increased longevity and population growth. It is noteworthy that the incidence of CKD has been rising disproportionately in middle to low-income countries, largely as a result of increased burden of hypertension and diabetes.18 This

CPD: Chronic Kidney Disease

fication of CKD Based on GFR and Albuminuria Categories: Figure 1: Classification of CKD based on eGFR and Albuminuria Categories from the Kidney Disease: Improving Global Outcomes (KDIGO) Working Group. Heatmap representing the risk for CKD progression, all-cause death and cardiovascular death according to GFR and albuminuria categories.

Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. Kidney Int Suppls. 2013;3:1-150.

implies that the greatest burden of disease affects the most vulnerable with the least access to healthcare. Burden of CKD in Ireland The prevalence of CKD in Ireland follows international trends.19 The Survey of Lifestyle, Attitudes and Nutrition (SLÁN) study estimated the prevalence of CKD in Irish adults over 45 years old to be 11.6%.19 Data from the National Kidney Surveillance System (NKDSS) [https://www.nkdss.ie/ ] reported a prevalence of 11.8 % (11.8-12.1) among adults aged 18 years and over in the health system, with this figure rising to 55.7% in patients over the age of 80 years.3 The prevalence of CKD in the Irish health system is influenced by age, sex, acute kidney injury and location. A recent report from the Irish Longitudinal Study in Aging (TILDA) [https://tilda.tcd.ie/ publications/reports/] has provided further insight to CKD burden in older adults. Among this nationally representative cohort of community dwelling adults, the prevalence of CKD among adults aged 50 years or older was 11.7% in 2009-2011 and rose to 15.6% in 2014-2015. These data point to continued growth in CKD burden with

important implications for strategic planning and service provision. Impact of CKD on morbidity and mortality in Ireland A diagnosis of CKD is associated with increased risk of morbidity and mortality. Several studies have found independent and inverse correlation between the level of kidney function and the risks of mortality.6 Recent studies using Irish data from the NKDSS have quantified the impact of CKD on the rates and risks of hospitalisation and death. Compared to patients with preserved kidney function, the risks of hospitalisation were 5-fold higher for patients with severely impaired kidney function (kidney function less than 30% of normal) in Ireland.20 [Figure 2-3]. Similarly, death rates for patients with a diagnosis of severe kidney disease were between 10 to 20-fold higher compared to patients with preserved kidney function. These statistics suggest that substantial progress must be made to lessen the impact of CKD on disability. CKD-related complications With progression of CKD, there is a progressive decline in kidney function with the development

of several metabolic, nutritional, and volume-related complications including anaemia, hyperkalaemia, metabolic acidosis, mineral bone dysregulation, malnutrition, volume overload, and worsening hypertension.21-27 Cardiovascular disease (CVD) is the leading contributor to excess mortality in this population.23 Traditional risk factors for CVD are more common in CKD. Maladaptive neurohormonal mechanisms result in a greater incidence of hypertension. Moreover, alterations in cholesterol metabolism and pathogenic modifications of HDL/ LDL result in a pro-atherogenic environment. Non-traditional risk factors such as volume overload, a consequence of net sodium balance and a reduction in the functional nephron mass, can predispose to hypertension and progressive left ventricular hypertrophy. Accumulation of uraemic toxins are also contributory with the induction of inflammation and oxidative stress. Hyperphosphataemia, 1-25 Vitamin D deficiency and secondary hyperparathyroidism which characterise CKD-Mineral Bone Disease (CKD-MBD) also contribute to ectopic vascular calcification and atherogenesis.24

However, CKD-MBD contributes to other pathologies such as renal osteodystrophy which predispose this population to fragility fractures. Anaemia frequently complicates advanced CKD. Several factors contribute to the anaemia of CKD including erythropoietin deficiency, iron deficiency and chronic inflammation.25 Studies reveal that anaemia has a major impact on a number of quality-of-life outcomes.26 Moreover, anaemia is yet another factor which heightens the risk of cardiovascular disease.27 Regional and national surveillance programmes can facilitate a better understanding of the burden of CKD and its associated complications on healthcare systems.28 CKD is silent for many patients Kidney disease is often asymptomatic for many patients in the early stages and there has been a growing interest in the development of national kidney surveillance programmes to enable early detection of disease and ensure effective implementation of treatment strategies to slow, delay or prevent kidney disease progression.3, 29-30 Early detection of kidney disease among highrisk groups and early deployment

Hospitalisation rates by level of kidney function in the hospitalisations increased x 5-fold 43 health system Rate per 100 Person years

hospitalisations increased x 5-fold

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el of Kidney Function (ml/min/1.73m²) Level of Kidney Function (ml/min/1.73m²)

Figure 2. of interventions offer patients the greatest potential to prevent future kidney failure and extend patient survival. Moreover, socioeconomically deprived populations incur greater burden of CKD and are less likely to receive appropriate early intervention.31 Screening programs improve detection rates amongst economically deprived individuals and enhance access to care as a result. Early diagnosis and early treatment offer the opportunity to delay or prevent kidney disease progression and its complications, and stem the tide of kidney failure, which now stands at 2.5 million adults globally. The costs of renal replacement therapy-dialysis and transplantation are significant even for the wealthiest countries. In the Unites States, the costs of ESKD alone exceeds 114 billion dollars annually.32 Targeted Surveillance Programmes for CKD Ireland lacks a comprehensive national chronic disease surveillance system and thus the capability to generate robust

Stack et al European Renal Association May 2022 Stack et19 alTH European Renal Association estimates of disease burden, risk factors, levels of preventive care, and clinical outcomes.33-35 National health policy initiatives, Slaintecare and emerging Integrated Care Programmes for Chronic Disease have provided an important road map for improved coordination and delivery of chronic disease in Ireland. KDIGO has urged countries to invest in dedicated, comprehensive, and systematic surveillance programs designed to capture and track all aspects of CKD, in order to improve patients’ outcomes.36 In the United States, the Kidney Disease Surveillance System funded by the Center for Disease Control (CDC) is the first surveillance system of its kind to focus on tracking kidney disease prior to kidney failure and reducing the burden and impact of kidney disease.30 Programmes such as the Kidney Early Evaluation Program (KEEP) have also facilitated screen for high-risk individuals in the community.37 This program has been successful in detecting CKD in the early stages as well as generating knowledge about this condition to influence public health practices.

In Ireland, efforts are progressing at establishing a National Kidney Disease Surveillance System (NKDSS) to support early detection, treatment, and monitoring of kidney disease in the population. Pioneering work is under way to create the infrastructure to better understand kidney disease, its determinants and impact in the health system.3, 20, 28

Figure 2: Hospitalisation rates by level of kidney function in the Irish health system. 125, 890 patients were followed up for a median of 7.8 years and experienced 93, 515 hospitalisations in the period 2005-2013, mean age 54.1 years, 45% men, 55% women. eGFR (estimated glomerular filtration rate) ml/min/1.73m2 using CKD-EPI equation.

New Optimism for treating CKD in Ireland Over the past decade, several major scientific advances in the treatment of CKD have led to renewed optimism that CKD and its downstream consequences can be greatly attenuated and even prevented.38-40 The role of the rennin-angiotensin system as a maladaptive driver of CKD progression, proteinuria and fibrosis is well established.39-40 Angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARB) have long been the cornerstone of CKD treatment by reducing proteinuria and optimising blood pressure control. The arrival of SGLT2 inhibitors has added another

pillar of protection with major benefits in reducing the risk of CKD progression and extending patient survival by blocking glucose transport and promoting glycosuria.41-43 The non-steroidal selective mineralocorticoid receptor antagonist, finerenone has added a further dimension of protection by reducing disease progression in patients with Type 2 diabetes and albuminuria.44 The glucagon-like peptide 1 receptor agonist (GLP-1 Receptor) has also demonstrated significant benefits in kidney and cardiovascular protection in Type 2 diabetes.45 Together these treatments used in combination

Mortality ates by level rates of by kidney levelfunction of kidneyinfunction the Irishin the Irish Chronic Kidney Disease 44 CPD:health system health system Deaths per 1,000 person years

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100 Women

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e 3.

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Kidney Function (ml/min/1.72m Kidney2) Function (ml/min/1.72m2) Figure 3: Mortality rates by level of kidney function in the Irish health system. 125, 890 patients were followed up for a median of 7.8 years and experienced 14, 083 deaths in the period 2005-2013, mean age 54.1 years, 45% men, 55% women.

Browne et al :European Renal Browne Association et al :European 19TH May Renal 2022 Association 19

eGFR (estimated glomerular filtration rate) ml/min/1.73m2 using CKD-EPI equation.

have the potential to alter the course of CKD by preventing or delaying disease progression, reducing the need for dialysis, reducing cardiovascular events, and extending patient survival. A recent analysis suggests that that the gains in life expectancy, kidney and cardiovascular benefits were greatest for patients who were treated with a combination

of an SGLT2, GLP-1 RA, and non-steroidal MRA compared to renin-angiotensin system blockade alone.46 The global kidney community, and allied care partners recommend that each country develop a comprehensive CKD care strategy to effectively screen, diagnose and treat CKD. The roll-out

CPD Questions: Chronic Kidney Disease in the 21st Century New opportunities to stop a Silent disease 1. How common is chronic kidney disease globally?

of a national kidney disease surveillance programme would serve to assess the burden and population impact of CKD as well as evaluate the beneficial impact of traditional and novel preventive strategies. The Structured National Chronic Disease Management (CDM) programme of Slaintecare is already underway and represents a major step forward in public health

for managing chronic disease and multimorbidity. The addition of CKD to the CDM programme is the logical next step, providing a much needed opportunity for early detection and early treatment of disease with disease modifying and life extending therapies. References available on request

4. ACE inhibitors and ARBs are contraindicated in the treatment of chronic kidney disease! True or false? 5. What are the two most important screening tests for CKD in routine clinical practice?

2. How many stages are used to classify CKD in clinical practice? 3. Chronic kidney disease often presents with loin pain in older patients? True or false

6. List 3 pillars of treatment that are used to slow the progression of CKD in 2023?

2024 & Retail Pharmacy Product Awards

OTC & Retail Pharmacy Product Awards 2024 One of the most eagerly anticipated events in the Irish retail calendar, Irish Pharmacy News OTC and Retail Pharmacy Product Awards are the only industry awards that specifically recognises and rewards the companies and their products within the OTC market. The OTC and Retail Pharmacy Product Awards act as a celebration and showcase of product innovation, marketing and value to its customer. Originally launched in 2008, they are designed to recognise product development and innovation in the pharmacy sector. OTC Market Overview Pharmacies remain by far the most important distribution channel for consumer health products in Ireland in value terms in 2023, with supermarkets placing a distant second. Despite increasing competition from other channels, it remains the first choice for most Irish people when buying several product types due to the wide assortments and professional advice available in these types of outlets. The total value of the Over the Counter (OTC) market in Ireland based on IQVIA’s data for the 12 months, May 2022 to April 2023, was ¤559 million. This market grew by 11.2% (value) & 7.3% (volume) when comparing yearon-year growth. Ireland General Manager for IQVIA Gwynne Morley notes, “As the world emerges from the pandemic, consumer trends such as rising awareness of the option to selfmedicate and interest in wellness continue to influence the market.”

“Currently, established models of commercial viability and brand fit continue to be applied in the consumer health industry, by contrast providers, health plans and other stakeholders are already turning to digital approaches to meet consumers’ evolving needs and expectations, improve patient engagement and experience, and drive loyalty.” Value of OTC Medicines Over the following pages, we showcase those products which have been shortlisted as finalists across categories, including Best Beauty Product, Best Product Marketing/Training Campaign, Best Baby Skincare Product, Best SPF/Tanning Product, Best Children and Baby Product, and much more. As pressure on hospitals and doctors in Ireland grows, so does the emphasis on the pharmacist as the first link in the healthcare chain. Pharmacy services, diagnostic testing and of course over-thecounter medicines and remedies now have a larger role to play than ever before. The pharmacy retail market has never been stronger.

chains. Product knowledge, education and marketing are factors that the retail pharmacist must develop a firm strategy for. The OTC Awards mark the standards of excellence and investment into product marketing that pharmacists use to add value to their customers.

All products entered will now be judged by an expert judging panel, which has been drawn from independent and multiple pharmacies across Ireland, during our official judging process. Make sure you catch the April issue of Irish Pharmacy News which will feature all of the winners.

With outside retailers and the buying power of symbol groups ever on the increase, innovation across the OTC market is crucial. With the rise of the internet as both a reference and shopping tool, consumers are now managing more and more ailments without the help of either doctor or pharmacist. However, the pharmacist does still have a key role to play in helping their customers make informed healthcare decisions. With a greater emphasis being placed on self-care and selfmedication, so is the emphasis placed on consumers and patients to ensure they select product that are safe and effective for their needs.

The OTC market is continuously faced with threats from large supermarkets and budget retail

“While the serious short-term trends still need to be tackled, its crucial to focus on the longer-term established trends that will shape the future of the consumer health market – especially in e-Commerce and digital innovation.

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Skincare by Sacha 2024 & Retail Pharmacy Product Awards

Skincare by Sacha is a beauty brand with a strong emphasis on delivering effective and palpable results through our SS89 products. Our brand is dedicated to using high-quality and expertly formulated ingredients suitable for all skin types. Our emphasis on skin-loving formulas shows our commitment to both the effectiveness and gentleness of our products.

Best Skincare Product

Our belief in beauty for all and the idea that everyone deserves to feel their most beautiful aligns with our brand’s mission to inspire confidence. We have collaborated with experts to create products that genuinely care for the skin and produce real results adding credibility to our brand’s commitment to quality.

Research has shown that many Irish consumers are heavily invested in their skin care routines, seeking products to make their skin look its best, particularly interested in preventing signs of ageing. There has been significant innovation within skin care in recent years, particularly within anti-ageing and multifunctional products.

Our overall message is one of inclusivity, confidence, and the pursuit of beauty through products that prioritise both effectiveness and skin health.

Due to Covid-19 there are some purchasing habits that have changed. Frequent handwashing and sanitisation can cause dryness, sensitivity and soreness which has led to an increasing number of people presenting to pharmacies with contact dermatitis. The Finalists in this Category are:

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Q+A Vitamin C Brightening Serum Q+A Vitamin C Brightening Serum is an antioxidant-rich serum formulated to boost radiance for an all-year-round glow. The hybrid formula is fast absorbing but still provides the hydration you’d expect from your favourite daily moisturiser to prime and prep your skin. Whilst Vitamin C can become unstable when exposed to sunlight, turning yellow in colour and reducing its effectiveness, Q+A uses a special encapsulation for a stable formula from first drop to the last! A Volcanic Soil encapsulation creates a barrier to protect Vitamin C from oxidising whilst seamlessly blending it with other ingredients for maximum benefit on every application. With an added boost of skinplumping Hyaluronic Acid, it’s ready to combat dull and lacklustre skin. In overview, Q+A is much loved by our online community of fans and customers alike, with an engaging audience on social media platforms including an abundance of support from influencer accounts organically and paid.

Elave Daily Skin Defence SPF45 Elave Daily Skin Defence SPF45 No.108 contains a unique combination of oil-free emollients to hydrate the skin, together with high UVA & UVB protection. The Invisible Zinc is absorbed quickly and the Vitamins B5 & E anti-oxidant enriched formula helps protect skin and repair environmental skin damage. Recommended for all skin types, including dry, sensitive, delicate & reactive skin. NO SULFATES, SLS, SOAP, PERFUME, MI, ALCOHOL, COLOURS & MORE. Sun protection factor SPF45 to protect skin every day from signs of UV exposure such as dark spots, roughness and loss of elasticity. • Enriched with Vitamins B5, C & E • Light, easy to use formula for use under makeup or without makeup • Oil-Free formula to prevent clogging of pores • Beneficial for all skin types even sensitive skin • Dermatologically approved & safety tested anti-irritation formula

Bio-Oil Skincare Oil Bio-Oil Skincare Oil was the first oil to be submitted to clinical trials and prove that it could improve the appearance of scars and stretch marks. Today, it is the world’s leading scars and stretch mark product, recommended by midwives and dermatologists. In clinical trials, after 8 weeks of use, 97% of participants saw an improvement in the appearance of stretch marks and 92% saw an improvement in the appearance of scars. The Skincare Oil contains the breakthrough PurCellin Oil for better absorption and includes a combination of plant extract oils like Chamomile, Lavender, Rosemary and Calendula carefully selected for their healing, anti-inflammatory and soothing benefits. It also includes Vitamin A & E to help improve uneven skin tone, ageing and dehydrated skin.

Neostrata 15% Vitamin C + PHA Serum Neostrata 15% Vitamin C + PHA Serum is a potent, brightening face serum powered by pure 15% Vitamin C (L-Ascorbic Acid) clinically proven to target the look of dark spots, fine lines and wrinkles and other signs of photoaging for skin that appears dramatically brighter, more even and youthful. A gold standard in Vitamin C serum, this unique powerhouse formula features four potent antioxidants (Vitamin C, Polyhydroxy Acid, Feverfew and Green Tea Extract) in every drop for brighter, more radiant skin in just one week. This lightweight and easy-to-absorb formula glides on smoothly and gives skin a boost of L-Ascorbic Acid (Pure Vitamin C), Feverfew Extract, Green Tea and Gluconolactone (Polyhydroxy Acid) to provide skin with antioxidant protection from external aggressors and oxidative stress, helping to diminish visible skin discolouration and even skin tone.

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2024 & Retail Pharmacy Product Awards

Best Women’s Product Health issues and care strategies for women’s health are far more wide-reaching than just pregnancy and gynaecology. Research has shown that increased global focus on women’s health disorders and an overall aging female population are helping to drive growth of the women’s health products over-the-counter.

IUB Ballerine®

Optibac For Women

The IUB™ Ballerine® is a novel intrauterine birth control device, representing a significant advancement in contraceptive technology. It comprises copper beads with a total exposed copper surface of 300mm2, strung on a flexible, PET-coated Nitinol frame. This unique construction allows the IUB™ Ballerine® to transform from a linear form inside a slender 3.2mm diameter insertion tube into a three-dimensional spherical shape once released into the uterus. A blue polypropylene tail thread is attached for easy detection and removal.

Optibac For Women is recognised as one of the best probiotics for intimate health. It is Optibac’s best-reviewed supplement, being highly recommended by complementary healthcare practitioners, top UK gynaecologists, and consumers alike.

The primary aim of the IUB™ Ballerine® is to strive to provide a safe, effective, and comfortable contraceptive option for women. It seeks to address common concerns associated with traditional intrauterine devices (IUDs), such as discomfort during insertion and the risk of malpositioning or perforation.

Today’s women are much more well informed with consumers leaning towards self-care and self-medication and thus the outlook has been witnessing a dramatic transformation in recent years. The Finalists in this Category are:

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This specialist supplement is designed specifically for the support of vaginal health. For Women contains highly researched strains of friendly probiotic bacteria, which are scientifically proven to reach the intimate area and complement the natural vaginal flora. Optibac For Women is recommended for anyone suffering with thrush, Cystitis or BV, and for anyone susceptible to these conditions wishing to maintain vaginal health on an ongoing basis. Ideal for women during all life stages, including menopause and beyond.

Cleanmarine® MenoMin® Cleanmarine® MenoMin® is ideal for Women over 40 years in Perimenopause and Menopause. This Irish Brand offers a unique all-in-one Omega 3, Phytonutrient and Vitamin blend, formulated specifically to give extra nutritional support for peri-menopausal and menopausal women. Cleanmarine® MenoMin® is rich in Omega-3 with Phospholipids, Vitamins B1, B2, B6, B12 and D3, as well as Rosemary Extract, Soy Isoflavones, Folate and Biotin. With Vitamin B6 to help regulate hormonal activity, biotin to help maintain normal mucous membranes, as well as Vitamin B2 to reduce tiredness and fatigue and Vitamin D to help maintain healthy normal bones, as well as the absorption and utilisation of calcium from the diet.

Multi-Gyn ActiGel

Utipro® Plus AF

Multi-Gyn ActiGel treats and prevents Bacterial Vaginosis (BV). This natural formula contains the patented 2-QR complex (a plant-based ingredient extracted from the Aloe Barbadensis plant) which neutralises harmful microbes by blocking their adhesion to human tissue thereby supporting the natural healing process and reducing infection. Multi-Mam ActiGel only removes bad microbes, hence protecting the vaginal microbiome and optimising vaginal pH.

Utipro® Plus AF, a new approach to the treatment of Uncomplicated Urinary Tract Infections. With a unique dual mode of action, it works simultaneously in the bladder and intestine to control and prevent urinary tract infections.

It has a prebiotic effect on the microbiota and reduces unpleasant odour and discharge, providing fast and direct relief.

Contains natural ingredients Xyloglucan-Gelose, which creates a protective film in the intestine while ingredients, Hibiscus & Propolis, acidify the urine in the bladder both reducing the growth of bacteria. Utipro Plus AF is available over the counter without prescription.

This synergistic formulation is ideal for women approaching the menopause who want to feel good every day. Cleanmarine® MenoMin® is reasonably priced at ¤29.99 inc VAT RRP, at ¤1 a day for the consumer.

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Matchstick Monkey 2024 & Retail Pharmacy Product Awards

Best Children and Baby Product Baby care and child-specific products have an important role to play in pharmacy particularly in Ireland as birth rates here are currently higher than the EU average. The birth rate in Ireland remains relatively high this year with 14.4 babies born per 1,000 residents compared to an average of 10.1 in the rest of the EU. By offering good advice from birth onwards, pharmacy teams can play a vital role in helping parents deal with the many self-limiting ailments that occur during childhood. These conditions range from colic to paediatric cold and flu. The Finalists in this Category are:

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Matchstick Monkey was born when new mum, Katie Windridge couldn’t find anything to ease her baby, Minnie’s teething pain. At just one-month-old, Minnie’s pain was constant. She wouldn’t settle and no one was getting much sleep. Minnie refused every teething toy, and Katie’s fingers hurt from being bitten when she tried to apply teething gel. After nursing yet another bleeding finger, Katie realised there had to be a better solution. Inspired by her daughter’s love of monkeys, the original designs for Matchstick Monkey were created. You can soothe your baby’s sore gums as well as care for their new teeth. Soft, safe teethers with a variety of textures. Ergonomically designed to help your baby hold from a young age. Features include: • Teething gel applicator – a fun soft textured teether • Toothbrush bumps soft and kind to baby’s gums • A hygienic approach to applying teething products • FDA approved food grade silicone • BPA free non-toxic and environment friendly • Made with BioCote® Antibacterial Protection • Dishwasher and steriliser safe and fridge friendly.

MAM Easy Start AntiColic 260ml Bottle

Calpol Vapour Plug & Nightlight

Sudocrem Antiseptic Healing Cream

The MAM Easy Start Anti-Colic 260ml Bottle is the ideal bottle for an easy switch between breast and bottle, thanks to the patented SkinSoftTM teat that is silky soft and provides a familiar feel for babies. Market Research confirmed that 94% of babies accepted the teat, making it perfect for when mum wants to be a bit more flexible*. (*Market Research 20092017, 2023, tested with 1508 babies).

Calpol has a range of products to treat the symptoms of a cold, not just the fever. For those night time sniffles…try Calpol Vapour Plug & Nightlight for a comfortable night’s sleep.

Trusted by families since 1931, Sudocrem Antiseptic Healing Cream has been parent’s simple, effective skin-care ally for over 90 years. Great for soothing and treating nappy rash symptoms, its gentle formulation is clinically proven to soothe and heal your baby’s delicate skin from birth. A truly versatile product, Sudocrem Antiseptic Healing Cream is a family favourite when it comes to their skincare needs.

The patented vented base of the MAM Easy Start Anti-Colic bottle ensures that babies can drink calmly and relax. The ventilation holes in the base, regulate pressure balance and airflow and as the bottle ventilates via the bottom, milk flows undisturbed without air bubbles, feeding without interruption. The result means no more air swallowing, more relaxed drinking, and more quiet nights. MAM engages in not only in-store displays and gondola end kits with partner pharmacies and grocery stores, but also tries to raise awareness of beneficial product USPs with the help of informative press drops, press releases in publications & digital mummy pages.

Calpol Vapour Plug & Nightlight is an electrical plug-in device suitable from 3 months plus. The device comes with 3 refill pads and further ones can be purchased in packs of 5 or 10. Refill pads emit a blend of Aromatic Oils, including lavender, chamomile, menthol, camphor and eucalyptus. The plug and refills help to clear and ease breathing and provides up to 8 hours night-time comfort relief. The nightlight emits a soft orange light to help comfort your child and aid a more restful sleep, also helping to guide you in the room so that you don’t disturb your sleeping child.

Sudocrem Antiseptic Healing Cream is licensed to treat a range of skin conditions including nappy rash, cuts & grazes, eczema, acne, minor burns, sunburn, bedsores & chilblains. Always read the label.

Calpol’s range of products is supported in store on a quarterly basis with a wide range of brand assets and POS materials provided.

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2024 & Retail Pharmacy Product Awards

Best Digestive Product Digestive remedies continue to experience stable demand due to a common diet that is high in sugar, fats, refined carbohydrates and low in fibre. As more consumers opt for fast food options and maintain poor diets, they will continue to reach for products that offer them fast relief from the resulting symptoms of heartburn and indigestion.

Udo’s Choice Ultimate Optibac Every Digestive Enzyme Day EXTRA Optibac Every Day EXTRA is an advanced Blend digestive supplement containing 20 billion Founder of the Udo’s Choice range, Udo Erasmus’ pioneering mission to change the health industry started in the 1980s. The Ultimate Digestive Enzyme Blend is designed to effectively address the most problematic digestive issues.

Udo’s Choice chose only plant-based enzymes for the digestive enzyme formula because animal-based enzymes are less effective, less versatile, and less sustainable. And, instead of packaging the digestive enzyme blends in plastic, they are packed in sustainable, recyclable glass. The Ultimate Digestive Enzyme Blend from Udo’s Choice is a unique blend of 7 plant-based digestive enzymes to assist in the breakdown of proteins, fats, carbohydrates, and fibre.

Before the pandemic, the digestive health sector benefited from consumer preferences shifting towards preventative health remedies. Digestive remedies benefited further from a small boost as stomach upset and diarrhoea were declared symptoms of Covid-19 and consumers bought preventative products. IBS, which is characterised by abdominal pain, excess gas and diarrhoea or constipation, is becoming a common gastrointestinal disorder in Ireland. The condition is predominantly seen in young and middle-aged females as women are twice as likely to experience IBS as men. The Finalists in this Category are:

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friendly bacteria, proven to reach the gut alive and support digestive health. Expertly formulated with high-quality probiotic strains, shown to support digestion, occasional bloating, immune and skin health, energy levels and well-being. Each easy-to-take capsule contains 4 extensively researched probiotic strains which naturally occur in the digestive tract, and target both the small (Lactobacillus) & large (Bifidobacterium) intestines. The probiotic strain combination includes Lactobacillus acidophilus NCFM®, the most researched acidophilus strain in the world, clinically trialled and shown to support immune health and overall digestion. Despite its powerful strength, this highly researched supplement is safe and suitable for use from the age of 4 years, including pregnant women and older people, in one convenient daily dose. The prebiotic-free formula is particularly suitable for low-FODMAP diets and those looking for a probiotic without added prebotics, such as IBS sufferers.

Alflorex®

DiaCare

Alflorex® Dual Action

Alflorex® is the leading probiotic for IBS, a condition that affects up to 1 in 7 people in Ireland every day. This probiotic is taken daily to manage and prevent recurrence of IBS symptoms. It costs approx. ¤1/day and reduces ALL of the symptoms of IBS including:

DiaCare is a unique oral electrolyte solution which contributes to electrolyte balance, normal digestion and absorption of water. Suitable for children 3+ and adults suffering from diarrhoea, fever or other conditions which can cause loss of body fluids. DiaCare a is scientifically balanced blend of glucose electrolytes, minerals and probiotic fibres (Lactobacillus Rhamnosus GG). An orange flavour food supplement which is suitable for vegans, gluten free, good for the gut and good for the stomach.

Alflorex® Dual Action is a unique combination of two PrecisionBiotic®® cultures (35624® and 1714 - Serenitas®. A clinical study confirmed the combination of the 35624® and 1714 Serenitas® strains were synergistic.

• abdominal pain • bloating & gas • unpredictable bowel movements like alternating diarrhoea and constipation The unique 35624® culture in Alflorex is a naturally occurring bacterial strain found in the human gut. This Bifidobacterium longum culture is part of the family of bacteria given by mother to baby at birth. The main long-term aim for Alflorex is to strive to have all IBS patients in Ireland take Alflorex for 1 month. The product conversion score is more than 80% (continued usage) and with a high percentage of this group needing direction and treatment we believe Alflorex can change their lives.

It contains Magnesium which contributes to electrolyte balance. DiaCare contains Chloride which contributes to normal digestion by production of hydrochloric acid in the stomach. Carbohydrate electrolyte solutions enhance the absorption of water during physical exercise. Suitable for vegans, gluten free, good for the gut, good for the stomach, for adults and children, suitable for ages 3+ years, exercise support, orange flavour.

This product was developed in line with Rome IV criteria, which now defines Irritable Bowel Syndrome (IBS) as a ‘disorder of gut-brain interactions’. Two individual strains, two different modes of action both targeting key mechanisms in IBS together, this specific combination of strains targets the gut-brain axis and helps manage both the gut and psychological symptoms associated with Irritable Bowel Syndrome (IBS). Alflorex® Dual Action also contains selected B vitamins, vitamin B6 and pantothenic acid, to reduce tiredness and fatigue* and contains calcium to support normal digestion*

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Zest Active 2024 & Retail Pharmacy Product Awards

Best VMS Product Increasing numbers of people are taking a proactive approach to their health and the wellbeing trend is sweeping the nation. Keeping up with consumers or even getting a bit ahead of their desires is the name of the game. In the ever-changing and extremely fickle vitamins, minerals and supplements (VMS) category, it is even more vital to stay on pace or ahead of the curve with those visiting their local pharmacy.

Zest Active is an innovative super supplement from Irish Supplement company Revive Active. Zest Active is scientifically formulated with 25 active ingredients including vitamins, minerals, amino acids and Beta Glucans, all carefully selected to support energy, the immune system, brain, and muscle function. Each sachet contains a range of B Vitamins (Riboflavin (B2), Niacin (B3), Pantothenic Acid (B5), B6, Folate, B12 which ensures that Zest Active contributes to a normal energy-yielding metabolism. It contains a natural sweetener, steviol glycosides and is suitable for vegetarian, vegan, diabetic, and gluten free diets and is Halal certified. Zest Active contains no caffeine, binders or fillers. With a refreshing orange flavored blend, Zest Active delivers the daily nutrients you need, to help you unlock your true potential.

According to latest market research reports, vitamins sales are expected to continue growing as consumers increasingly look towards preventative measures over cures. A growing number of consumers are expected to monitor their health through blood tests, which will result in greater awareness of vitamin and other deficiencies. The Finalists in this Category are:

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One Nutrition Ashwagandha One Nutrition Ashwagandha contains a unique blend of organic KSM-66® ashwagandha root extract (600mg per 2 capsules), the highest concentration full spectrum ashwagandha on the market, along with the added benefits of magnesium and zinc*. This vegan supplement is designed to support normal cognitive function and to protect cells from oxidative stress. Formulated in Ireland, One Nutrition premium, high potency nutritional products have been designed to support overall wellbeing, immunity and energy. Good health is at our core. Life is busy enough, so we make good nutrition easy. We use ethically sourced functional ingredients that are rigorously tested and organic where possible. We also look after the environment - our products come in recyclable amber glass and cardboard packaging.

Dextro Zero Calories

O.R.S Hydration Tablets

Vivio Junior Multivitamin

Dextro Zero Calories Carbohydrate-free° electrolyte drink in effervescent tablet form with the five essential electrolytes: sodium, magnesium, calcium, potassium and chloride for fast mineral absorption, especially for shorter training sessions and when carbohydrate intake is not absolutely necessary.

O.R.S Hydration Tablets, developed by pharmacists, are formulated to follow World Health Organisation oral rehydration solution guidelines and suitable for adults and kids. The mix of electrolytes combined with a low-calorie dose of glucose (17.2 kcal) is not only proven to be the fastest way to restore a healthy level of hydration, it also keeps you hydrated for longer than water alone. Containing a balanced combination of glucose, salts and electrolytes O.R.S Hydration tablets are effective in restoring lost fluids during sport, in hot climates, when feeling unwell or during the consumption of alcohol.

Vivio Junior is a delicious-tasting multivitamin tonic suitable from 1 year+ and specifically formulated in accordance with the latest research and nutrient guidelines for children. It is packed with all 12 vitamins loved before, including Vitamin D, C and B12 but with increased levels of zinc and added iodine to support growth in children, their immune system, and cognitive function.

Fat free, Gluten free, Lactose free, Vegan, Vegetarian, Sugar free. Available in 2 Flavours: Orange and Lime, 20 tablets per tube. RSP ¤7.99

O.R.S Hydration is the fastest proven way to restore a healthy hydration level for everyone.

What makes it unique is it is jam-packed with 12 vitamins and 2 minerals, all suitable from 1year+ with a delicious orange taste. It is gluten and lactose free, no added sugar and does not need to be refrigerated. In-store support includes strong window displays (window stickers, dummy boxes, posters, push/pull door stickers) shelf edges, staff training, a product detail wall chart, branded Height chart for kids to measure their height.

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Wellbaby Multi-vitamin Liquid 2024 & Retail Pharmacy Product Awards

Best Baby and Children’s Supplement Vitamins, minerals and supplements (VMS) have always been an important category in the pharmacy. Growing children, especially those who don’t eat a varied diet, sometimes don’t get enough vitamins A and C. It can also be difficult to get enough vitamin D through food alone for them. Children’s vitamins, alongside a healthy balanced diet, can help to make sure babies and children are getting everything they need to prevent vitamin deficiencies and stay healthy. The Finalists in this Category are:

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This is a carefully balanced supplement for babies and infants. From the makers of Pregnacare, Wellbaby Multi-vitamin Liquid is ideal for babies and young children from 6 months to 4 years to provide a carefully balanced, comprehensive range of 14 essential vitamins and minerals. Wellbaby Multi-vitamin Liquid formula includes vitamins A, C and D. Wellbaby Multi-vitamin Liquid provides an ideal nutritional safeguard during a time when babies and infants have a high nutrient requirement in relation to body size, to support their rapid physical growth and development of bones, muscles, blood and the brain. Key nutrients include iron, which contributes to normal cognitive development, and 10 µg vitamin D, which is needed for normal growth and development of bone in children. Vitamin D also contributes to their normal immune system function.

Optibac Babies & Children Optibac Babies & Children is a premium probiotic for digestive health and wellbeing, expertly formulated with 3 high-quality friendly bacteria strains – including Lactobacillus rhamnosus GG, the world’s most scientifically studied strain. This comprehensive supplement also contains added Vitamin D3 to maintain immune health and prebiotic FOS fibres to increase natural gut bacteria, offering little ones high-quality gut and immune support. This flavourless sachet probiotic is easyto-take and suitable for babies, toddlers and children aged 0-12 years. Created by the brand most trusted by parents*, Optibac Babies & Children can be mixed into your child’s favourite cool, non-acidic foods or drinks for a more natural way to support daily gut and immune health for little ones.

Colief Infant Drops

Eskimo-3 Kids

Colief Infant Drops have been trusted by mums and healthcare professionals for over 25 years as a natural remedy for infant colic. Suitable from birth, Colief Infant Drops are completely natural and help break down the lactose in milk into simpler sugars, glucose and galactose, making it easier for baby to digest milk whilst reducing discomfort.

Eskimo-3 Kids provides optimised levels of Omega-3 fatty acids EPA and DHA, Omega-6 and Omega-9, contributing to normal brain function, vision and heart health. ⁣The formula is packed with omega-3 DHA to support brain function, concentration and vision, while omega-6 helps to keep your mood more balanced.

The drops contain the naturally occurring enzyme lactase which helps relieve colic symptoms caused by temporary lactose intolerance – common in many babies as their digestive systems develop. Adding a few drops to infant formula or mum’s expressed breast milk helps to break down the lactose in the milk, making it easier to digest.

Eskimo-3 Kids also contains Vitamin D which supports healthy teeth, bones and muscles, as well as a strong immune system, all important for growing children.⁣ Eskimo-3 kids is available in either liquid (tutti frutti or orange flavour) or as an orange chewable. The delicious orange or tutti frutti liquid can be taken directly off the spoon or added to smoothies, yoghurt, juice or food for an extra brain boost. The Eskimo-3 Kids chewables are a tasty orange flavour which children absolutely love. Eskimo3.ie

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2024 & Retail Pharmacy Product Awards

Best Pain Relief Product The rise in self-medication recently is one of the major drivers of market expansion in the pain relief area. The market is expanding as a result of more people moving from prescription to over-the-counter medications due to lower costs and an increase in OTC medicine approvals from regulatory bodies. The industry is expanding due to the accessibility and affordability of OTC products as well. Customers in Ireland have shown a growing preference for over-thecounter analgesics for the relief of pain and fever. This preference can be attributed to the convenience and accessibility of these products. One of the unique factors influencing the Analgesics market in Ireland is the country’s aging population. Ireland has one of the highest proportions of elderly individuals in Europe, and this demographic is more likely to experience chronic pain and require analgesics.

Brupro Max 400mgx24 Panadol Extra Soluble Brupro Max 400mg Film-coated tablets work where they’re needed - at the site of pain. They relieve pain, reduce inflammation and lower temperature. Brupro Max provides fast and effective relief from: • headaches • muscular pain • dental pain • cold and flu symptoms • period pain • fever • backache The Brupro brand is marketed by Rowex Ltd., based in West Cork, Ireland. In 2016, the product was ranked 193rd in IPN OTC BEST SELLING PRODUCTS IN IRELAND. We fast to 2023 and Brupro Max 400mg x 24 was ranked 13th in the IPN’s OTC TOP 100 products.

The Finalists in this Category are:

Calpol Infant Suspension Calpol is Ireland’s Number 1 Paediatric Pain Brand (based on IMS units, IMS/Nielsen Value), trusted by HCPs for over 45 years. It is specially formulated for children and gets to work on fever in 15 minutes. It is suitable from 2 months plus, gentle on tummies (can be used with an upset stomach) and kids love the taste. Calpol Infant range is available in Original and Sugar Free Formulations in 60ml and 140ml size. Dosing syringe is included and is strawberry flavoured. Calpol Six Plus Suspension range is available in Original (orange flavour) and Sugar Free (strawberry flavour) in 60ml and 140ml sizes and is suitable from age 6. Calpol Six Plus Fastmelts are a strawberry flavour tablet that melt in the mouth – no water needed. Calpol is heavily supported in-store quarterly with brand assets and POS materials provided.

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Panadol is Made and Trusted in Ireland. Panadol Extra Soluble is indicated against 5 types of tough pain, only available in pharmacies, and contains a second active ingredient (caffeine), that amplifies the analgesic effect of paracetamol, making it more powerful than standard paracetamol tablets. So, when you’ve got a headache you can count on Panadol Extra Soluble to deliver powerful, effective relief. And it’s gentle on your stomach, too. Panadol Extra Soluble is also effective in treating backache, rheumatic pains and muscle pains, period pains, and toothache.

2024 & Retail Pharmacy Product Awards

Best Self-Testing Product Medicare Non-Contact Infrared Thermometer

SURESIGN Urinary Tract Infection Test

Medicare’s Non-Contact Infrared Thermometer is a fast, accurate thermometer with convenient features to help you monitor temperature with ease. The 3-in-1 measurement for body, surface and room temperature makes it ideal for managing temperatures around your home for babies and children. It operates without the need for direct skin contact, measuring from a distance of 3-5cm. The device includes a convenient fever alarm for easy identification of elevated temperatures. Its large color-coded backlit display enhances visibility, while the inclusion of 32 memory sets allows users to track and monitor temperature trends over time. Additionally, the thermometer offers versatility with a switchable °C/°F option and emits a beep at the end of each measurement. The practical storage box provides convenient storage, and users can recalibrate the device as needed. A low battery indicator adds to the functionality, and the thermometer comes with a 1-year warranty for added assurance.

Urinary tract infections (UTI’s) affect the urinary tract, including the bladder(cystitis), urethra (urethritis) or kidneys (kidney infection). UTI’s may be treated with antibiotics, but they are not always required. This is where SURESIGN UTI test is appropriate and can assist with antibiotic overprescribing. A 24-hour customer service telephone number is included on all SURESIGN branded retail packaging assisting the end consumer with any queries they may have regarding any product. Launched in June 2021 the SURESIGN UTI has three individually foil wrapped tests and is now one of CIGA Healthcare’s best sellers.

A rapidly increasing number of global consumers are taking greater interest in and control of their personal health and wellbeing. A recent Global Health & Wellness Study of 17 Markets carried out by NielsenIQ reported 48% of global consumers regularly make proactive health and wellness choices and these health-conscious consumers are driving the phenomenal growth of the over-the-counter home diagnostics market. The home care and testing market is enabling consumers to gain greater control over their everyday wellbeing. Test kits conveniently and affordably purchased over-the-counter or online provide rapid results without the need for traditional referrals and, in many cases, laboratories.

The Finalists in this Category are:

CONTOUR®NEXT Blood Glucose Meter The CONTOUR®NEXT blood glucose meter is the most used meter in Ireland; with the team behind the brand focused on quality products, improving patient lives and empowering selfmanagement along with providing top class support and education for pharmacists. The CONTOUR®NEXT is an easy-to-use system:  Easy to read: Big numbers on display.  Easy to use: Large rubber buttons.  No initial set up.  Personalised target ranges with averages on the meter. The unique smartLIGHT® feature makes it quicker and easier to interpret blood glucose readings using coloured lights that clearly identify if the reading is above, within or below your target range. CONTOUR®NEXT (connected) has a 60 second count down screen that provides patients the opportunity to apply more blood to the same strip if the first sample is insufficient.

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Riemann P20 Urban Shield 2024 & Retail Pharmacy Product Awards

Best SPF/Tanning Product There has been a noticeable rise in ‘beauty’ claims in suncare NPD, such as moisturising/hydrating claims, meaning brands are meeting consumer demand for products that can be seamlessly incorporated into daily routines. These trends reflect a shift toward aesthetics in the category, emphasising the importance of multifunctional products that provide both protection and beauty benefits. Sun protection products have seen a surge in demand in Ireland due to the high UV index and increased awareness about skin cancer prevention. In Ireland, the revenue generated in the Sun Protection market amounted to ¤41.71m in 2024. It is projected to experience an annual growth rate of 2.65% (CAGR 2024-2028). Consumer patterns in the European region shows a significant shift from natural tanning in recent years, particularly in areas where ozone depletion can be a subject of major concern. Consumer awareness of the sun’s harmful effects in specific countries, as well as an increase in the number of skin cancer cases in areas with significant ozone depletion, are two key factors that have sparked significant interest in self-tanning products among market players and customers. The Finalists in this Category are:

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The brand-new Riemann P20 Urban Shield protects the face and neck from UV-induced skin damage and premature skin aging. This broad-spectrum sunscreen also offers an extra layer of protection against pollution, shielding the skin from smog and dust. The sunscreen contains antioxidants that help reduce free radicals in the skin, which can cause the breakdown of the collagen structure and premature aging of the skin. As UV-rays and pollution are daily aggressors that can cause skin damages, a combination of our unique high-performance sunscreen and antipollution protection is a great match and will work as your daily skin guardian. The formula is fast absorbing, tested to be safe to use around the eyes, noncomedogenic, and is suitable for wear under make-up. It features our Triple Protection Technology that provides up to 10 hours of protection, twice the EU’s required UVA protection, and is very water resistant. P20’s Urban Shield is dermatologically tested for sensitive skin, fragrance-free, and vegan.

Elave Sun SPF30 Elave Sun SPF30 is an allergen-free, high daily UVA and UVB protection system that is EU compliant and, if used as directed, prevents long term sun damage of the skin. If used as directed below and with other sun protection measures Elave Sun SPF30 decreases the risk of skin cancer and early skin ageing caused by the sun and absorbs 97% of UVB radiation that causes sunburn. • Available in 200ml and 100ml travel friendly pack • Suitable for use on eczema/dermatitis prone and sun-sensitive skin • Water-resistant, broad spectrum UVA/UVB SPF30 sun protection • Enriched with naturally soothing and nourishing botanical extracts • Paediatrician approved and suitable from newborn onwards • With Vitamin’s B5, C & E to protect against environmental damage • Lightweight, oil-free formula prevents clogging of pores • Beneficial for all skin types even sensitive skin

NUXE Tanning Sun Oil High Protection SPF 50 This SPF50 Tanning Sun Oil protects the face and body from the sun’s rays while contributing to respect the marine environment. Its patented filtering complex** provides wide-spectrum UVA/ UVB protection and prevents premature photo-aging of the skin. Rapidly absorbed with no residual oily film, its irresistible texture nourishes the skin and enhances the tan with a beautiful satin finish. Skin is enveloped in an evocative holiday scent with notes of Sweet Orange, Tiare Flower and Vanilla. A real invitation to savour that summer feeling. NUXE Tanning Sun Oil High Protection SPF 50 face and body (150 ml, ¤26)

Bare by Vogue Clear Tan Water The Clear Tan Water applies with no colour guide, then gradually develops into a natural looking tan. Whether you’re a seasoned tanner or new to the self-tanning world, Clear Tan Water works for both. The water-based formula and its skin-loving ingredients ensure your skin is drenched in hydration, making the tan effortless to apply and easily glide across the skin. Completely undetectable - wear this during the day and within 4-8 hours you’ll be greeted with a beautiful golden tan that doesn’t need to be rinsed off. It is lightweight, non-sticky and incredibly easy to use - meaning a streak-free application every time.

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2024 & Retail Pharmacy Product Awards

Best Pregnancy/ Fertility Product Community pharmacy is often the starting point for many when it comes to fertility and pregnancy. Infertility is a public health concern and as such, utilisation of pregnancy and fertility services is prevalent, and the role of the pharmacist and the wider pharmacy team. Pharmacists can assist customers by providing education on infertility causes, referrals, nonpharmacologic and pharmacologic management options, and the OTC options. For those trying for a baby, there are some essentials that can really help to support them.

Pregnacare Max

SURESIGN 6 day Pregnacare Max is the ultimate pregnancy early twin midstream support in the Pregnacare range. Specially formulated by experts to be pregnancy test our most optimal and comprehensive pregnancy supplement - ideal for mumsto-be who want the maximum nutritional support during pregnancy.

• Innovative formula with 21 vitamins and minerals, plus Omega-3 • Includes the recommended 400μg folic acid incorporating the advanced form L-Methylfolate and 10μg vitamin D • Also includes 500mg calcium to help maintain normal bones and teeth • Capsules provide Omega-3 fatty acids 300mg DHA and 60mg EPA. RSP ¤44.99

The Finalists in this Category are:

Proceive® Trimester 1 Proceive® Trimester 1 is designed to support mother and baby with optimal nutrition levels during the first trimester. For mother nutrients support the regulation of hormonal activity, energy levels and reduce tiredness and fatigue. While for baby this is a time of rapid growth, nutrients focus on cell division, neural tube development and bone development. The Proceive team goal is to provide the most functional, innovative products to customers, as such they are continually reviewing the latest scientific research. With their latest update, they have further improved the bioavailability of a number of nutrients and certified the Proceive® Pregnancy range as Vegan. Proceive Trimester 1 is a comprehensive, scientifically formulated pregnancy supplement tailored for weeks 0-12 of pregnancy. For mother nutrients focus on the regulation of hormonal activity, energy support as well as tiredness and fatigue. While for baby this is a time of rapid growth, nutrients focus on cell division, neural tube development and bone development.

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SURESIGN 6 day early twin midstream pregnancy test detects elevated levels of the pregnancy hormone, HCG, in the urine. HCG occurs naturally in the women’s body but will increase greatly if an egg is fertilised, resulting in pregnancy. Due to the high sensitivity of this test it can be carried out as early as 6 days prior to a missed period. A 24-hour customer service telephone number is included on all SURESIGN branded retail packaging assisting the end consumer with any queries they may have regarding any product. Retail boxes can also be placed horizontally or vertically to minimise or maximise space accordingly.

2024 & Retail Pharmacy Product Awards

Best Eye Care Product MACU-SAVE

Visionace

MACU-SAVE contains clinically proven ingredients to enhance the quality of vision and visual performance. All of the three macular carotenoids in MACU-SAVE are of the highest quality grade and are harvested from the marigold plant Tagetes Erecta. MACU-SAVE contains FloraGlo Lutein, and OPTISHARP Natural Zeaxanthin. With the added benefit of Vitamin B2 which contributes to the maintenance of normal vision. Plus Vitamin E which contributes to the protection of cells from oxidative stress.

Visionace is a comprehensive multivitamin specially formulated to support normal vision

MACU-SAVE provides layers of protection. Lutein and Zeaxanthin are powerful antioxidants that work like internal sunglasses, protecting the macula from the damaging effects of blue light and oxidative stress.

• Includes 23 nutrients including Bilberry extract and betacarotene • Contains vitamins A and B2, plus zinc which contribute to the maintenance of normal vision • Recommended by leading UK optometrists and eye care specialists, and independently tested in a clinical trial. RSP ¤17.00

The Eye Care market in Ireland has been experiencing significant growth in recent years. Customer preferences have shifted towards more advanced and specialised eye care products and services. This trend can be attributed to several factors, including increased awareness about eye health, technological advancements in the industry, and changing demographics. Customers in Ireland are becoming increasingly conscious about their eye health and are seeking out products and services that cater to their specific needs. There is a growing demand for specialized eye care solutions which can be attributed to the rising prevalence of vision problems and the aging population in Ireland. The Finalists in this Category are:

HYLO-FORTE® HYLO-FORTE® is an eye-drop that provides intense lubrication and long-lasting relief from symptoms of dry eye disease. HYLO-FORTE® contains 0.2% sodium hyaluronate (SH) and provides patients with a preservative free & phosphate free formulation that is gentle on sensitive eyes. It is contact lens compatible making it convenient for patients and remains sterile for up to 6 months once opened. It is suitable for adults and children of all ages and can be used during pregnancy and breastfeeding. HYLO-FORTE®’ consists of high molecular weight, long chain Sodium Hyaluronate. As a result, HYLO-FORTE® displays a higher viscosity profile and is over three times more viscous than other 0.2% sodium hyaluronate eye drops on the market (Data on file). This profile offers continued long lasting relief for patients suffering with dry eye. HYLO-FORTE® uses an airless application system called the COMOD® (COntinuous MOno Dose) system. The innovative COMOD® bottle delivers one calibrated drop for every click via a pump action mechanism.

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2024 & Retail Pharmacy Product Awards

Best Natural Product More and more consumers are in search of natural solutions to their ailments, including both homeopathic remedies and supplements supportive of a healthier lifestyle. Driven by consumer interest in all things natural, the market for natural products available over-the-counter has increased over the last number of years. Consumers are purchasing these for both prevention and immune boosting properties as well as to help aid healing when they are sick.

fabÜ MENO & PERI

Cys-Control FORT

fabÜ SHROOMS MENO & PERI is unique supplement with seven active ingredients. It is based on the concentrated extract of the functional, edible mushroom Lion’s Mane, blended with Vitamin D, Vitamin K2, Vitamin B6, Vitamin B12, Magnesium and Chromium tailored specifically to support a woman’s journey through perimenopause and menopause. This blend was expertly formulated by Laura Dowling, Fabulous Pharmacist, after years of research and development and many more years of listening to women coming into the pharmacy everyday looking for extra support. It is trusted by hundreds of thousands of women across Ireland. Lion’s Mane mushroom, is long revered in ancient practices and eaten around the world. It has been used traditionally in Asia to support women through perimenopause and menopause. This edible mushroom is carefully blended with premium grade vitamins and minerals. Simple & Safe Usage: Just two mushroom capsules daily with water. Designed with your convenience and safety in mind, our mushroom supplement is the hassle-free solution to support your journey through perimenopause and menopause.

Cys-Control FORT is a 100% vegetal solution, to be used at the first signs of urinary discomfort, to alleviate symptoms and promote urinary comfort, while preserving the balance of the microbiota. It combats urinary problems, without harming the body. Cys-Control FORT is safe to use during pregnancy and while breast feeding. Sachets can be used to treat a current infection with a complimentary preventative product available to thereafter. Cys-Control FORT is unique 100% natural and effective product against recurrent cystitis which safe to use during pregnancy and while breast feeding, thanks to the complementary action of Cranberry and D-Mannose on both types of E. coli pili: • A double anti-adhesion effect thanks to the fixation of D-mannose on type 1 pili and Cranberry PACs on P pili • Most effective quantity of D-Mannose (2 g) and Cranberry (36 mg of PACs), proved by scientific testing

The Finalists in this Category are:

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BioGaia Baby Drops

Solgar Ultimate Calm

BioGaia Baby Drops are a trusted probiotic solution for your little one’s digestive health. Specially formulated for infants, these drops contain clinically proven Lactobacillus reuteri DSM17938, a friendly bacterium that promotes a balanced gut flora.

Designed for relaxation and mental wellbeing, Solgar® Ultimate Calm combines two scientifically studied plant-based ingredients, Ashwagandha KSM-66® and affron® Saffron, to create a convenient one-a-day formulation which can help balance a worried mind and promote a positive mood.

Easy to administer, the drops can be added to breast milk, formula, or food. BioGaia’s probiotics aid in reducing colic, regurgitation, wind and gut discomfort, fostering a happy tummy for your baby. With no artificial flavors or colours, these drops provide a natural and safe way to support your baby’s developing digestive system. Ensure a healthy start for your little one with BioGaia Baby Drops.

Super Natural Activity Pre and Probiotic Spritz Super Natural Activity Pre and Probiotic Spritz is pH balanced prebiotics and probiotics to help maintain skin immunity. Infused with frankincense, lavender and sweet orange.

Rooted in the tradition of Ayurveda, Ashwagandha is celebrated for its adaptogenic properties, promoting mindfulness and calm, whilst affron® Saffron is scientifically shown to support a positive mood and emotional wellbeing. This unique formula is ideal for adults who occasionally feel overwhelmed or under pressure. It’s gluten, wheat, dairy, soya and yeast-free and is vegetarian-friendly.

Prebiotics and Probiotics protect against bacterial pathogenic invasion that can cause skin irritation in the form of rashes, breakouts, dry skin and other irritations. For skin prone to acne, inflammation or Rosacea, this product will promote healing and strengthen the skin’s immune responses helping to reduce flare ups. Boosting skin immunity results in healthier skin and reduction in damage and premature ageing. It is made with plant waters and extracts and is vegan, cruelty free and packaged in eco friendly, highly recyclable aluminium.

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2024 & Retail Pharmacy Product Awards

Best Marketing/Training Campaign Effective marketing & training campaigns have a way of sticking with people, because they make companies memorable. They promote a focused effort that guides consumers towards a desired action. They also give brands identity and personality. Marketing and training campaigns are the perfect way to reach customers, clients, and leads. They can be the game-changing move. Producing campaigns with a series of touchpoints will grab someone’s attention better than a single advertisement. With a need to break through the clutter when promoting a product, an effective marketing and/or training campaign can do that for you. The Finalists in this Category are:

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Solpa Cold & Flu Multi Relief In September 2023, Perrigo launched an exciting new product into the Cold and Flu market, Solpa Cold & Flu Multi Relief, available in both Capsules and Sachets. This is a new product launch with a difference; a unique triple active formulation to Relieve All cold and flu symptoms. Now it’s time to differentiate and satisfy a large cohort of consumers looking for an effective solution to Relieve All cold and flu symptoms; stemming from a brand strongly associated with fast acting, effective and long-lasting relief. ‘When I’m suffering from a cold or flu, I experience many different symptoms; aches, pains, fever, cough, swelling…all leave me feeling miserable. I wish there was an easy solution, strong enough to tackle all my symptoms to help me get on with my life.’ Introducing, NEW Solpa Cold & Flu. We’re simplifying the consumer offering with one solution for All cold and flu symptoms. We’re bringing a leading adult pain brand, Solpa-Extra, to cold and flu with triple active ingredients that Relieves All cold and flu symptoms.

Bronchostop 5in1

HYLO® & OPTASE®

The cough category has not developed the same way as other categories, there are a lot of single indication SKUs; dry cough, chesty cough cluttering the category. While this may be beneficial for other categories it doesn’t apply to cough as coughs tend to change during the cycle; start with a sore throat which then becomes a dry cough and then a chesty cough.

Scope is a trusted supplier of both HYLO® & OPTASE® eyecare brands which are used in the management of Dry Eye Disease, Blepharitis and Meibomian Gland Dysfunction (MGD). Scope recently partnered up with totalhealth pharmacy to pilot an eyecare category marketing campaign focused on bringing eyecare products from behind the dispensing counter out to the shop floor. This will allow self-selecting customers to better understand what eye drop they need to treat their mild, moderate or severe Dry Eye symptoms.

72% of people don’t know what type of cough they have. Introducing, NEW Broncho 5in1 Multi-Symptom Action Syrup for all coughs associated with a cold to relieve: dry cough, chesty cough, sore throat, hoarseness and throat dryness. We lent on the successes of Bronchostop (THR) and Bronchostop Junior (MD) to develop a product that not only targets cough but sore throats; often the first sign of a cough.

This campaign gave this usually ‘hidden’ category a new lease of life and a prime position within the store with features like a revolving eye and lit up shelves.

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Elave Baby Bath 400ml ECOCERT Organic 2024 & Retail Pharmacy Product Awards

Best Baby Skincare Product Irish parents increasingly invest in their children’s health focusing on using preventative measures to strengthen their children’s immune systems and overall health, according to the latest market research. Product innovation, attractive packaging, impact to the customer, unique selling point, and manufacturer support are all important if a baby product is to be successful in an already saturated marketplace. Consumers are very much concerned not only about what they feed to their baby but are also equally concerned about what they are applying on their baby’s skin. People prefer products which are chemical free and full of natural/organic ingredients for their children. Millennial parents are much more concerned about the ingredients that are being used in the baby skin care products.

The Finalists in this Category are:

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Elave Sensitive Baby Bath [Ecocert Organic] is a clinically tested extremely gentle cleanser enriched with Organic Camomile and Organic Aloe Vera to protect and hydrate baby’s delicate skin. Natural and Organic certified by ECOCERT - 99% of the total ingredients are from natural origin and 20% of the total ingredients are from Organic farming. • Suitable for use on eczema/dermatitis prone skin • Paediatrician approved & suitable from newborn onwards • Clinically proven to be kind and mild to baby’s sensitive skin, protecting against dryness and flaking • Dermatologically approved & safety tested • Anti-irritation formula gently cleanses delicate skin Natural and Organic Cosmetic certified by Ecocert Greenlife according to Ecocert standard available at http://cosmetics.ecocert.com.

Sudocrem Antiseptic Healing Cream Trusted by families since 1931, Sudocrem Antiseptic Healing Cream has been parent’s simple, effective skin-care ally for over 90 years. Great for soothing and treating nappy rash symptoms, its gentle formulation is clinically proven to soothe and heal your baby’s delicate skin from birth. A truly versatile product, Sudocrem Antiseptic Healing Cream is a family favourite when it comes to their skincare needs. Sudocrem Antiseptic Healing Cream is licensed to treat a range of skin conditions including nappy rash, cuts & grazes, eczema, acne, minor burns, sunburn, bedsores & chilblains. Always read the label.

Attitude Baby Leaves ATTITUDE is a Canada-based company that develops natural personal care products to promote healthy living. The team behind this brand believe in living consciously. In creating and using products that are kinder to bodies and the planet. They believe in being the change they want to see in the World. Attitude Baby Leaves 2 in 1 Shampoo & Body Wash along with all the Attitude products are • Crafted with natural, hypoallergenic, dermatologically-tested and EWG VERIFIED™ ingredients. • Adhering to highest quality and ecoconscious standards. • 100% vegan, cruelty-free, and certified by PETA and ECOLOGO. The Attitude Baby Leaves range of products go above and beyond any other brand on the Irish market to ensure that their products don’t contain any ingredients of concern and are sustainable sourced making them safer for the environment. Attitude believe in clean products, less plastic and more trees.

Child’s Farm Baby OatDerma Moisturiser Child’s Farm Baby OatDerma Moisturiser is formulated to hydrate and moisturise even the most sensitive dry and itchy skin. Packed with the goodness of oats, colloidal oatmeal is rich in beta-glucan and avenanthramides which are clinically proven to help soothe and gently nourish the natural balance of delicate skin. • created for dry & itchy skin • colloidal oatmeal, rich in beta-glucan and avenanthramides, is clinically proven to help soothe and nourish skin • natural shea butter to nourish and hydrate skin • free from parabens, phthalates, artificial colours and dyes, petroleum, formaldehyde • wrapped in our happy skin promise™ as best for your little ones

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Sacha Day & Night Hydration 2024 & Retail Pharmacy Product Awards

Best Beauty Product The beauty industry is fastmoving and highly saturated. Understanding changing consumer opinions and the behavioural indicators behind global trends is integral to securing the success of any company or brand within the space.

Sacha’s Moisturiser is a potent daily renewal for the face that goes beyond the ordinary to provide skin with a multitude of benefits. The formula is thoughtfully crafted to be suitable for all skin types, ensuring that everyone can enjoy the benefits of radiant, youthful, and revitalized skin. Elevate the skincare experience with Sacha. Day and Night Hydration Formula—because every moment is an opportunity to let beauty shine.

King Hair & Beauty Miracle Mist 7 in 1 Spray King Hair & Beauty is a homegrown Irish Company and is a work of passion for Founder and CEO Samantha King.

Key Features:

Guaranteed to leave you with a glasslike sheen without the fuss. The Miracle Mist 7 in 1 spray with its fine nozzle technology creates the ideal mist for even application. The multi-use mist acts as a leave in conditioner, thermal protector, adds hydration and nutrition, prevents frizz, refreshes hair and leaves you with an intense shine without the fuss.

1. Lifting and Firming Support

RSP ¤19.95.

2. Increased Tone, Suppleness and Tightness 3. Revitalises the Complexion 4. Indulgent Firming Care

Last year, consumer spending on colour cosmetics is starting to increase, regaining the value lost over the previous years. In 2022, 53% of global consumers claim to prefer a natural or no make-up style, seeking to achieve a clean, fresh, and healthy look with the make-up products they use every day. Originating in K-beauty, dewy and glassy skin has been a key trend, prompting the adoption of “your skin but better” products. As attitudes change, the definition of beauty is becoming more blended with wellness, and as such, beauty brands are under increasing pressure to promote skin health. The Finalists in this Category are:

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Beauty Complex Beauty Complex is a unique and innovative super supplement from Irish Supplement company Revive Active. Beauty Complex contains a distinctive combination of eight active ingredients including Marine Collagen, Phytoceramides, Hyaluronic Acid and Biotin. It was designed by experts to compensate for declining collagen, ceramides and hyaluronic acid in the body. The type of collagen used in Beauty Complex is Collagen Peptides. These peptides are derived from a 100% natural source, containing more than 97% protein and are the same as the collagen found in our skin and bones. Their hydrolysed form makes them more easily digestible. The key is the combination of ingredients delivered in optimal quantities that provide synergistic effects. This results in consumers really noticing a difference in their skin, hair and nails.

King Hair & Beauty Bye Bye Baby Hairs CEO of King Hair & Beauty Samantha King is very passionate about hair and scalp health after experiencing her own hair issues after losing almost 14 stone in weight in 2022, she is committed to helping women with their hair and has since gone back to train in Trichology to be able to help women at all stages in life when our hair needs a little TLC. The King Bye, Bye Baby Hair Wand protects your hair against dryness, breakage and split ends. With an added ingredient that helps oxidative stress from free radicals in the scalp, therefore reducing hair loss and stimulating growth. All while softening and restoring your hairs natural sheen. RSP ¤12.95.

ACNAUT 3 ACNAUT 3 Proven 3 Steps is the ideal product for those struggling with oily and acne prone skin. The kit contains three tested products needed for daily cleansing, active care and gentle moisturising of oily and blemish-prone skin. The patented formula of active ingredients delivers amazing results with a clearer complexion in no time. ACNAUT is gentle on the skin, contains no harsh chemicals and no side effects/ ACNAUT products are created by leading Dermatologists: ACNAUT Active Lotion 60ml – for oily and blemish prone skin ACNAUT Soap with lactic and salicylic acid to gently wash oily and blemishprone skin ACNAUT Hydro Active Cream 60ml for daily hydrating care. • Stocked in leading pharmacies • Sole Distributor. Biofresh Skincare Ireland www.biofreshskincare.ie

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VIVIO® Junior Cough Syrup 2024 & Retail Pharmacy Product Awards

Best Cough, Cold and Flu Product The outlook for cough, cold and flu products is favourable, according to the most recent market research, with most categories projected to expand consistently in volume terms. Overall demand should remain buoyant as life in Ireland continues on a normal path with exposure to pathogens and environmental pollutants that cause common or seasonal respiratory illnesses and allergies. The Finalists in this Category are:

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VIVIO® Junior Cough Syrup is a 100% natural and preservative free cough syrup, specifically formulated for Children 1 year+ for both dry and congested cough. The exclusive formula has a soothing and delicious taste thanks to the natural honey and strawberry. The added marshmallow extract reinforces the soothing and calming properties of the syrup due to its natural mucilage properties. Dry cough: VIVIO® Junior Cough Syrup forms a protective film on the throat, thanks to the xanthan gum and arabic gum action, which protect the throat from the contact of irritant or infectious agents, relieving its irritation and keeping it hydrated and lubricated. Congested cough: VIVIO® Junior Cough Syrup also hydrates and reduces the thickness of the mucus thanks to the cane sugar, which stimulates saliva and increases the water content in the mucus to make it more fluid and easier to clear. Free from artificial colours, flavours or sweeteners.

Solpa Cold & Flu Multi Relief In September 2023, Perrigo launched an exciting new product into the Cold and Flu market, Solpa Cold & Flu Multi Relief, available in both Capsules and Sachets. This is a new product launch with a difference; a unique triple active formulation to Relieve All cold and flu symptoms. Now it’s time to differentiate and satisfy a large cohort of consumers looking for an effective solution to Relieve All cold and flu symptoms; stemming from a brand strongly associated with fast acting, effective and long-lasting relief. Solpa Cold & Flu is a triple active formulation that works together on the most common cold & flu symptoms: runny nose, headache, sore throat, muscle ache and cough. The 3 key active ingredients together Relieves All Cold & Flu symptoms, with: • Paracetamol: a pain reliever and helps reduce temperature • Guaifenesin: an expectorant to help loose phlegm

Bronchostop 5in1 Introducing, NEW Broncho 5in1 MultiSymptom Action Syrup for all coughs associated with a cold to relieve: dry cough, chesty cough, sore throat, hoarseness and throat dryness. The team behind this product lent on the successes of Bronchostop (THR) and Bronchostop Junior (MD) to develop a product that not only targets cough but sore throats; often the first sign of a cough. Broncho 5in1 Multi-Symptom Action Syrup has a unique formulation, fuelled by natural ingredients** working together for relief at all stages of the cough cycle, soothing the cough reflex linked to a chesty cough* Broncho 5in1 Multi-Symptom Action Syrup for all coughs including sore throat* • Natural ingredients: Marshmallow, Icelandic Moss & Hyaluronic Acid • Free from lactose, GMO’s, gluten and alcohol • Lemon and lime flavour with a touch of menthol • Available in 120ml & 200ml bottles

Benylin® Day & Night Tablets BENYLIN® DAY & NIGHT tablets are the only cold/flu remedy to offer 24 hour relief with tablets specifically designed for Day and Night. Each white tablet contains 500mg Paracetamol and 60mg Pseudoephedrine hydrochloride. Each blue tablet contains 500mg Paracetamol and 25mg Diphenhydramine hydrochloride. During the day the white tablet relieves fever and decongests the nose. During the night the blue tablet helps relieve cold symptoms for a better night’s sleep. The product is the only day & night tablets for 24 hour cold and flu relief, and the consumer-friendly packaging clearly demonstrates which tablets are for each occasion, day and night. Benylin is supported in-store each winter season with brand assets and POS materials as well as TTL media campaign.

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2024 & Retail Pharmacy Product Awards

Best Launch of the Year When launching a new product there are several steps to success that are crucial for any business, taking time and careful planning. These include understanding your target audience and how to reach them effectively, looking at what makes your product innovative or different and unifying the product team across all channels, whether it’s marketing, social media or sales.

UreaRepair Plus 10% Urea Foot Foam

Solpa Cold & Flu Multi Relief

This new product supports skin regeneration and revitalizes the skin, giving immediate relief lasting for 48 hours. The product is also fast absorbing allowing for high frequency use.

In September 2023, Perrigo launched an exciting new product into the Cold and Flu market, Solpa Cold & Flu Multi Relief, available in both Capsules and Sachets. This is a new product launch with a difference; a unique triple active formulation to Relieve All cold and fly symptoms.

This product works by combining the unique UreaRepair PLUS Complex of urea, ceramides and NMF. The delicate, soothing and skin friendly scent; free from perfume makes it suitable for those with skin conditions such as Xerosis, Psoriasis and Diabetes. UreaRepair offers a comprehensive care range with a wide variety of products to combat different types of dry to extremely dry skin.

The finalists in this category have demonstrated that consistency is key when launching a new product within the OTC market. The Finalists in this Category are:

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The cold & flu category is cluttered and confusing, relief depends on; symptoms, active, ingredients, and formats - we want to make treatment choices easier for consumers. Perrigo’s aim is to de-cluttering the category through a simplified consumer offering with one solution that relieves All symptoms. Cold & Flu remains one of the most common and treated illnesses during winter, with 1 in 3 people catching cold & flu, and 80% seeking treatment. Now it’s time to differentiate and expand their Solpa portfolio, satisfying a large cohort of consumers looking for one effective solution; stemming from a brand strongly associated with fast acting, effective and long-lasting relief.

Bronchostop 5in1 The cough category has not developed the same way as other categories, there are a lot of single indication SKUs; dry cough, chesty cough cluttering the category. While this may be beneficial for other categories it doesn’t apply to cough as coughs tend to change during the cycle; start with a sore throat which then becomes a dry cough and then a chesty cough. 72% of people don’t know what type of cough they have. Introducing, NEW Broncho 5in1 Multi-Symptom Action Syrup for all coughs associated with a cold to relieve: dry cough, chesty cough, sore throat, hoarseness and throat dryness. We lent on the successes of Bronchostop (THR) and Bronchostop Junior (MD) to develop a product that not only targets cough but sore throats; often the first sign of a cough.

Pharma Plus PharmaBiotic Pharma Plus was developed by Pharmacists in Ireland using evidencebased nutrition that is backed by science. The team behind the brand wanted to add a Probiotic to the range that had evidence based ingredients. LactoSpore® is a probiotic preparation, containing L(+) lactic acid producing microbial preparation from Bacillus coagulans, MTCC 5856. This is a gut friendly bacteria proven to reach the gut alive. The packaging is fresh and appealing and the PharmaBiotic comes in two pack sizes; a handy 7-day pack for those after taking antibiotics and a 28-pack. It is easy to take and comes in a sachet containing a citrus flavoured drink.

Nuxuriance Ultra Global Anti-Ageing Cream NUXE’s latest skincare breakthrough, the Nuxuriance Ultra Alfa [3R] Range surpasses the effectiveness of retinol on three powerful levels of action – Resurfacing the skin’s surface, Renewing skin activation, and Revitalizing skin activity. The Hero product of this range, Global Anti-Ageing Cream (50ml, ¤63) is a scientific breakthrough from NUXE. Harnessing the power of the Alfa [3R] technology, it targets key signs of ageing, delivering visibly youthful skin. In the first application, 81% of users experience plumper skin, while 85% notice improved tone. After one month of use, 76% witness smoothed wrinkles, with skin appearing tighter for 90% and firmer for 96%.

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Revive Active 2024 & Retail Pharmacy Product Awards

Best Immunity Product A healthy immune system is the first step of attack against outside invaders such as bacteria or viruses. When an immune system is strong, consumers are more likely to be able to ward off sickness. There are lifestyle factors that can aid a healthy immune system such as getting enough sleep and exercise, but OTC supplements are also available to help strengthen the body’s immune response either by taking them regularly or at the onset of certain symptoms. The Finalists in this Category are:

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Revive Active is an award-winning super supplement with 26 active ingredients working together, helping put back what life takes out. This Irish super supplement is delivered in a powdered format and contains a comprehensive combination of vitamins, minerals and amino acids in one convenient daily powdered sachet. The daily sachet can be added to water, juice or a smoothie and due to the form of ingredients used and the powdered format it offers higher bioavailability as vitamins and minerals dissolved in liquid form are absorbed in the body more easily than in tablet or capsule form. Each sachet contains a powerful combination of ingredients, delivered in a convenient way to support active people balancing work, home and family life while maintaining a healthy immune system, heart health and energy levels and a reduction in fatigue. 8 of the 26 active ingredients have authorised claims against them to support the immune system and these ingredients are Vitamins C, D, B12 and B6, Folate, Copper, Zinc and Selenium

Pharma Plus Active Immune Peach & Mango Pharma Plus Active Immune was developed by Pharmacists using evidence-based nutrition, keeping in mind the likelihood of interactions with other medications and conditions. Dosage of active ingredients are optimised for therapeutic effect, to benefit immune health and energy, based on research and scientific evidence. It includes Wellmune® which is a leading yeast beta glucan clinically shown to help strengthen your immune system. Wellmune allows you to be well and stay well. Ingredients which are not recommended for the general population, and which are likely to interact with medications, [such as iron, L-arginine, caffeine, vitamin K, Calcium, potassium...], have been purposely omitted from the preparation to aid with ease of recommendation by Pharmacy teams. Can be taken at any time of day, with or without food, Free from caffeine, gluten-free, and vegan friendly.

Symprove Symprove is a water-based digestive health supplement designed to support the digestive system and enhance your overall well-being. Developed by leading experts in the field, Symprove is crafted to help you achieve optimal gut health. Symprove utilizes a unique formulation of live and active bacteria that work harmoniously with your body’s microbiome. Through a patented delivery system, these beneficial bacteria bypass the harsh stomach environment and reach the targeted areas of your gut, where they can flourish and provide their numerous benefits. One shot of Symprove each morning is the ideal way to maintain the balance of bacteria in your gut.

fabÜ SHROOMS IMMUNE fabÜ SHROOMS IMMUNE is a unique supplement with six active ingredients. It is based on a concentrated extract of two functional, edible mushrooms, Cordyceps and Chaga blended with vitamin D, Vitamin C, copper and zinc. This blend was expertly formulated by Laura Dowling, Fabulous Pharmacist. It harnesses 6 powerful ingredients to support your immune system and energy levels and to protect cells from oxidative stress. Cordyceps and chaga mushrooms have been used traditionally around the world for thousands of years in teas, extracts and as part of everyday cooking. Easy-to-Use Daily Supplement: Simply take two mushroom capsules daily with cool or tepid water. This easy regimen is your step towards strengthening your immune system and safeguarding your cells from oxidative stress.

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2024 & Retail Pharmacy Product Awards

Best Irish Pharmacy Brand In an increasingly borderless world, many consumers are favouring Irish pharmacy brand products. Research has shown that a brand’s country of origin can be as important as other purchasing criteria such as price and quality with many Irish pharmacy shoppers wanting to support local businesses, finding local more trustworthy and more attuned to their needs and wants.

Revive Active

Pharma Plus Brand

Revive Active is an award-winning super supplement with 26 active ingredients working together, helping put back what life takes out.

Pharma Plus was developed by Pharmacists in Ireland using evidencebased nutrition that is backed by science. As healthcare professionals the team behind the brand believe diet and lifestyle are the pillars of good health and only to take supplements as needed. It’s also important that the customer knows what and why they are taking these Vitamins omitting ingredients that they should not be taking.

This Irish super supplement is delivered in a powdered format and contains a comprehensive combination of vitamins, minerals and amino acids in one convenient daily powdered sachet. The daily sachet can be added to water, juice or a smoothie and due to the form of ingredients used and the powdered format it offers higher bioavailability as vitamins and minerals dissolved in liquid form are absorbed in the body more easily than in tablet or capsule form. Each sachet contains a powerful combination of ingredients, delivered in a convenient way to support active people balancing work, home and family life while maintaining a healthy immune system, energy levels and heart and supports a reduction in fatigue.

With OTC Products available from global companies also, Irish brands must work hard to establish themselves in order to get ahead of the competition. The Finalists in this Category are:

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The Range consists of: • Active Immune Peach & Mango 30pk • Active Immune Berry 30pk • Active Immune Teen 28pk • Omega 3 1000 mg Caps 60pk • Vitamin 1000IU 60pk • MenoPlus 60pk • Pharma Biotic 28pk • Pharma Biotic 7 Day pk for those after taking Antibiotics

Panadol Extra Soluble Panadol is Made and Trusted in Ireland. Panadol Extra Soluble is indicated against 5 types of tough pain. Panadol Extra Soluble contains a second active ingredient caffeine, that amplifies the analgesic effect of paracetamol, making it more powerful*. So, when you’ve got a headache you can count on Panadol Extra Soluble to deliver powerful, effective relief. And it’s gentle on your stomach, too. Panadol Extra Soluble is also effective in treating backache, rheumatic pains and muscle pains, period pains and toothache. *than standard paracetamol tablets Panadol’s Irish manufacturing roots had been one of Haleon’s best kept secrets. The 700 Haleon employees in Dungarvan play a vital role in Panadol’s global success story, and indeed in the wider community in Waterford.

Cetrine Allergy 10mg x 30 Cetrine Allergy is Ireland’s Number 1 allergy relief product (Source: IMS Data, 2023). Cetrine Allergy FCT is available in a 7 and 30 pack containing:10 mg of cetirizine dihydrochloride. Cetrine Allergy Oral Solution is also available in a 200ml bottle (One ml of the oral solution contains 1 mg cetirizine dihydrochloride). Cetrine Allergy is exclusive to Irish pharmacies. The Cetrine Allergy brand is proudly marketed by Rowex Ltd. based in West Cork. In 2023, Cetrine Allergy was ranked 13th in the IPN’s OTC TOP 100 products.

Active Iron Active Iron is an Irish iron supplement which is clinically proven to increase iron and energy levels, helping to fight tiredness & fatigue. Active Iron is specially formulated to avoid constipation, making it kind on the stomach while being strong enough to increase iron levels. Active Iron’s groundbreaking whey protein formula targets the body’s natural site of absorption, the DMT-1. This helps reduce oxidation and protects the gut from inflammation. As a result, Active Iron delivers 2X better absorption of iron sulfate. Headquartered in Cork Ireland, Solvotrin Therapeutics is a rapidly growing healthcare development company. Their mission is to create products that deliver on significant unmet medical needs through ground-breaking innovation and cutting-edge research.

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Myeloma

High-Risk Multiple Myeloma Written by Dr Roisin McAvera (Postdoctoral Researcher RCSI), Miss Niamh McAuley (PhD Student RCSI), Prof Ann Hopkins (Associate Professor RCSI), Prof Siobhan Glavey (Clinician-Scientist Beaumont Hospital/RCSI)

Dr Roisin McAvera

Niamh McAuley

Introduction

regimens; RVD (bortezomib, lenalidomide, dexamethasone), VMP (bortezomib, melphalan, prednisone), CyBorD (cyclophosphamide, bortezomib, dexamethasone), Rd (lenalidomide, dexamethasone) or most recently D-VTD (daratumumab, bortezomib, thalidomide, dexamethasone).

Multiple myeloma (MM) is a haematological malignancy characterised by the clonal expansion of malignant plasma cells in the bone marrow. MM manifests clinically as hypercalcaemia, renal failure, anaemia and bone lesions (known as CRAB features), with a median age of diagnosis of 71 in Ireland.1 MM affects around 384 people in Ireland each year1 and despite advancements in treatments remains incurable in 2024, as patients eventually relapse. At a genomic level MM is extremely heterogeneous, meaning patients present with a wide range of different genetic abnormalities. As a result, patient outcome and response to treatment also varies. Despite this, personalised treatment plans are still in their infancy relative to those in some of the more common solid cancers, with MM patients generally treated in a similar manner. Treatment of MM normally consists of a combination of two, three or even four drugs from different classes. Treatment approaches vary, depending on patient fitness, co-morbidities, disease features and eligibility for an autologous stem cell transplant (ASCT). Initial treatment in Ireland at present consists of one of the following National Cancer Control Programme (NCCP)-approved

Notwithstanding significant improvements to patient prognosis as a result of these drug combinations, the median survival of MM patients is currently still low, at around 6 years.2 However, in reality patient outcome varies significantly. ‘High-risk’ MM patients tend to

have a median survival of 2-3 years, whilst for ‘standard-risk’ patients this is 7-10 years.2 There are several methods to identify high-risk patients and, as a result, a major clinical challenge is the lack of standardisation. Ideally, a standardised approach to risk-stratification would aid with streamlined characterisation of patient response in different risk groups, and potentially enable risk-adapted treatment plans in the future. In this article, we will discuss some of the commonly employed methods to identify high-risk MM, with a focus on those related to our own research at the Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Dublin.

Current Risk Classification Most current classification systems used for MM incorporate common cytogenetic abnormalities as detected by fluorescence in situ hybridisation (FISH). In 2005, the International Myeloma Working Group (IMWG) introduced the International Staging System (ISS) to stratify patients into three prognostic groups. ISS criteria are based on the clinical levels of serum β2 microglobulin and serum albumin. In 2015, this was revised (R-ISS) to include the level of lactate dehydrogenase (LDH) and several cytogenetic abnormalities, specifically high-risk cytogenetic abnormalities t(4;14), t(14;16) or del(17p).3 The R-ISS criteria are shown in Table 1.

Table 1. Revised International Staging System (R-ISS) for Risk Classification of MM

Stage I

All of the following: • Serum albumin ≥3.5 gm/dL • Serum beta-2-microglobulin <3.5 mg/L • No high-risk cytogenetics • Normal serum LDH level Stage II Not fitting Stage I or III Stage III Both of the following: • Serum beta-2-microglobulin >5.5 mg/L • High-risk cytogenetics [t(4;14), t(14;16), or del(17p)] or elevated serum lactate dehydrogenase level Table 1. Revised International Staging System (R-ISS) for Risk Classification of MM

Additionally, the Mayo Stratification for Myeloma and Risk-adapted Therapy (mSMART) guidelines use several more genetic factors to guide genetic risk, such as gain(1q), p53 mutation, and gene PHARMACYNEWSIRELAND.COM signatures (Table 2) (4).

• High-risk cytogenetics [t(4;14), t(14;16), or del(17p)] or elevated serum lactate dehydrogenase level Table 1. Revised International Staging System (R-ISS) for Risk Classification of MM

Gene expressionTrisomies profiling (GEP) has become increasingly popular in MM risk prediction, offering better Table 2. The mSMART Guidelines Standard-Risk t(11;14) standardisation and sensitivity than FISH. Accordingly, several gene signatures that can accurately t(6;14) identify molecular subgroups of MM patients and predict prognosis have been identified. To date, two High-Risk High-risk genetic abnormalities: gene signatures have  been t(4;14)commercialised – the MyPRS® which detects a 70-gene signature known as  t(14;16) GEP-70, and the MMProfiler™ which detects a 92-gene signature known as SKY92 (6, 7). Both are  t(14;20) commonly incorporated into ongoing clinical trials and have proved to successfully identify high-risk  del(17p) mutation patients. However, thep53MMProfiler™ is currently the only GEP test with CE-IVD (in vitro diagnostic)  gain(1q) approval, meaning it meets European standards to be used in a clinical setting. The MMprofiler™ R-ISS Stage III of 92 genes in MM plasma cells from patient bone marrow. Dependent on determines the expression High plasma cell S-phaseexpressed, a score is calculated and anything equal or above 0.827 the way these genes are collectively GEP: High risk signatures is considered high-risk with a predicted survival of less than 2 years (2). Additionally, the MMProfiler™ Double-hit MM: t(14;16), Any two high-risk factors can detect t(4;14), t(11;14), t(14;20) and gain(1q). Several studies have shown that using Triple-hit MM: Any three high-risk factors MMProfiler™ can overcome the need for FISH and in fact provide additional information often missed by FISH. The MMProfiler™ is already used in private healthcare settings in the UK, and in several NHS Table 2. The mSMART Guidelines clinical trials. We are currently investigating its use in Ireland in newly-diagnosed MM, and our Roughly half of MM patients present with trisomies of odd-numbered chromosomes, and generally preliminary results show a particularly high proportion of Irish patients are classified as high-risk this is associated with better prognosis (5). Translocations t(11;14) t(6;14) are considered to only can predict treatment response, Additionally, the Mayo Stratification described in more detail later in this andMMProfiler™ is currently the (>30%). Several trials are article. also Additionally, investigating whether response, GEPMMProfiler™ test with CE-IVD (incan vitro with treatment preliminary results showing it for Myeloma andeffect Risk-adapted del(13) found have a neutral on prognosis, observed in 15-20% andis2% of patients respectively. t(4;14) is predict diagnostic) approval, meaning can aid clinical decision making to Therapy (mSMART) guidelines in 50% of patients and predicts observed inmore around 10-15% of patients, whilst areit present in only 2-5% 1% with preliminary results showing it t(14;16) can aidand making to and escalate or deescalate treatment meets European standards escalate or deescalate treatment use several genetic factors poor outcome, however itclinical ist(14;20) also decision be patient used in outcome. a clinical setting. (PROMMIS trial, NCT02911571). to guide genetic risk, such and as all considered not included in current classification of patients respectively, to have a detrimental effecttoon (PROMMIS trial, with NCT02911571). ItThis is highlights hoped that will ultimately justify incorporation The data MMprofiler™ determines It is hoped that these data of will the gain(1q), p53 mutation, gene guidelines. the needthese Del(17p) is associatedand loss of p53 and is found in around 10% of newly-diagnosed patients. the expression of 92 genes in ultimately justify incorporation signatures (Table 2). for ongoing improvement of riskMMProfiler™ routine MM diagnostic and/or treatment workflows Gain(1q) is presentinto in around 35-40% of patients, and is often found alongside del(1p), present inin Ireland. MM plasma cells from patient of the MMProfiler™ into routine stratification systems. 4

Roughly half of MM patients

boneabove marrow. Dependent on the MM diagnostic and/or treatment around 20%trisomies of casesof(5). However, Gene del(1p) is currently not included in the classification present with oddExpression Profiling – way these genes are collectively workflows in Ireland. Interestingly, both1and gene signatures herelater include many located on chromosome 1. In numberedChromosome chromosomes, systems. abnormalities are described in more detail in this article. MMProfiler ™described SKY92 expressed, a scoreAdditionally, isgenes calculated Interestingly, both gene generallyisthis is associated with and anything equal or above del(13) found in 50% of patients and predicts poor outcome, however it is also not included in expression profiling (GEP) fact, 30% of5 Translocations genes makingGene up GEP-70 are located on0.827 chromosome 1, with most upregulated genes on signatures described here better prognosis. is considered high-risk has become increasingly popular current classification guidelines. This highlights the need for ongoing improvement of survival risk- of less include many genes located on t(11;14) and t(6;14) are considered with a predicted chromosome 1q, on 1p. Several of the SKY92 genes are also on1. chromosome MM risk prediction, offering chromosome In fact, 30% to have a neutral effect on and mostindownregulated stratification systems. than 2 years.7 Additionally, the better standardisation and

of genes making up GEP-70 prognosis, observed in 15-20% and MMProfiler™ can detect upregulation t(4;14), 1, as respectively. NUF2 and LBR. From our have t(14;16), identified of NUF2, located sensitivity thanown FISH. analysis, Accordingly, wet(11;14), are located on chromosome 1, on 2%such of patients t(4;14) t(14;20) and several gene signatures that can with most upregulated genes is observed in around 10-15% of gain(1q). Several studies have 1q, as a potential driver ofaccurately the SKY92 high-risk phenotype. identify molecular disease on chromosome 1q, and most patients, whilst t(14;16) and t(14;20) shown that using MMProfiler™ are present in only 2-5% and 1% of patients respectively, and all considered to have a detrimental effect on patient outcome. Del(17p) is associated with loss of p53 and is found in around 10% of newly-diagnosed patients. Gain(1q) is present in around 35-40% of patients, and is often found alongside del(1p), present in around 20% of cases.5 However, del(1p) is currently not included in the above classification systems. Chromosome 1 abnormalities are

Chromosome 1q

subgroups of MM patients and predict prognosis have been identified. To date, two gene signatures have been commercialised – the MyPRS® which detects a 70-gene signature known as GEP-70, and the MMProfiler™ which detects a 92-gene signature known as SKY92.6, 7 Both are commonly incorporated into ongoing clinical trials and have proved to successfully identify high-risk patients. However, the

can overcome the need for FISH and in fact provide additional information often missed by FISH. The MMProfiler™ is already used in private healthcare settings in the UK, and in several NHS clinical trials. We are currently investigating its use in Ireland in newly-diagnosed MM, and our preliminary results show a particularly high proportion of Irish patients are classified as high-risk (>30%). Several trials are also investigating whether MMProfiler™

downregulated on 1p. Several of the SKY92 genes are also on chromosome 1, such as NUF2 and LBR. From our own analysis, we have identified upregulation of NUF2, located on 1q, as a potential driver of the SKY92 highrisk disease phenotype.

Chromosome 1 instabilities are the most common genomic alterations contributing to MM pathogenesis, resulting in the gain/amplification of chromosome arm 1q or the loss of regions on the Chromosome 1q shorter 1p arm. These chromosome 1 cytogenetic abnormalities are indicative of high-risk disease. Chromosome 1 instabilities are the Various tumour suppressor genes are located on 1p. Downregulation or loss of such genes associate most common genomic alterations contributing1q to MM with worse survival. Moreover, 30% of patients present with gain or amplification at pathogenesis, diagnosis. resulting in the gain/amplification Abnormalities of 1q may induce increased genetic instability in MM, and typically manifest with Table 3: Chromosome 1 inferior prognosis. Although both copy number variations of chromosome 1q are considered “highabnormalities associated with MM risk”, gain(1q) does not appear to be as detrimental as amp(1q) (Table 3). Gain(1q) One extra copy of some portion of chromosome 1q (3 total copies) Amp(1q) Two or more extra copies of chromosome 1q (4 or more total copies) Del(1p) Poor prognosis due to downregulation/ loss of tumour suppressors Table 3: Chromosome 1 abnormalities associated with MM. As chromosome 1 is the largest human chromosome, a plethora of possible therapeutic candidate PHARMACYNEWSIRELAND.COM genes reside in tow. Interestingly, patients with chromosome 1 alterations have not benefitted from

Myeloma

of chromosome arm 1q or the loss of regions on the shorter 1p arm. These chromosome 1 cytogenetic abnormalities are indicative of high-risk disease. Various tumour suppressor genes are located on 1p. Downregulation or loss of such genes associate with worse survival. Moreover, 30% of patients present with gain or amplification 1q at diagnosis. Abnormalities of 1q may induce increased genetic instability in MM, and typically manifest with inferior prognosis. Although both copy number variations of chromosome 1q are considered “high-risk”, gain(1q) does not appear to be as detrimental as amp(1q) (Table 3). As chromosome 1 is the largest human chromosome, a plethora of possible therapeutic candidate genes reside in tow. Interestingly, patients with chromosome 1 alterations have not benefitted from novel treatments as well as other genetic subgroups. To address this, our research team is designing and testing novel therapies for the protein products of the gene F11R which is located on 1q23.3. Additionally, we are investigating the function of NUF2, also on 1q23.3. High expression of either of these genes is associated with inferior outcomes in MM. F11R encodes the JAM-A protein whose overexpression has been associated with poor patient prognosis in various cancers (breast, lung, glioma) and most recently in MM. JAM-A is found on diverse cell types, where it plays physiological roles in tight junction formation, angiogenesis and leukocyte extravasation. As the pathophysiological overexpression of JAM-A has been linked with various oncogenic traits; it is intriguing to speculate that attenuation of this protein may impair MM progression. Moreover, we have seen an association between high F11R expression and gain(1q) which further supports its exploration as a novel potential target in high-risk MM patients. The NUF2 gene is part of the SKY92 gene signature, and is upregulated in high-risk MM. Similar to F11R we see a link between high expression and presence of gain(1q). NUF2 facilitates normal chromosomal segregation and centromere microtubule attachment. Abnormal expression of NUF2 leads to mitotic dysregulation and further chromosomal instability associating with reduced survival. We aim to find novel therapies that may target high NUF2 expression.

Extramedullary Disease In rare cases, extramedullary disease (EMD) may also occur and is characteristic of high-risk MM. This is a particularly aggressive manifestation of MM whereby the malignant plasma cells have become independent of bone marrow and may infiltrate other organ systems. This occurs in around 7% of MM patients at diagnosis (primary EMD), and up to 20% at the relapsed stage (secondary EMD).8 Prognosis is extremely poor, with survival rates of less than 3 years at diagnosis, and less than 1 year in refractory patients. The incidence of EMD is on the increase, potentially because most novel therapeutics target the bone marrow and thus surviving cells post-treatment have adapted mechanisms to survive outside of this microenvironment. Regarding the genomic make-up of EMD in MM, definitive studies are currently lacking. However, the few that have been performed generally show an increased rate of high-risk abnormalities in patients presenting with EMD.9 Examples include t(4;14), gain(1q) and del(13). Moreover, t(11;14), which is generally considered standard-risk, is less likely to occur in EMD. Patients classified as GEP-70 high-risk are also five times more likely to experience EMD than standard-risk patients. Of interest, several studies have shown high chromosome 1 instability in EMD patients, namely deletions of 1p and gains of 1q, reinforcing the role chromosome 1 plays in high-risk disease. We currently have an ongoing study investigating the genetics of EMD in Irish MM patients. Conclusion High-risk MM represents an aggressive subtype of MM with particularly poor outcome. How high-risk disease is defined can vary, due to the heterogeneity of the disease and varying clinical manifestations. We propose that standardising how it is defined is necessary to understand its underlying disease biology. Currently, there are no personalised therapies that specifically target high-risk MM, and thus research should aim to find novel targets. At RCSI, we are trialling the use of the MMProfiler™ test to aid with risk-classification in Ireland, and are investigating several molecular markers of highrisk disease (JAM-A and NUF2) as potential new therapeutic targets. Their location on chromosome 1 makes them even more compelling

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objects of investigation, since chromosome 1 abnormalities are a common occurrence in high-risk MM. Additionally, presentation of EMD is associated with high-risk disease, and we are currently studying its genetic make-up to better understand its pathogenesis. Ultimately, we hope that identifying and understanding high-risk MM will lead to riskadapted therapy approaches and improve outcome for this poor prognostic group. Empowering Patients In response to a lack of patientfriendly materials on MM research, the MM research group in RCSI recently launched a patient-driven resource discussing MM research in Ireland with the support of the Health Research Charities Ireland, the Health Research Board and Breakthrough Cancer Research. Co-developed by patients, clinicians and researchers, this booklet aims to aid patients and their caregivers in understanding their role in MM research. It is essential to equip patients with knowledge to not only navigate their diagnosis, and treatment options but also to develop an understanding of informed consent and how they may contribute to advancing MM research in Ireland. This booklet can be freely downloaded using the following QR code.

References 1. Ireland NCR. Cancer in Ireland 1994-2022. 2022. 2. Rajkumar SV. Multiple myeloma: 2022 update on diagnosis, risk stratification, and management. Am J Hematol. 2022;97(8):1086107. 3. Palumbo A, Avet-Loiseau H, Oliva S, Lokhorst HM, Goldschmidt H, Rosinol L, et al. Revised International Staging System for Multiple Myeloma: A Report From International Myeloma Working Group. J Clin Oncol. 2015;33(26):2863-9. 4. Mikhael JR, Dingli D, Roy V, Reeder CB, Buadi FK, Hayman SR, et al. Management of newly diagnosed symptomatic multiple myeloma: updated Mayo Stratification of Myeloma and Risk-Adapted Therapy (mSMART) consensus guidelines 2013. Mayo Clin Proc. 2013;88(4):360-76. 5. Kumar SK, Rajkumar SV. The multiple myelomas - current concepts in cytogenetic classification and therapy. Nat Rev Clin Oncol. 2018;15(7):40921. 6. Shaughnessy JD, Jr., Zhan F, Burington BE, Huang Y, Colla S, Hanamura I, et al. A validated gene expression model of highrisk multiple myeloma is defined by deregulated expression of genes mapping to chromosome 1. Blood. 2007;109(6):2276-84. 7. Kuiper R, Broyl A, de Knegt Y, van Vliet MH, van Beers EH, van der Holt B, et al. A gene expression signature for high-risk multiple myeloma. Leukemia. 2012;26(11):2406-13. 8. Bansal R, Rakshit S, Kumar S. Extramedullary disease in multiple myeloma. Blood Cancer J. 2021;11(9):161. 9. McAvera R, Quinn J, Murphy P, Glavey S. Genetic Abnormalities in Extramedullary Multiple Myeloma. International Journal of Molecular Sciences. 2023;24(14).

Topic Team Training – Dealing with Dandruff 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 Dandruff. Most people have had dandruff at one time or another but it can become uncomfortable due to the itchiness it causes. Dandruff is not caused by poor hygiene but rather can be caused due to a number of reasons. Dandruff is essentially dead skin cells that fall off the scalp. They look like little white flakes and can fall onto clothing and shoulders easily. Causes There are a variety of factors that can cause dandruff, and identifying the exact cause can prove difficult. The main causes are: Lack of Shampooing: Skin cells will build up on the head if shampoo is not used frequently to clean and care for hair. Using the right shampoo for hair and skin type is important to prevent dandruff buildup. Those with dry skin and hair will need a moisturising shampoo and conditioner that helps restore hair protein and moisture to the skin to help prevent dead skin cells (dandruff) from falling off the scalp. On the other hand, those with oily skin and hair will need less harsh and strong hair products, to prevent excessive moisture and oils, which can also increase dandruff. Anti-dandruff shampoos may also be a good product to add to a hair care routine. Common Skin Conditions; Skin conditions, such as Eczema and Contact Dermatitis, can cause dandruff because they can affect the skin on the scalp. They can

cause dry, red, flaky and very itchy skin on different areas of the body. Malassezia Yeast: Malassezia yeasts can be found on the skin of those with dandruff. This yeast is found on the skin of most adults. Normally it does not cause any problems, however, for some people it is believed this yeast could irritate the scalp and increase skin cell growth. Advice The sufferer should avoid wearing dark clothes when their dandruff is particularly bad. They should not use hair spray or other products that can irritate the scalp, such as hair dyes. Frequent (daily or every other day) shampooing with a mild shampoo may be sufficient to control dandruff. Some treatments may work better than others, and several may need to be tried. Dandruff is likely to return so it may have to be treated again from time to time to stop it recurring. Follow directions on the shampoo label. If it irritates or burns the scalp, rinse it away thoroughly and do not use it again. Do not use dandruff products if the skin is broken, and avoid contact with eyes. Treatments Shampoos containing zinc pyrithione, selenium sulphide and coal tar help relieve scaling and itching. They help stop the growth of some yeasts and fungus and help treat dandruff. Keratolytic agents such as salicylic acid help by removing scales of dead skin from the scalp.

Consider:  Can I explain the causes of dandruff to my pharmacy team and how can they apply this knowledge to treatment?

Do not use selenium sulphidecontaining shampoos for 48 hours before or after colouring, bleaching or perming the hair. Selenium sulphide may discolour jewellery. Coal tar products can make the scalp more susceptible to sunburn, so avoid strong sunlight. Coal tar products are best avoided during pregnancy and breastfeeding unless recommended by a doctor. Ketoconazole is an antifungal agent that stops growth of yeast and other fungal infections, and provides relief from dandruff. It may be successful when other treatments have failed. Ketoconazole shampoo should be massaged into the scalp and left for three to five minutes before rinsing, and should be used twice a week for two to four weeks, and then every one to two weeks to prevent recurrence. A normal shampoo product can be used on the days when the

Key Points: Check your pharmacy team are aware and understand the following key points:  Most people have had dandruff at one time or another but it can become uncomfortable due to the itchiness it causes

ketoconazole shampoo is not being used. There is some evidence that tea tree oil shampoos can improve dandruff. Medicated ointment for dandruff Medicated ointment contains coal tar, which helps reduce scaling and itching, and salicylic acid, a keratolytic agent. It should be used once a day for three to seven days until the dandruff improves – it can then be used once a week to prevent dandruff coming back. The ointment should only be used in children under 12 years if recommended by a doctor.

Actions:  Include POS with associated condition treatments  Ensure efficient sign posting to discreet consultation areas within the pharmacy for further help and advice  Keep products merchandised together, along with related products such as appropriate shampoos and hair care treatment

 Misconceptions around dandruff – it is not a sign of poor hygiene, how to treat it

 Ensure that this important category is fully stocked at all times and merchandising plans are amended based on time of year, such as winter for dry skin

 Do we stock an efficient range of shampoo and medicated treatments? Do I, and my team, know enough about them to recommend them?

 The issues around appropriate hair care and defining hair types for treatment

 Ensure that I know the recommendations for each OTC treatment depending on the customer’s hair type

 Do I know what to recommend if a customer returns saying the treatment has not worked?

 Key advice on managing flaky scalp

 Train the team to meet all the above considerations

 Can I, or my team, explain to dandruff sufferers how to best manage their dandruff and offer appropriate lifestyle tips and advice?  Is the pharmacy area set-up for discreet conversations with customers?

 The impact of dandruff on work, school and leisure

News

New Benefits of Weight Loss for Type 2 Diabetes Researchers in the School of Population Health at RCSI University of Medicine and Health Sciences have provided new evidence of the health benefits of weight loss efforts that lead to diabetes remission for type 2 diabetes patients. Professor Edward Gregg, Head of the School of Population Health, RCSI University of Medicine and Health Sciences,

Gregg, Head of the RCSI School of Population Health. The study called Look AHEAD (Action for Health in Diabetes) monitored over 5,000 patients during a period of 12 years. The magnitude of risk reduction was greatest for participants with evidence of at least four years of remission.

For participants in the weight-loss trial who were able to achieve remission i.e. reduce the need for medications and reduce their HbA1c levels (a measure of blood sugar control), the research found there was a 40% lower rate of cardiovascular disease and 33% lower rate of chronic kidney disease in this group.

While previous trials have shown that substantial weight loss using diet and lifestyle can reverse type 2 diabetes, the new research published in Diabetologia is among the first to show that reversal of diabetes, in turn, affects cardiovascular and kidney disease outcomes. The research was led by Professor Edward

“Using lessons learned from this study we can help inform diabetes treatment methods and improve quality of life for people with type 2 diabetes. It has highlighted the significance of weight loss for achieving remission from type 2 diabetes and then long-term positive cardiovascular and kidney disease outcomes” said Professor Gregg. Over the course of the study, the effect of intensive lifestyle

intervention was compared with that of diabetes support and education on cardiovascular disease and other long-term health conditions. It was noted that although 18% of participants achieved remission at some point during follow-up, the percentage of participants with current remission had decreased to 3% by the 8th year of the study, underlining the challenges of keeping weight off using lifestyle interventions. RCSI researchers collaborated on the study with colleagues Wake Forest University, Brown University and other study sites in the United States. Professor Gregg added, “As the first intervention study to associate remission with reduction of diabetes-related complications, this is encouraging news for those who can achieve remission from type 2 diabetes. While our study is also a reminder that maintenance of weight loss and remission is difficult, our findings suggests any success with remission is associated with later health benefits.”

The Use of Nucleotides in Peripheral Nerve Disorders The key to effective management of patients with peripheral neuropathy is to adopt a comprehensive approach that addresses both the symptoms and underlying causes.1 Research suggests that certain molecules known as nucleotides play a crucial role in repairing damaged nerve cells, as well as improving the quality of life of patients with neuropathy.2 Peripheral Neuropathy (PN) is a common condition, with a global prevalence estimated at 2.4%, rising as high as 8% among the elderly and 50% among those with diabetes.3 PN is a broad term that refers to a range of conditions that cause damage to peripheral nerves, some of which include diabetic neuropathy, sciatica, cervical (neck) and lumbar (back) radiculopathy, carpel tunnel syndrome and postherpetic neuralgia. The diverse range of symptoms, such as pain, numbness, weakness and sensory issues, can significantly diminish the quality of life for those affected with PN.3 The regenerative potential of peripheral nerves The underlying pathophysiology of PN centers on the damage sustained to the myelin-producing

Schwann cells in peripheral nerves.1 Unlike the central nervous system, the repair and functional recovery of peripheral nerves may be possible after injury.2 The pyrimidine nucleotides, uridine and cytidine, when used alone or in combination with certain vitamins have reparative properties, helping to rebuild the myelin sheath and other important components of the nerve.1,2 In the treatment landscape for PN, conventional medications primarily focus on alleviating the pain associated with the condition. Although these may be effective at relieving the pain, they often bring undesirable side effects and do not address the important element of nerve regeneration. This is where nucleotides, specifically uridine and cytidine may be of benefit in the clinical management of PN.1,2 Their use offers potential

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as a complementary therapy to standard treatment, acting at the origin of the damage to enhance the recovery process.1,2,3 Clinical Evidence Nucleotides have demonstrated efficacy in several clinical trials in patients with neuropathies of various origins. The results showed a reduction in pain intensity, improved sensory and motor function and quality of life.2 Additionally, nucleotides have demonstrated a favourable safety profile in patients with PN.2 For more information: www.nubit.ie Nubit is a food supplement formulated with high doses of nucleotides that contribute to nerve regeneration, with vitamins B1 and B12 that contribute to the normal functioning of the nervous system. Available in pharmacies.

References 1. Fister, N., & Oros, M. The use of nucleotides in diseases of the peripheral nervous system. INTERNATIONAL NEUROLOGICAL JOURNAL, 2021. 16(8), 33–36 2. Manhães M, Cesar M, Justo R, Geller M, Suchmacher M, Cisne R. The Role of Nucleotides in Glial Cells during Peripheral Nerve Trauma and Compressive Disorders. En Maurício AC, ed. Peripheral Nerve Regeneration - From Surgery to New Therapeutic Approaches Including Biomaterials and Cell-Based Therapies Development. Croacia: InTech; 2017. 3. Negrão L, Almeida P, Alcino S, Duro H, Libório T, Melo Silva U, Figueira R, Gonçalves S, Neto Parra L. Effect of the combination of uridine nucleotides, folic acid and vitamin B12 on the clinical expression of peripheral neuropathies. Pain Manag. 2014 May;4(3):191-6.

News

Ensuring ‘No Patient is Left Behind’ New research from the RCSI has highlighted continued shortcomings in fracture prevention services across Ireland as well as the urgent need to adequately fund and resource the implementation of a National Fracture Liaison Service. In its second annual report, the RCSI found that while improvements across a number of areas have been made, a number of regions across Ireland lack any sort of Fracture Liaison Service (FLS) infrastructure. As of September 2023, just 69% (11 out of 16) of all adult hospitals that manage trauma in Ireland have a FLS. This figure makes clear the need for a National Fracture Liaison Service. Not only would this benefit patients and offer improved health outcomes, but it is a cost-effective prevention that would deliver longterm savings to the health service. Professor Frances Dockery, Joint Clinical Lead for the Fracture Liaison Service (FLS) Database, said:, “We are pleased to publish our second annual report on how patients in Ireland with fractures are being managed in order to reduce future fracture risk. While great strides have been made in rolling out FLS across Ireland, there remains significant room for improvement and this year’s report underlines the need for our National FLS so that no patient

is left behind. We welcome the HSE’s commitment to prioritise the FLS pathway for implementation in 2023/2024 and hope that all 16 adult trauma hospitals will soon be operating a fully resourced FLS.” This year, nine hospitals submitted data for inclusion in the Irish Fracture Liaison Service Database Annual Report 2023. Between them, they reported 3,195 non-hip fragility fractures in 2022. This figure represents just 33% of the expected number of non-hip fragility fractures attending hospitals in Ireland but is nonetheless an improvement on 2021. In the absence of a fully resourced National Fracture Liaison Service, no hospital successfully met each of the standards outlined in the International Osteoporosis Foundation’s Capture the Fracture best practice framework. Ireland is home to an ageing population with the incidence of new fragility fractures each year estimated to be 32,000. This figure is expected to increase to 51,000 per year in the next ten years and

is the highest in all EU countries as the population ages. A fragility fracture is defined as a broken bone sustained from a minor trip or bump. Such fractures can be extremely debilitating and can have a devastating impact on a person’s ability to live independently, which is why secondary fracture prevention is so important. Among the report’s key findings was that vertebral (spine) fractures need to be prioritised for case finding as these patients are at greatest risk of further fractures. Data from 2022 showed that just 26% of the expected number of vertebral fractures were identified nationally(1). This illustrates the need to develop a specific national strategy for case finding within this patient group. Additionally, the report identified a need for greater follow-up care with just 35% of patients recommended anti-osteoporosis medication (down from 53% in 2021). Only 11% of patients were referred to start strength and balance training and just

5% started within 16 weeks of their fracture. This is despite the fact that these are recognised as critical interventions when it comes to reducing the risk of re-fracture and preventing future falls. Mr. Aaron Glynn, Joint Clinical Lead for the Fracture Liaison Service Database, said, “The 2023 fracture liaison service database report demonstrates the efforts being made at a national level to reduce the risk of avoidable fractures for patients. However, it is abundantly clear that real progress cannot be made until we have a fully funded and resourced National Fracture Liaison Service. The social and economic burden imposed by fragility fractures mandates that we move away from therapeutic nihilism toward a proven model for reducing their occurrence. Our recommendations clearly outline the steps needed to close the treatment gap and ensure patients across Ireland have access to quality proactive care. We urge decision-makers at all levels to review the report and act on the recommendations as a matter of priority.”

IRC Early Career Researcher of the Year Award Maynooth University congratulates Professor Aisling McMahon of the School of Law and Criminology on receiving the highly prestigious IRC Early Career Researcher of the Year Award for her work in health and intellectual property law. This national IRC Award recognises a current or previous IRC awardee, who is within eight years of award of their PhD, and who has demonstrated an exceptional level of achievement in their field at this stage in their career. Professor McMahon has led pioneering and internationally recognised research on the impact of intellectual property (IP) rights on people’s access to healthcare and on the development and delivery of health technologies. A 2020 article by Professor McMahon examining the impact of patent rights on which countries could access Covid-19 vaccines, medicines and diagnostics first, and on what terms, was cited as an information source for a UK House of Commons Briefing in November 2020.

Professor Aisling McMahon

In 2022, she was awarded a highly prestigious European Research Council Starting grant for the PatentsInHumans project. Professor McMahon’s research is especially focussed on the

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regulation of emerging healthtechnologies and biotechnologies, and the relationship between intellectual property law and bioethics in the context of health-related technologies. Maynooth University received a total of three Researcher Awards, including two commendations, and nine ‘Research Allies’ honours in last night’s ceremony, which recognises excellence and an exceptional track record in a field of research funded by the IRC. Accepting her award, Professor McMahon said, “Scientific research can have incredible benefits for human health. My research is driven by building understandings of the role that legal and regulatory mechanisms can play in fostering the development of cutting-

edge ethically responsible health technologies; and alongside this, developing understandings of how legal tools can facilitate and ensure equitable access to such health technologies for all those who need them. “To me, this award underlines the importance of this field of research. Children and young people in care, in particular residential care, are seldom heard in the education space or in the space of research, and tend not to get many opportunities to research, discuss and analyse the issues affecting their lives. We need more research to understand how to better deliver care and other services for this population, and to learn from children and young people who have so much to offer the research space,” she said.

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Finance

Minding the Gap in Finance You would expect when advising our clients the same principles and assumptions apply to both males and females. However, this is not the case and some areas need more attention by both us as advisers and our female clients. Written by Colm Moore, Moore Wealth Management Colm Moore is a CERTIFIED FINANCIAL PLANNER™ with Moore Wealth Management. They have been advising the pharmacy community for over 20 years. He can be contacted on 086-8603953 or at colm@mwm.ie

conditions to be in a worse position at retirement and a fuller explanation of risk and reward is key. Recent changes in PRSA legislation via Finance Act 2023 that has removed funding limits and Benefit in Kind on employer pension contributions can certainly help in this regard. We have covered this extensively in previous articles. All of this is crucial when you step back and look at the future pension situation in Ireland. With Auto enrolment, increasing eligibility ages and a declining workforce/retiree ratio the message is very clear, make your own provision taking advantage of every tax break possible if you want the comfortable and dignified retirement you desire. Income Protection

Mind The Gap The most obvious example of this is in pension planning where the most recent ESRI report on the funding shows a 35% gap between male and female pension coverage. This is a startling figure and begs the question as to why this is the case. One starting point is the gender pay gap which according to the CSO stands at 9.6%. Where pension contributions are a function of salary you can see where salary equalisation is a starting point to address this issue.

most pension investors do you can afford to take on more risk(higher equity content) in your pension. By higher equity content I’m referring to investing in the biggest and best companies in the world who evolve, innovate and grow to the benefit of your pension over the long term.

over the last 10 years and the ESMA risk-rated 5 fund with 75% equity exposure returned 133% over the same time frame. A proper conversation about risk and reward is needed to advise females to take on more risk over the longer term. Yes, it will be a more volatile journey but this is the price of return coupled with a de-risking strategy moving towards retirement that protects your taxfree lump sum.

Over the long term this will reward you with higher growth and a larger fund to have the retirement your hard work deserves. To illustrate this, take the example of these two Lower contributions and salary popular funds. One is an ESMA coupled with this predisposition to risk-rated three fund that has 25% lower risk options are presenting One of the more obvious reasons exposure and returned 35% with the optimum for this gap is that women are Allequity performance is shown in EURfemales currency. more likely to take a career break when children arrive. These PAST PERFORMANCE years out of the workforce have 160.0 % a cumulative effect on career and salary progression but also on 140.0 % ongoing pension contributions and result in missing the compounding 120.0 % effect of investing this money over the long term. With statistics telling 100.0 % us that females on average live 4 years longer than males the need 80.0 % for a larger pot is evident. The Risk Issue Without fail when we run risk profilers on our clients males will always come out having a higher risk tolerance than females. This has in the past blindly led to investment decisions that are not the best option for long-term investors. If you have 7 years plus in your investment timeframe as

The gender equalisation directive of 2012 removed gender as an assessable criteria for life insurance across Europe and in my view worked against females. Men tended to take out cover more than women and women have longer life spans so always paid less for this benefit. All this change did was to make cover for women more expensive as women now had to pay the same as men rather than premiums for men coming down. However, there is an anomaly with income protection that’s significant and I believe needs to change but I can’t see happening. This is

60.0 % 40.0 %

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Performance data as at 15 Jan 2024 YTD 1m

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make your own provision taking advantage of every tax break possible if you want the comfortable and digniﬁed re�rement you desire. Income Protec�on

The gender equalisa�on direc�ve of 2012 removed gender as an assessable criteria for life insurance across Europe and in my view worked against females. Men tended to take out cover more than 13-week basis with one of the where a company pays for income It is also worth noting that one Estate Planning women lifeproviders spans so paid less for this beneﬁt. Allnow thisoffers change did was main thealways difference protectionand for a women female life.have Owinglonger of the main providers A final area of consideration is premium is on 50% to the fact the company is the of suspending to make cover for women morein expensive asaverage women now hadthetooption pay the same as the men rather than estate planning. As above the higher when company paid. The policy owner and not the individual, premiums and the cover on your actuaries tell us that females difference is more significant when premiums for men coming gender is factored in resulting in a down. income protection for one year large premium increase compared

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is available on the personally paid a relationship end up being the to cover paidthere for personally where without theand needI believe for any medical However, is an anomaly with income protec�on that’s signiﬁcant needs to change policy. This and pensions are two spouse trying to deal with estates gender is not a factor. underwriting. This would tie the onlyatax breaks left at this but I cant see happening. This isofwhere company pays for income protec�on for ataking female life.and Owing inheritances at a time of in neatly with someone As you can see from the premiums point. If you are paying for this bereavement and on occasion, on maternity leave. to the fact the company is the policy owner and not the individual, gender is factored in resul�ng in a quoted for a 40-year-old female cover through a company this is their own. Having an estate plan in lookingpremium for cover on a deferredcompared certainly an item to review. large increase to cover paid for personally where gender is not a factor. place including a will and a power

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of attorney is a vital component of any proper financial plan. Getting this right early allows for a more orderly transition of assets that are in line with both spouses’ wishes. No client likes to talk about this but once in place they always have peace of mind.

As you can see from the premiums quoted for a 40-year-old female looking for cover on a deferred 13week basis with one of the main providers the difference in premium is on average 50% higher when company paid. The difference is more significant when you factor in that tax relief at 40% is available on the personally paid policy. This and pensions are two of the only tax breaks le� at this point. If you are paying for this cover through a company this is certainly an item to review.

News

Predicting Progression of Ulcerative Colitis A new partnership between RCSI University of Medicine and Health Sciences and Irish diagnostics company Serosep Ltd is set to personalise treatment for ulcerative colitis and ultimately improve quality of life for patients with the condition. Under the new alliance, RCSI researchers will work with Serosep to accelerate the development of new tests to help predict disease progression in ulcerative colitis, a form of inflammatory bowel disease that damages the lining of the gut over time. The condition causes inflammation and ulcers in the large intestine (colon) and rectum. The project will develop technology to identify ulcerative colitis patients who are likely to progress in their disease, ensuring that people get the most effective care for their disease, and sparing people treatments where they are not likely to be of benefit to them. The partnership between Serosep and RCSI is co-funded by Serosep and the Enterprise Ireland Innovation Partnership Programme. At present, medications known as 5-Aminosalicylates (5-ASA) are the most common first line of treatment for mild-tomoderate ulcerative colitis, and as the disease progresses it is typically managed with steroids, immunosuppressants and biological drugs. There is a pressing need to develop accurate biomarkerbased methods to identify the best treatment regimes for patients soon after diagnosis. “Currently there are no biomarkers which allow prediction of disease progression in patients with ulcerative colitis,” explained

Dr Sudipto Das, Lecturer and Principal Investigator at RCSI School of Pharmacy and Biomolecular Sciences. “Having such biomarkers could augment decision-making for clinicians about whether the patient could benefit from an escalation of treatment at an early stage of the disease.” Dr Das’s team will work with Serosep to validate specific ulcerative colitis biomarkers that the RCSI group has identified in the lab. The plan is to create a new in-vitro diagnostic solution that can support clinicians as they make decisions about the most suitable treatment for the patient based on a panel of biomarkers that can be measured and tracked in samples of their tissue and potentially in the blood as well. “Through recent work in our lab we have identified specific genes that can potentially predict disease progression in adult ulcerative colitis patients,” said Dr Das. “This partnership will allow us to further validate these genes in a larger cohort of patient samples and enable development of a test that can be applied in the clinic to identify patients who are likely to progress at an early stage of disease. This in turn would allow early treatment for those patients, and sparing patients who are less likely to progress from unnecessary treatment. The

Dr Hannah Fitzgerald, Postdoctoral Researcher, RCSI School of Pharmacy and Biomolecular Sciences; David Clancy, Serosep CTO; and Dr Sudipto Das, Principal Investigator at RCSI School of Pharmacy and Biomolecular Sciences ultimate impact of this test would be to improve quality of life in patients with ulcerative colitis.” Collaborative research Serosep Ltd, founded in 1997, is headquartered in Limerick with subsidiaries in London and Johannesburg, and is focused on the clinical in-vitro diagnostic market specifically in infectious disease, which has seen the company build an infrastructure to support its products from conception to commercialisation. Serosep was awarded Irish Medtech Company of the Year in 2022.

The company is excited to partner with RCSI on the project, according to Serosep CEO Dermot Scanlon. “It will allow us to create knowledge within the company through collaborative research, the outputs of which would present us with the opportunity for strategic diversification in our product offering to support our continued growth.” Serosep CTO David Clancy outlined: “The collaboration with RCSI presents an opportunity for Serosep that will enable us to build expertise in new technologies to further develop our product portfolio and access new markets.”

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Iron Deficiency

Screening and treatment of iron deficiency anemia in pregnancy: A review and appraisal of current international guidelines Written by Fiona O’Toole1, Rachel Sheane2, Niamh Reynaud3, Fionnuala M. McAuliffe1, Jennifer M. Walsh1,4 UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin Department of Dietetics, National Maternity Hospital, Dublin 3 Department of Hematology, St Vincent’s University Hospital, Dublin 4 Obstetrics & Gynecology, National Maternity Hospital, Dublin 1 2

Iron deficiency anemia (IDA) is the most common nutritional deficiency, globally affecting 1.2 billion people, and is the leading cause of anemia. Iron deficiency anemia is the end stage of iron deficiency. Nonanemic iron deficiency also carries morbidity and if incorporated, the total number of people affected worldwide approaches 3 billion. Iron deficiency anemia in pregnancy is a common yet potentially preventable problem associated with a significant disease burden. It has been linked to poor health outcomes in the mother, fetus, and infant.1 Anemia in pregnancy has been associated with increased maternal mortality and postpartum hemorrhage risk;2 it has been reported that a hemoglobin less than 7 g/dL doubles the risk of death in pregnancy.2 Postpartum anemia has been linked to depression, fatigue, impaired cognition, lactation failure, and early cessation of breastfeeding.3-5 For the infant, maternal IDA is a recognized risk factor for preterm labor, low birthweight, and small-for-gestational-age (SGA) neonates.6 It is also associated with increased perinatal and neonatal mortality as well as long-term measurable deficits in neurodevelopment.7, 8 An iron-deficient diet in pregnancy is common and may compound the problem.9 The prevalence of IDA in pregnancy is high worldwide. In low- and middle-income countries, the prevalence approaches 50%.10 A two-center study in the UK in 2017 found that 46% of women had anemia at some time during pregnancy.11 A 2017 publication describes incidence rates of 21%–35% of IDA in pregnancy in data from over 15 European countries.12 The WHO Global health repository data describes largely unchanged rates of anemia in pregnancy over time with rates of 41% in 2000 dropping to only 37% in

2019. The 2017 WHO Global Nutrition Targets include a 50% reduction of anemia in women of reproductive age by 2025.13 IDA is treated with oral iron supplementation. Ferrous iron salts are the oral supplementation of choice because of their better absorption and bioavailability compared with ferric salts. Multivitamin formulations usually have insufficient iron to correct anemia and can contain other minerals that hinder iron absorption. Oral iron is an effective, relatively inexpensive, and safe way to replenish low iron stores and treat IDA. Treatment, however, is not always straightforward because of adverse effects, which can affect compliance with treatment. Oral iron supplementation is notoriously challenging for patients to tolerate and can lead to significant gastrointestinal adverse effects including constipation, nausea, abdominal discomfort, diarrhea, and thick green stools. Pregnancy itself can predispose to gastrointestinal disturbance including nausea and vomiting, which may persist beyond the first trimester; heartburn and gastrointestinal reflux disease; slowed gut motility and transit secondary to high levels of progesterone; and hemorrhoidal disease. The presence of any of these common underlying conditions of pregnancy may affect absorption and compliance, and worsen any pre-existing dysfunction. Absorption of iron supplements may also be limited if ingested with certain foods such as tannins, dairy, and phytates, or if ingested at the same time as certain medications including proton pump inhibitors, antacids, and other vitamin and mineral supplements. Mucosal luminal damage may also limit absorption. Therefore, although oral iron is relatively inexpensive and widely used globally, its effectiveness can be compromised by incorrect ingestion, poor compliance, adverse effects, and discontinuation of treatment.

It is also worthwhile highlighting the valid concerns regarding routine iron supplementation in iron-replete pregnant populations when considering recommendations. The evidence suggests an increased risk of hypertensive disease, SGA infants, and gestational diabetes when oral iron supplementation is used indiscriminately in pregnancy.14, 15 There is significant variation in antenatal management of IDA. This review of international guidelines on the screening and management of IDA in pregnancy was performed to review how the guidance on the management of IDA in pregnancy varies internationally, and to appraise the guidelines using a generic tool designed to assess the methodologic quality of clinical practice guidelines.

Materials and Methods A search was conducted using the PubMed and TRIP (Turning Research into Practice) databases to screen for relevant guidelines. The search was confined to those guidelines in the English language only and limited to guidance published since 1998. Search terms included iron deficiency anemia, pregnancy, clinical practice guidelines, policy, oral iron supplementation, and obstetric anemia. International bodies including the National Institute for Health and Care’s Excellence (NICE), the Royal College of Obstetricians and Gynaecologists (RCOG), the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG), the World Health Organization (WHO) and the

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Iron Deficiency Another guideline from Auckland, New Zealand had a much lower hemoglobin cut-off of 7 g/dL as a threshold for antenatal intravenous iron in addition to a ferritin threshold of less than 15 μg/L. This guideline specified that intravenous iron could be considered at a hemoglobin of less than 10 g/dL if early delivery was anticipated. Only eight of the guidelines specify timing of repeat hemoglobin after commencing oral iron, typically 4 weeks after commencement of treatment. One recommends an earlier hemoglobin at 3 weeks if a later gestation in addition to a repeat ferritin. Three guidelines give no specifics in terms of follow up after commencing oral iron in pregnancy21, 23, 28 and only five guidelines give hemoglobin rises to expect within specific timeframes.17, 22, 24, 27, 29

American College of Obstetricians and Gynecologists (ACOG) were also systematically searched for guidance related to the screening and treatment of IDA in pregnancy. Additionally, reference lists on reviewed guidelines were also checked for relevant papers. We included 14 international guidelines in the English language. A full list of the guidelines reviewed can be found in Appendix 1.

obstetricians, a hematologist, and a senior dietician. The scores for each reviewer were recorded. A mean score from all four reviewers across all seven domains was calculated and this is presented in Table 2. Feedback was also sought on each guideline in the form of comments as to why the guideline scored well or poorly in certain domains. This study did not require ethical approval.

The quality of the guidelines was assessed with the Appraisal of Guidelines for Research and Evaluation II Global Rating Scale Instrument (AGREE II GRS), which has been previously described in detail.16 In brief, AGREE GRS is a short-item tool to evaluate the quality and reporting of practice guidelines. It is used as an alternative tool to AGREE II when time and resources are limited. Instructions and points to consider are detailed for each core item. Each user rates the quality of the guideline on a scale of 1 to 7 for the following four domains: (1) process of development, (2) presentation style, (3) the completeness of reporting, and (4) clinical validity of the recommendations. Each assessor also rates the guideline on a scale of 1 to 7 based on three evaluative statements on the overall quality of the guideline, whether they would recommend it for use in practice, and whether they would make use of this guideline in their professional decisions.

Results

Guidelines were independently reviewed by a multidisciplinary team of clinicians consisting of two

In terms of diagnostic criteria, the majority of the guidelines (12/14) gave specific hemoglobin diagnostic cut-offs, typically less than 11 g/dL in the first trimester and less than 10.5 g/dL in the second and third trimesters, although four guidelines gave a third trimester hemoglobin diagnostic level of less than 11 g/dL.17-20 Only four guidelines give diagnostic hemoglobin thresholds for postpartum, these were predominantly less than 10 g/dL, with the Australian Red Cross Lifeblood guideline giving a cut-off of less than 11 g/ dL.1, 20-22 This review showed that only half of the guidelines recommend routine iron in pregnancy, with one guideline specifically stating that there is insufficient evidence in favor of routine supplementation in pregnancy.23 In terms of screening recommendations, five guidelines recommend screening with ferritin in addition to a full blood count in pregnancy,17, 20-22, 24 two recommend selective screening with ferritin for at risk groups only,1, 25 and one guideline suggests using ferritin

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where feasible.26 In contrast, the FIGO committee report and international working group specifically advise against routine use of ferritin in pregnancy.19 Although the majority of the reviewed guidelines recommend similar doses of oral elemental iron of between 100 and 200 mg daily for established IDA in pregnancy, two guidelines recommend twice daily or even three times daily dosing.24, 27 The UK guideline, updated in 2019, specifically recommends lower dosing at 40–80 mg elemental iron in the mornings. This contrasts with the Swiss guideline, which comments that less than 100 mg per day is inadequate. Only three guidelines reference hemoglobin thresholds for the use of intravenous iron in pregnancy and the postnatal period.17, 22, 24 Expert recommendations for the Asia-Pacific region give a hemoglobin threshold of 9.9 g/ dL for recommending intravenous iron in pregnancy, this same guideline advises consideration of a blood transfusion with a hemoglobin of less than 9 g/dL.22 The Swiss Society of Obstetrics and Gynecology guideline advises intravenous iron in cases of a less than 1 g/dL rise in hemoglobin after a 2-week trial of oral therapy. It also recommends intravenous iron in the setting of non-compliance or intolerance at hemoglobin level less than 9 g/dL. Its recommended hemoglobin threshold for the administration of intravenous iron postpartum was 9.5 g/dL.17

The mean score across all the guidelines was 4.4 (range 3.5–6.5). The median score was 4 (interquartile range 3.6–5.2). The British Committee for Standards in Hematology guideline1 scored the highest with an overall mean score of 6.5 (range 5–7). The other higher scoring guidelines from this multidisciplinary review included the 2016 WHO Recommendations for Antenatal Care for a Positive Pregnancy Experience28 (mean score 5.5), the United States Preventative Services Task Force Statement on Screening for IDA and Iron supplementation in Pregnant Women to Improve Maternal Health and Birth Outcomes23 (mean score 5.1), the ACOG Practice Bulletin No. 233 Anemia in Pregnancy30 (mean score 4.7), the Iron Deficiency Anemia Working Group consensus report published in the Turkish Journal of Obstetrics and Gynecology in 201521 (mean score 4.7) and the Irish Guideline on Nutrition in Pregnancy26 (mean 4.8). The remaining guidelines had lower mean scores due to reduced scores in varying individual domains. Reasons for lower scores included underdeveloped evidentiary base, not reporting involvement in all appropriate stakeholders, and suboptimal presentation style. Although a guideline may have scored highly in some domains, its overall score was affected if it scored poorly in another. Taking less than 3.5 as a cut-off of lower mean score for a domain, five guidelines scored below 3.5 in the domain of process of development,17, 18, 20, 24, 27 four guidelines scored below 3.5 due to presentation style,17-19, 27 and five guidelines scored below 3.5 in terms of whether the guideline development process seemed transparent and

93 reproducible.17, 19, 20, 22, 27 In terms of scores for whether the recommendations were clinically sound and appropriate for the intended patients (Clinical Validity Domain), the vast majority (13/14) of the guidelines scored above 3.5.20 There was noted variation in overall scores among the different disciplines of the reviewers, as evidenced in Table 3. The hematologist ranked almost all the guidelines higher on average— this may be partly explained by a better appreciation of the clinical relevance according to this specialty. The clinical dietician noted that dietary counseling was recommended in certain guidelines but there was no supportive material referred to inform practitioners without a background in nutrition or dietetics. The obstetricians’ scores were most similar to each other reflecting how two practitioners in the same discipline are perhaps more likely to rank guidelines similarly. Discussion Although there is some overlap between these international guidelines, there remain obvious variations in the recommendations. The diagnostic hemoglobin cutoffs, screening recommendations, and advice surrounding routine supplementation in pregnancy vary. This review showed that only half of the guidelines recommend routine iron in pregnancy, with one guideline specifically stating that there is insufficient evidence in favor of routine supplementation in pregnancy.23 In terms of screening recommendations, five guidelines recommend screening with ferritin in addition to a full blood count in pregnancy,17, 20-22, 24 two recommend selective screening with ferritin for at-risk groups only,1, 25 and one guideline suggests using ferritin where feasible.26 In contrast, the FIGO committee report and international working group specifically advise against routine use of ferritin in pregnancy.19 Although the majority of the guidelines recommended similar doses of oral elemental iron of 100–200 mg daily for the treatment of established IDA in pregnancy, two guidelines are still recommending twice daily or three times daily dosing.24, 27 Interestingly, the UK guidelines on the management of iron deficiency in pregnancy recommend 40–80 mg oral iron daily and reference evidence on the advantages of lower dose elemental iron and intermittent dosing in terms of absorption.

Follow up of confirmed IDA in pregnancy can be unclear and only five guidelines specify a satisfactory expected increase in hemoglobin within a certain timeframe following initiation of oral iron supplementation. Certain geographical areas will differ from an economical perspective, but there is a lack of sound scientific supportive evidence surrounding certain recommendations.

increase blood viscosity and compromise placental blood flow, and excess iron intake may contribute to oxidative stress via postprandial increase in circulating non-transferrin bound iron, which can lead to lipid peroxidation and DNA damage of placental cells. Iron overload may also impair the systemic response to inflammation and infection as well as impair the maternal gut microbiome.

Routine and prophylactic prescribing of oral iron in pregnancy is potentially controversial. Seven of these 14 guidelines recommend routine low-dose iron supplementation in pregnancy.18, 19, 21, 26-28, 30 Although in theory this practice makes sense, given the iron deficit created by pregnancy and the inability of diet alone to replenish iron stores when iron deficient; in practice, prescribing oral iron to women who are iron replete may increase their risk of gestational diabetes.14 A prospective cohort study demonstrated a significant increased risk in GDM in women who took 30 mg elemental iron a day for any length of time but was most strongly associated with those that were iron-replete who took it for more than 3 months periconceptually and with no family history of diabetes.14

The cost-effectiveness of routine ferritin measurement on all antenatal patients must be considered when planning any screening program. Its rise during any inflammatory process also needs to be highlighted to users of any guideline as well as the potential for it to be falsely low due to hemodilution in the third trimester. Two guidelines recommend screening for IDA with a full blood count and ferritin twice in pregnancy20, 24, 25 and two others recommend screening for IDA at least once with ferritin in pregnancy.21, 22 This might not be feasible and affordable in all healthcare environments. One guideline recommends screening with ferritin if feasible.26 Two guidelines advise screening at-risk groups with ferritin only if there are normal hemoglobin levels.1, 25 Ferritin is highlighted as potentially unreliable by WHO28 and one guideline advises a C-reactive protein if performing serum ferritin.17 In contrast, one guideline specifically advises against routine use of ferritin in screening for IDA in pregnancy.19

Some studies have also shown statistically significant increases in the risk of SGA and low-birthweight infants, increased risk of preterm birth and stillbirth in women with high hemoglobin concentrations in the second trimester.31-34 High hemoglobin concentrations in the third trimester were also associated with increased risk of stillbirth in two studies.35, 36 High maternal iron status, as determined by serum ferritin levels, has also been shown to be associated with an increased risk of preterm birth in all trimesters.37-41 A Cochrane review from 2012 initially showed a reduced risk of low-birthweight neonates with routine iron supplementation in pregnancy, but was updated in 2015 to show borderline significance and was not significant for any other birth outcomes.42 A randomized controlled trial examining the effect of 50 mg oral iron versus placebo in iron-replete Iranian pregnant women showed that they were significantly more likely to have higher mean hemoglobin concentrations in the third trimester but also more likely to deliver an SGA infant and to have a hypertensive disorder of pregnancy.15 There are a variety of mechanisms through which excess iron may be harmful in pregnancy. High hemoglobin concentration may

It is worth remembering that non-anemic iron deficiency is estimated to be twice as prevalent in the global population as irondeficiency anemia and has similar symptoms.43 Undiagnosed iron deficiency in pregnancy has the potential to increase the risk of antenatal and postnatal IDA with its negative sequelae. Interestingly, only two guidelines refer to alternate day or intermittent dosing to aid absorption.1, 28 This is interesting given the recent scientific evidence in non-pregnant populations that demonstrate better iron absorption and bioavailability with alternate day dosing.44, 45 Hepcidin, an important peptide involved in iron uptake and homeostasis, rises with daily oral iron further affecting absorption.46 One of the two guidelines to still recommend twice daily and three times daily dosing of oral iron was updated as recently as 2019.27 Few guidelines give specific follow-up advice in terms of what rise in hemoglobin is acceptable and how quickly to expect it. Obviously, there will be clinical judgement exercised in terms of gestation and other parameters,

such as reticulocyte count, but a strong guideline would guide staff as to the appropriate follow up with less uncertainty. Two guidelines particularly focused on and had specific hemoglobin thresholds for administering intravenous iron.17, 21 The clinical picture, gestation, and urgency will sometimes determine the need for intravenous iron, but it is not without significant cost in comparison with oral supplementation, from a drug, staffing, and possible complications perspective. Although anaphylaxis and genuine hypersensitivity reactions tend to be rare, hypophosphatemia can also occur with clinical consequences.47 Another very important consideration is the possibility of permanent hemosiderin skin staining from extravasation of intravenous iron and women need to be adequately counseled about this risk preadministration. Some cheaper forms of intravenous iron require multiple infusions over the course of several weeks. The cost of safe monitoring and observation by staff on each admission must also be considered. A quality guideline is one that clearly outlines its process of development, with clear objectives and where all stakeholders are described. There is visual appeal when recommendations are summarized at regular intervals, and it is useful to have each recommendation graded appropriately with reference to supportive evidence. If there are limitations within the available research, it is important that this is documented. Each of these guidelines was independently appraised by four separate reviewers with comments and feedback. Although each guideline has a unique target audience and often applies to a particular population and economic area, each one was appraised in a systematic fashion using the AGREE GRS II tool. This focused review evaluates their individual quality from a standardized approach and demonstrates areas that could be improved to help clinicians and caregivers to feel confident in their use. Scientific advances in our understanding of iron physiology may lead to considerable improvement in the management of iron deficiency in pregnancy by altering the dosing strategy for oral iron. In non-pregnant populations there is increasing recognition that alternate day dosing is better tolerated with superior absorption. Additionally,

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Iron Deficiency

lower doses of oral iron appear to be more effective than higher doses at improving anemia.46 It is timely that a randomized controlled trial examining the benefits of daily versus alternate day oral iron supplementation in pregnancy be performed. The PANDA (Primary Prevention of maternal Anemia to avoid preterm delivery and other adverse outcomes) research program is being funded by the National Institute for Health and Care Research in the UK and is focused on identifying barriers and enablers to iron supplementation, exploring the development of a behavioral intervention to promote compliance, and checking feasibility of an RCT to identify the optimal dosing schedule for oral iron. This group is also planning on following on with a larger, two-arm, multicenter trial of routine iron supplementation versus placebo aiming to recruit over 11 000 women. Their proposed primary outcome is a composite of preterm birth, neonatal birth, and SGA infants. Importantly, they are also going to evaluate long-term maternal and infant neurodevelopmental outcomes. Most trials so far have focused on hematologic parameters and from a clinical perspective and guideline point of view, trials need to report on maternal and neonatal outcomes. The use of universal iron supplementation to prevent maternal anemia needs to be explored considering geographical variation in rates, diet, and helminthic disease given the potential risks of gestational diabetes, hypertensive disease, and preterm birth in treating iron-replete women.

Qualitative research among pregnant and postnatal women may help further our understanding of drivers and inhibitors of compliance with iron supplementation both in pregnancy and in the postpartum period. These results again are likely to vary according to geography and economy of different populations and may guide future recommendations. Targeted reinforcement of accurate ingestion advice in a clinical setting has been shown to greatly improve tolerance and compliance with oral iron supplementation.48 More evidence is also required for the optimal screening strategies in pregnancy, remembering that that non-anemic iron deficiency is missed with a routine full blood count and will dramatically decrease a woman’s iron reserves, which may be dangerous in the context of hemorrhage at delivery. From a quality-of-life perspective, non-anemic iron deficiency results in similar symptoms to IDA and may have potential negative effects in the postnatal period also.49 Research on the rates of iron deficiency in the setting of normal hemoglobin levels both in early and late pregnancy may be useful in providing an evidence base for targeted versus universal ferritin screening in various populations. This is particularly relevant in pregnancy given the potential longterm consequences in childhood and later life of untreated iron deficiency in pregnancy.8 Obstetric patients with underlying active inflammatory conditions are a more complex cohort to treat given that they are likely to be suffering from functional iron deficiency with high levels of

hepcidin inhibiting iron absorption, and entrapment of iron within storage pools. Their ferritin results may also be misleadingly high. Future guidelines warrant referencing the management and precautions in these more high-risk antenatal patients. This is the first paper to use the AGREE GRS II criteria to compare international clinical practice guidelines on the management of IDA in pregnancy. Although AGREE GRS II is shorter and not as robust and thorough as the longer AGREE II assessment, it is well validated and allows busy clinicians to give their appraisal from a clinical perspective. The multidisciplinary nature of our team helped to demonstrate how certain guidelines might appeal to different disciplines. The scores were aggregated to reflect their overall performance across the group and each reviewer’s individual mean scores were also calculated per guideline to reflect differences among the disciplines. In conclusion, an effective userfriendly guideline that directs action in a clear layout with reference to supportive evidence and strengths of recommendations is required for guidance on screening and treatment of iron deficiency in pregnancy. There is clearly a need for more consistency and evidence-based advice in terms of screening, treatment, and follow up, and a consensus on routine oral iron in all pregnant women needs to be determined. Randomized controlled data on the optimal treatment regimen for established iron deficiency in pregnancy is

required, for example, daily versus alternate day versus intermittent dosing, higher versus lower dosing of elemental iron. A good guideline will ideally reduce hospital admission, guide staff as regards appropriate follow up and referral as required, identify at-risk women for IDA, avoid unselected use of iron with consequent adverse effects of gastric upset and constipation, and identify women who would benefit from intravenous iron early (the non-absorbers and compliers) and avoid intravenous iron in those who could have better compliance with alternate day iron. A useful guideline is one that gives knowledge to users without compromising expediency. This paper summarizes the content and quality of these selected international guidelines and their referenced evidence. The results of this analysis may be used to drive future guideline development and targeted high-quality trials. This review has highlighted that despite such a high prevalence, there remain many clinical questions regarding optimal prevention and management of IDA in pregnancy; the problem is clearly not as simple as it may be perceived. Author Contributions Jennifer M. Walsh, Fionnuala M. McAuliffe, and Fiona O’Toole contributed to study design and planning. Fiona O’Toole, Jennifer M. Walsh, Rachel Sheane, and Niamh Reynaud conducted the study and performed the data analysis. Fiona O’Toole, Rachel Sheane, Niamh Reynaud, Fionnuala M. McAuliffe, and Jennifer M. Walsh wrote the manuscript.

News

Sharing the Vision Conference The Sharing the Vision - National Mental Health Conference recently took place at Dublin Castle. The Conference provided an opportunity for stakeholders to discuss developments in national mental health policy and delivery, and to review how Sharing the Vision is driving the delivery of a modern, patient-centered mental health service which is focused on best practice, innovative service development, and improved service delivery. The Conference was convened and opened by Minister for Mental Health and Older People Mary Butler with contributions from Taoiseach Leo Varadkar and Minister for Health Stephen Donnelly. Speaking at the event, Minister Donnelly emphasised the need for continued investment in

mental health services, across the spectrum of prevention and early intervention, through to acute specialist services. “Today’s event has further highlighted the core issue that mental health challenges can impact on anyone, at any stage of life. The central theme that there is ‘no health, without mental health’ exemplifies the need to ensure

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that mental health services, and modern, person-centred, and accessible to everyone.” Opening the Conference, Minister Butler said, “Over the lifetime of this government, investment in mental health services has grown to ¤1.3 billion. Today’s announcement of a further ¤10 million to support the clinical programmes and youth mental

health, further highlights the government’s recognition of mental health as a central component to overall health. I look forward to working with colleagues in my department and the HSE to identify service improvements and innovations that can be underpinned and delivered through this funding.”

If you’re constantly exhausted, a lack of iron could be the reason. Try

Today’s hectic pace of life is enough to leave anyone feeling tired, but if you’re permanently worn out, it may be more than a busy life that’s to blame. Often, feeling washed-out is the first sign your iron levels have fallen too low. One third of all women in the UK have such low iron intakes, they are left exhausted and unable to concentrate on anything for more than a few minutes. Nutritionists recommend 15mg of iron a day for women to stay healthy, but most women consume 10mg or less. If you’re not getting enough iron, you may find the condition of your hair and nails deteriorates or you may develop cracked skin around the corners of your mouth. But that’s not where it ends. Once your body’s iron levels are depleted, you are more likely to develop anaemia (the more exhausted you feel, the closer you are to developing the condition). As iron levels drop, you may begin to feel breathless, suffer palpitations and even experience temporary memory loss. Research carried out at King’s College, London, found low iron levels can even affect your IQ.

Menstruation is one of the main reasons and goes a long way to explaining why women are about 10 times more likely than men to suffer from a lack of iron – just a few heavy periods in a row can cause a loss of this vital mineral. Also, pregnancy and breastfeeding increase a woman’s iron requirements. When it comes to childbirth, further amounts of iron will be lost. And that’s on top of bad lifestyle habits – such as drinking excessive black tea or coffee which can inhibit iron intake, or intense fitness routines or dieting which can also boost the likelihood of anaemia. However it’s also children who need sufficient iron due to the rapid rate at which they develop, both physically and mentally.

Floradix Floradix liquid iron formula contains 7.5mg of iron gluconate per 10ml, so a daily dosage of 20ml ensures you receive the recommended daily amount. Floradix also contains vitamins B1, B2, B6, B12 and vitamin C to increase iron absorption. To help with digestion and avoid any chance of constipation, Floradix contains herbal extracts of nettle, fennel and ocean kelp. There couldn’t be an easier way to ensure a healthy iron intake and get your energy levels back on track. What’s more, Floradix is free from chemical preservatives and is suitable for vegetarians. There is also a yeast and gluten free version available, called Floravital Liquid Iron, which is suitable for vegans.

The solution So how can you ensure you keep your iron levels healthy and combat tiredness for good? Alongside a balanced diet, nutritionists recommend you take iron supplements for six weeks at least two to three times a year. If you’re worried about the constipation and headaches often associated with taking iron tablets, try liquid iron supplements which allow the nutrients to be more easily absorbed by the digestive system.

Distributed in Ireland by: The Natural Medicine Company, Burgage, Blessington, Co. Wicklow Tel: 045-865575 email: sales@naturalmedicine.ie www.naturalmedicine.ie

Clinical Profiles

GROUNDBREAKING EV-302 TRIAL SIGNIFICANTLY EXTENDS OVERALL SURVIVAL AND PROGRESSION-FREE SURVIVAL IN PATIENTS TREATED WITH ENFORTUMAB VEDOTIN AND PEMBROLIZUMAB IN FIRST-LINE ADVANCED BLADDER CANCER Astellas Pharma recently announced results from the Phase 3 EV-302 clinical trial (also known as KEYNOTE-A39) for enfortumab vedotin in combination with pembrolizumab versus chemotherapy. The combination improved overall survival (OS) and progressionfree survival (PFS) with statistically significant and clinically meaningful results in patients with previously untreated locally advanced or metastatic urothelial cancer (la/mUC). The findings were presented at the European Society for Medical Oncology (ESMO) Congress 2023 as part of the Presidential Session (Abstract #LBA6). The EV-302 study met its dual primary endpoints of OS and PFS, compared to platinum and gemcitabine chemotherapy. Patients treated with enfortumab vedotin and pembrolizumab experienced: • Median OS of 31.5 months (95% CI: 25.4-NR) compared to 16.1 months (95% CI: 13.9-18.3) in the chemotherapy arm. o Significantly prolonged OS, reducing the risk of death by 53% compared to treatment with chemotherapy (Hazard Ratio [HR]=0.47; 95% Confidence Interval [CI]: 0.38-0.58; P<0.00001). • An Independent Data Monitoring Committee determined that OS crossed the pre-specified efficacy boundary at interim analysis. • Median PFS of 12.5 months (95% CI: 10.4-16.6) compared to 6.3 months (95% CI: 6.2-6.5) in the chemotherapy arm. o 55% reduction in the risk of cancer progression or death compared to treatment with chemotherapy (HR=0.45; 95% CI: (0.380.54); P<0.00001). • Consistent OS results across all pre-defined subgroups, including cisplatin eligibility and PD-L1 expression level. The most common (≥3%) Grade 3 or higher adverse events (AEs) related to treatment with enfortumab vedotin and pembrolizumab were rash maculo-papular, hyperglycemia, neutropenia, peripheral sensory

neuropathy, diarrhea, and anemia. The safety results in EV-302 are consistent with those previously reported with this combination in EV-103 in cisplatin-ineligible patients with la/mUC. No new safety issues were identified. Ahsan Arozullah, M.D., M.P.H., Senior Vice President, Head of Oncology Development, Astellas “The remarkable findings presented today demonstrate that the combination of enfortumab vedotin and pembrolizumab could offer longer survival and more time without disease progression for patients with advanced urothelial cancer. The presentation of this data is an important milestone for this patient population, and we look forward to continued discussions with regulatory authorities as we work to expedite bringing this therapy to those who need it most.” Among secondary endpoints, results demonstrated a 68% confirmed objective response rate (ORR) (95% CI: 63.1-72.1, P<0.00001) in patients treated with enfortumab vedotin plus pembrolizumab, versus an ORR of 44% (95% CI: 39.749.2) in patients treated with chemotherapy. In the enfortumab vedotin plus pembrolizumab arm, 29.1% of patients experienced a complete response, and 38.7% of patients experienced a partial response, compared with 12.5% and 32.0% in the chemotherapy arm, respectively. The median duration of response (DOR) was not reached in the enfortumab vedotin plus pembrolizumab arm, versus 7 months (95% CI: 6.2-10.2, P<0.00001) in the chemotherapy arm. The EV-302 trial is an open-label, randomized, controlled Phase 3 study, evaluating enfortumab vedotin in combination with pembrolizumab versus chemotherapy in patients with previously untreated la/mUC. The study enrolled 886 patients with previously untreated la/mUC who were eligible for cisplatinor carboplatin-containing chemotherapy regardless of PD-L1 status. Patients were randomized to receive either enfortumab vedotin in combination with pembrolizumab or chemotherapy. The dual primary endpoints of this trial are OS and PFS per RECIST v1.1 by blinded independent central review (BICR). Secondary endpoints include ORR per RECIST v1.1 by BICR, DOR per RECIST v1.1 by BICR, and safety. The EV-302 trial is intended to serve as the basis for global submissions and as the confirmatory trial for the

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U.S. accelerated approval of this combination. In April 2023, the U.S. Food and Drug Administration (FDA) granted an accelerated approval to enfortumab vedotin in combination with pembrolizumab for the treatment of adult patients with la/mUC who are not eligible to receive cisplatin-containing chemotherapy based on tumor response rate and durability of response from the EV-103 trial. The EV-302 trial is part of an extensive program evaluating this combination in multiple stages of urothelial cancer and other solid tumors. Topline results of the EV-302 trial were announced in September 2023.

irishoffice@consilienthealth.com.

NEW SMOKING CESSATION MEDICATION CITIDARON® (CYTISINE 1.5 MG TABLETS) LAUNCH IN IRELAND ON JANUARY 1ST, 2024

Access to the new service will be available at centres based in Dublin, Galway, Limerick, Louth and Meath. This will bring the total number of clinics offering female health consultations with a specialist GP to 27 nationwide.

In a significant advancement in the battle against nicotine addiction, Consilient Health Ireland, is delighted to announce the launch of their new prescription-only medication (POM), Citidaron®. This novel treatment indicated for smoking cessation and reduction of nicotine cravings in smokers who are motivated to quit will be available to patients across Ireland from January 1st, 2024. In Ireland, approximately18% of individuals still smoke, many are struggling to quit, despite being aware of the known side effects. Citidaron® is a nicotine-free, effective, fast treatment indicated for smoking cessation and reduction of nicotine cravings in smokers who are willing to stop smoking.2 Citidaron®, a plant alkaloid, targets the same receptors in the brain as nicotine, but with a stronger binding affinity and less stimulation.2 This means that it can help reduce nicotine cravings and withdrawal symptoms more effectively than nicotine itself, making it easier for individuals to quit smoking while potentially having fewer side effects due to the weaker overall stimulation of the receptors. Ireland’s commitment to becoming a smoke-free country by 20251 means that such advancements could not only help individual smokers but also significantly impact public health initiatives. With Citidaron’s introduction, the path to a smoke-free life is more accessible and supportive than ever before. For more information on Citidaron visit https://www. consilienthealth.ie/ or contact

IRISH LIFE HEALTH ANNOUNCES CONTINUED EXPANSION Irish Life Health, one of Ireland’s leading health insurance providers, has announced the expansion of the female health specialist GP service, with access to a further 11 in-person Centric Health clinics, set to be available by the end of Q1 2024. Irish Life Health’s female health service offers an initial digital consultation with GPs who are specialist in female health issues, as well as direct access to an in-person consultation if a referral is required*.

Since the launch of this first of its kind female health consultation in August 2023, almost half the consultations are for issues relating to menopause which aligns with research commissioned by Irish Life Health in July 2023**, which found that almost half of 35 – 54 year olds are worried about perimenopause or menopause. A further 1 in 3 appointments are for women aged 18 – 34 which highlights the need for such services amongst younger women in Ireland. The Irish Life Health research identified that 89% of 18 - 34 year olds want to understand more about female health with 75% curious about their fertility status. The average consultation time through this service is 20 minutes, giving more time to women to discuss their female health concerns in comparison to a standard GP consultation. The female health consultation offers Irish Life Health members access to a GP consultation by phone or video, potentially a diagnosis and a recommended course of action with an in-person appointment at one of Centric Health’s specialist female health clinics across Ireland. This benefit is available on all Irish Life Health plans. To date, almost half of all digital consultations have required an inperson follow-up, with blood tests and scans being the most common services required. Liz Rowen, Head of Marketing, Irish Life Health said: “Ensuring that our customers have quick and easy access to the care and advice they need is at the heart of what

97 we do. Women across Ireland have indicated that getting fast access to specialist female health expertise is difficult, which is why we developed this service and why we’re continuing to invest in this much needed offering in 2024. Irish Life Health has committed to investing over ¤30m to build out digital and community-based health services, which includes this female health service and our digital doctor offering. We are really pleased to see younger people accessing the service as we saw from our research that four in ten 18 – 24 year olds in Ireland are worried about menstruation issues, while four in ten 25 – 34 year olds are worried about fertility issues. I would urge any one of our female members that has such concerns to check out this service.” Dr Maire Finn, one of Centric Health’s specialist GPs delivering this service for Irish Life Health, comments: “The research carried out by Irish Life Health** indicated that women wanted to know more about the health matters that relate specifically to them and that they were finding it hard to access specialist female health expertise. We have seen from the response in the first four months that this new Irish Life Health female health consultation is an important and necessary step in providing specialised care and information that women need and want.” The Irish Life Health survey, which was carried out amongst women aged 18+, revealed insights into perceptions of female healthcare in Ireland. Over half of respondents believe female healthcare is not well serviced in Ireland, while 38% are finding it difficult to get fast access to specialist female health expertise. *Access to the Female Health consultation is available to customers across all Irish Life Health hospital plans for ¤40 per visit (50% discount). Cover for inperson referrals varies by Plan. **Research conducted by Red C in July 2023, featuring a panel of 500+ female representatives aged 18+ NEW PODCAST SERIES LAUNCHED ON GYNAECOLOGICAL CANCERS, WHICH REPRESENT 12% OF ALL FEMALE CANCERS A new podcast series has been launched by The Irish Society of Gynaecological Oncology (ISGO) as a valuable resource for patients undergoing treatment for gynaecological cancers.

whilst most importantly, making a difference for those affected by cancer.” In the Republic of Ireland, over 1,400 gynaecological cancers are diagnosed annually with 591 diagnosed annually in Northern Ireland, representing over 12% of female cancers. Symptoms of gynaecological cancer may include: abnormal vaginal bleeding or discharge, feeling full too quickly, bloating or difficulty eating, pelvic pain or pressure, abdominal or back pain, a more frequent need to urinate, constipation, itching burning changes of vulva and changes in vulval colour or skin. If you have been experiencing any of these, please visit your healthcare provider. Dr. John Coulter, Cancer patient Bridget Carr, Dr. Dearbhaile Collins, President ISGO and Eoghan O Sullivan, Breakthrough Cancer Research. Picture by Chani Anderson @capturesbychani

Hosted by G.P., Dr. Doireann O’Leary, and sponsored by Breakthrough Cancer Research, the podcast series shares the stories and first-hand experiences of people who have had a cancer diagnosis. They are joined by healthcare professionals, who provide expert advice, and the podcasts also delve into cuttingedge research and advancements, which aim to improve survival and treatment options. Episodes include topics focused on specific cancers like ovarian cancer (in particular PARP inhibition) and gestational trophoblastic disease, to topics which bridge all cancer types including experience of palliative care services. People share their stories of being diagnosed with a genetic cancer syndrome and what this has meant for them and their family as well as patient and public involvement in research. They also explore the psychological and psychosexual consequences of cancer treatment. Dr. Dearbhaile Collins remarked, “As President of ISGO, I am delighted to present our podcast series in collaboration with Dr. Doireann O’Leary. Our vision is to deliver accurate information to the public from both specialists and patients themselves, to create easily understandable and accessible audios. We are delighted with the engagement from Irish experts in their fields and the frank and insightful personal

experiences from patients. ISGO looks forward to being involved in future podcasts in other areas of gynaecological cancer.” Tamsin Finlay, one of the contributors on the podcast series remarked “This was a very empowering and therapeutic platform to air my journey of infertility with cancer and my resilience to a state of acceptance and happiness.” Dr. Doireann O’Leary says: “It’s a privilege to host the ISGO podcast. The patient voice is central to this series. I learned so much from the patient advocates who courageously shared their story and lived experience to help others. I also got to speak to the dedicated consultants who care for them; their lifelong dedication to providing evidence-based care with empathy is inspiring. This series is a must listen for all women; we discuss gynaecological cancers, ‘red flag’ symptoms never to ignore, how to ‘speak up’ and advocate for yourself in the oftentimes overwhelming healthcare setting. We say the ‘unsaids’. For me, having these conversations was educational, uplifting and inspiring and I know it will be for the listener too! Jenny Maginn told us “I was diagnosed with advanced ovarian cancer. A year of surgeries and treatments took my independence away and made me very reliant on family and friends. It was important to me after treatment to get back to as normal a life as possible. I wanted to feel valued and to be doing something worthwhile. The opportunity to create a podcast came at the right time. I was ready to be heard so that I could use my experience to help and give me a sense of purpose again. I feel empowered that I have found something I feel passionate about, that I can do and can feel valued for,

ISGO is an all-Ireland venture encompassing all gynaecological cancers whose aim is to advocate for patients through improvements in education training and research. Breakthrough Cancer Research is Ireland’s leading research charity for poor prognosis cancers. It supports research all over Ireland in gynaecological cancers. Sponsor Breakthrough Cancer Research is Ireland’s leading research charity for poor prognosis cancers and committed to funding research to improve cancer care and outcomes. To access the series, please visit Dr. Doireann’s Podcast wherever you get your podcasts. For further information and support regarding gynaecological cancers please visit: www.thisisgo.ie THÉA PHARMA MAYO SCHOOL ART COMPETITION With the theme “The Eyes are the Window to the Soul!”, Ireland’s No 1 choice for eye care Théa Pharma created and implemented a unique Art competition for Mayo secondary schools. Transition Year students in Co. Mayo were asked to get their creative juices flowing grabbing the opportunity to showcase their talent and charisma. More than 60 students participated from Balla Secondary School, St. Brendan’s Belmullet, Ballyhaunis Community School, Sacred Heart Secondary School Westport and St. Joseph’s Secondary School, Castlebar. Among them the 10 most creative ideas were selected and presented in a lovely ceremony in Théa’s Headquarters in Castlebar on Tuesday December 12th. All 10 students participated along with their teachers and parents. From the 10, the 3 most charismatic and talented ones were singled out. The Grand

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Clinical Profiles

Eyes Wide Open: Théa Pharma’s top 10 art competition finalists

Winner received ¤1,000, the second winner ¤500 and the third ¤250. Théa Pharma’s Country Manager Diarmuid Gavin said: “This is a day that demonstrated all that Ireland stands for, the warmth, the talent, the promise of its younger generation and that our tomorrow is filled with promise because of these young students. This is a great day for Mayo and all its future potential. Everyday 1 out of 2 people suffer from Dry Eyes. We are proud and honoured to raise awareness on the importance of Eye Care. The Eyes are the Window to the soul. Let’s take good care of them!”. NEW CHAIR OF NATIONAL RARE DISEASE STEERING GROUP

Kellecher, College Principal at the UCD College of Health and Agricultural Sciences. “Most important, I believe, is the planned consultative patient forum to facilitate patient input and engagement in all stages of the process.” A rare disease is defined in Europe as a disease having a prevalence of fewer than 5 cases for every 10,000 persons. There are currently up to 8,000 described rare diseases. Collectively, these diseases affect around 6% of the population, accounting for an estimated 300,000 individuals in Ireland. The new Steering Group aims to address Rare Disease service gaps to ensure patients receive timely and accessible care. It will also consider how best to integrate the European Reference Networks into the national health, as well as identify the core practical requirements of a Rare Disease Registry. Assessing how best to promote awareness and research around rare diseases will also be a key area for the body.

Professor Cecily Kelleher has been appointed as chair of the newly established National Rare Disease Steering Group, a panel of experts tasked with formulating a plan for the management of rare diseases in Ireland. The body will develop a new Rare Disease Plan that sets out the vision for the country’s rare disease services, including the actions required to achieve this. “We will be considering how best to improve access and address gaps in Rare Disease services and to promote awareness among healthcare professionals and the public, employing International best practice and top-quality available research,” said Professor

SANOFI ANNOUNCES END OF PROGRAM EVALUATING TUSAMITAMAB RAVTANSINE AFTER A 2L NSCLC PHASE 3 TRIAL DID NOT MEET A PRIMARY ENDPOINT

An Independent Data Monitoring Committee (IDMC) found that tusamitamab ravtansine as a monotherapy did not meet its dual primary endpoint of progressionfree survival (PFS) compared to docetaxel. Despite an improved overall survival (OS) trend, termination of the program was based on non-improvement in PFS at the final analysis. Tusamitamab ravtansine had a similar safety profile as previously presented with a lower incidence of various important clinical categories of adverse events versus docetaxel. Trial participants will have the option to stay on their current therapy if they are benefitting, as deemed by their provider, or to transition to an appropriate standard-of-care therapy. Sanofi will continue exploring the potential of antibody tusamitamabbased ADCs and CEACAM5 research in several types of cancer. Dietmar Berger, Chief Medical Officer and Head of Development said, “Our team is grateful to the patients, families and healthcare professionals involved in the tusamitamab ravtansine development program. Although the results are not what we hoped for, our research and work to advance potentially transformative therapies in areas of high unmet need for people living with cancer will not stop. We will continue to explore the potential of CEACAM5 as a biomarker in cancer types where it is highly expressed.” CEACAM5 is a member of the CEACAM family of 12 glycoproteins and may drive cell adhesion and migration, as well as inhibit apoptosis, and may be overexpressed in many different cancer types. ZITA WEST PRODUCT INFORMATION TZita West is a name synonymous with excellence in the world of fertility and pregnancy. For over 25 years, Zita West has been a trusted name for women and couples who are seeking support and guidance on their journey

to parenthood. From bestselling books on fertility and pregnancy to premium supplements and holistic therapies, the Zita West brand is the gold standard for those who value quality and expertise. By listing Zita West products, you will be offering your customers access to a brand that has helped thousands of women and couples achieve their dream of starting a family. You can trust that the Zita West range is rigorously researched and developed by a team of experts, using only the highest quality ingredients and materials. Whether your customers are seeking support with fertility, pregnancy, or postpartum recovery, the Zita West range has something for everyone. From conception support supplements to pregnancy teas and massage oils, every product is designed to support optimal health and wellbeing for both mother and baby. By listing Zita West, you will be aligning your brand with a trusted and respected name in the world of fertility and pregnancy. Your customers will appreciate the opportunity to access these premium products, and you can feel confident knowing that you are offering them the very best. Don’t miss out on the opportunity to add the iconic Zita West to your inventory today! https://www.dailymail.co.uk/femail/ commercehealth/article-11644239/ Fertility-expert-Zita-West-helpedcelebs-like-Kate-Winslet-conceivetips.html POOLBEG PHARMA: FURTHER DATA CONFIRMS POLB 001’S POTENTIAL IN CANCER IMMUNOTHERAPYINDUCED CYTOKINE RELEASE SYNDROME (CRS) Poolbeg Pharma, a biopharmaceutical company focused on the development and commercialisation of innovative medicines targeting diseases with a high unmet medical need, has announced promising in vivo results for POLB 001 in addressing cancer immunotherapy - induced CRS.

Sanofi is discontinuing the global clinical development program of tusamitamab ravtansine. The decision is based on the outcome of a prespecified interim analysis of the Phase 3 CARMEN-LC03 trial evaluating tusamitamab ravtansine as monotherapy compared to docetaxel in previously treated patients with metastatic nonsquamous (NSq) non-small cell lung cancer (NSCLC) whose tumors express high levels of carcinoembryonic antigenrelated cell adhesion molecule 5 (CEACAM5). Zita West Product Information

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Zita West is a name synonymous with excellence in the world of fertility and pregnancy. For over 25 years, Zita West has been a trusted name for women and couples who are seeking support and guidance on their journey to parenthood. From bestselling books on fertility and pregnancy to premium supplements and holistic therapies, the Zita West brand is the gold standard for those who value quality and expertise.

99 Positive study results POLB 001 demonstrated efficacy in reducing cancer immunotherapyinduced CRS in an in vivo animal model with CRS symptoms significantly improved following administration of POLB 001. Reductions were seen in all serum proinflammatory cytokines tested. The results, together with the data from the recent LPS human challenge trial, further support the Company’s strategic expansion of the Phase II ready POLB 001 to treat and prevent cancer immunotherapy induced CRS. The data strengthens and facilitates the expansion of patent applications for POLB 001 in cancer immunotherapy-induced CRS. Market opportunity estimated at over US$1 billion Largely due to the CRS risk (which can be life threatening), administration of cancer immunotherapies, such as bispecific antibodies, is currently restricted to cancer centres which limits uptake of these effective therapies. As an oral therapy to prevent or treat CRS, POLB 001 has the potential to enable broader use of cancer immunotherapies in an outpatient setting. The Company believes that POLB 001 represents a significant market opportunity estimated at > US$1 billion in Multiple Myeloma, High Grade Lymphoma and Acute Lymphoblastic Leukaemia alone. Cancer immunotherapies are being widely developed across a broader range of haematological malignancies, solid tumours and immune inflammatory diseases, which represents an even greater market opportunity. In the U.S., the American Cancer Society estimates that there will be 24.6 million cases of cancer by 20301,2. Cancer immunotherapies, such as bispecific antibodies and CAR T cell therapy, are rapidly moving into earlier lines of treatment in many tumour types, with these markets anticipated to grow to US$100bn+ (~35% CAGR) by 20303 . Independent Advisory Board Supportive of POLB 001’s Potential Poolbeg convened an Independent Advisory Board with international Key Opinion Leaders, healthcare payers and clinical trial experts, which endorsed the attractiveness of POLB 001’s Target Product Profile (TPP) and its potential as an oral therapy to address the significant unmet medical need of cancer immunotherapy induced CRS. POLB 001 has been shown to reduce hyperinflammation without complete ablation of an effective

immune response, which makes it potentially a very attractive therapy for this disease area. David Allmond, Chief Business Officer of Poolbeg Pharma, commented: “POLB 001 has the potential to revolutionise the impact of cancer immunotherapies by enabling safer and broader use in an outpatient setting, reducing healthcare resource utilisation and making these next generation cancer treatments more widely available to the patients that need them. The pharmaceutical sector is seeking an effective solution for CRS and, as an oral therapy, we believe there is a significant opportunity for POLB 001 to meet this critical unmet medical need and have a positive impact on global health.” THE AKKERMANSIA COMPANY™ LAUNCHES THEIR TWO PIONEERING PRODUCTS CONTAINING PASTEURIZED AKKERMANSIA MUCINIPHILA MUCT IN IRELAND

with Stress Management, a blend of 30 billion pasteurized Akkermansia muciniphila mucT cells, chamomile extract, and essential B-vitamins. This tablet not only supports gut health but also contributes to psychological well-being. Additionally, The Akkermansia Company™ offers Weight Management with Glucose Control, a food supplement promoting weight management and blood sugar control. Each tablet contains 30 billion pasteurized Akkermansia muciniphila mucT cells, with EGCG Green Tea supporting weight control. Chromium helps maintain optimal glucose levels, and Vitamin B2 strengthens mucous membrane health. Excitingly, these groundbreaking products have officially launched in Ireland since January 2024. The Akkermansia Company™ invites the Irish community to embrace these advancements, unlocking the potential of Akkermansia mucT for improved health and well-being. BLACKROCK HEALTH INVESTS ¤1.5 MILLION IN NEUROSURGICAL TECHNOLOGY

An international leader in developing “next generation” probiotic and postbiotic supplements, The Akkermansia Company™ is on a mission to shift the focus of the microbiome health paradigm from symptoms to root cause. Founded in 2016 by Profs. Patrice Cani and Willem M de Vos (inventors on the Cani et al. application), the company discovered, named, patented, and developed Akkermansia mucT, which plays a major role in helping to maintain a healthy gut microbiome.

Blackrock Health, combining Hermitage, Blackrock, Galway and Limerick Clinics’, has invested ¤1.5 million in new neurosurgical technology that will facilitate robotic cranial and spinal surgery. The ExcelsiusGPS® Robotic Navigation Platform has been installed in the Hermitage Clinic and is now operational for spinal surgery, with training for cranial surgery due to take place before the end of Q1 2024. Once training has been complete, the Hermitage Clinic will be the first hospital in Ireland to offer cranial robotic surgery. In a significant development for people living with Parkinsons Disease and other neurological conditions, the advanced technology solution will be used in

cranial surgery to place electrodes for people undergoing Deep Brain Stimulation Treatment (DBS). DBS is a long-term treatment option for patients with selected movement disorders, which involves implanting neurotransmitters in the brain. All Spinal and Cranial Neurosurgeons will be fully conversant in the use of the ExcelsiusGPS robot navigation platform. The team has already undertaken training and some consultants will participate in observerships in the United States to deliver new surgical techniques at Blackrock Health Hermitage Clinic. The ExcelsiusGPS® can facilitate more minimally invasive surgeries, translating to smaller incisions, less tissue damage, reduced postoperative pain, shorter hospital stays, and faster recovery times. The system is also designed to streamline the surgical workflow and reduce radiation exposure to surgeons and staff. This revolutionary robotic navigation platform is the world’s first technology to combine a rigid robotic arm and full navigation capabilities into one adaptable platform for accurate trajectory alignment in spine surgery. Gordon Dunne, CEO of the Blackrock Health Hermitage Clinic said, “The ExcelsiusGPS® platform will have a huge impact for patients by improving safety and accuracy within operating theatres. The acquisition of the robotic platform marks an important milestone in neurosurgery not only in the Hermitage Clinic, but for patients across Ireland who will be treated with this technology. At Blackrock Health Hermitage Clinic, we are committed to surgical excellence and delivering new technologies to provide best in class care for our patients.”

Outcome from clinical trials demonstrate a significant relationship where Akkermansia mucT plays a crucial role in preventing the entry of harmful toxins and fats into the body. The key to overcoming lifestyle diseases lies in restoring the natural levels of Akkermansia mucT, promoting a healthier life. Acknowledging the significance of gut health, The Akkermansia Company™ has introduced a range of products to support overall well-being. Among their innovative offerings is the Gut Support

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™

*when applied twice daily

Adverse events should be reported. Reporting forms and information can be found at www.hpra.ie. Adverse events should also be reported to Teva UK Limited on +44 (0) 207 540 7117 or medinfo@tevauk.com Please refer to the Summary of Product Characteristics (SmPC) for full details of Prescribing Information. Motusol Max (diclofenac sodium) 2% w/w gel Abbreviated Prescribing Information. Presentation: White to almost white, homogeneous gel. 1g of gel contains diclofenac as 23.2mg diclofenac diethylamine corresponding to 20mg of diclofenac sodium. Indications: Local symptomatic treatment of pain in acute strains, sprains or contusions following blunt trauma. For short term treatment only. Dosage and administration: For cutaneous use. Apply to affected parts of the body thinly and gently rub into skin. Wash hands after application unless area to be treated. Allow gel to dry on skin before applying bandages. Adults and adolescents aged 14 years and over: depending on the size of the affected site, apply a cherry to walnut size quantity 2 times a day (preferably morning and evening). Should not be used for longer than 1 week without medical advice. Children: no data in children and adolescents under 14 years of age. Elderly: no dosage adjustment required. Monitor patient carefully. Renal and hepatic impairment: no dosage adjustment required. Contraindications: Hypersensitivity to active substances or excipients; patients with a history of hypersensitivity reactions such as asthma, bronchospasmus, urticaria, acute rhinitis in response to acetylsalicylic acid or non- steroidal anti-inflammatory drugs (NSAIDs); 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. Precautions and warnings: Systemic undesirable effects cannot be excluded if applied on larger areas of skin over a prolonged period of time. Must only be applied to intact, not diseased or injured skin. Must not come into contact with eyes and oral mucous membranes. Must not be taken orally. May be used with non-occlusive bandages, but not with airtight occlusive dressing. Consult doctor if symptoms worsen or do not improve after 3-5 days. Patients suffering from asthma, hay fever, swelling of nasal mucous membranes (so called nasal polyps) or chronic obstructive pulmonary disease, chronic respiratory infections (particularly associated with 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 (so called analgesic intolerance / analgesic asthma), to local skin or mucous membrane swelling (so-called quincke edema) or to urticaria than other patients when treated with Motusol Max. In these patients, Motusol Max 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. Discontinue treatment if skin rash occurs. Photosensitivity can occur with the appearance of skin reactions after exposition to sunlight. Avoid children coming into contact to the skin areas where the gel has been applied. Contains butylhydroxytoluene which may cause local skin reactions or irritation to the eyes and mucous membranes. Contains fragrance with benzyl alcohol (0.15mg/g), citral, citronellol, coumarin, eugenol, farnesol, geraniol, d-limonene and linalool which may cause allergic reactions. In addition, benzyl alcohol may cause mild local irritation. Interactions: None known. Pregnancy and lactation: Should not be used during first and second trimester unless clearly necessary. Contraindicated during third trimester. Should only be used during breast-feeding under advice from a healthcare professional and should not be applied on the breasts, nor elsewhere on large areas of skin for a prolonged period of time. Effects on ability to drive and use machines: No or negligible influence. Adverse reactions: Hypersensitivity, angioedema, dermatitis bullous, Common: dermatitis (including contact dermatitis), skin rash, erythema, eczema, pruritus. Consult the Summary of Product Characteristics in relation to other side effects. Overdose: Wash skin with water where applied. If ingested, apply general therapeutic measures normally adopted to treat poisoning with non-steroidal anti-inflammatory medicinal products. Gastric lavage and use of activated charcoal should be considered. Legal category: Pharmacy. Marketing Authorisation Number: PA1986/093/002. Marketing Authorisation Holder: Teva B.V., Swensweg 5, 2031GA Haarlem, Netherlands.

Job Code: MED-IE-00036. Date of Preparation: June 2021. Job Code: MOT-IE-00005. Date of Preparation: December 2023.