IPN July 2025

July 2025 Volume 17  Issue 7 PHARMACYNEWSIRELAND.COM

THE INDEPENDENT VOICE OF PHARMACY

In this issue: CONFERENCE: Building a Resilient Pharmacy Page 5

NEWS: Pharmacy Regulator publishes Annual Report Page 8

BACK2SCHOOL: Migraine in Children Page 12

CPD: Dry Eye Disease Page 43

MEDICINES: Healthcare Transparency Bill Page 58

FEATURE: Osteoporosis Therapy Page 60

TEAM TRAINING: Acute Pain Page 66

AWARDS: Self-Care Excellence Page 68 This Publication is for Healthcare Professionals Only

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Contents

Foreword

Page 4: Chemist Warehouse open 14th Store

In one of our lead news stories this month, we highlight overage from the recent 2025 PGEU Annual Conference, which was themed “Building a Resilient Pharmacy Workforce for the Future.”

Page 5: Pharmacy insights into Mental Health

Ireland’s Minister for Health, Jennifer Carroll MacNeill, TD, gave a keynote address and acknowledged the essential role of community pharmacists as constructive and reliable partners within the healthcare system.

Page 6: PGEU host Annual Conference in Dublin

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Page 8: Pharmaceutical Society publish Annual Report

Speaking to an audience of European pharmacy leaders, representatives of national pharmacists’ organisations, chambers, and pharmacy associations, Minister Carroll MacNeill expressed her gratitude for the tireless efforts of pharmacists and their valued partnership in delivering healthcare.

She stated: “The future of Community Pharmacy is bright, with real and meaningful opportunities for both our health service and pharmacies on many fronts. Governments, particularly the Irish Government, remain committed to supporting community pharmacy services through investment, reform and modernisation.”

Page 20: Back2School VMS Guide Page 30: Back2School Periods, Pimples and Pubert

You can read more about this on page 5.

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Page 58: IPHA Respond to Transparent Payments Bill Page 70: Michael puts the Super in Superintendent

In other Government news, the Minister has also revealed community pharmacists will soon witness the first steps towards full independent pharmacist prescribing. The Minister was responding to a question from Deputy Pádraig Rice who asked the status of plans to have pharmacists prescribe for common conditions and = the timeline she is working towards.

“The next key step in the reform of community pharmacy is the development and introduction of a Common Conditions Service.

This service will be the first step in enabling full independent pharmacist prescribing. It will allow pharmacists in Ireland to treat the public for common conditions such as shingles, urinary tract infections, and conjunctivitis,” she said.

Page 78: ¤6.5m Horizon Europe Bone Regeneration Project

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PUBLISHER: IPN Communications Ireland Ltd. Clifton House, Fitzwilliam Street Lower, Dublin 2 00353 (01) 6690562

On page 8 are full details of the Pharmaceutical Society of Ireland Annual Report, outlining the many ways the pharmacy regulator pursued its core purpose of assuring patient safety and public trust by regulating pharmacists and pharmacies in Ireland.

MANAGING DIRECTOR Natalie Maginnis n-maginnis@btconnect.com

President of the PSI, Katherine Morrow, reflected on the achievements and future direction of the PSI, stating, “This annual report is the last under our Corporate Strategy 2021-2024, and it marks the progression of several significant strategic work programmes in addition to delivering our significant functions as a regulatory body.

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

This issue carries our Annual Back to School special focus section, with articles for pharmacy training across areas such as childhood allergies and asthma, pimples and puberty and the vitamins, minerals and supplements market.

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SALES MANAGER Amy Evans | amy@ipn.ie 0872799317 CONTRIBUTORS John McCourt Dearbhla Walsh Dr Clodagh Toomey Dr Helen O’Leary Dr Donal Fitzpatrick Dr Kevin McCarroll Professor Patrick Mitchell DESIGN DIRECTOR Ian Stoddart Design PHARMACYNEWSIRELAND.COM @Irish_PharmNews IrishPharmacyNews

Irish Pharmacy News is circulated to all independent, multiple Pharmacists and academics in Ireland.

All rights reserved by Irish Pharmacy News. All material published in Irish Pharmacy News is copyright and no part of this magazine may be reproduced, stored in a retrieval system or transmitted in any form without written permission.

IPN Communications Ltd. has taken every care in compiling the magazine to ensure that it is correct at the time of going to press, however the publishers assume no responsibility for any effects from omissions or errors.

IRISH PHARMACY NEWS

I hope you enjoy the issue.

Regulars CPD: DRY EYE DISEASE

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FEATURE: EXERCISE & ASTHMA

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FEATURE: JOINT PAIN

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TEAM TRAINING: ACUTE PAIN

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CLINICAL PR:

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4

News

Impact of Pharmacy-based Vaccination An analysis of the funding models, economic value, and broader societal benefits of pharmacy-based vaccination (PBV) services worldwide is published in a new FIP report.

Drawing on global data and case studies from FIP reports and literature, it offers insights into how pharmacist-led vaccination supports public health and generates cost savings across diverse health systems. The publication explores challenges to sustainable financing of PBV, the economic case for investment in pharmacist-administered vaccines, and strategies to ensure timely vaccine procurement. It highlights both direct and indirect savings generated through PBV, including improved immunisation coverage, reduced burden of vaccine-preventable diseases, and enhanced productivity.

The role of pharmacists in public health has evolved significantly, with increasing recognition of their capacity to provide critical vaccination services. Traditionally, pharmacists were involved in vaccine distribution, storage, and education, but regulatory changes in many countries have expanded their role to include direct vaccine administration, improving accessibility to the public. Beyond administration, pharmacists also contribute by raising awareness, addressing vaccine hesitancy, ensuring proper vaccine storage, and reporting adverse events.

With a comprehensive set of recommendations, the report serves as a guide for policymakers, healthcare leaders and pharmacy stakeholders seeking to strengthen vaccination services through integrated, sustainable models.

This report draws on data from the 2024 FIP global vaccination surveillance survey, literature reviews, and international case studies. This report presents an analysis of funding models that support and sustain PBV

services across various countries.

Beyond funding mechanisms, it highlights the economic and societal impact of these services, including direct cost savings, such as reduced hospitalisations and lower healthcare costs, and indirect cost savings, such as improving productivity and maintaining functional ability in aging populations. The report also addresses broader societal benefits of vaccination, including improved public health equity and increased vaccine accessibility in underserved areas. Additionally, the report summarises the challenges pharmacists face in securing sustainable funding models and provides case studies showcasing different remuneration and reimbursement approaches.

Chemist Warehouse opens 14th Store Chemist Warehouse have recently announced the grand opening of their newest Chemist Warehouse store in Bray, Co. Wicklow – another exciting step in the continued expansion of their store network across Ireland!

Sid, a pharmacy spokesperson, “The 14th store wouldn't be possible without the hard work, dedication, and passion of our incredible team. A huge thank you to everyone who played a role in bringing this store to life – from construction to logistics, recruitment, pharmacy store operations and beyond.

“We look forward to welcoming customers from Bray and the surrounding area to experience our unbeatable prices, trusted brands, and exceptional service.

“Here’s to making health and wellness more accessible and affordable, one community at a time!”

PHARMACYNEWSIRELAND.COM

Integrated Care Hub The Benbulbin hub, which is located in Ballytivnan, Sligo town was opened in 2023 as part of a ¤240m nationwide Enhanced Community Care (ECC) programme to enhance the care provided by the HSE in community settings.

This move away from hospitalbased care means patients have access to highly specialised clinical teams, closer to their home and is a cornerstone of Sláintecare, Ireland’s strategy for reforming the health and social care system.

Since opening in 2023, clinical teams in the hub have facilitated 45,000 patient contacts and accepted 10,000 referrals from GPs and Sligo University Hospital consultants.

The Benbulbin hub is home to three specialist teams in Cardiology, Diabetes and Respiratory Medicine. Patients attending the hub have access to a full multidisciplinary team (MDT) staffed with Consultants, Clinical Nurse Specialists and Advanced Nurse Practitioners in Diabetes, Respiratory, Cardiology, Respiratory and Cardiac Physiologists, Physiotherapists, Dieticians, Podiatrists, Psychologists and Administration support.

These services are all delivered in the community, helping to reduce pressure on the acute hospital system while also targeting these conditions at an earlier stage of development.

During a visit to Sligo last month, Minister for Health Jennifer Carroll MacNeill spent time with patients and staff at the hub and has commended the clinical teams for their efforts in bringing care closer to home.

The Benbulbin hub now has three Consultants working 50% of their time in the community (the hub) and another 50% in Sligo University Hospital.

Dr Ciara Gough supports the Respiratory team, in particular, COPD and Asthma, Dr Arun Eapen supports the Cardiology team and Dr David Tansey supports people with Diabetes (mainly Type 2).

The Diabetes service in particular is yielding very positive results in terms of reduced waiting times for patients and earlier diagnosis and access to treatment.

News Pharmacy Insights in Men’s Health Insights on advancing men’s health through pharmacy have been published in a new International Pharmaceutical Federation (FIP) insight board report to mark International Men’s Health Week.

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Irish Ministers Address Pharmacy Conference At the 2025 PGEU Annual Conference, themed “Building a Resilient Pharmacy Workforce for the Future”, Ireland’s Minister for Health, Jennifer Carroll MacNeill, TD, acknowledged the essential role of community pharmacists as constructive and reliable partners within the healthcare system.

Thomas Byrne TD, Ireland’s Minister of State for European Affairs and Defence

The report explores key health challenges faced by men, from non-communicable diseases and mental health to sexual and reproductive health concerns, while identifying behavioural, cultural, and systemic barriers to their engagement with pharmacy services. It also highlights effective strategies for improving men’s health outcomes, including targeted communication, inclusive pharmacy environments, and cross-sector policy support.

In 2019, global life expectancy was estimated at 71 years for males and 76 years for females. A stark disparity exists in premature mortality, with one-quarter of all men dying before the age of 65, compared to less than one-fifth of women.

Additionally, men and boys face disproportionately poor health outcomes in areas such as cancer, cardiovascular disease, diabetes, and suicide. This is due to a combination of biological, behavioural, and social factors, all of which contribute to higher mortality rates in men across various age groups and regions.

Given these challenges, community pharmacies represent a critical touchpoint for improving men’s health outcomes. As universally accessible healthcare providers, pharmacists offer walk-in services in pharmacies without the need for appointments, reducing logistical barriers to care.

As part of its EquityRx programme and its efforts to advance equity and equality through pharmacy, and in collaboration with the international charity Global Action on Men’s Health, FIP hosted an insight board to strengthen pharmacy’s role in improving men’s health outcomes, thereby improving gender equity.

The report findings will lead to actionable recommendations that will inform future policies and practices within the pharmacy profession and clear next steps for FIP and its membership.

Speaking to an audience of European pharmacy leaders, representatives of national pharmacists’ organisations, chambers, and pharmacy associations, Minister Carroll MacNeill expressed her gratitude for the tireless efforts of pharmacists and their valued partnership in delivering healthcare. She stated: “The future of Community Pharmacy is bright, with real and meaningful opportunities for both our health service and pharmacies on many fronts. Governments, particularly the Irish Government, remain committed to supporting community pharmacy services through investment, reform and modernisation.” The Minister also emphasised her commitment to working collaboratively with pharmacists to unlock new opportunities for the sector: “The report of the Expert Taskforce for Expansion of the Role of Pharmacy in Ireland, sets a clear policy direction for future pharmacy care in Ireland and in collaboration with stakeholders we want a future where Ireland leads the way at a European Level in services available in Community Pharmacy. I am keen to work with pharmacists to develop new revenue streams for pharmacies, creating a community pharmacy model that brings care closer to patients.”

Addressing the ongoing workforce challenges facing the sector, PGEU President, Clare Fitzell said “We need to strengthen

existing services, broaden the scope of pharmacy practice, and implement effective policy measures to ensure a sustainable workforce capable of meeting growing healthcare demands. This includes efforts to increase the number of pharmacy graduates and to enhance recruitment and retention strategies.”

sourcing and associated administrative tasks.

Community Pharmacists proactive management of medicine shortages protects patients, over 11 hours per week of an EU pharmacist time is devoted to managing medicine shortages.

Commenting on the Critical Medicines Act, Minister Byrne commented: “Ireland supports the potential of the Critical Medicines Act. We believe that, as part of a complete solution, the proposal will assist in addressing medicines shortages and inequitable access to medicines across the EU. The Irish Government will work closely, and speedily, with fellow Member States, to shape and progress the final Act over the coming months. We want to ensure that the final Act benefits all of the key stakeholders in Ireland.”

Also speaking at the conference, Thomas Byrne TD, Ireland’s Minister of State for European Affairs and Defence, addressed attendees emphasising the vital role European pharmacists play in shaping EU health policies.

In his keynote speech, Minister Byrne described pharmacists and community pharmacies as “pillars of the community.”

Medicine shortages continue to disrupt pharmacy practice in all European countries and a recent report by PGEU showed pharmacies across the EU spent on average 11 hours per week last year dealing with medicine shortages. This is a growing trend over the last decade, this time spent by pharmacists could be deployed more positively in the provision of pharmaceutical care to patients, and employing pharmacists’ expertise in clinical skills, rather than on medicine

Minister Byrne addressed the issue of medicine shortages and welcomed efforts, at national and EU level, to mitigate medicine shortages. Minister Byrne underlined the potential impact of upcoming EU legislation.

PGEU President, Clare Fitzell said "European Community Pharmacists welcome the European Commission’s proposal as a significant step forward to strengthen the EU’s pharmaceutical supply chain. We call for sustainable incentives for pharmaceutical production, improved coordination of medicine security initiatives, strengthening oversight of supply obligations, strategic investment, optimised contingency stocks, better public procurement practices, and swift implementation".

PHARMACYNEWSIRELAND.COM

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News

Pharmacy Closer to Common Conditions Service Community pharmacists will soon witness the first steps towards full independent pharmacist prescribing, according to the Minister for Health Jennifer Carroll MacNeill who spoke at a recent Dáil Éireann Debate.

The Minister was responding to a question from Deputy Pádraig Rice who asked the status of plans to have pharmacists prescribe for common conditions and = the timeline she is working towards.

My vision for the future includes pharmacists playing a much larger role in our health service, and I’m happy to see the progress being made by my Department to facilitate this.

“I am a huge advocate for the reform and expansion of pharmacy services,” she noted. “The findings and recommendations from the Expert Taskforce to Support the Expansion of the Role of Pharmacy provide an important framework to inform the reforms and developments required to deliver expanded pharmacy services.

“The next key step in the reform of community pharmacy is the development and introduction of a Common Conditions Service.

This service will be the first step in enabling full independent pharmacist prescribing. It will allow pharmacists in Ireland to treat the public for common conditions such

as shingles, urinary tract infections, and conjunctivitis.

“The development of the service is well under way, and the Community Pharmacy Expansion Implementation Oversight Group (IOG) continues to meet monthly to finalise the clinical protocols, education and training for pharmacists, a package of required regulations, and operational aspects of the service.

“I am confident that we will see the beginning of this service available in Irish communities within 2025.”

New Pharmacy Critical Medicines Position Paper Community pharmacists have welcomed the European Commission’s proposal for a Critical Medicines Act as an important step to strengthen the security of supply and availability of critical medicines.

The panel debate on future-proofing pharmacy with Susan O’Dwyer, IPU, PSI Chief Officer Joanne Kissane, Eileen Rocard (OECD - OCDE), Daragh Connolly FFIP and Susana Leonor Araújo (EPSA European Pharmaceutical Students' Association) reflected on how workforce strategies must evolve in parallel with expanded scope of practice

The Pharmaceutical Group of the European Union (PGEU) which recently held its annual conference in Dublin, has just released a position paper outlining key recommendations to ensure that pharmacists, as vital players in medicine supply chains, are fully integrated into efforts to prevent shortages and safeguard publichealth.

health systems and healthcare professionals. Therefore, PGEU urges policymakers to shape the Critical Medicines Act into an effective instrument that delivers tangible improvements on shortages of critical medicines.

The paper also highlights concrete measures to enhance the overall resilience of the supply chain. Community pharmacists witness first-hand the impact of medicine shortages on patients and the associated pressure on

The conference brought together policymakers, experts, students and professionals to explore workforce strategies that will empower pharmacists to thrive in a rapidly evolving healthcare landscape.

The PGEU Annual Conference ran under the theme "Building a Resillient Pharmacy Workforce for the Future"

PHARMACYNEWSIRELAND.COM

The keynote address was delivered by Joanne Kissane, Registrar and Chief Officer at PSI– The Pharmacy Regulator, who laid the foundation for a panel debate on future-proofing pharmacy.

Panellists Eileen Rocard (OECD - OCDE), Daragh Connolly FFIP (International Pharmaceutical Federation (FIP)), and Susana Leonor Araújo (EPSA - European Pharmaceutical Students' Association) reflected on how workforce strategies must evolve in parallel with expanded scope of practice.

In the second panel, keynote speaker Katherine Morrow (PSI President & APPEL Director) opened an insightful conversation on upskilling and innovation within the curricula. Panelists Prof. Borut Bo�ič, Prof. Roisin O'Hare, and Prof. Helder Mota Filipe stressed the urgency of integrating lifelong learning, digital innovation and inclusive strategies to prepare the pharmacy workforce for the future.

Smartphone Link to Haemorrhoids Smartphone users spent significantly more time on the toilet and had an increased risk for haemorrhoids compared to non-users, according to results of a recent survey. The study was presented at an annual meeting of medical experts in San Diego recently.

It concluded that smartphone users spent significantly more time on the toilet and had a 46% increased risk for haemorrhoids than non-users.

Participants completed survey questions regarding their smartphone habits while using the toilet; any functional gastrointestinal problems and behaviours such as straining; fibre intake; and levels of physical activity. The findings came from a cross-sectional survey of 125 adult patients undergoing colonoscopies for screening purposes.

Overall, 66% of respondents used smartphones while on the toilet; most (93%) of those used a smartphone on the toilet at least one to two times per week or more, and more than half (55.4%) used it most of the time.

Smartphone use on the toilet was associated with a 46% increased risk for haemorrhoids after adjustment for age, sex, body mass index, exercise activity, and fibre intake.

Participants who used smartphones on the toilet spent significantly more time there than those who did not; 37.3% of them spent more than six minutes per visit on the toilet compared with 7.1% of nonusers, and 35% said they believed they spent more time on the toilet because of their smartphone use.

The most common activity performed while on the toilet was reading “news” (54.3%), followed by “social media” (44.4%), and email/texting (30.5%).

The study was presented in San Diego by Dr Trisha Satya Pasricha of the Beth Israel Deaconess Medical Centre in Boston.

She was speaking during Digestive Disease Week, an event for professionals working in gastroenterology, hepatology, GI endoscopy, gastrointestinal surgery and related fields.

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Adverse events should be reported. Reporting forms and information can be found at HPRA Pharmacovigilance: https://www.hpra.ie/report-an-issue. Adverse events should also be reported to Church & Dwight +44 808 175 6410. Charges may apply.

For more information, please contact your UDC Representative or Customer Service on 01-4632424 www.UDConsumer.com

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News

The Pharmacy Regulator Publishes Annual Report The Pharmaceutical Society of Ireland (PSI) has published its Annual Report and Financial Statements for 2024, outlining the many ways the pharmacy regulator pursued its core purpose of assuring patient safety and public trust by regulating pharmacists and pharmacies in Ireland.

PSI Registrar and Chief Officer Joanne Kissane,

the Taskforce published in August 2024, included a recommendation to enable pharmacists to act as independent prescribers within and relating to their scope of practice and competence, to be implemented in a stepwise manner, beginning with a Common Conditions Service.

“The final recommendations of the Taskforce marked another important milestone for pharmacy and its future direction. We were pleased to contribute to the final report, in collaboration with other stakeholders. The establishment of the Community Pharmacy Expansion Implementation Oversight Group to oversee the delivery of a Common Conditions Service in 2025 benefits from a range of clinical, regulatory, academic and policy colleagues’ expertise. We are pleased to support its ongoing work.”

Key activities for the PSI during 2024 included: • Significant contribution to the Department of Health’s Expert Taskforce to support the expansion of the role of pharmacy resulting in recommendations empowering pharmacists to extend prescriptions and to prescribe within their scope of practice.

• Participation in the Community Pharmacy Expansion Implementation Oversight Group to oversee the delivery of a Common Conditions Service in community pharmacies, a recommendation of the Taskforce report.

• Progressing initiatives to ensure the sustainability of community pharmacy, through implementation of recommendations from the PSI’s Workforce Intelligence Report, including establishing a multistakeholder Future Pharmacy Workforce Group with the Department of Health.

• Development of a new PSI Corporate Strategy for 20252028.

• Launch of a new PSI website.

• Streamlining the Third Country Qualification Recognition Route (TCQR), the application process for non-EU pharmacists to apply for recognition to practise in Ireland.

• Registering 417 new pharmacists, bringing the total number of pharmacists eligible to practise in Ireland to 7,731 at the end of 2024.

• Maintaining the register of pharmacies, which at the end of the year numbered 1,989, an increase of four on 2023.

• Handling 78 formal complaints, an increase of 6% on the previous year, and improving the PSI’s online facility to make these complaints online.

• Conducting 347 risk-based pharmacy inspections.

Commenting on the publication of the Annual Report, PSI Registrar and Chief Officer Joanne Kissane said, “This annual report marks the progression of a significant body of work that comes at a time of enormous change and development for pharmacy.

PHARMACYNEWSIRELAND.COM

“We were pleased to continue our work as part of the Expert Taskforce to support the expansion of the role of pharmacy, established by the Minister for Health in 2023. It has been a long-term objective of the PSI and the Department of Health to expand the role of pharmacy, as part of an integrated healthcare system and to realise the vision as set out in Sláintecare to best meet patient needs within the community. As part of this, the PSI has very actively participated in initiatives which are integral to advancing the recommendations of the Expert Taskforce, bringing about changes in how care will be available through pharmacies into the future.”

The first recommendation of the Taskforce – empowering pharmacists to extend certain prescriptions – came into legislative effect in March 2024.

The PSI has supported legislative changes, developed resources including principle-based guidelines for pharmacists, and collaborated with the Irish Institute of Pharmacy to develop further training and practice supports for pharmacists. The final report of

The PSI remains focused on ensuring the sustainability of the pharmacy workforce, in collaboration with a range of pharmacy, health service, and policy partners. During 2024, the PSI sought to clarify governance roles and responsibilities in pharmacy with the publication of new guidance.

Further to the Government decision to expand access to new healthcare training places last year, the PSI has been supporting the move to establish three new pharmacy programmes in the state. One of the PSI’s core functions is to evaluate, for accreditation purposes, programmes of education that lead to qualifications appropriate for practice as a pharmacist. There was important engagement with the higher education institutions in preparation for new programme accreditation visits.

The core statutory functions of the PSI are documented in the annual report, including registration data, work in relation to compliance and complaint-handling.

There was a continued increase in the Register of Pharmacists in 2024, with a total of 7,731 registered pharmacists at the end of the year. In 2024, there were 417 new pharmacist registrations.

Of those newly registered

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News with by an inquiry. Twenty hearings were conducted before the PSI’s Committees of Inquiry in 2024.

In addition, the PSI reviewed and took actions to address general concerns raised with it about a range of pharmacy matters. Almost all (92%) of the 111 concerns came from members of the public.

These concerns are expressed where someone does not wish to make a formal complaint but provides information to the PSI. The PSI also made inroads as part of its strategic objective to build its organisational capabilities and enhance its performance as a regulatory body, particularly its digital offering to the public.

A new website was launched in the summer of 2024, offering significantly improved functionality and searchability for users.

This is an important information platform for the public, including those registered or seeking to register as a pharmacist, or to open a pharmacy, as well as for those interested in pharmacist education or pharmacy resources provided by the PSI. Advancing its ongoing business transformation project, the regulator developed a new online facility, where people can submit their complaints, concerns or queries in relation to pharmacists and pharmacies.

pharmacists, 41% received their qualification from Irish universities.

Other new registrants to Ireland have qualifications from 31 different countries worldwide.

The total number of pharmacies registered was 1,989, an increase of four from the previous year.

regulator, and/or in the event of a member of the public or external body raising a concern.

The PSI’s compliance role involves ensuring the safety of pharmacy care and services in accordance with legislative and regulatory requirements.

The PSI conducted 347 risk-based inspections last year, as well as 18 registration-related inspections for new pharmacy openings or changes in pharmacy ownership.

Risk-based inspections are undertaken following a review of information available to the

As the body responsible for dealing with statutory complaints about pharmacists and pharmacies, the PSI received 78 complaints in 2024, up from 73 in 2023. The majority of these were made by members of the public. Not all complaints reach the threshold to be dealt

Heart Failure Survey Many people living with heart failure continue to face serious physical emotion, financial and social challenges that often go unseen.

The Irish Heart Foundation is working to change that.

They are asking heart patients to share their experiences by completing a short survey – https://www.surveymonkey.com/r/LH9H5DL Patient insights will help them to highlight the real impact of heart failure in communities across Ireland and push for meaningful action from politicians and policymakers.

PHARMACYNEWSIRELAND.COM

President of the PSI, Katherine Morrow, reflected on the achievements and future direction of the PSI, stating, “This annual report is the last under our Corporate Strategy 2021-2024, and it marks the progression of several significant strategic work programmes in addition to delivering our significant functions as a regulatory body. During the year, the PSI Council also focused on the organisation’s future development and strategy for 2025-2028. This considers the evolving pharmacy and healthcare landscape and benefitted from broad public consultation. The PSI looks forward to continuing its remit to ensure continued trust in pharmacy through effective regulation, achieved successfully in collaboration with patients, and wider public, all those registered with PSI, and our many other stakeholders.”

Navigator Tool Minister for Mental Health Mary Butler has launched ‘Navigator’ a signposting tool designed to support the mental health and wellbeing of young people aged 14 to 34 across Ireland.

Navigator was launched in collaboration with spunout, the Department of Health and the Health Service Executive (HSE). The signposting tool, a Programme for Government commitment, was developed by spunout in response to the challenges young people face in accessing mental health support, including stigma, low mental health literacy, and fragmented access to services.

This innovative web-based and mobile-first tool offers anonymous, immediate, and personalised access to mental health information, resources, and services, addressing the gap in the availability of a single, national repository for tailored youth mental health support.

Minister for Mental Health Mary Butler today emphasised the importance of this tool, “spunout’s Navigator is a national digital gateway that empowers young people to take the first step toward support in a way that is simple, private, and tailored to their needs.

By answering just three short questions, users of the tool will receive clear, trustworthy, and relevant results, helping them find the right support, right now.

“The launch and promotion of this important tool was included in the Programme for Government which was agreed at the beginning of this year, and I’m delighted to see this commitment being delivered on so early in the lifetime of this government.”

The digital tool includes a wide range of mental health resources, including factual information, lived experience articles and videos, expertapproved mental health apps, books, and podcast recommendations, as well as guided activities like grounding exercises and safety planning.

The tool also provides direct service connection to 24/7 support through spunout’s ‘Text About It’ service for immediate support and signposts to specific and relevant local and national services for ongoing support.

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Back2School - Migraine

Migraine Management in School-Aged Children: A Guide for Community Pharmacy Teams Migraine is not exclusive to adults. An estimated 10% of school-aged children in Ireland experience migraines, with the condition often under-recognised or misattributed to other issues such as stress, eyesight problems, or behavioural concerns. For community pharmacists and their teams, being able to identify symptoms, guide appropriate treatment, and advise on when to refer is crucial in reducing the impact of migraine on children’s education, quality of life, and family wellbeing.

Written by John McCourt, Superintendent Pharmacist, Millmount Pharmacy

3. Screen Exposure and Lighting Smartboards, flickering fluorescent lights, and prolonged screen use (including tablets or phones during breaks) can act as visual triggers.

Where patterns are suspected, advise parents to speak with the school about seating arrangements or lighting adjustments.

4. Stress and Anxiety Academic pressure, tests, social challenges, or bullying may contribute to emotional stress

• Behavioural changes or neurological signs Understanding Migraine in Children Children may present differently to adults. Pharmacists should be alert to these age-specific features: • Pain may be bilateral rather than one-sided • Attacks are shorter, often lasting 2–24 hours • Children may appear pale, yawn frequently, or become irritable or lethargic • Gastrointestinal symptoms (nausea, vomiting, abdominal pain) are more prominent • Some may experience an aura, particularly visual disturbances or speech difficulty Red flags requiring urgent referral include: • Sudden, severe headache (“thunderclap”) • Worsening headaches over time • Headache with fever, rash, or neck stiffness • Early morning headaches with vomiting (possible raised intracranial pressure)

Pharmacy tip: Always document key features and duration of symptoms if advising OTC treatment, and clarify whether the child has a formal diagnosis.

Common Triggers in Children The school environment presents several unique migraine triggers for children. Pharmacists should be aware of these when advising parents or young patients, especially if attacks are reported during or after school hours.

1. Irregular Meal Patterns Busy school mornings or skipped lunches can lead to dips in blood sugar, a known migraine trigger.

Encourage families to ensure children eat breakfast and have access to nutritious snacks during the day. Lunchboxes with balanced options and hydration are key.

2. Dehydration Children may avoid drinking water during school hours to skip toilet breaks. This can lead to dehydration, especially in warmer weather or after physical education. Parents should be advised to send children with refillable water bottles and encourage regular intake.

12 | PHARMACYNEWSIRELAND.COM

– a common trigger. Encourage open family communication and suggest mindfulness or relaxation techniques suitable for children.

5. Sensory Overload Noisy classrooms, strong smells (e.g., cleaning products, markers), or crowded assemblies may overwhelm children prone to sensory sensitivity. Identifying and managing these environmental triggers can help reduce attack frequency.

Paracetamol

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

Electrical Device

Medical Device

Medicine

CALPOL® Vapour Plug & Nightlight is an electrical device and non-medicine. CALPOL® Saline Nasal Spray is a medical device for congestion relief. ALWAYS READ THE LABEL. Calpol 120 mg/5 ml Sugar Free Infant Oral Suspension, Calpol Six Plus Sugar / Colour Free Oral Suspension. Composition: Calpol Infant Oral Suspension contains - Paracetamol 120 mg per 5 ml. Calpol Six Plus Oral Suspension contains Paracetamol 250 mg per 5 ml. Pharmaceutical Form: Oral Suspension, Indications: Calpol is indicated for the symptomatic relief of headache, migraine, neuralgia, toothache and teething pains, sore throat, influenza, feverishness and feverish colds. Dosage: Calpol Infant: Age: 2 – 3 months 1. Post-vaccination fever 2. Other causes of Pain and Fever - if your baby weighs over 4 kg and was born after 37weeks Child’s Age 3 – 6 months 6 – 24 months 2 – 4 years 4 – 6 years

Calpol Six Plus Oral Suspension: Dose 2.5 ml If necessary, after 4-6 hours, give a second 2.5 ml dose How Much 2.5 ml 5 ml 7.5ml (5 ml + 2.5 ml) 10ml (5 ml + 5 ml)

How often (in 24 hours) 4 times 4 times 4 times 4 times

Child’s Age 6 – 8 years 8 – 10 years

How Much One 5 ml spoonful (large end) One 5.0 ml spoonful (large end) and one 2.5ml spoonful (small end) 10 – 12 years Two 5 ml spoonfuls (large end) 12 – 16 years Two – three 5ml spoonfuls (large end) Adults and children over 16 years Two – four 5ml spoonfuls (large end)

How often (in 24 hours) 4 times 4 times 4 times 4 times 4 times

Children under 6 years: Calpol Six Plus Suspension is not suitable for administration to children under 6 years of age.

Renal impairment: It is recommended, when giving paracetamol to patients with renal impairment, to reduce the dose and to increase the minimum interval between each administration to at least 6 hours unless directed otherwise by a physician. Patients should be advised to contact their healthcare professional before use. Recommended Dose for Adults with Renal Impairment: Glomerular filtration rate 10-50 ml/min <10ml/min

Dose 500mg (10 ml) every 6 hours 500mg (10 ml) every 8 hours

Hepatic impairment: In patients with hepatic impairment or Gilbert’s Syndrome, the dose should be reduced or the dosing interval prolonged. Patients should be advised to contact their healthcare professional before use. The Elderly: Experience has indicated that normal adult dosage is usually appropriate. However, in frail, immobile, elderly subjects or in elderly patients with renal or hepatic impairment, a reduction in the amount or frequency of dosing may be appropriate. For certain patient groups, a reduced maximum daily dose should be considered: Patients who are underweight (for adults, those under 50kg), Chronic alcoholism, Dehydration, Chronic malnutrition. These patients should be advised to contact their healthcare professional before use. Contraindications: Hypersensitivity to the active substance or to any of the excipients. Special warnings and precautions for use: Paracetamol should be administered with caution under the following circumstances: Hepatic impairment, Chronic alcoholism, Renal impairment (GFR≤50ml/min), Gilbert’s Syndrome (familial non-haemolytic jaundice), Concomitant treatment with medicinal products affecting hepatic function, Glucose-6-phosphate dehydrogenase deficiency, Haemolytic anaemia, Glutathione deficiency, Dehydration, Chronic malnutrition, Patients who are underweight (for adults, those under 50 kg), Elderly. In general, medicinal products containing paracetamol should be taken for only a few days without the advice of a physician or dentist and not at high doses. If high fever or signs of secondary infection occur or if symptoms persist for longer than 3 days, a physician should be consulted. Prolonged or frequent use is discouraged. Patients should be advised not to take other paracetamol containing products concurrently. Taking multiple daily doses in one administration can severely damage the liver; in such cases medical assistance should be sought immediately. Serious skin reactions such as acute generalized exanthematous pustulosis (AGEP), Stevens - Johnson syndrome (SJS), and toxic epidermal necrolysis (TEN), have been reported very rarely in patients receiving paracetamol. Patients should be informed about the signs of serious skin reactions and use of the drug should be discontinued at the first appearance of skin rash or any other sign of hypersensitivity. Cases of high anion gap metabolic acidosis (HAGMA) due to pyroglutamic acidosis have been reported in patients with severe illness such as severe renal impairment and sepsis, or in patients with malnutrition or other sources of glutathione deficiency (e.g. chronic alcoholism)who were treated with paracetamol at therapeutic dose for a prolonged period or a combination of paracetamol and flucloxacillin. If HAGMA due to pyroglutamic acidosis is suspected, prompt discontinuation of paracetamol and close monitoring is recommended. The measurement of urinary 5-oxoproline may be useful to identify pyroglutamic acidosis as underlying cause of HAGMA in patients with multiple risk factors. Calpol Infant Sugar Free: Carmoisine (E122) which may cause allergic reactions.-Methyl parahydroxybenzoate (E218),Propyl parahydroxybenzoate (E216), Ethyl parahydroxybenzoate (E214) which may cause allergic reactions (possibly delayed).This medicine contains less than 1 mmol sodium (23 mg) per 5ml, that is to say essentially ‘sodium-free’. This medicine contains 14.32mg propylene glycol (E1520) in each 5ml dose, which is equivalent to 2.86mg/ml. This medicine contains 0.16mg benzyl alcohol in each tablet.

High volumes should be used with caution and only if necessary, especially in subjects who are pregnant or breastfeeding, or subjects with liver or kidney impairment because of the risk of accumulation and toxicity (metabolic acidosis).

This medicine contains 0.00071mg of alcohol (ethanol) in each 5ml which is equivalent to 0.000142 mg/ml. The amount in 5 ml is equivalent to less than 1ml beer or 1 ml wine. The small amount of alcohol in this medicine will not have any noticeable effects. Due to the sorbitol (E420) and maltitol (E965) content of this product, patients with rare hereditary problems of fructose intolerance should not take this medicine. Sorbitol and maltitol may cause gastrointestinal discomfort and have a mild laxative effect. Calorific value 2.3kcal/g maltitol. Calpol Six Plus Sugar/Colour Free: Contains 2.04g Maltitol and 1.4g Sorbitol per 5ml.Sorbitol and maltitol may cause gastrointestinal discomfort and have a mild laxative effect.

Patients with hereditary problems of fructose intolerance (HFI) should not take/be given this medicine. Calorific value 2.3kcal/g maltitol. Methyl and propyl parahydroxybenzoates may cause allergic reactions (possibly delayed). This medicine contains less than 1 mmol sodium (23 mg) per 5ml, that is to say essentially ‘sodium-free’. This medicine contains 20.92mg propylene glycol (E1520) in each 5ml dose, which is equivalent to 4.18mg/ml. This medicine contains 0.05mg benzyl alcohol in each tablet. High volumes should be used with caution and only if necessary, especially in subjects who are pregnant or breastfeeding, or subjects with liver or kidney impairment because of the risk of accumulation and toxicity (metabolic acidosis). This medicine contains 0.00075mg of alcohol (ethanol) in each 5ml which is equivalent to 0.00015 mg/ml. The amount in 5 ml is equivalent to less than 1ml beer or 1 ml wine. The small amount of alcohol in this medicine will not have any noticeable effects. Undesirable effects: Blood and lymphatic system disorders Not known Thrombocytopenic purpura Haemolytic anaemia Agranulocytosis Immune system disorders Not known Anaphylactic reaction Rare Hypersensitivity Hepatobiliary Disorders Not known Hepatic function abnormal Hepatic necrosis Rare – Hypersensitivity. Skin and subcutaneous tissue disorders Rare Rash Not known Urticaria Rash pruritic Fixed Eruption Renal and urinary disorders Uncommon Nephropathy toxic Renal papillary necrosis (after prolonged administration). Investigations Not known Transaminases increased. Metabolim and nutrition disorders: Not known High anion gap metabolic acidosis. MAH: JNTL Consumer Health I (Ireland) Ltd. Block 5, Hight Street, Tallaght, Dublin 24, Ireland. PA No. Calpol 120 mg/5 ml Sugar Free Infant Oral Suspension PA23490/003/004. Calpol Six Plus SF-CF Oral Suspension PA23490/003/003. Date of revision of text: February 2025. Products Not subject to medical prescription. Supply though pharmacy and non-pharmacy outlets. Full prescribing information available upon request.

IE-CAL-2025-119570

Back2School - Migraine

14

Pharmacists can gently prompt: “Do the headaches tend to happen more during the school week than the weekend?” – This often uncovers a pattern.

Vaping and Migraines: An Emerging Concern While vaping is often perceived as less harmful than smoking, growing evidence suggests it may be a trigger for frequent headaches and migraines, especially in children and teenagers.

1. Nicotine-Induced Blood Vessel Constriction Vaping delivers nicotine, which causes vasoconstriction— narrowing of cerebral blood vessels. This mechanism is strongly linked with migraine onset in susceptible individuals.

2. Dehydration from Vape Liquids Propylene glycol (PG) and vegetable glycerin (VG), common vape carriers, are hygroscopic (they draw moisture), increasing dehydration risk, an established migraine trigger.

3. Chemical & Aroma Sensitivities Flavourings and sweeteners in e-liquids (e.g., sucralose, spicy or fruity scents) can provoke headaches or migraines in sensitive individuals.

Avoid codeine-containing products - not recommended in children under 12 and restricted under EU guidance.

• Provide written information to take home, if possible

Antiemetics

Migraine in children is common, yet under-recognised.

As accessible healthcare professionals, community pharmacists and their teams can:

• Often prescription-only in paediatrics (e.g., domperidone, prochlorperazine) • Pharmacists should advise parents to consult a GP if nausea or vomiting is a regular feature Triptans • Triptans are not generally available OTC for children in Ireland • Some (e.g., sumatriptan nasal spray) may be prescribed for children ≥12 • Always refer children for a formal diagnosis before any triptan treatment is considered When to Refer Referral to a GP is appropriate when: • The child experiences recurrent headaches affecting school or activities • OTC medications are ineffective or overused • There are red flag symptoms • Preventive treatment may be needed

4. Frequency & Nicotine Withdrawal

• A formal diagnosis of migraine is not yet made

Daily vaping that escalates nicotine intake or sudden reduction can lead to withdrawal headaches and increased.

Non-Pharmacological Advice

OTC Treatment Considerations in Children Pharmacists and their teams should ensure that product selection and dosing are safe and age-appropriate. Treatment works best if taken at migraine onset.

First-Line Options 1. Paracetamol o Suitable for children >2 months (ensure weight-based dosing) o Liquid formulations for younger children 2. Ibuprofen o More effective in some cases; avoid on empty stomach o Suitable from 3 months (again, dose by weight) o Avoid if dehydrated or with vomiting to reduce renal risk

Community pharmacy teams can play a vital role in holistic support: • Hydration: Encourage 6–8 glasses of water a day • Sleep hygiene: Promote regular bedtimes and screens-off policies • Diet: Regular meals/snacks to avoid hypoglycaemia • Relaxation: Breathing exercises, mindfulness apps for children, or journaling • Screen breaks: Encourage breaks during prolonged screen use Communication Tips for Pharmacy Teams • Use reassuring, simple language for younger children • Engage both the child and parent in the consultation • Ask open questions: “Can you tell me what happens before the headache starts?”

14 | PHARMACYNEWSIRELAND.COM

Final Thoughts

• Identify symptoms early

• Support appropriate OTC treatment • Provide non-drug advice • Encourage diary keeping • Refer when necessary By working collaboratively with parents, GPs, and schools, pharmacy teams can help reduce the burden of paediatric migraine — and support children in leading healthier, more active lives.

A European Perspective: Recent Epidemiological Insights While migraine remains a major concern in Ireland, its burden is reflected across Europe, as highlighted in a recent large-scale survey conducted across five EU countries—France, Germany, the UK, Italy, and Spain. The 2020 National Health and Wellness Survey (NHWS), published in early 2025, offered valuable insights into the prevalence, impact, and treatment patterns of migraine across the European region.

According to the findings, migraine affects around 11.5% of the adult population across these nations, aligning closely with Irish figures. Women continue to bear a disproportionate share of the burden, with prevalence rates almost twice as high as those in men. Notably, among migraine sufferers, more than a quarter (25%) reported experiencing four or more migraine days per month. Over half experienced at least four headache days monthly, highlighting that even those not diagnosed with chronic migraine often still live with significant, recurring symptoms.

These figures reinforce what many community pharmacists already observe on the ground—migraines are common, frequently disabling, and often not managed optimally.

Perhaps more concerning is the data showing persistent underdiagnosis and inconsistent treatment. While many patients reported using analgesics, triptans, or combination therapies, only a small percentage were receiving preventive treatment—despite being eligible based on migraine frequency and severity. This gap is compounded by delays in seeking medical advice, inconsistent follow-up, and challenges in accessing specialist care, particularly in rural areas.

Primary care providers remain the main prescribers of migraine medications across Europe, but the survey findings underscore the importance of a more proactive role for community pharmacists. With pharmacists often being the first point of contact, there is a unique opportunity to screen, advise, and signpost patients appropriately— especially those with frequent or poorly controlled symptoms who may benefit from preventive therapies or specialist input.

Another insight from the survey was the high prevalence of medication overuse headaches (MOH), particularly among patients frequently self-medicating with over-the-counter pain relief. Pharmacists are ideally placed to spot patterns of overuse, offer education on proper medication intervals, and suggest safer alternatives.

Ultimately, this European-level data reinforces several key themes: migraine remains underrecognised and undertreated; many patients are managing suboptimally with OTC solutions alone; and there is a growing opportunity for pharmacy-led interventions in both identification and support.

For Irish pharmacists, these findings affirm that the challenges seen here are not isolated but part of a broader pattern across Europe. They also serve as a call to action—encouraging more structured migraine consultations at the counter, better documentation of headache patterns, and proactive collaboration with GPs when red flags arise or preventive treatment may be warranted.

For further resources, both pharmacists and patients can access information and support via the Migraine Association of Ireland at migraine.ie.

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16

Back2School - Omega 3

Omega-3 for Cognitive Function Omega-3 fatty acids are polyunsaturated fats that are essential for human health. They contribute to the function of the heart, brain, and blood system. They may also be used for many kidney-related problems.

The European Food Safety Authority (EFSA) suggests a combined daily intake of around 250 mg of EPA and DHA for children over two years of age.

However, most children fall short of this intake. Pharmacy teams are well positioned to support families in closing this nutritional gap through accessible advice and trusted product recommendations.

How Much Omega-3 is Required?

The ideal intake of Omega-3 varies by age, gender, and overall health.

International guidelines differ and usually refer to weekly portion recommendations rather than specific daily quantities.

• The Irish Heart Foundation advises eating fish twice a week for a healthy heart.

There are eleven types of Omega-3, but the three most referred to are: • ALA (alpha-linolenic acid): Contributes to overall health but is deemed to be of lower importance than other types.

• EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid): These are considered most important for overall health, particularly for maintaining healthy circulation. While ALA can be converted into EPA and DHA in the body, the conversion rate is low and often insufficient to meet physiological needs.

There is little doubt that n-3 fatty acids have an important role in nutrition. They are significant structural components of the phospholipid membranes of tissues throughout the body, particularly in the brain and retina. Because of their role in cell membranes, n-3 fatty acids are essential for the formation of new tissue and are therefore important for development and growth — for example, during foetal and infant development.

Key Points for Pharmacy Teams: • Identify individuals who may benefit from increased intake of n-3 fatty acids: The typical Irish diet contains relatively low amounts of Omega-3.

• Understand cardiovascular benefits: Fish oil appears to reduce the risk of coronary heart disease (CHD). It may reduce thrombosis risk (by increasing bleeding tendency), lower blood triacylglycerol levels, prevent atherosclerosis and arrhythmias, and reduce blood pressure.

• Be aware of emerging research in mental health: Fish oil may play a role in supporting mental health conditions such as depression, schizophrenia, and Alzheimer’s disease, though more robust evidence is still needed.

The Role of Omega-3 in SchoolAged Children While much attention is given to the cardiovascular and cognitive benefits of Omega-3 in adults, it's equally important to consider its role in the growth and development of school-aged children. DHA, in particular, is a vital structural component of the brain and retina, with brain development continuing well into adolescence. Sufficient levels of DHA are thought to support cognitive performance, learning ability, and visual acuity.

Emerging research suggests that Omega-3 intake in children may contribute to: • Improved attention and behaviour: Some studies

16 | PHARMACYNEWSIRELAND.COM

indicate a potential link between Omega-3 supplementation and improved symptoms of ADHD and behavioural concerns.

• Cognitive development: Adequate DHA levels are associated with enhanced memory, learning, and problemsolving skills.

• Immune function and inflammation regulation: EPA contributes to a healthy immune response and helps regulate inflammation, which may support resilience and general wellbeing during the school years.

Practical advice for the pharmacy team: • Be prepared to recommend age-appropriate Omega-3 supplements, especially for children who rarely consume oily fish.

• Many children's formulations use DHA-rich algal or fish oil and are flavoured for improved taste.

• Encourage dietary sources wherever possible — oily fish such as salmon, mackerel, and sardines are excellent options.

• Check the label for verified purity, appropriate EPA/DHA content, and age suitability.

• One adult portion of salmon contains approximately 1.24 grams of DHA and 0.59 grams of EPA. • Daily Omega-3 intake should generally not exceed 3 grams.

• The British Dietetic Association (BDA) recommends the following weekly oily fish intake for general health: o Adults and teenagers: 2 portions per week (1 portion = ~140g cooked weight) o Children (5–12 years): 1–2 portions per week, adjusted for age and appetite Conclusion Omega-3 fatty acids play a vital role in overall health across all age groups, from early development through to later life. Community pharmacists and their teams are in a prime position to offer guidance on increasing Omega-3 intake, whether through diet or supplementation. A good understanding of the health benefits and appropriate dosage for different patient groups — including children — enables pharmacy teams to give trusted, evidence-based advice and optimise health outcomes for their communities.

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18

Back2School - Oral Health

Tooth Decay in Children Tooth decay remains one of the most common health issues affecting children globally. Despite advances in dental care, up to 90% of children worldwide still experience decay, making it the most widespread chronic childhood disease. Beyond causing pain and distress, tooth decay disrupts education and often leads to hospital treatment under general anaesthetic. The good news? Tooth decay is largely preventable with simple, consistent oral health routines. their children’s teeth. Yet simple, clear strategies can make a big difference: • Start brushing as soon as the first tooth appears, using a softbristled brush and a smear of fluoride toothpaste.

• From ages 3–6, use a peasized amount of toothpaste and supervise brushing.

• Brush twice a day, including once before bed, when saliva flow is lower and teeth are more vulnerable to acid.

• Children should be supervised while brushing until at least age 7.

• Transition babies to a free-flow cup by 6 months, and phase out bottles by 12 months.

The Impact of Tooth Decay

Key Oral Health Strategies

Each year, thousands of children miss out on school, play, and sleep because of dental pain. In many cases, poor oral health becomes a barrier to normal childhood activities and development.

Establishing healthy dental habits early in life is critical to preventing decay and protecting children’s overall well-being.

Preventing tooth decay starts with three simple but powerful habits:

How Tooth Decay Happens

When these steps are followed consistently from infancy, the risk of dental disease drops significantly.

The mouth contains bacteria— some helpful, others harmful.

When sugary or acidic food and drinks are consumed frequently, harmful bacteria feed on the sugar and produce acid. This acid attacks the outer layer of the tooth, leading to demineralisation.

If not addressed, this process continues and results in cavities (dental caries).

A sticky film called plaque forms on teeth when bacteria accumulate, especially if brushing is infrequent.

Every time sugar is consumed, plaque bacteria produce acid for around 30 minutes, slowly eroding tooth enamel.

• Limit sugary and acidic foods and drinks, keeping them to mealtimes only.

• Brush teeth at least twice daily using fluoride toothpaste.

• Visit the dentist regularly, starting by age one.

Understanding Dental Caries Tooth enamel is made of minerals like calcium and phosphate. In an acidic environment, these minerals leach out (demineralisation), weakening the tooth. However, saliva naturally neutralises acid and helps replace lost minerals through remineralisation, especially when supported by fluoride.

Fluoride strengthens enamel by speeding up remineralisation and making teeth more resistant to acid attack. Fluoride can be found in toothpaste, mouth rinses, and professionally applied varnishes—

18 | PHARMACYNEWSIRELAND.COM

each proven to reduce cavities in children.

Oral Health Starts Early By their first birthday, many infants are already at risk of developing dental caries. Early feeding habits play a big role. While breastfeeding up to 12 months offers some protection against decay, prolonged bottle feeding— especially with sugary drinks—can increase risk.

The primary bacteria behind decay, Streptococcus mutans, are usually passed from caregiver to infant.

This makes early education for parents and caregivers essential.

Supporting Children with Special Needs Children with special care needs often face greater oral health challenges, including increased risk of gum disease, cavities, and oral trauma. These children benefit from tailored support and extra vigilance in oral hygiene routines.

Parental Guidance and Home Care Many parents receive little guidance on how to protect

• Avoid bottles in bed and sugary snacks after teeth are brushed.

Diet and Fluoride: A Crucial Duo Alongside fluoride, diet plays a major role in preventing decay.

Caregivers should limit both the amount and frequency of sugar intake—especially before bed.

Ideally, only breast milk, formula, or water should be offered in bottles.

Supporting exclusive breastfeeding for the first 6 months also reduces cavity risk.

Promising New Tools Emerging solutions, like xylitol wipes, show potential for cleaning babies' gums and new teeth while reducing harmful bacteria. These innovations, while still under evaluation, may become part of early oral care routines in the near future.

Labelling Challenges: “No Added Sugar” Despite awareness efforts, many products marketed as “no added sugar” still contain high levels of natural or free sugars, which can damage teeth. Clearer regulation and labelling are needed to help families make informed choices.

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20

Back2School - VMS

Vitamin Supplements in Children To supplement or not to supplement? That is the question Vitamins and minerals are important for healthy growth and development in children. Children who eat a well-balanced diet usually do not need a vitamin or mineral supplement. However, some children are at risk for deficiencies and may need a supplement.

Vitamin A: Vitamin A is important for babies and young children, and some may not be getting enough.

It's needed for a healthy immune system, can help their vision in dim light, and keeps skin healthy. Good sources of vitamin A include: • Dairy products • Fortified fat spreads • Carrots, sweet potatoes, swede and mangoes • Dark green vegetables, such as spinach, cabbage and broccoli Vitamin C: Vitamin C is important for child's general health and immune system. It can also help their body absorb iron. Good sources of vitamin C include: • Oranges • Kiwi fruit • Strawberries • Broccoli • Tomatoes • Peppers When to Supplement Children who follow vegetarian or vegan diets may need to supplement with vitamin B12 since it's only found in animal-based foods. Children who have coeliac disease are at a higher risk for nutritional deficiencies and may need supplements.

Additionally, children who have a poor appetite, drink a lot of sugar-sweetened beverages, take certain medications or have chronic medical conditions that interfere with intake may need a supplement.

Important Considerations Parents should strive for a wellrounded diet to ensure their child meets the daily recommended vitamin and mineral intakes. A balanced diet includes dairy or dairy alternatives, fruits and vegetables, whole grains and protein foods such as poultry, fish, eggs, nuts and legumes including beans and lentils. While all vitamins and minerals are important for growth and development, some are especially critical for children.

Vitamins, minerals and supplements

(VMS) have always been an important category in the pharmacy with various benefits for not only adults but children of all ages from birth right up to the elderly.

It is generally recommended that all children aged 6 months to 5 years are given vitamin supplements containing vitamins A, C and D every day. Babies who are having more than 500ml (about a pint) of infant formula a day should not be given vitamin supplements. This is because formula is fortified with vitamins A, C and D and other nutrients.

Babies who are being breastfed should be given a daily vitamin D supplement from birth, whether or not mum is taking a supplement containing vitamin D herself.

Vitamin D: Babies need vitamin D for healthy growth and development. It helps them build strong, healthy bones and teeth.

Babies who don’t get enough vitamin D are said to have a deficiency. If the levels are low enough, they are at risk of getting

20 | PHARMACYNEWSIRELAND.COM

rickets, a disease that affects the way bones grow and develop.

The recent re-emergence of rickets (a severe form of vitamin D deficiency causing deformity of the bones) amongst infants in Ireland indicated the widespread low levels of vitamin D in the Irish population.

FSAI recommendations 1. All babies living in Ireland should be given a vitamin D only supplement providing 5µg Vitamin D from birth.

2. Supplements that provide only vitamin D and are in a suitable form to be given to infants should be used. The daily amount of vitamin D provided by such supplements should be 5µg per day.

3. Health professionals and parents need to be made aware that vitamin D deficiency is prevalent in Ireland, particularly among dark-skinned infants and young children.

The B vitamin family plays a vital role in supporting children’s growth, development, and energy metabolism—especially during the school years, when physical, cognitive, and emotional demands are high.

Vitamin B1 (Thiamine) helps convert carbohydrates into energy and supports nerve and muscle function. This is particularly important for active children who need sustained energy throughout the school day.

Vitamin B2 (Riboflavin) and B3 (Niacin) are also involved in energy production and contribute to healthy skin, eyes, and nervous system function. Deficiencies may lead to fatigue, irritability, and poor concentration.

Vitamin B6 (Pyridoxine) is essential for brain development and function. It supports the production of neurotransmitters like serotonin and dopamine, which influence mood, sleep, and attention—key factors in learning and classroom behaviour.

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Back2School - VMS

Vitamin B9 (Folate) plays a role in cell growth and red blood cell formation. It is crucial during periods of rapid growth, making it especially important during childhood and adolescence.

shellfish), dairy products, legumes, seeds, and whole grains. However, absorption can be lower in children following vegetarian or high-fibre diets, so supplementation may be advisable in those cases.

Vitamin B12 (Cobalamin) is vital for neurological development and red blood cell production. Children following vegetarian or vegan diets may be at risk of deficiency, as B12 is primarily found in animal products.

Pharmacists can guide parents in choosing age-appropriate zinc supplements or multivitamins that include zinc, ensuring safe use and avoiding excessive intake, which can lead to gastrointestinal discomfort or reduced copper absorption.

Together, B vitamins help support mental clarity, reduce tiredness and fatigue, and maintain healthy cognitive function—all of which contribute to a child’s ability to learn, concentrate, and stay active. A balanced diet should provide adequate amounts, but in children with restrictive eating habits, a B-complex supplement may be beneficial under pharmacist guidance.

Calcium and Iron Calcium helps build strong bones as a child grows. Good sources include milk, cheese, yogurt, tofu, and calciumfortified orange juice. Iron builds muscle and is essential to healthy red blood cells. Iron deficiency is a risk in adolescence, especially for girls once they begin to menstruate. Good sources include beef and other red meats, turkey, pork, spinach, beans, and prunes.

Zinc is an essential trace mineral that plays a critical role in numerous biological functions important for growing children. It supports immune system function, wound healing, and normal growth and development, making it particularly valuable during the school years when children are frequently exposed to germs and undergoing rapid physical and cognitive changes.

One of zinc’s key benefits is its role in maintaining a strong immune defence. Children with low zinc levels may experience more frequent colds and infections, slower recovery times, and reduced appetite. Supplementing with zinc—especially during cold and flu season—can help reduce the severity and duration of common childhood illnesses.

Zinc also contributes to cognitive performance and memory, supporting neurotransmitter function and protecting nerve cells from oxidative stress. This makes it a valuable nutrient for concentration, problem-solving, and overall school performance.

Dietary sources of zinc include red meat, poultry, seafood (especially

Supplement Safety Megavitamins, large doses of vitamins, aren't a good idea for children. The fatsoluble vitamins (vitamins A, D, E, and K) can be toxic if kids get too much of them. The same goes with iron.

For children and teens with highly selective diets, such as vegetarianism or a dairy-free diet, and for children with erratic eating patterns, you can recommend a daily supplement. Over-thecounter vitamin supplements are typically safe and come in chewable forms in case a child has difficulty swallowing.

Remember, however, that higherthan-recommended dosages of supplements can cause problems.

For example, giving high doses of vitamin C in hopes of preventing colds and the flu can cause a child to have nausea, diarrhoea, and cramps.

Children’s vitamins and supplements may come in fun colours and shapes, but they are not candy. Make sure parents are able to communicate with their child that vitamins are a kind of medicine—not a snack. They should also always follow label instructions about serving size and dosage instructions.

The Growth of Natural Products In recent years, the demand for natural and plant-based children’s supplements has grown significantly, reflecting broader consumer trends toward wellness, sustainability, and “clean-label” living. Parents are increasingly seeking natural alternatives that are free from artificial colours, flavours, preservatives, and unnecessary additives—especially when it comes to products for their children.

This shift has been driven by heightened parental awareness of food sensitivities, allergies, and the long-term impact of dietary choices on children’s health. As a result, many families now

22 | PHARMACYNEWSIRELAND.COM

prioritise supplements made with organic ingredients, vegan formulations, and those that are non-GMO, allergen-free, or free from added sugars.

In pharmacy, this presents a major opportunity to diversify and grow the vitamins, minerals and supplements (VMS) category by stocking trusted, evidence-backed natural brands. Popular product lines now include plant-based vitamin D3, whole food-based multivitamins, fermented nutrients, and herbal blends for immunity, digestion, and sleep.

Natural children’s supplements also appeal to lifestyle-driven shoppers—particularly parents following plant-based or ecoconscious lifestyles—who may otherwise shop exclusively in health food stores or online. By offering these products in-store, pharmacies can retain customers, attract new demographics, and reinforce their role as modern wellness destinations.

Pharmacy teams should be confident in discussing the benefits and limitations of natural supplements and be prepared to address common questions around efficacy, sourcing, and safety. With the right training and merchandising, natural VMS lines can complement traditional products and drive both trust and sales in this growing category.

Additional Considerations for Pharmacists Pharmacists play a key role in guiding parents through the often confusing VMS landscape. Some useful points to remember when recommending supplements: • Check for medication interactions: Iron can reduce absorption of some antibiotics; calcium may interfere with thyroid medication.

• Consider seasonal variations: During the winter, children in Ireland are unlikely to get enough vitamin D from sunlight and will need supplements even if they have a balanced diet.

• Special populations: Children with autism spectrum disorder (ASD) or sensory processing disorders often have restrictive diets, which may require a multivitamin tailored to their intake gaps.

• Probiotics: While not a vitamin, many parents enquire about gut health. A daily probiotic may be helpful for children

on antibiotics or with minor digestive complaints, though evidence varies.

• Omega-3 fatty acids: DHA and EPA, essential for brain development, are often lacking in children who don't eat oily fish. Supplements can be recommended based on age, diet, and cognitive development concerns.

Communicating with Parents Community pharmacists are in an ideal position to support and educate parents. Take the time to ask open-ended questions about the child's diet, medical history, and lifestyle. Always encourage food-first approaches where possible, and reassure parents that supplements should fill in nutritional gaps—not replace healthy meals.

Provide written guidance when appropriate, especially for complex regimens involving iron or vitamin D. Offer practical advice on storage (e.g., away from heat and out of children's reach) and dosage reminders.

Finally, encourage parents to check with a healthcare professional before starting any new supplement, especially if the child is on prescribed medication or has a chronic condition. With the right advice, pharmacists can help ensure children get the nutrition they need for lifelong health and wellbeing.

Boosting Sales Children’s vitamins and supplements remain a consistent and growing category within pharmacy retail, driven by increasing parental awareness of nutrition, seasonal health needs, and targeted product marketing.

For pharmacies, this presents a valuable opportunity not only to grow sales but also to provide trusted, evidence-based guidance to families. Here are practical strategies pharmacy teams can implement to boost sales and maximise their role in this important sector.

Engage in Seasonal and Thematic Campaigns Pharmacies can align VMS promotions with key seasons and school terms. For example: • Back to school (August– September): Focus on immunity and concentration—highlight vitamin C, D, omega-3 and multivitamins.

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• Winter months (October– March): Emphasise vitamin D for immune and bone health, particularly in line with national guidelines.

• Exam season: Promote supplements that support mental performance and energy levels, such as iron, B-vitamins, and DHA. Use prominent signage, themed end-of-aisle displays, and window posters to create visibility and make it easy for time-pressed parents to find the right products.

Offer Staff-Led Nutritional Advice Training pharmacy staff to confidently offer advice on children’s nutrition and supplement choices adds value to every transaction. A knowledgeable recommendation can make all the difference in whether a customer purchases in-store or looks elsewhere.

Encourage staff to: • Ask open-ended questions about diet, lifestyle, and medical

Back2School - VMS

history (e.g., “Is your child a picky eater?” or “Do they follow a dairy-free or vegan diet?”).

• Suggest age-appropriate multivitamins or single supplements based on identified needs.

• Explain the importance of dosage, frequency, and safe storage.

• Reinforce that supplements should support, not replace, a balanced diet.

This consultative approach builds trust and increases customer satisfaction and loyalty.

Stock a Diverse, Quality Range Ensure a broad range of highquality VMS products that cater to varying age groups, dietary needs, and preferences. Consider: • Sugar-free and allergen-free options for children with dietary restrictions.

• Chewable, gummy, and liquid formulations for children with difficulty swallowing tablets.

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• Trusted brands with clear labelling and parent-friendly education materials.

Merchandise according to age brackets (e.g., toddlers, schoolaged children, teens) and health goals (e.g., immunity, bones, cognition) to help shoppers navigate the category easily.

Utilise Loyalty Programs and Multi-Buy Offers Incentivise repeat purchases with loyalty schemes, bundle deals or multi-buy discounts (e.g., “3 for 2 on all children’s VMS”).

These not only drive sales but encourage customers to stock up on essentials, particularly when multiple children are in the household.

Consider digital reminders for refills or seasonal check-ins via pharmacy apps or customer emails, especially for products like vitamin D, which need ongoing daily dosing.

Collaborate With Local Schools, Creches, and GPs

Build awareness by offering free vitamin advice sessions or educational leaflets to local schools and crèches. This positions the pharmacy as a community health partner and can generate footfall from parents seeking accessible and trustworthy information.

Collaboration with GPs, public health nurses or paediatric clinics can also help ensure your pharmacy is the first port of call when supplementation is recommended.

Promote Expert Content on Social Mediawhat Use social media to share short videos, blog-style posts, or infographics about common childhood deficiencies, benefits of supplements, and pharmacist tips.

Featuring your pharmacy team can personalise the content and foster engagement.

Highlighting your role as a reliable, professional resource can help parents feel confident about shopping locally rather than relying on less informed sources online.

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26

Back2School - Skin Conditions

Common Childhood Skin Conditions Community pharmacists play a vital frontline role in healthcare, particularly in managing minor ailments and guiding families through appropriate treatment pathways. Skin conditions are among the most frequently encountered health issues in school-aged children (ages 5–12), ranging from mild irritations to more persistent or infectious disorders. These conditions can affect a child’s comfort, self-esteem, school attendance, and overall well-being. With timely identification and intervention, pharmacists can prevent complications, promote healing, and improve quality of life.

Pharmacist’s Role: • Assessment: Identify triggers (e.g., soaps, temperature changes, allergens), assess severity, and determine if overthe-counter (OTC) management is appropriate.

• Treatment: o Emollients: First-line therapy.

Recommend frequent, liberal application of fragrance-free emollients (ointments are more effective than creams or lotions).

This article provides a practical guide for community pharmacists on the identification, treatment, referral, and strategies needed to manage the most common dermatological conditions in this age group.

Eczema (Atopic Dermatitis) Eczema is a chronic inflammatory skin disorder characterized by dry, itchy, and inflamed skin. It typically presents in school-aged children as patches of erythema, dryness, and lichenification—often on the flexural areas such as elbows and knees.

Eczema remains one of the most prevalent chronic skin conditions in school-aged children, with a significant impact on quality of life and family wellbeing. Although many children experience improvement as they grow older, some will continue to have flares well into adolescence. Community pharmacists can provide essential guidance in day-to-day management and early intervention during exacerbations.

Pharmacists should help caregivers identify and avoid common triggers. These include environmental factors (such as cold weather, pollen, and pet dander), irritants (like soaps, bubble baths, or scratchy clothing), and allergens (such as dust mites or certain foods).

Emotional stress and sweating

from physical activity can also provoke flares in some children.

Education is critical in eczema care. Many families underuse emollients or corticosteroids due to misinformation or corticosteroid phobia. Pharmacists should reinforce the importance of applying emollients at least twice daily and continuing their use even when the skin appears clear.

Emollients should be applied in a downward stroking motion to prevent folliculitis and should be stored in a way that prevents contamination (e.g., pump dispensers or clean spatulas).

For mild to moderate eczema, 1% hydrocortisone can be safely recommended short-term for flares. It's vital to explain the “fingertip unit” rule for dosing and to stress that steroids should not be used indiscriminately or on broken or infected skin.

Pharmacists should advise caregivers to apply steroids before emollients and to wait 20–30 minutes before applying moisturiser to avoid dilution.

Red flags include signs of secondary infection (e.g., crusting, yellow pus, fever), suspected eczema herpeticum (painful, rapidly spreading lesions), or poor response to OTC treatments.

Pharmacists should also refer if the condition is affecting sleep, schooling, or mental health.

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o Topical Corticosteroids: Mild to moderate cases can often be managed with OTC 1% hydrocortisone cream applied sparingly to affected areas.

• Referral Criteria: o Infected eczema (oozing, crusting, yellow discharge) o Failure to improve with appropriate treatment o Widespread or severely inflamed lesions • Advice and Tips: o Encourage consistent emollient use even when symptoms improve. o Recommend soap substitutes and lukewarm baths. o Educate caregivers on the correct use of corticosteroids to avoid phobia or misuse.

Impetigo Impetigo is a superficial bacterial skin infection, often caused

by Staphylococcus aureus or Streptococcus pyogenes. It typically presents as honeycoloured crusted lesions, often around the nose and mouth.

Impetigo is a highly contagious superficial bacterial skin infection, most commonly affecting children aged 2–10 years. It is caused predominantly by Staphylococcus aureus and sometimes Streptococcus pyogenes.

Community pharmacists are ideally placed to identify impetigo early, offer practical advice, and guide parents on when medical treatment is needed.

Impetigo usually begins as small red papules that rapidly evolve into pustules and then characteristic honey-coloured crusted lesions, typically around the nose, mouth, or extremities. Bullous impetigo, a less common form, presents with fluid-filled blisters and is more likely to affect infants or young children. The condition is highly transmissible through direct contact or via contaminated items like towels and toys.

Impetigo is typically managed with topical antibiotics such as fusidic acid or mupirocin, but these are often prescription-only.

Pharmacists should refer patients with suspected impetigo to their GP for a definitive diagnosis and treatment initiation. For very mild, localised cases, some guidelines support the use of antiseptic treatments like hydrogen peroxide 1% cream.

Pharmacists should emphasise strict hygiene to prevent spread.

Key advice includes: • Keeping lesions covered with a non-stick dressing.

• Avoiding scratching or touching the lesions.

• Not sharing personal items such as towels, clothing, or bedding.

• Washing hands regularly and trimming nails.

• Excluding the child from school or daycare until at least 48 hours after starting antibiotics or until lesions have fully dried and crusted over.

Pharmacist’s Role: • Assessment: Distinguish between non-bullous (more common) and bullous types; inquire about recent injuries or insect bites that may have preceded the infection.

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• Treatment: o Topical antibiotics like fusidic acid (prescription only in many regions) for localised cases. o Advise on hygiene to prevent spread—do not share towels, keep lesions covered, and stay home from school until lesions are dry or 48 hours after starting antibiotics.

• Referral Criteria:

Back2School - Skin Conditions

out other conditions such as molluscum contagiosum or calluses.

• Treatment: o Salicylic acid preparations are first-line and available OTC. o Advise daily application and paring down of thickened skin.

• Referral Criteria:

o Spreading or recurrent infection.

o Painful, rapidly spreading, or treatment-resistant lesions.

o Presence of fever or systemic symptoms.

o Multiple lesions in immunocompromised children.

o Bullous impetigo or suspected MRSA infection.

• Advice and Tips: o Emphasize hand hygiene and nail trimming to prevent scratching and spread. o Dispose of dressings carefully and wash clothes/towels in hot water.

• Advise and Tips: o Encourage patience—warts may take weeks or months to resolve. o Discourage picking or scratching lesions. o Suggest use of waterproof plasters in communal showers to reduce transmission.

• Referral Criteria: o Signs of secondary bacterial infection. o Extensive lesions or eyelid involvement.

• Advice and Tips: o Inform parents that spontaneous resolution is expected within 6–18 months. o Avoid sharing towels, and cover lesions when swimming.

Head Lice (Pediculosis Capitis) Head lice infestations are extremely common in school-aged children and are not a sign of poor hygiene.

Symptoms include scalp itching and visible lice or nits. Head lice (Pediculus humanus capitis) are a common nuisance among schoolaged children, especially those between 4 and 11 years old.

Infestation is typically characterised by itching of the scalp, especially behind the ears and at the nape of the neck.

Caregivers may notice live lice or whitish nits (empty egg cases) attached to hair shafts, but the presence of live lice is required to confirm active infestation.

Warts and Verrucae

Molluscum Contagiosum

Caused by human papillomavirus (HPV), warts and verrucae are common viral skin infections in children. Warts usually appear on hands and fingers; verrucae affect the soles of the feet.

A viral infection caused by a poxvirus, presenting as small, flesh-coloured, dome-shaped papules with central umbilication.

It is benign and self-limiting but can persist for several months.

Warts (common warts) and verrucae (plantar warts) are benign skin growths caused by the human papillomavirus (HPV), frequently affecting school-aged children due to their developing immune systems and increased exposure through shared surfaces like swimming pools and changing rooms.

Molluscum contagiosum is a common, self-limiting viral skin infection caused by a poxvirus.

It primarily affects children aged 1–10 years and is spread through direct skin-to-skin contact or via contaminated objects such as towels, toys, or clothing.

Outbreaks in households or among siblings are common.

Warts typically appear as rough, raised lesions with a cauliflowerlike surface, commonly on the hands and fingers. Verrucae are found on the soles of the feet and may be painful due to pressure. They often have a flatter appearance and may show tiny black dots—clotted capillaries—on their surface.

Lesions are typically small (2–5 mm), flesh-coloured, dome-shaped papules with a central dimple (umbilication). They often appear in clusters on the trunk, limbs, or face. Molluscum is usually asymptomatic but may become itchy, red, or inflamed—particularly when healing or if secondarily infected.

• Treatment:

Most warts and verrucae are self-limiting and resolve spontaneously within 6–24 months, so reassurance and conservative management are appropriate in many cases. However, for symptomatic or persistent lesions, topical treatments can be recommended.

Pharmacist’s Role:

• Referral Criteria:

• Assessment: Usually painless unless secondarily infected; commonly affects trunk, limbs, or face.

• Treatment:

Pharmacist’s Role:

o Generally no treatment required; reassurance is key.

• Assessment: Confirm typical appearance (rough, raised lesions with black dots), rule

o Advise on hygiene and avoiding scratching to prevent spread.

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Pharmacist Role: Pharmacists can guide parents through effective detection and treatment strategies. The detection combing method with a fine-toothed lice comb on wet, conditioned hair is the gold standard for diagnosis.

• Assessment: Confirm presence of live lice (not just empty nits) using a fine-tooth detection comb.

o OTC treatments with dimeticone, isopropyl myristate, or insecticides like permethrin. o Wet combing method may also be recommended for parents wishing to avoid chemicals.

o Repeat treatment after 7–10 days to kill newly hatched lice.

Scabies Caused by the Sarcoptes scabiei mite, scabies results in intense itching (especially at night) and burrows commonly found in web spaces of fingers, wrists, and ankles.

Pharmacist’s Role: • Assessment: Look for classic burrows and ask about other household members with similar symptoms.

• Treatment: o Permethrin 5% cream (firstline, usually prescription). o Treat all household members simultaneously.

• Referral Criteria: o Infants under 2 months. o Treatment-resistant cases.

• Advice and Tips: o Emphasise need to apply cream to the entire body and leave on overnight. o Wash bedding and clothing in hot water and dry on high heat. o Itch may persist for weeks post-treatment—reassure parents.

Psoriasis (Mild Forms) Although less common, plaque psoriasis may appear in schoolaged children as well-demarcated, scaly, erythematous plaques on the scalp, elbows, or knees.

Pharmacist’s Role: • Assessment: Chronic nature, family history, and lesion characteristics can support diagnosis.

• Treatment: o Emollients for all patients. o Mild corticosteroids may be used for limited involvement.

• Referral Criteria:

o Treatment failure after two cycles.

o Extensive, severe, or treatment-resistant cases.

o Suspected skin infection due to scratching.

o Uncertain diagnosis.

• Advise and Tips: o Treat only if live lice are found—not based on school policy alone. o Check and treat close contacts simultaneously.

• Advice and Tips: o Avoid known triggers (trauma, stress). o Provide support and reassurance, as visible lesions can cause psychological distress.

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Back2School - Menstrual Care

Periods, Pimples and Puberty Supporting School-Aged Children with Menstrual Acne, Hormonal Changes, and Period Care Menstruation is a natural part of growing up, yet it remains a source of confusion, stigma, and discomfort for many school-aged children. Community pharmacists and their teams are in a unique position to provide guidance, reassurance, and practical support. This article explores the role of hormones in menstrual acne, addresses period care for young people, and outlines how pharmacy teams can deliver compassionate, ageappropriate advice to young patients and their caregivers.

• Offer over-the-counter (OTC) treatments such as benzoyl peroxide, salicylic acid, or topical retinoids (age-appropriate and within licensing).

• Consider the suitability of gentle skincare routines: noncomedogenic cleansers, oil-free moisturisers, and sunscreen.

• Educate caregivers about the psychosocial impact of acne and the importance of a supportive home environment.

Period Care for School-Aged Children

Understanding Hormonal Changes and Menstrual Acne Menstrual acne is a common concern for many young people during puberty and the early years of menstruation. Acne flares are typically linked to the hormonal fluctuations that occur throughout the menstrual cycle, particularly the rise and fall of androgens, such as testosterone.

How hormones trigger acne: • In the second half of the menstrual cycle (the luteal phase), progesterone levels rise. This can lead to increased sebum (oil) production, creating an environment where acnecausing bacteria can thrive.

• Androgens stimulate sebaceous glands and can lead to clogged pores, resulting in comedones (blackheads/whiteheads), papules, or pustules.

• Hormonal acne typically appears on the lower face, jawline, and chin, and may worsen just before or during menstruation.

Pharmacy considerations: • It’s important to differentiate hormonal acne from other forms of acne and refer to a GP or dermatologist if the acne is severe, persistent, or affecting mental health.

Menstruation often begins between the ages of 9 and 13, though it can start earlier or later depending on the individual. The early cycles may be irregular and can vary in flow and duration.

For young menstruators, this can be overwhelming and may affect their confidence, self-esteem, and school participation.

Period products and support: Pharmacy teams are ideally placed to provide non-judgmental, accessible information on the wide range of menstrual products available today. Understanding and respecting individual preferences is key.

or synthetic materials. Organic or hypoallergenic options are often available in pharmacy settings.

Tips for the pharmacy team: • Create a discreet, welcoming environment for young people to ask questions.

• Use inclusive and ageappropriate language: phrases like "people who menstruate" or "period care for young people" can be helpful, especially in diverse communities.

• Offer starter kits or pre-packed period bags to help young menstruators manage their periods at school or on the go.

• Support caregiver education, especially for parents who may feel unsure about how to start the conversation.

The Role of Pharmacists in Hormonal Education While puberty education is covered in schools, young people and their families often seek clarity and guidance from their local pharmacy team. Pharmacists can be a trusted voice in helping children understand the changes happening in their bodies.

Key messages to convey:

• Pads (sanitary towels): Still the most commonly used product among first-time menstruators. Available in various absorbencies and sizes.

• Menstrual cycles are unique and can take time to regulate — reassure young patients that irregular periods are normal in the first year or two.

• Tampons: Generally not recommended until a child is older, more comfortable with their body, and confident with insertion. Pharmacy teams can support caregivers in discussing these options when appropriate.

• Changes in mood, bloating, cramps, and skin concerns are common and can often be managed with simple self-care strategies.

• Menstrual cups or period pants: Increasingly popular but may not be suitable for all age groups. Good for sustainability and may suit older adolescents.

• Sensitive skin options: Some children may react to fragrances

30 | PHARMACYNEWSIRELAND.COM

• If periods are excessively painful, heavy, or affecting quality of life, referral to a GP is essential. Conditions such as endometriosis or PCOS can present early.

OTC options for symptom relief: • Paracetamol and ibuprofen can be recommended for menstrual

cramps and general discomfort.

Always ensure appropriate dosing for age and weight.

• Heat patches, herbal teas, and reusable hot water bottles can be promoted for natural relief.

• Some pharmacists may wish to discuss nutritional supplements, such as magnesium or vitamin B6, though this should be based on individual need.

Reducing Stigma and Promoting Body Confidence Period stigma and embarrassment still persist, especially among young people. The pharmacy team can contribute to breaking taboos and promoting a culture of openness and support.

Actionable ideas: • Create a discreet display of period care products with educational leaflets.

• Host drop-in clinics or school outreach talks in partnership with local educators.

• Provide staff training to improve confidence when engaging with young people and their caregivers on sensitive topics.

Conclusion Community pharmacy teams play a vital role in supporting the physical and emotional wellbeing of school-aged children as they navigate hormonal changes and menstrual health.

From offering practical product recommendations to educating on skin and hormonal issues, your team’s guidance can help build confidence, comfort, and body literacy in young patients.

By being approachable, informed, and sensitive, pharmacy teams can make a significant difference — helping to normalise conversations about menstruation and empowering the next generation to take ownership of their health.

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Back2School - Digestion

Children’s Digestive Health: Supporting Young Tummies This School Term Children’s digestive health is foundational to their overall growth, cognitive development, immunity, and dayto-day comfort. Digestive issues in children—ranging from functional constipation and reflux to diarrhoea and food intolerances—can disrupt their ability to learn, play, and thrive. With the new school term underway, it's an opportune time for pharmacy teams to play a proactive role in supporting young tummies and reassuring parents who may be concerned about their child’s gastrointestinal wellbeing.

Written by Dearbhla Walsh, Pharmacist

Common Digestive Conditions Seen in Children – A Pharmacist's Overview 1. Functional Constipation This is one of the most common issues seen in children, particularly during school terms when routines change and toilet avoidance becomes common.

Pharmacist's role: • Encourage good hydration and dietary fibre intake.

• Support families with the correct use of laxatives.

Pharmacists are a cornerstone of community-based healthcare, and their expertise places them in a unique position to promote, support, and manage digestive health in children. As trusted professionals with direct access to the public, pharmacists can bridge the gap between concerned caregivers and more specialist services when needed.

Community pharmacists are often the first healthcare professional consulted when a parent is worried about their child’s digestive symptoms. Whether it’s a baby with colic, a toddler who’s constipated, or a school-aged child with frequent tummy aches or reflux, pharmacists can assess the situation, provide clinical advice, and help families determine the best course of action.

Importantly, pharmacists are trained to recognise red-flag symptoms that warrant urgent referral to a GP or paediatric specialist. Signs such as persistent vomiting, weight loss, blood in stools, severe abdominal pain, or failure to thrive should never be overlooked. Pharmacists’ ability to triage these cases accurately protects children's health while easing the burden on GP practices.

By providing timely advice and identifying serious cases early, pharmacists help ensure that children receive the appropriate care as efficiently as possible.

Managing Parental Anxiety and Misinformation Digestive issues in children are often distressing for parents, particularly if the symptoms are chronic or interfere with school attendance, sleep, or eating. In the digital age, many parents turn to the internet for answers— sometimes encountering unverified or misleading information.

This is where the pharmacist’s role as an educator and trusted advisor becomes vital. Pharmacy teams can provide parents with reliable, evidence-based information, helping to dispel common myths and clarify confusion surrounding digestive conditions, medications, and nutritional management.

For example: • Myth: All tummy pain in children is caused by food intolerances.

• Fact: Functional abdominal pain is far more common, especially during times of stress like returning to school.

Pharmacists can also guide parents through treatment plans prescribed by a GP or consultant, explaining how medications work, when they should be taken, and what side effects to watch for. This is especially important in chronic conditions such as gastroesophageal reflux disease (GORD), food allergies, coeliac disease, or irritable bowel syndrome (IBS).

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• Advise on toilet routines and behaviour modification techniques.

• Refer when constipation is chronic or associated with other red flags (e.g., weight loss, blood in stool, failure to respond to OTC treatment).

2. Infant Colic Often self-limiting, colic is distressing but not dangerous.

However, it can cause significant anxiety in parents.

Pharmacist's role: • Offer reassurance and advice on feeding techniques.

• Discuss options such as simethicone drops or hydrolysed formulas if appropriate.

• Ensure red flag symptoms are ruled out (e.g., persistent vomiting, poor weight gain).

3. Reflux (GORD) Gastro-oesophageal reflux is common in infants and can persist in older children.

Pharmacist's role: • Explain differences between physiological reflux and GORD. • Recommend nonpharmacological strategies like upright feeding and burping.

• Advise on appropriate use of alginates or acid-suppressing therapy under medical supervision.

4. Diarrhoea and Gastroenteritis Acute diarrhoea can spread rapidly in school environments.

Pharmacist's role: • Educate on the importance of hydration and use of oral rehydration solutions.

• Counsel on infection control (hand hygiene, exclusion from school).

• Recommend zinc supplementation where appropriate.

• Refer if symptoms persist or signs of dehydration are present.

Gastroenteritis, often referred to as the “stomach bug,” is a common, usually self-limiting illness in children. Caused by viral, bacterial, or (less commonly) parasitic infections, it typically presents with diarrhoea, vomiting, abdominal cramps, fever, and malaise. Norovirus and rotavirus are the most common viral culprits, particularly in childcare and school settings, where outbreaks can spread rapidly due to close contact and shared surfaces.

Pharmacist’s Role: As first-line healthcare providers, pharmacists can guide parents through the safe and effective management of gastroenteritis at home. The mainstay of treatment is oral rehydration therapy (ORT) to prevent or correct dehydration, especially in younger children who are at greater risk of fluid loss.

Key advice includes: • Encourage small, frequent sips of oral rehydration solutions (ORS), which contain balanced electrolytes and glucose to aid absorption.

• Continue breastfeeding or formula feeding in infants.

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Back2School - Digestion

taking to avoid harmful interactions or duplications (Ireland, 2016).

Probiotics – A Supportive Option for Gut Recovery Probiotics are live microorganisms that, when administered in adequate amounts, confer a health benefit to the host. In paediatrics, they are often used to support digestive health, restore gut flora after illness, and manage certain gastrointestinal conditions.

Other Potential Uses in Children Beyond gastroenteritis, probiotics are being explored in a range of paediatric digestive issues: • Antibiotic-associated diarrhoea: Probiotics may help maintain gut flora balance and reduce disruption.

• Infant colic: Some studies show promise for certain strains in reducing crying time.

• Avoid sugary drinks and undiluted fruit juices, which can worsen diarrhoea.

• Watch for signs of dehydration: dry lips, sunken eyes, reduced urine output, and lethargy.

Pharmacists should refer urgently if any red flag signs are observed, including: • Persistent vomiting or inability to keep fluids down.

Vaccination against rotavirus, introduced in Ireland in 2016, has significantly reduced the burden of gastroenteritis in infants. Pharmacists can support awareness and adherence to vaccination schedules as part of public health education.

5. Food Allergies and Intolerances

• Blood or mucus in stool.

Lactose intolerance and food allergies (e.g., to milk, eggs, nuts) may present with GI symptoms.

• High fever or listlessness.

Pharmacist's role:

• Symptoms lasting longer than 3–5 days.

• Help parents identify potential triggers through symptom diaries.

• Signs of moderate or severe dehydration.

Some parents may request antidiarrhoeal medicines, but these are generally not recommended in children under 12 years.

Pharmacy teams should explain why supportive care is preferable and reinforce the natural course of viral gastroenteritis.

Hygiene Advice Prevention is just as important.

Pharmacy teams should take every opportunity to promote: • Regular handwashing with soap and water.

• Disinfecting toys, surfaces, and toilets during outbreaks.

• Exclusion from crèche or school for at least 48 hours after the last episode of vomiting or diarrhoea.

• Support safe food elimination under medical or dietetic supervision.

• Advise on nutritional supplements if required.

Promoting Treatment Adherence and Long-Term Management Adherence to prescribed treatment regimens in children can be a challenge. Taste preferences, fear of side effects, or misunderstandings about the need for long-term use can lead to poor compliance. According to ElRachidi et al. (2017), pharmacists are instrumental in supporting adherence in paediatric patients.

By taking time to talk through treatment plans with both children and their parents or guardians, pharmacy teams can reinforce the importance of consistency and address concerns in a non-

34 | PHARMACYNEWSIRELAND.COM

judgmental way. This collaborative, supportive approach can prevent treatment failure and promote better long-term outcomes.

In addition, follow-ups at the pharmacy can act as informal check-ins—particularly valuable for families managing chronic digestive conditions.

Appropriate Use of OTC Medicines in Children Pharmacists and their teams are well-placed to guide families in choosing safe and ageappropriate over-the-counter (OTC) medications for digestive symptoms such as: • Constipation: Treatments may include lactulose, macrogols, or glycerin suppositories depending on the child’s age, symptom severity, and duration.

• Diarrhoea: Oral rehydration therapy is often first-line, with careful monitoring for signs of dehydration.

• Acid reflux and indigestion: Antacids or alginate-based products may be considered, but should always be weighed against the child’s age, frequency of symptoms, and medical history.

Pharmacists also play a critical role in ensuring that correct, weightbased dosing is used—especially in infants and toddlers where even minor overdoses or underdoses can have significant consequences (Conn, 2021). They can review other medications the child is

• Irritable bowel symptoms: Though data are mixed, some children may benefit from strain-specific products under medical guidance.

Product Selection and Safety Considerations Pharmacists should ensure probiotic products are: • Strain-specific and supported by clinical evidence.

• Suitable for the child’s age group.

• Stored correctly (refrigerated if required).

• Free from allergens if the child has food sensitivities.

Education and Public Engagement Initiatives As accessible healthcare professionals, pharmacists can play a key role in public health campaigns, particularly at the start of the school year when many digestive issues are exacerbated by changes in routine.

In-store events, school talks, and collaborations with local GP practices or dietitians can amplify awareness. Topics might include: • "Back to School Bowel Health" week • "Healthy Lunchbox Tips for Happy Tummies" • "Understanding Probiotics for Children" Educational materials and targeted campaigns using leaflets, digital screens, and social media can further support outreach.

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Back2School - Injuries

First Aid Essentials for Minor Injuries As a community pharmacist, you’re often the first point of contact for parents managing minor injuries at home—cuts, grazes, and playground tumbles are all part of growing up. Providing practical first aid advice and recommending the right products can help parents feel confident and prepared, while ensuring minor injuries are managed appropriately and safely at home.

Pharmacy support: • Provide advice on R.I.C.E. (Rest, Ice, Compression, Elevation).

• Guide parents on how to safely remove superficial splinters and when to refer for deeper or embedded objects.

• Stock crepe and tubular bandages for light support.

• Provide advice on infection prevention and monitoring.

• Recommend anti-inflammatory creams or oral analgesics (where appropriate).

7. Nosebleeds

• Educate parents on when a sprain might actually be a fracture and require a medical assessment.

4. Blisters Often seen in children breaking in new shoes, playing sports, or walking long distances (e.g. school trips or camps), blisters can be painful and prone to infection if popped or torn.

This guide outlines key first aid essentials for treating minor wounds and bruises, as well as what pharmacists and their teams should consider when advising customers on building a reliable home first aid kit.

Common Injuries in SchoolAged Children: What Community Pharmacists Need to Know Children of school age— particularly those involved in sports, outdoor play, and group activities—are prone to a wide variety of minor injuries. As accessible healthcare providers, community pharmacists and their teams play a vital role in recognising, advising on, and managing these injuries appropriately. Below are some of the most frequent injuries seen in this age group and how pharmacies can assist.

1. Cuts, Grazes, and Scratches These are among the most common minor injuries in school children, typically occurring during outdoor play, sports, or falls on hard surfaces like tarmac.

Elbows, knees, and hands are particularly vulnerable.

Pharmacy support: • Offer a range of dressings suitable for different skin types and body areas.

• Stock antiseptic wipes, sprays, and creams.

• Advise on signs of infection and when to escalate care.

• Educate parents on correct wound cleaning techniques and dressing changes.

2. Bruises and Bumps

Pharmacy support: • Recommend blister plasters or hydrocolloid dressings.

• Advise against bursting blisters unless absolutely necessary.

• Provide hygiene and wound-care advice if a blister does rupture.

5. Insect Bites and Stings

Often caused by bumps to the nose, dry air, or frequent nosepicking, nosebleeds can seem dramatic but are usually minor.

Pharmacy support: • Educate parents on correct management: tilt head forward, pinch soft part of nose, apply pressure for 10–15 minutes.

• Recommend saline sprays or gels if dry air is a contributing factor.

• Know when to refer: recurrent bleeds, bleeds that last longer than 20 minutes, or bleeds following significant trauma.

8. Head Bumps Minor head injuries are common during rough play or sports. While most are not serious, parents may need reassurance or guidance on when to seek further help.

Bruising often results from minor trauma like collisions, tumbles, or sports injuries. While most resolve on their own, they can be painful or alarming to parents.

Outdoor play and warm weather increase the likelihood of insect bites and stings, which may lead to localised swelling, itching, or allergic reactions.

Pharmacy support:

Pharmacy support:

Pharmacy support:

• Recommend cold compresses, instant ice packs, or reusable gel packs.

• Stock antihistamines (oral and topical), soothing creams (e.g., calamine or hydrocortisone), and bite relief pens.

• Recommend cold compresses for swelling.

• Suggest appropriate analgesia for pain or swelling.

• Advise on when bruising might be a sign of something more serious (e.g., unexplained, extensive, or in unusual locations like the abdomen or behind the ears).

3. Sprains and Strains Ankles and wrists are particularly susceptible to sprains and strains in active children. These soft-tissue injuries are usually mild but can cause considerable discomfort and limit movement.

36 | PHARMACYNEWSIRELAND.COM

• Offer advice on cold compresses and when to seek medical help (e.g., signs of anaphylaxis, difficulty breathing, or swelling around the face and throat).

6. Splinters and Foreign Bodies Children often pick up splinters from wooden playgrounds or small debris while playing outdoors.

Gravel or sand may also become embedded in wounds.

• Provide basic advice on monitoring symptoms such as drowsiness, confusion, or vomiting post-injury.

• Always encourage parents to seek medical attention for any head injury with concerning symptoms or in very young children.

Treating Bruises: Advice to Offer in Pharmacy Consultations Your role: Educate carers on safe and effective bruise management, when to monitor, and when to escalate concerns.

Recommend:

Pharmacy support:

1. Cold compresses

• Sell fine-tipped tweezers, sterile saline, and antiseptics.

Instant ice packs are ideal for home kits. Emphasise wrapping

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in a towel to prevent cold burns.

Apply for 10 minutes every hour during the first 24 hours.

2. Elevation Encourage parents to elevate the affected area to help reduce swelling.

3. Rest and recovery Advise gentle rest of the injured area.

4. Pain management Recommend age-appropriate analgesics like paracetamol or ibuprofen, and discuss dosage where needed.

5. Topical treatments Arnica cream may be useful for older children. Check suitability and advise on application.

OTC Considerations Understanding which treatments are most suitable for children, along with proper usage guidance, age restrictions, and safety precautions, is vital to ensuring good outcomes and customer trust.

Age-Appropriate Pain Relief Children experiencing pain from bruises, sprains, or minor cuts may benefit from analgesics.

Paracetamol and Ibuprofen: • Both are commonly used and well-tolerated in children, but dosing must be based on age and weight.

• Always ask about existing medical conditions (e.g., asthma, gastrointestinal issues) or other medications to check for interactions.

• Offer liquid formulations for younger children and chewable or meltable tablets for older ones.

• Encourage parents to use a measuring syringe or spoon for accurate dosing.

Top tip for staff: Always doublecheck the child’s age and weight before recommending a product and remind carers to read the patient information leaflet (PIL) fully.

Topical Antiseptics Cleaning a wound effectively is crucial in preventing infection.

Back2School - Injuries

• Avoid recommending products with high alcohol content for young children, as these may cause stinging and distress.

• Always check label instructions—many topical antiinflammatories are only suitable for use in children over 12.

• For children with sensitive skin or eczema, suggest alcohol-free or hypoallergenic antiseptics.

Insect Bites and Stings

Pharmacy tip: Stocking a few child-friendly options in easy-touse formats (like spray bottles or individual wipes) makes it easier for parents to use them confidently at home.

Skin Protectants and Healing Creams After cleaning, many parents want a product that promotes healing and offers a barrier.

OTC recommendations: • Antibiotic-free wound healing creams like Sudocrem, Savlon, or gels containing allantoin or panthenol can soothe and protect.

• Avoid excessive use of antibiotic creams unless medically indicated—this can contribute to resistance and allergic reactions.

• For minor burns, suggest hydrogel dressings or burnspecific creams (check age limits).

Bandages, Plasters and Dressings Pharmacy staff should be familiar with: • Waterproof plasters for hands and knees.

• Hypoallergenic options for sensitive skin.

• Elasticated tubular bandages for strains or sprains (helpful for older children).

• Sterile dressings with adhesive borders for knees or elbows where standard plasters may peel.

Practical tip: Have a few examples available to show customers how they work. It’s particularly helpful for anxious parents or those caring for a child with special needs.

Anti-inflammatory and Bruise Creams For bruising or minor soft tissue injury:

Considerations:

• Arnica-based creams are a popular natural option for older children.

• Antiseptic wipes, sprays, or creams containing ingredients like chlorhexidine or cetrimide can be helpful.

• Products like ibuprofen gel should be avoided in younger children unless specifically indicated and age-appropriate.

38 | PHARMACYNEWSIRELAND.COM

Summer months bring increased demand for bite and sting relief.

OTC options include: • Antihistamine creams (e.g., diphenhydramine or mepyramine)—check age restrictions.

• Mild steroid creams (e.g., 1% hydrocortisone)—generally not recommended for children under 10 without GP advice.

• Oral antihistamines like cetirizine or loratadine syrups can reduce itching and swelling.

Pharmacy tip: Caution carers about scratching, as it can lead to secondary infections. Recommend cooling gels or calamine lotion as soothing alternatives.

Cold Packs and Heat Therapy Parents often overlook cold and heat therapy products as part of their home care.

• Instant cold packs are essential for sprains, strains, and swelling.

• For older children, heat packs may help with muscle aches (e.g., after sports).

• Always advise wrapping cold/ heat packs in a towel to prevent skin damage.

When to Refer or Escalate Ensure parents understand the red flags that warrant further medical assessment: • Embedded foreign objects • Persistent heavy bleeding • Signs of infection (e.g., pus, increased redness/swelling) • Wounds that aren’t healing • Bruising near the eyes, head, spine, or abdomen

• Large, painful, or unexplained bruises that don’t improve in a few days What Every Home First Aid Kit Should Include Pharmacists should guide parents in preparing a well-stocked, familyfriendly kit. Suggest including: • Alcohol-based hand gel • Disposable gloves • Sterile gauze swabs and absorbent pads • Antiseptic wipes and cream • A variety of adhesive plasters • Crepe bandages and tubular bandages • Triangular bandages (for slings and arm support) • Medical scissors and tweezers • Instant cold packs Encourage customers to also keep: • A basic first aid manual or printout from a reliable source • Emergency contact details and home address (especially useful for babysitters) • Regular checks to replace expired or used items Supporting Families, Strengthening Trust By offering practical advice, personal product recommendations, and helping customers build confidence in basic first aid, community pharmacies strengthen their essential role in family health.

Training the whole team to confidently discuss minor injury management ensures that every member of staff can provide trusted, consistent care.

Remember: Always remind carers—when in doubt, seek advice from a healthcare professional or call emergency services.

First Aid Essentials Be Ready for Back to School Cuts & Grazes Our Home Woundcare range offers a variety of plasters, from fabric, waterproof, sensitive and clear

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40

Back2School - Asthma & Allergies

Managing Asthma and Allergies Community pharmacists play a vital role in supporting the health and well-being of school-aged children with asthma and allergies. As trusted and accessible healthcare professionals, pharmacists are uniquely positioned to help manage these chronic conditions, ensure medication adherence, provide education to families, and collaborate with schools and healthcare providers. With the prevalence of asthma and allergic diseases continuing to rise among children, community pharmacists must be well-informed and proactive in identifying, educating, and supporting affected children and their caregivers.

Understanding the Scope Asthma affects approximately 1 in 11 children globally, while allergic rhinitis, food allergies, and atopic dermatitis are increasingly common. These conditions can severely affect a child’s quality of life, academic performance, and physical activity. Importantly, poorly managed asthma or anaphylaxis from severe allergies can be life-threatening.

Community pharmacists should be familiar with: • Asthma triggers: including viral infections, allergens (dust mites, pollen, pet dander), exercise, and environmental pollutants.

• Allergy types: such as seasonal allergic rhinitis, food allergies (e.g., peanuts, tree nuts, milk), and insect sting allergies.

• Medication regimens: including relievers, preventers, and emergency treatments like epinephrine auto-injectors.

Key Responsibilities Medication Review and Advice Pharmacists should regularly review medication regimens for appropriateness and adherence. For asthma, this includes understanding the stepwise approach to therapy, assessing inhaler technique, and distinguishing between rescue (e.g., salbutamol) and maintenance medications (e.g., inhaled corticosteroids).

Pharmacists should: • Reinforce proper inhaler technique, possibly using demonstration devices or videos.

• Discuss adherence challenges, especially for daily maintenance therapy.

• Highlight the importance of spacer devices, especially in younger children.

In allergy management, pharmacists should ensure families are: • Aware of trigger avoidance strategies.

• Carrying and regularly checking the expiration of epinephrine auto-injectors (e.g., EpiPen).

• Educated on anaphylaxis recognition and proper administration techniques.

Asthma Action Plans and Allergy Emergency Plans Pharmacists should encourage families to maintain an up-to-date asthma action plan or allergy emergency action plan developed in consultation with their doctor.

These plans provide guidance on daily management and steps to take during worsening symptoms or emergencies.

of their day at school, making school personnel critical partners in managing asthma and allergies.

Pharmacists can empower parents to:

Public Health Education

• Communicate with school staff and ensure they’re aware of the child’s condition and how to respond to emergencies.

• Recognising asthma and allergy symptoms in children.

• Provide extra medications for school use (e.g., spare inhalers or epinephrine).

• Advocate for allergy-safe food policies and asthma-friendly environments.

Pharmacists can also support school education campaigns or provide leaflets and posters on asthma and allergy management.

Monitoring for Red Flags and Referrals Pharmacists are often the first to spot warning signs of poorly controlled asthma or worsening allergic reactions. These include: • Frequent use of reliever inhalers (>2 times/week).

• Nighttime cough or wheeze.

• School absences due to symptoms.

• History of emergency visits or hospital admissions.

Pharmacists can also play a public health role by educating the broader community on:

• Reducing stigma around inhaler use.

• Promoting smoke-free environments.

Seasonal Considerations Back-to-school periods and seasonal changes often trigger asthma and allergy flare-ups.

Pharmacists should anticipate increased demand for medications and be proactive in contacting families to: • Review and update prescriptions.

• Check medication stocks and expiry dates.

• Encourage pre-emptive use of preventer inhalers before pollen seasons.

Practical Tools for Pharmacists • Checklists for asthma and allergy reviews.

• Inhaler technique demonstration kits.

• Repeated prescriptions for antihistamines or oral corticosteroids.

• Educational leaflets for children, parents, and schools.

Community pharmacists can:

If these red flags are observed, pharmacists should refer the child back to their general practitioner or asthma specialist for a review.

• Reminder systems for medication renewals and vaccine schedules.

• Help interpret and reinforce understanding of these plans.

Vaccination and Preventative Health

• Remind caregivers and school personnel about the importance of plan accessibility—at school, home, and with caregivers.

Children with asthma are more vulnerable to respiratory infections.

Community pharmacists should promote:

• Promote regular plan reviews, particularly before the school year starts.

• Annual influenza vaccination.

Community pharmacists are essential allies in the management of asthma and allergies in schoolaged children. By offering expert advice, ensuring medication adherence, identifying risks early, and fostering communication between families and schools, pharmacists can significantly reduce the burden of these conditions. With proactive engagement, pharmacists can help children thrive—both in health and in the classroom.

Liaison with Schools and Parents Many children spend the majority

40 | PHARMACYNEWSIRELAND.COM

• Pneumococcal vaccination if indicated.

• Education on hand hygiene and allergen avoidance, especially during high pollen seasons.

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Abbreviated prescribing information Product Name: Fexo Allergy Relief 120 mg Film-coated tablets Composition: Each tablet contains 120 mg of fexofenadine hydrochloride equivalent to 112 mg of fexofenadine. Description: Peach coloured oblong, bi-convex film-coated tablet. Dimensions of 14.9-15.3 mm x 6.4-6.8 mm; plain on both sides. Indication(s): Adults and children 12 years and older: Relief of symptoms associated with seasonal allergic rhinitis. Dosage: Adults and children aged 12 years and over: One tablet (120mg) once daily taken before a meal. Children under 12 years: Efficacy and safety of fexofenadine hydrochloride 120 mg has not been studied in children under 12. Children from 6 to 11 years of age: Administer fexofenadine hydrochloride 30 mg. Special populations: No need to adjust the dose confirmed by studies in special risk groups (older people, renally or hepatically impaired patients). Contraindications: Hypersensitivity to the active substance or to any of the excipients. Warnings and Precautions for Use: Limited data in the elderly and renally or hepatically impaired patients. Administer with care in these special groups. Warn patients with a history of or ongoing cardiovascular disease that, antihistamines have been associated with the adverse reactions, tachycardia and palpitations. Interactions: Fexofenadine does not undergo hepatic biotransformation and therefore will not interact with other medicinal products through hepatic mechanisms. Fexofenadine is a P-glycoprotein (P-gp) and organic-anion-transporting polypeptide (OATP) substrate. Concomitant use with P-gp inhibitors or inducers can affect the exposure to fexofenadine. Co-administration with P-gp inhibitors erythromycin or ketoconazole resulted in 2-3 times increase in the level of fexofenadine in plasma. The changes were not accompanied by any effects on the QT interval and were not associated with any increase in adverse reactions compared to the medicinal products given singly. A clinical drug-drug interaction study showed that co-administration of apalutamide (a weak inducer of P-gp) and a single oral dose of 30 mg fexofenadine resulted in a 30 % decrease in AUC of fexofenadine. No interaction with omeprazole. Administration of an antacid containing aluminium and magnesium hydroxide gels 15 minutes prior to fexofenadine hydrochloride caused a reduction in bioavailability, most likely due to binding in the gastrointestinal tract. It is advisable to leave 2 hours between administration of fexofenadine hydrochloride and aluminium and magnesium hydroxide containing antacids. Pregnancy and Lactation: Pregnancy: Do not use unless clearly necessary. No adequate data from the use of fexofenadine hydrochloride in pregnant women.

Limited animal studies do not indicate direct or indirect harmful effects with respect to effects on pregnancy, embryonal/foetal development, parturition or postnatal development. Breast-feeding: Not recommended. No data on the content of human milk after administering fexofenadine hydrochloride. However, when terfenadine was administered to nursing mothers’ fexofenadine was found to cross into human breast milk. Fertility: No human data available. Ability to Drive and Use Machinery: Based on the pharmacodynamic profile and reported adverse reactions it is unlikely that fexofenadine hydrochloride tablets will produce an effect on the ability to drive or use machines. In objective tests, Fexo Allergy Relief has been shown to have no significant effects on central nervous system function. This means that patients may drive or perform tasks that require concentration. However, in order to identify sensitive people who have an unusual reaction to medicinal products, it is advisable to check the individual response before driving or performing complicated tasks. Undesirable Effects: Nervous system disorders: Common: headache, drowsiness, dizziness. Gastrointestinal disorders: Common: nausea. General disorders and administration site conditions: Uncommon: fatigue. Refer to the SPC for other undesirable effects. Marketing Authorisation Holder: Rowa Pharmaceuticals Limited., Newtown, Bantry, Co. Cork. Marketing Authorisation Number: PA0074/096/001 Further information and SPC are available from: Rowex Ltd., Bantry, Co. Cork. Freephone: 1800 304 400 Fax: 027 50417 E-mail: rowex@rowa-pharma.ie Legal Category: Not Subject to medical prescription. Date of Preparation: September 2024 CCF FOR API: 26741 Adverse events should be reported. Reporting forms and information can be found on the HPRA website (www.hpra.ie) or by emailing Rowex pv@rowa-pharma.ie Date of preparation: (02/2025) CCF: 26995

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CPD: Dry Eye Continuing Professional Development

CPD 60 Second Summary Dry eye disease (DED) is a multifactorial ocular surface disorder characterised by loss of tear film homoeostasis and may result in various ocular symptoms and visual disturbances. DED pathology can significantly affect an individual’s visual function, quality of life2 and work productivity and has been associated with lower health utility. Moreover, DED can have considerable negative personal and socioeconomic repercussions.

The prevalence and contributing mechanisms in DED among children are influenced by multiple factors related to congenital, autoimmune and inflammatory disorders, and the condition may also be caused or exacerbated by factors such as the living environment.

We performed a systematic review and meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist guidelines. Data extraction, risk of bias assessment and statistical analyses were conducted following the methods outlined in the Cochrane Handbook for Systematic Reviews of Interventions.

43

Written by: Yuhao Zou1, Dongfeng Li1 2 , Virgili Gianni3 4, Nathan Congdon2 5 6, Prabhath Piyasena2, S Grace Prakalapakorn7, Ruifan Zhang1, Zixiang Zhao1, Ving Fai Chan2 , Man Yu1 Department of Ophthalmology, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China 2 Center for Public Health, Queen’s University Belfast, Belfast, UK 3 Department of NEUROFARBA, University of Florence, Firenze, Italy 4 IRCCS – Fondazione Bietti, Roma, Italy 5 Orbis International, New York, New York, USA 6 Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangzhou, China 7 Departments of Ophthalmology and Pediatrics, Duke University Medical Center, Durham, North Carolina, USA 1

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?

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

Nathan Congdon 4 previous steps, log and record your findings.

Published by IPN. Copies can be downloaded from www.irishpharmacytraining.ie Disclaimer: All material published is copyright, no part of this can be used in any other publication without permission of the publishers and author. Théa Pharma has no editorial oversight of the CPD programmes included in these modules.

Prevalence of dry eye disease among children: a systematic review and meta-analysis Dry eye disease (DED) is a multifactorial ocular surface disorder characterised by loss of tear film homoeostasis and may result in various ocular symptoms and visual disturbances.1 DED pathology can significantly affect an individual’s visual function, quality of life2 and work productivity3 and has been associated with lower health utility.4 Moreover, DED can have considerable negative personal and socioeconomic repercussions.5 This includes direct economic costs, such as medical professional visits and treatment costs and intangible personal costs, including impaired social, emotional and physical function.6

While DED has been widely recognised as a common eye disease in adults, it has been understudied in children.15 According to the Tear Film and The current study provides a Ocular Surface Society (TFOS), comprehensive estimate of the global prevalence of DED in the global prevalence of DED children and explores factors ranges between 5% and 50% associated with DED. Our review in the general population, and identified no other studies epidemiological studies vary widely reporting separately on the in terms of geographical and global prevalence of DED among age differences, and diagnostic children. We also observed an criteria.7 It is currently agreed that For protection and regeneration apparent increase in DED among of theofocular children after the onset the surface the prevalence of DED is higher in people over 50 years of age, COVID-19 pandemic. Most especially among postmenopausal notably, this review found that women.8 The prevalence of DED DED diagnosis by clinical signs Preservative-free may be higher in Asia than in other versus by questionnaires of Phosphate-free symptoms in children yield very regions.9 It has been reported that different prevalence figures and Hypotonic lower DED prevalence is associated require further study. with higher latitude and relative Osmoprotective

humidity and a temperate climate.10

The prevalence and contributing mechanisms in DED among children are influenced by multiple factors related to congenital, autoimmune and inflammatory disorders, and the condition may also be caused or exacerbated by factors such as the living environment.11 With the popularisation of computers and smartphones, associated exposure to electronic screens that emit blue light and decreased blink rates have led to an increase in the prevalence of DED.12 Furthermore, during the COVID-19 pandemic, children around the world stayed at home and studied online, leading to an increase in complaints of dry eyes and visual fatigue.13 In addition, wearing face masks, a widespread public health intervention during the pandemic, is a risk factor for DED. Many children had difficulty finding a mask that fits well and was easy to wear correctly.14 The epidemiology and pathological processes of DED in children have not been described as comprehensively as in adults.15 Therefore, we conducted a systematic review and metaanalysis to understand the current profile associated with childhood DED. Accurate estimation of the current prevalence of paediatric DED is essential for developing

appropriate strategies to promote paediatric ocular surface health on a global scale.

Methods We performed a systematic review and meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist guidelines.16 Data extraction, risk of bias assessment and statistical analyses were conducted following the methods outlined in the Cochrane Handbook for Systematic Reviews of Interventions. The review protocol was registered on PROSPERO (CRD42023343999) on 24 April 2023. Following the first review, we adjusted our analysis plan and updated the registration on 18 September 2024. Our revised inclusion criteria now focus on cross-sectional studies involving children under 18 years of age. We added an analysis of children wearing contact lenses, along with subgroup analyses based on study setting, DED diagnostic methods, climate zones and regions (Asian vs non-Asian). Additionally, we included a regression analysis of climate factors (temperature, latitude, humidity and rainfall) and prevalence. The final literature search was conducted on 1 April 2024.

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44

CPD: Dry Eye

Results Study characteristics The initial literature search identified 7309 articles. After removing 2911 duplicates, 4398 titles and abstracts were screened. After screening the titles and abstracts, 85 articles were retained and assessed for eligibility, among which 41 articles24–64 were included in the review (figure 1). One article investigated the situation in both the Philippines and South Korea, which we reported separately, resulting in a total of 42 studies for meta-analysis. Donthineni et al found only 1023 cases of DED (0.4%) in a retrospective study of 259 969 children from 2010 to 2018 using electronic medical records.65 The use of electronic records may reduce sensitivity, and more than 30% of the children were older than 18. Additionally, the study had a long observation period. Due to these limitations, it was excluded from the meta-analysis despite its large sample size.

All 42 studies included in the meta-analysis were cross-sectional and were conducted from 2008 to 2023. The studies included 48 479 participants (median 368; IQR 223–1926; range 60–5006) and were conducted in 14 countries, of which 35 studies (83.3%) were from Asia.24–46 50 51 54 55 57–59 61–64 Four studies (9.5%) were from lower-middle-income countries (1 each from India,41 Indonesia,42 Egypt60 and the Philippines64), 27 (62.3%) from upper-middle-income countries (1 each from Colombia48 Mexico53 and Thailand62) and 24 (58.5%) from China25–40 45 46 51 54 57–59 63 ) and 11 (26.2%) from highincome countries (1 each from New Zealand47, the UK49 and Saudi Arabia61; 2 from Japan24 50 and the USA,52 56 and 4 from South Korea34 43 44 55). 25 studies (59.5%) were conducted in a school or community setting,26 28–30 32 35 36 38 40 42–44 46 48–51 53 55 57 58 62–64 while the rest (n=17, 40.5%) in clinical settings.25 27 31 33 34 37 39 41 45 47 52 54 56

Figure 1

There was heterogeneity (p=0.01) among the four groups of studies formed by diagnostic criteria and setting. Lower values of DED prevalence were recorded in studies using clinical diagnosis as diagnostic criteria: 19.3% (95% CI 15.4% to 23.2%; I2=86.1%; 59-61 11 studies; 2849 children) in clinical setting and 14.7% (95% 20 studies contained an CI 10.9% to 18.6%; I2=98.8%; approximately equal number of 15 studies; 24 258 children) in girls and boys,24 26 28–30 32 35 36 38–41 43 45 51 53 57–59 63 school/community setting. Studies For protection regeneration 4 studies includedand <40% using questionnaire to diagnose girls31 33 44 50 and 1 study included of the ocular surface DED recorded higher prevalence <40% boys.62 17 studies did not estimates: 29.8% (95% CI 10.7% report on the gender distribution to 48.8%; I2=99.6%; 6 studies; of participants.25 27 30 34 37 42 46–49 52 54–56 60 64 2329 children) in clinical setting One study Preservative-free investigated the Phosphate-free and 37.5% (95% CI 23.8% to situation in both the Philippines Hypotonic 51.3%; I2=99.8%; 9 studies; 19 and South Korea, which we 64 reported separately.

043 children) in school/community Osmoprotective

setting. Heterogeneity was high in all groups formed by diagnostic criteria and setting, as expected in observational prevalence studies.

Among studies using symptoms for DED diagnosis, there was a larger spread of prevalence estimates, with four studies finding values above 60%.

Prevalence of DED: subgroup analyses Table 1 shows the results of subgroup analyses by setting, diagnostic criteria, geographical area, temperature zone, country income and effect of COVID-19.

In terms of setting subgroups, there are no statistically significant differences, the prevalence of school/community studies with

better representation of the population being 24.1% (95% CI 16.8% to 31.5%; I2= 99.8%; 25 studies; 43 301 children) and the prevalence of clinical studies being 23.1% (95% CI 15.9% to 30.4%; I2= 97.8%; 17 studies; 5178 children). Diagnostic criteria subgroups were statistically significantly different (p<0.01 for subgroup heterogeneity), with clinical diagnosis yielding nearly half the DED prevalence compared with questionnaire diagnosis: 16.6% (95% CI 13.7% to 19.5%; I2=98.0%; 26 studies; 27 107 children) and 34.6% (95% CI 23.7% to 45.6%; I2=99.7%; 16 studies; 21 372 children), respectively. Prevalence was statistically significantly different

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45 Table 1 Subgroup meta-analyses Variable

Subgroups

n. studies (participants)

Estimate (95%confidence interval)

I2

P value

Setting

Clinic

17 (5178)

23.1% (15.9–30.4)

97.8%

0.85

School/Community

25 (43 301)

24.1% (16.8–31.5)

99.8%

Clinical Diagnosis

26 (27 107)

16.6% (13.7–19.5)

98.0%

Questionnaire Diagnosis

16 (21 372)

34.6% (23.7–45.6)

99.7%

Asia

35 (46 417)

23.2% (17.5–28.9)

99.7%

Non-Asia

7 (2062)

26.4% (12.2–40.6)

98.3%

Temperate

32 (40 393)

21.3% (16.2–26.5)

99.5%

Tropical

10 (8086)

31.5% (17.4–45.7)

99.7%

Lower-middle

4 (944)

22.1% (12.3–32.0)

92.3%

Upper-middle

28 (41 203)

24.3% (17.9–30.7)

99.7%

High

10 (6332)

22.8% (10.6–35.1)

99.4%

Before COVID-19

34 (39 316)

18.7% (15.6–21.9)

98.7%

After COVID-19

8 (9163)

44.1% (25.5–62.7)

99.7%

Diagnostic criteria

Geographic area

Temperature zone

Country income

Effect of COVID-19

Prevalence of DED: meta-regression on climate determinants

before and after the start of the COVID-19 pandemic (subgroup heterogeneity p<0.01), where the prevalence of DED in studies before COVID-19 was 18.7% (95% CI 15.6% to 21.9%; I2=98.7%; 34 studies; 39 316 children) and after the start of the pandemic the prevalence of DED increased to 44.1% (95% CI 25.5% to 62.7%; I2=99.7%; 8 studies; 9163 children). Small differences in pooled estimates were apparent for other subgroups, but none were statistically significant.

Table 2 shows the results of the meta-regression, including latitude (a proxy of temperature and sun irradiation), average annual rainfall, average annual temperature and average annual humidity for each study. In the univariable model, both latitude and average annual temperature were statistically significantly associated with DED, where DED prevalence increased by 7.1% for each 10° decrease in

latitude (ie, moving towards the equator, p=0.015) and by 10.2% for each 10° mm increase in average annual temperate (p=0.010).

Discussion While DED has been widely recognised as a common eye disease in adults, it has been understudied in children.15 The current study provides a comprehensive estimate of the global prevalence of DED in children and explores factors associated with DED. Our review identified no other studies

＜0.01

0.68

0.18

0.93

0.01

reporting separately on the global prevalence of DED among children. We also observed an apparent increase in DED among children after the onset of the COVID-19 pandemic. Most notably, this review found that DED diagnosis by clinical signs versus by questionnaires of symptoms in children yield very different prevalence figures and require further study.

Our results suggest that the prevalence of DED among children is close to that in the adult

Table 2 Meta-regression on climate determinants Variable

Median (range)

For protection and regeneration Latitude (10° more) of the ocular surface 35.69° (4.61, 51.5)

Univariable

P value

−0.071 (−0.139, –0.129)

0.015

Annual average rainfall (1000 mm more)

1022 (34–2997)

−0.027 (−0.130, 0.077)

0.615

Preservative-free Annual average temperature (10° more)

14°(0.9, 28)

0.102 (0.137, 0.190)

0.024

69%(53, 83)

0.019 (−0.049, 0.087)

0.584

Phosphate-free Annual average humidity (10% more) Hypotonic Osmoprotective

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46

CPD: Dry Eye

population. The current study estimated the overall prevalence of DED in children to be 23.7%.

A number of previous systematic reviews have reported DED estimates globally, and for Africa, Asia and the USA. The estimated prevalence of DED in Africa is 42.0% (95% CI 30.7% to 53.8%).66 In relation to Asia, Cai et al included four studies reporting the prevalence of DED in people under 20 years old, and estimated that 11.9% of individuals suffer from DED (95% CI 4.4% to 19.4%).67 A study in the USA reported that the population prevalence of DED was 8.1% (95% CI 4.9% to 13.1%), lower than seen in our study.68 It is imperative to acknowledge the significant global burden posed by paediatric ocular surface health issues. Based on a median prevalence rate of 23.7% observed in school and community studies, an estimated 495 million children worldwide are affected by ocular surface disorders.

In line with the expected outcomes of observational epidemiological studies, the studies included in the analysis exhibited a high degree of heterogeneity. The wide variation in DED prevalence estimates reflects significant clinical and methodological heterogeneity across studies, including choice of clinical versus community or school-based cohorts. The studies included in our metaanalysis differed in population characteristics, study designs, general climate information and definitions of DED, all of which add to the uncertainty in overall prevalence estimates.

Additionally, asymptomatic children may present with alterations in the appearance and function of their meibomian glands.72 The OSDI questionnaire, comprising 12 questions, includes inquiries such as whether vision problems have impacted nighttime driving (question 7) or computer usage or bank machine (question 8), which may pose challenges for children to answer. Chidi-Egboka et al found that 57% of children required adult supervision to complete the OSDI questionnaire, possibly due to difficulty understanding certain symptoms.

This highlights children’s lesser awareness of DED-related issues and terminology compared with adults.64 Modifications to questionnaires, such as annotations or adjusted wording, may mitigate bias. Given the varying cognitive abilities of children, the questionnaire should include different versions for different age groups (0–4 years, 5–11 years and 12–17 years), with a parental proxy option for younger children who may have difficulty expressing symptoms.73 For younger children (5–11 years) whose language skills are still developing, a simplified verbal and 3-point response scale with an expression scale ranging from happy to sad is used to help children understand the questions more easily.74 Hence, tailored diagnostic tools and further research are necessary for paediatric DED diagnosis.

We found that the prevalence of DED was 18.7% before and 44.1% after the COVID-19 The prevalence of DED in our outbreak (p=0.01 for subgroup meta-analysis differed significantly heterogeneity). Globally, between studies using clinical governments implemented diagnosis versus questionnaire, various control measures, 16.6% and 34.6%, respectively. such as restrictions on public Vehof et al’s study in adults found activities, home quarantine, that dissociation of signs and social distancing and school symptoms of DED is an indicator of closures. Online schooling self-perceived health.69 This finding was used as an alternative to suggests the possibility of a similar face-to-face teaching.75 In line pattern existing among children. with other studies, Saldanha Higher prevalence of DED based on et al found an increase in the symptom-focused questionnaires prevalence and severity of DED in children is associated with in adults following the COVID-19 more corneal nerve fibres and outbreak.76 Of the eight studies lower pain tolerance. Spierer et al included in the analysis that were For protection and regeneration showed that mechanical thresholds conducted after the COVID-19 the ocular surface outbreak, four studies46 53 61 62 and pain thresholdsofcorrelate with age, resulting in children’s reported a high prevalence of susceptibility to detecting ocular DED. Three46 53 61 used the OSDI surface discomfort.70 Conversely, questionnaire and one62 used Preservative-free clinical test thresholds designed the DEQ-5 questionnaire. These Phosphate-free for adults may not be directly studies involved high school Hypotonic applicable to children.

Healthy students, potentially facilitating Osmoprotective children typically exhibit a thinner questionnaire comprehension. lipid layer compared with adults.71 Conversely, the prevalence rates in

the other four studies54 58–60 closely aligned with the pre-COVID-19 average of 23.7%. The relationship between COVID-19 and DED may be influenced by various factors, necessitating further research to understand its effects on paediatric DED. Contact lenses are recognised as an independent risk factor for DED in adults, but their impact on children remains inadequately characterised. Among the 11 included studies, only 3 used both signs and symptoms for diagnosis.

Notably, two studies reported prevalence rates of less than 10%, while the prevalence of DED diagnosed using symptoms varied considerably. The relationship between DED and contact lens wear in children lacks definitive evidence. Given the rising prevalence of myopia and the increasing use of contact lenses to manage it among children, comprehensive multicentre studies are warranted to elucidate the association between DED and different types of contact lens use in this population.

This study reveals potential associations between climate factors and the prevalence of paediatric DED through a metaregression analysis incorporating general climate information. We found increasing rates of DED with greater temperature and closer distance to the equator.

Higher latitude results in a smaller angle of direct sunlight exposure, resulting in a lower impact on the ocular surface, likely yielding a lower prevalence rate.77 Although the prevalence of DED increased with increasing temperature in our study, consistent results have not been obtained in several studies, and the relationship between temperature and DED requires further study.78 79 Using more detailed environmental factors in a climate model (subtropical monsoon vs Mediterranean climate, etc), we may be able to better simulate the local effects of environment.10 This study highlights the urgent need to prioritise paediatric ocular surface health as a distinct clinical and public health concern.

Traditionally underestimated, DED in children presents unique challenges, including the absence of standardised diagnostic criteria, which contributes to inconsistent prevalence estimates and hinders effective management.

The paediatric ocular surface is anatomically and physiologically distinct from that of adults,

rendering it more susceptible to environmental and behavioural influences such as increased screen time, contact lens use and extreme climates.

To improve detection and treatment, tailored diagnostic tools—such as simplified questionnaires and pediatricspecific clinical tests—are crucial.

Clinicians must also account for environmental and lifestyle factors when evaluating children for DED, with a particular focus on high-risk groups. Future research should prioritise developing standardised diagnostic criteria and age-appropriate assessment tools for paediatric DED. Largescale, multicentre studies are needed to investigate regional and environmental influences on prevalence and to clarify associations with emerging risk factors like digital device usage and climate. Longitudinal studies are also warranted to explore the long-term effects of paediatric DED on vision, mental health and educational outcomes. Through improved awareness, prevention strategies and targeted interventions, the growing burden of DED in children can be effectively addressed, ensuring better outcomes for this vulnerable population.

Conclusions This comprehensive metaanalysis demonstrates that DED is common in the paediatric population under the age of 18 years, which poses a serious burden to individuals and society.

The prevalence and burden of DED are likely to increase due to the widespread use of electronic screens and lifestyle changes resulting from COVID-19, which may affect children’s mental health and educational attainment. Varying diagnostic criteria and inconsistencies in DED questionnaires for children have led to heterogeneity in its observed prevalence. The substantial variation in prevalence estimates reflects the need for standardised diagnostic criteria and age-appropriate diagnostic tools. Addressing paediatric DED will require a multidisciplinary approach that considers both clinical and environmental factors.

Enhanced awareness and targeted interventions are critical for mitigating the growing burden of paediatric DED and safeguarding children’s ocular and overall health.

References available on request

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Relative change in Tear Film Thickness (%)

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130

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120

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#

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#

100 0 0

20

40

60

80

100

120

140

160

180

200 220 240

Timepoint (minutes) Thealoz ® Duo

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reatment of mild non-infectious allergic or inflammatory conjunctival diseases. Posology: The recommended dos of 14 days. Gradual tapering off up to one administration every other day may be recommended in order to avoid 150 years Products Educating bstance or to any glucocorticosteroid-induced that of are the 100%excipients; Known of knowledge & & empoweringocular hypertension and other forms of o preservative free expertise in eye care ept when combined with specific chemiotherapeutic agents forprofessionals herpes virus), conjunctivitis withour ulcerative let’s open eyes keratit vitis and purulent blepharitis, stye and herpes infection that may be masked or aggravated by anti-inflammatory glucocorticoids are excreted in breast milk and may cause suppression of growth or of endogenous corticosteroid Reference: 1. Schmidl D1, Schmetterer L et al. Tear film thickness after treatment with artificial tears in patients with moderate dry eye disease. Cornea. 2015 Apr;34(4):421-6. 2: 8. 2. IQVIA Consumer Health Customized Insights for the period 2024, volume and value sales in Euros PUB, limited to IQVIA CHC3 07A3 Artificial Tears and Ocular Lubricants, reflecting estimates of real-world activity in these countries: Austria, Belgium, Bulgaria, Croatia, Czech Republic, Estonia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Netherlands, Norway, Poland, Portugal, Romania, Russia, Saudi Arabia, Serbia, Slovakia, Slovenia, South Africa, Spain, Sweden, Switzerland, UAE (United Arab Emirates), UK. Copyright IQVIA. All rights reserved. TP25015

48

Back2School - Vaccines

Know your Role in Childhood Vaccinations The role of pharmacists in immunisation and vaccination varies across the world; in some countries pharmacists are primarily involved in ensuring the safe supply and dispensing of vaccines, as well as advocating for immunisation, while in other countries they are empowered to play a more active role, as they are legally authorised organise vaccinations activities and campaigns. years of age, especially children under 1 year old. The next highrisk group are young people aged 15-19 years.

Importantly for community pharmacists to be aware, they might have school children and/ or their parents presenting to the pharmacy with associated after effects. Some students can have an area of soreness, swelling and redness in their arm where the injection was given. This usually passes after a day or two.

It is estimated that ten million lives per year could be saved by increasing access to medicines and vaccinations. Community pharmacists are therefore in a strong position to provide a major contribution to public health due to their accessibility, distribution and available medicines expertise.

recently seen an alarming rise in a particularly deadly strain of meningococcal W meningitis and septicaemia.

Y. In addition, this vaccine also reduces the risk of carrying the disease so can help protect other people too.

There are five main groups that commonly cause disease - MenA, MenB, MenC, MenW, MenY.

MenACWY being used in Ireland is Nimenrix. This is a conjugate vaccine containing Group A, C, W and Y polysaccharides conjugated to tetanus toxoid carrier protein.

The vaccine protects against N. meningitidis Groups A, C, W and Y invasive disease.

Vaccines being Offered:

MenB causes the majority of the disease.

During the school year

How it is caused:

• Children in Junior Infants will be offered 4 in 1 and MMR vaccines

• Around 10% of the population carries meningococcal bacteria in the back of their throats at any given time. This is usually healthy carriage and helps develop immunity

• Students in first year of secondary school will be offered HPV, Tdap and MenACWY These vaccines are also available to students who are in special schools or are home schooled in the same age group.

Meningococcal Disease Meningococcal disease is caused by infection with Neisseria meningitidis and presents as bacterial meningitis (15 per cent of cases), septicaemia (25 per cent of cases), or a combination of the two. It is the leading infective cause of death in early childhood.

There are several strains or ‘groups’ of meningococcal bacteria (A, B, C, W, X and Y). In the past 50 years, most meningococcal disease in the UK and Ireland2has been due to group B (MenB) and group C (MenC), although the MenC vaccine introduced in 1999 has now successfully reduced cases to just a handful each year.

Currently MenB accounts for the vast majority of meningococcal disease although we have

• Occasionally the bacteria defeat the body’s defences and cause infection • The bacteria are passed from person to person by coughing, sneezing and intimate kissing • The bacteria break through the lining at the back of the throat and pass into the bloodstream • They can travel in the bloodstream to infect the meninges, causing meningitis, or while in the bloodstream they can cause septicaemia From September 2021, secondary school children in first-year are offered a meningococcal ACWY booster vaccination.

The Meningococcal ACWY vaccine will boost children’s protection against group C meningococcal disease. It will also provide additional protection against meningococcal groups A, W and

48 | PHARMACYNEWSIRELAND.COM

Since 2015 more cases of invasive meningococcal serogroups W and Y disease have been seen in Ireland. Prior to 2015 the annual number of both serogroups was low. Between 1999 and 2014 there was an average of two cases for both serogroups reported per year.

Between 2015 and 2018, a total of 36 serogroup W and 20 serogroup Y cases were reported, giving an average annual notification rate 9 cases per year of serogroup W and for 5 cases per year of serogroup Y. In view of the emergence of meningococcal serogroups W and Y, the National Immunisation Advisory Committee (NIAC) recommended that one dose of MenACWY vaccine should be given to all students in 1st year of second level education replacing the MenC vaccine in 2019.

Meningococcal disease can start very suddenly. Symptoms include fever, stiff neck, headache, joint pains and a rash.

Meningococcal disease can occur at any age, but the highest rate occurs in children under 5

Some students may get a headache, feel sick in their tummy or run a slight temperature. If this happens, paracetamol or ibuprofen will help.

HPV vaccine for girls and boys The HPV vaccine has been offered to girls in their first year of secondary school since 2010.

This is because the most common cancer caused by the HPV virus is cervical cancer which only affects women.

Since September 2019, boys have also been offered the HPV vaccine. This is because HPV can cause cancers and genital warts in boys too.

Conditions caused by HPV infection In girls, HPV infection can cause cancer of the: • cervix • vulva (the area surrounding the opening of the vagina) • vagina • anus • oropharynx (part of the throat at the back of the mouth) In boys, HPV infection can cause cancer of the: • anus • oropharynx (part of the throat at the back of the mouth) • penis HPV infection can also cause genital warts in both girls and boys.

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50

Advertorial

Back to School Means Back to Bugs Equip Parents with BioGaia Pharax® Kids for Immune Support Where It Matters September signals fresh notebooks, sharpened pencils—and, unfortunately, the return of colds, coughs, and sore throats. With schoolchildren exposed to new germs daily, pharmacies become the frontline for parents seeking safe, effective, and science-backed ways to keep their little ones well.

This autumn, stand ready with BioGaia Pharax® Kids: a clinically proven probiotic and vitamin D supplement designed specifically to support children’s throat health, immune function, and faster recovery from upper respiratory tract infections (URTIs).

The Microbiome: An Overlooked Ally in Children’s Health We now understand that over 70% of the immune system resides in the gut, and the microbes that populate the gut and throat mucosa play a vital role in defending against illness. When this microbial community— known as the microbiota—is disrupted by illness, antibiotics, stress, or seasonal changes, children become more vulnerable to repeated infections.

Pharmacists are uniquely placed to educate parents on the importance of the microbiome in building immune resilience. This is especially true for children under five, who experience an average of 6–8 colds per year.

BioGaia Pharax® Kids: Clinically Proven, Naturally Effective BioGaia Pharax® Kids is a probiotic supplement for the throat, containing two well-documented strains of Limosilactobacillus reuteri—DSM 17938 and ATCC PTA 5289—alongside immune-boosting vitamin D3.

In a clinical trial with 70 children aged 6 months to 5 years with pharyngitis and/or tonsillitis, BioGaia Pharax® Kids showed: - Significantly faster recovery - Fewer fever days - Less throat pain Children taking Pharax had just 3 days of symptoms versus 5 in the placebo group and were fever-free by day 2.

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Parents today seek evidence-based, natural solutions. Pharax is the microbiome-friendly, immune-smart option to break the cycle of recurring infections.

Whether for a toddler starting crèche or a school-age child with their third sore throat, Pharax is a proactive and effective solution.

- 400 million live L. reuteri CFU per daily dose - 10 µg Vitamin D3 (200% EU RI)

Back to school shouldn’t mean back to the GP. Help families break the cycle of sore throats and constant colds—naturally—with BioGaia Pharax® Kids.

For orders or further information, contact: hello@happytummy.ie Also available through Wholefoods wholesaler.

Written by Dearbhla Walsh, Pharmacist

52

News

United Drug Retail Solutions – Supporting the Future of Pharmacy In today’s fast-moving retail pharmacy environment, United Drug enables you in having the right products at the right time. To run a successful, sustainable business, pharmacies need more than just a reliable wholesaler, they need a strategic partner who understands the challenges and provides practical, realworld solutions.

United Drug Retail Solutions is built around the needs of pharmacists, with an offering that brings together essential services and tools that help you manage your business more efficiently, improve patient care and drive growth.

At the core of United Drug Retail Solutions is a simple promise: we help you do more with less time and effort. Whether it’s smarter purchasing, streamlined operations, reliable access to specialist medicines or training for your team, our goal is to help pharmacies thrive.

We are Ireland’s number one provider of Ostomy & Urology products, trusted by pharmacists for reliable service, expert support and a wide range of specialist products. With over 3,000 lines, a dedicated customer care team, and a complimentary cutting service, we support you in offering your patients confidence, dignity and peace of mind.

• Highlighting of hardship payments

We provide training support through UDW.ie, helping your team stay informed and confident when advising patients.

Our Knowledge Hub brings together everything you need to stay ahead of the curve, all in one place on UDW.ie:

Meanwhile, Elements gives you access to Ireland’s largest portfolio of unlicensed medicines, with over 1,400 products ready to order. We offer:

• Award-winning webinar series for ongoing professional development

o Front-of-shop value through Profitlines Plus

Our two buying groups have been developed with different pharmacy needs in mind.

o A consistent and secure supply chain • Pharma Le Chéile is our choicebased buying group, offering flexibility with a quality selection of OTC, branded, generic and cold chain products—so you can build a range that fits your patient base.

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• Pharmacy podcast covering current trends, insights and challenges

• Training tools and sales aids for your whole team

• 24/7 online ordering through UDW.ie

• POS kits to help support your in-store sales

If it’s not on the list, it’s on the way!

We’re always adding new content and updating resources to reflect what’s happening in the industry.

• Alerts at the point of dispensing

o Next-day delivery and reliable supply

Grow with Insights, Training and Support

• Emergency turnaround in under 48 hours

Features include:

o Transparent and easy-to-use systems

With ARC, you can focus on patients—not paperwork.

• Category sales insights and articles to help you plan ahead

ARC is our bespoke claims management solution, designed to give you full oversight of your dispensary claims and help you protect your revenue.

o Improved pricing and margin

• Clean, readable reports that save time and reduce error

• Same-day dispatch on stocked lines

Claims Management That Works

Smarter Buying with Pharmax & Pharma Le Chéile

• Pharmax, our compliancebased group, is designed for independent pharmacies looking to boost margin and simplify their purchasing. Members benefit from:

• Auto-downloads of GMS, DPS and methadone booklets

• HPRA-compliant sourcing, storing and delivery

Built Around Your Business

With three depots located in Dublin, Limerick and Ballina, we offer next-day delivery, six days a week, on over 14,000 stocked SKUs. Our best-in-class warehousing and logistics ensure you get what you need, when you need it—backed by a team that’s always here to help.

Expert Patient Support – When It Matters Most

• Regular alert saving for repeat issues

Whether you’re looking to improve efficiency, grow sales or simply free up more time for your team to focus on patients, United Drug Retail Solutions is here to help.

Talk to your area manager today to learn more about how we can support your business United, we do better.

Barry Scannell South Region 087 251 7573 Barry.Scannell@united-drug.com

Leonard Manley Central Region 087 268 8740 Leonard.Manley@united-drug.com

Orla Doyla North Region 087 414 9716 Orla.Doyle@united-drug.com

Kerry Murphy East Region 086 811 7075 Kerry.Murphy@united-drug.com

Alan Franklin ARC Manager Alan.Franklin@united-drug.com

Adrian O’Sullivan Buying Groups Business Development Manager Adrian.O’Sullivan@united-drug.com

Helping you grow your business with United Drug Retail Solutions Delivering best-in-class products, service and business support for optimum patient care for your customers

Choice Based Buying Group.

Range of quality products including a mix of OTC, branded, generic and cold chain.

Safe and secure sourcing of unlicensed medicines.

Compliance Based Buying Group.

Bespoke medicines tailored to patients needs.

Rewarding you with competitive pricing.

Ireland’s No1 provider of Ostomy products and services.

Best in class advice, service and support, enabling pharmacists to give patients confidence and peace of mind.

Insights & Education.

Providing meaningful insights to help drive business forward and deliver better patient care.

Call: 01 463 2300

Visit: www.united-drug.com

Email: wholesale@united-drug.com

Login: www.udw.ie

54

News

Irish Adults neglecting Preventative Health Checks New research by Clonmel Healthcare reveals that almost one third of Irish people (31%) do not engage in any preventative health checks. The comprehensive study, released today, surveyed attitudes across 22 countries globally.

Donagh O’Leary, Managing Director of Clonmel Healthcare

was the main cause, with 18% saying social isolation/loneliness and 16% selecting work-related stress as contributing factors.

Of the 31% of Irish respondents who admitted they do not attend preventative health check-ups at all, reasons cited include a lack of awareness about what check-ups that they can and should do (28%), perceived cost (21%) and limited access/availability (17%) and concerningly, avoiding check-ups for fear of getting a bad diagnosis (15%). This indicates a need for clearer public information and accessibility.

The study also found that Irish people place higher trust in their healthcare professionals than

global respondents. 73% said that they trust their GP on matters related to health (vs 69% globally), 69% trust pharmacists (vs 58%) and 65% trust hospital staff and care workers (vs 61%).

• Prevalence of burnout: A striking 39% of Irish people report experiencing burnout at some point in their lives, significantly higher than the global average of 31%. This trend is compounded by 17% admitting to calling in sick due to stress in the past year.

Other key findings from the research include:

• Satisfaction with public health system: Just 41% of Irish people are satisfied with the public health system, compared to the average of 58%.

• Mental health maintenance: 62% of Irish people feel that they have good mental health, comparing to an average of 64% from global respondents.

In terms of factors contributing to mental health challenges, 38% felt that financial worries

• Unhealthy habits: Almost onein-four Irish people (24%) smoke or vape on a regular basis, with 45% reporting drinking alcohol at least once a week. 8% said that they consume soft-drugs weekly, with 4% consuming hard-drugs.

Donagh O’Leary, Managing Director of Clonmel Healthcare, commented, "At Clonmel Healthcare, our ethos is deeply rooted in being a trusted partner in patient health. This comprehensive research, surveying attitudes across 22 countries, brings critical insights to the forefront, particularly regarding preventative health in Ireland.

The findings have uncovered a significant disconnect and that while Irish people demonstrate remarkably high trust in their healthcare professionals, nearly one-third are not engaging in preventative health checks.

Driven by factors such as lack of awareness, perceived cost, and even fear of diagnosis, there is a clear call to action for the healthcare sector. These findings offer crucial benchmarks against European trends, providing essential information for policymakers, healthcare professionals, and the public to address the challenges and build a more trusted and effective health system for all."

Clonmel Healthcare is the number one generic supplier of medicines by value and volume in the Irish market* and is part of the STADA Group. The STADA Group Health Report 2025 was carried out amongst 27,000 respondents across 22 countries.

1,001 Irish respondents took part in the research.

Celebrating World Microbiome Day Each year on June 27th celebrates World Microbiome Day. This year, attention is turning to something you can’t see, but your skin feels every day: The microbiome – the invisible ecosystem of bacteria living on and within us is finally having a well-deserved moment of appreciation. And the 2025 theme ‘Microbiome 101 -Everything You Need to Know’ couldn’t be more timely!

It’s no longer just about gut health, skin has its own living, breathing community of microbes. When this delicate balance is maintained, your skin thrives: healing faster, resisting breakouts, sensitivity and aging more gracefully. But when the balance is disrupted by stress, pollution, harsh cleansers or over-exfoliation, the effects are all too familiar: inflammation, acne, irritation and redness.

One Irish brand is bringing skin health back to basics, powered by cutting-edge science. Sásta

Skin Health, founded by Michelle McDonald, is all about feeding that good bacteria so skin can do what it was designed to: protect, repair and thrive.

Sásta’s hero product, the Microbiome Booster Serum (RRP ¤45), isn’t just skincare, it’s skin healthcare. This daily topical supplement supports the skin barrier, soothes inflammation and calms sensitivity. Developed over three years this isn’t fast beauty it’s precision skincare, grounded in science and sustainability.

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The serum is packed with microbiome-nurturing ingredients: Ectoin to protect, Lactobacillus Ferment Lysate to restore & balance, and Cottonbloom Extract to Nourish.

With an advanced blend of prebiotics and postbiotics it’s no surprise the serum is MyMicrobiome Certified - meaning it’s been independently proven to support the delicate ecosystem of the skin.

“As someone who’s spent over 25 years in the beauty industry

and also as a mother, I’ve seen first-hand how disconnected we’ve become from what our skin really needs. I created Sásta to bring the focus back to skin health - to treat the skin like the living organ it is, starting with the microbiome. We don’t need complicated routines; we need smarter, science-led solutions that work with the body, not against it. That’s what Sásta is about - creating calm, resilient skin by supporting the microbes that're already working for us,” says Michelle McDonald, Founder of Sásta Skin Health.

Calcium •

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56

Joint Pain

JointPain.ie – a new free educational resource for healthcare professionals and patients with joint pain Written by Dr Clodagh Toomey and Dr Helen O’Leary - School of Allied Health, University of Limerick

Dr Clodagh Toomey

Dr Helen O’Leary

Chronic, painful conditions affecting the joints are extremely prevalent, with joint pain responsible for approximately 21% of GP presentations.1 Musculoskeletal conditions are a common cause of repeated consultations,2 and take up a high proportion of orthopaedic waiting lists in Ireland (outpatient orthopaedic wait list 64,000+ as of April 2025). However, many patients find themselves on these waiting lists for months or even years, often without the need for specialist consultations. During this time, their pain can intensify, hindering their ability to live, work, and remain active.

it also presents challenges due to the prevalence of misinformation and "fake news," making it hard to locate reliable resources. Many websites offer inaccurate or biased information, often promoting unproven expensive treatments or sensationalising the condition.

More than ever, we are aware of the importance of the impact that language, diagnostic labelling and explanations have on patient beliefs about how to manage their pain.5 We therefore need to exercise caution and check the source of information we provide to our patients carefully.

Many of these conditions (e.g., osteoarthritis) can be diagnosed without imaging, and managed well with education and advice on exercise, optimal load management and lifestyle factors such as sleep and healthy eating.

These approaches can help limit symptoms, prevent disability, and improve outcomes. Gaining expert knowledge on how to exercise with these conditions and manage pain and other symptoms can be transformative for these individuals and is an essential aspect of recommended care.3 However, insufficient time in consultations and accessibility of physiotherapy are two of the biggest barriers to exercise prescription or referral for GPs in Ireland.4 In addition, physiotherapists in Ireland find that insufficient time is a barrier, while the provision of educational resources would be an enabler to the care they provide.4 While the internet provides access to a wealth of health information,

What is JointPain.ie?

JointPain.ie is a new free Irish educational resource co-designed by academics, patients and clinicians for healthcare professionals and patients presenting with different musculoskeletal painful conditions related to the hip and knee joint.

The website can be accessed in the hospital or clinic consult, or by patients at home, on computer, tablet or smartphone (using the QR code below). It contains evidencebased accessible information for patients on conditions such as osteoarthritis, degenerative meniscal tears, patellofemoral pain and gluteal tendinopathy. It should be a very useful supportive resource for you to share with your patients that they can use on a day-to-day basis to improve their pain and function.

How did this website come about?

The development of this website was supported by a Health Research Board Knowledge Translation Award, awarded

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to Dr Clodagh Toomey and Dr Helen O’Leary, researchers and physiotherapists in the School of Allied Health at the University of Limerick. In their respective research projects focused on improvement of health services for hip and knee osteoarthritis and meniscal tears, there was a clear need identified by healthcare professionals and patients for an educational resource for people in Ireland with joint pain.

While “education and selfmanagement” are key tenets of clinical guidelines for conditions like osteoarthritis, there is little consistency in how or what gets delivered to the patient. This website was developed to fill that gap and provide evidence-based and expert-backed messages to help patients manage their pain and make informed decisions.

With input from a team of clinicians, researchers and people with joint conditions, the new resource, JointPain.ie, was codesigned to suit an Irish audience.

This was done in collaboration with Arthritis Ireland, the National Clinical Programme for Trauma and Orthopaedic Surgery and collaborators at La Trobe University Melbourne.

What are the key conditions being covered?

At the time of launch, the website has evidence-based accessible information on the most common hip and knee conditions including: knee osteoarthritis, degenerative meniscal tears, patellofemoral pain, hip osteoarthritis and gluteal tendinopathy. In future, additional joints and conditions will be added including femoro-acetabular impingement, hand osteoarthritis, shoulder rotator cuff tears etc.

What are the key messages?

For each condition, the user is presented with information on understanding the condition (causes, symptoms, diagnosis) and the evidence-based management options. There is a large emphasis on management of joint conditions through physical activity and lifestyle with practical tips on coping with pain, sleep, diet and optimal loading of the affected area. It also features an extensive video library of recommended exercises for each condition, organised by level of difficulty.

The user is advised on how to monitor pain levels during exercise and when to seek additional help. Evidence and expert-based information, infographics and videos are also provided on medication use, injections and surgery, highlighting the most appropriate order of treatment.

There is also an accessibility feature on the website that allows the user to personalise features including text size, colour, font type, use a screen reader etc.

What resources are available for healthcare professionals?

The website also has a section for clinicians which features “Quick Guides” for diagnosis and management of each condition.

There are links to most recent clinical guidelines for conditions and downloadable exercise programmes and information sheets to share with patients.

How should this website be used?

This website is intended to be used with you and your patients who have a new diagnosis or who would benefit from learning more about any aspect of their joint condition, including exercise and self-management. It is not intended to replace the individualised advice from a healthcare professional but offers an evidence-based educational resource to help support management. Depending on the patient and time allowance, healthcare professionals can talk and guide the patient through components of the website in clinic, print off resources or prescribe the learning resources to be completed at home via the QR code or link: www.jointpain.ie.

A promotional video of the website can be accessed here: https:// youtu.be/LR6wSn8A7Jw Project Team: Co-PI’s: Dr Clodagh Toomey (clodagh.toomey@ul.ie) and Dr Helen O’Leary (helen.oleary@ul.ie) Collaborators: Prof Liam Glynn (University of Limerick), Prof Karen McCreesh (University of Limerick), Stacey Grealis (Patient Partner), Grainne O’Leary (Arthritis Ireland), Ruth Kiely (National Clinical Programme for Trauma and Orthopaedic Surgery), Dr Christian Barton (La Trobe University).

References available on request

Call for papers: make your contribution to Irish Pharmacy News  Articles  Research Papers  Reviews  Programme Descriptions  Reports Case Reports  Letters to editor  In-depth review articles critique fundamental concepts, issues, and problems that define a field of research or practice and support advanced practitioners as well as aspiring early-year pharmacists.  Practice reports share innovations on any area of practice, including delivering clinical services, pharmacy administration, or new approaches to inform and engage with patients with the aim to improving pharmacy practice.  Perspective articles focus on a specific field or discipline and discuss current advances or future directions, and may include original data as well as expert insight and opinions.

Contact: Kelly Jo Eastwood at: kelly-jo@ipn.ie or Robyn Maginnis robynmaginnis@ipn.ie

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58

News

IPHA Respond to Transparent Payments Bill The Irish Pharmaceutical Healthcare Association (IPHA), representing the research-based biopharmaceutical industry in Ireland, have noted Sinn Féin’s proposed Healthcare (Transparent Payments) Bill 2022 due for Second Stage Debate in the Dáil towards the end of last month (June).

Teachta Darren O’Rourke

(Transparent Payments) Bill 2022 is needed to bring Ireland in line with international best practice, and is a measure in the interest of industry, professionals, organisations and the general public.”

Issuing a statement, IPHA said, “Ahead of this debate, we would like to reaffirm IPHA’s unwavering commitment to integrity and transparency in all interactions between our member companies and healthcare professionals (HCPs) and healthcare organisations (HCOs).

The Bill, sponsored by Darren O’Rourke TD, David Cullinane TD and Seán Crowe TD, seeks to make it mandatory for pharmaceutical companies and medical equipment suppliers to declare payments, gifts, donations and all other transfers of value made by them to healthcare professionals and organisations.

Teachta O’Rourke said, “We know payments to healthcare professionals and organisations can create a conflict of interest.

Evidence shows that receipt of payments from the pharmaceutical industry is, for example, associated with higher prescribing rates, higher prescribing costs, increased use of specific drug classes, including opioids, and lower prescribing quality.

“The popular show ‘Dopesick’ highlighted this to great effect in the context of the opioid epidemic in the United States.

“In Ireland, tens of millions of euros are paid to healthcare professionals and organisations each year by the pharmaceutical industry.

“While a voluntary register of these payments is currently in place and maintained by the Irish Pharmaceutical Healthcare Association, research conducted at the Royal College of Surgeons in Ireland found that the identity of many recipients is anonymous, while other payments may not be reported at all.

“The current voluntary system is inadequate. The Healthcare

“The shared ambition of our member companies is to bring innovative treatments to Irish patients under the guidance of qualified HCPs. We place great value on our longstanding, ethical relationships with doctors, nurses, dentists, and pharmacists, whose experience and insight are essential to advancing the development and appropriate use of new medicines.

“Our industry has already taken significant steps to ensure accountability and transparency in all such engagements with the healthcare community. Since July 2016, in line with the IPHA Code of Practice for the Pharmaceutical Industry, companies have disclosed financial transfers of value—whether direct or indirect,

in cash or in kind—made to HCPs and HCOs. IPHA members are required to disclose, and these disclosures are publicly accessible on www.transferofvalue.ie which is open to all pharmaceutical companies to use, not just IPHA members. Currently, of the 50 companies who publish their data through the platform, 11 are non IPHA members.

“For 2023 data, we achieved 100% named disclosure for HCOs and 96% for HCPs. We expect the 2024 data, due for publication on June 30th, 2025, will maintain or exceed these strong levels of transparency.

“Our aim is to reach 100% named disclosure for HCPs, and we will continue to support our member companies in using legitimate interest as a legal basis for making these disclosures under data protection law.”

IPHA believes that any legislative proposals in this area must be informed by the progress that has already been made by the industry. “We are very willing to work with Government to ensure more companies, and indeed other sectors such as medical devices, use this already established and effective website to disclose their payments to HCPs and HCOs. “Constructive engagement with stakeholders, including Oireachtas members, remains a priority as we continue to uphold the highest standards of conduct in support of patient care and public confidence,” they add.

Teva Launches Ticagrelor Teva 90mg Film Coated Tablets Teva Pharmaceuticals is pleased to announce the launch of Ticagrelor Teva 90 mg Film-coated Tablets.

Ticagrelor Teva co-administered with acetylsalicylic acid (ASA), is indicated for the prevention of atherothrombotic events in adult patients with acute coronary syndromes (ACS) or a history of myocardial infarction (MI) and a high risk of developing an atherothrombotic event.

For any queries or further information, please contact your local Teva representative or contact Teva on 1800 201 700.

Further product information is available upon request or from the SmPC available at hpra.ie.

Adverse events should be reported. Reporting forms and information can be found at hpra.ie. Adverse events should also be reported to Teva UK Limited on +44 (0) 207 540 7117 or medinfo@tevauk.com.

Date of preparation: May 2025 Job code: GEN-IE-NP-00146

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Ticagrelor Teva 90 mg Film-coated Tablets ticagrelor 56 tablet pack

Indications Ticagrelor Teva co-administered with acetylsalicylic acid (ASA), is indicated for the prevention of atherothrombotic events in adult patients with acute coronary syndromes (ACS) or a history of myocardial infarction (MI) and a high risk of developing an atherothrombotic event Ticagrelor

Teva

Film

Coated

Tablets

Abbreviated

Prescribing

Information. result in an increased risk of cardiovascular (CV) death MI or stroke due to the patient’s underlying disease.

Interactions: Strong CYP3A4 inhibitors (e.g. ketoconazole, clarithromycin, nefazodone, ritonavir and atazanavir) are known to reduce the Cmax and AUC of the active metabolite of ticagrelor, therefore, their concomitant use is contraindicated. Moderate CYP3A4 inhibitors (e.g. amprenavir, aprepitant, erythromycin and fluconazole) can be co-administered with ticagrelor. A 2-fold increase of ticagrelor exposure was observed after daily consumption of large quantities of grapefruit juice. CYP3A inducers (e.g. phenytoin, carbamazepine and phenobarbital) would be expected to decrease the exposure to ticagrelor. Coadministration of ticagrelor with potent CYP3A inducers may decrease exposure and efficacy of ticagrelor, therefore, their concomitant use with ticagrelor is discouraged. Co-administration of cyclosporine with ticagrelor increased ticagrelor Cmax and AUC. No data are available on concomitant use of ticagrelor with other active substances that also are potent P-gp inhibitors and moderate CYP3A4 inhibitors (e.g. verapamil, quinidine) that also may increase ticagrelor exposure. If the association cannot be avoided, their concomitant use should be made with caution. Co-administration of ticagrelor with heparin, enoxaparin and ASA or desmopressin did not have any effect on the pharmacokinetics of ticagrelor or the active metabolite or on ADP-induced platelet aggregation compared with ticagrelor alone. Co-administration of ticagrelor with simvastatin increased simvastatin Cmax and AUC. Ticagrelor may have similar effect on lovastatin, therefore, the concomitant use of ticagrelor with doses of simvastatin or lovastatin greater than 40mg is not recommended. Co-administration of ticagrelor with atorvastatin increased atorvastatin Cmax and AUC, but these increases are not considered clinically significant. Ticagrelor is a mild CYP3A4 inhibitor.

Co-administration of ticagrelor and CYP3A4 substrates with narrow therapeutic indices (i.e. cisapride or ergot alkaloids) is not recommended, as ticagrelor may increase the exposure to these medicinal products.

Appropriate clinical and/or laboratory monitoring is recommended when giving narrow therapeutic index P-gp dependent medicinal products like digoxin concomitantly with ticagrelor. Co-administration of ticagrelor with tolbutamide resulted in no change in the plasma levels of either medicinal product, which suggests that ticagrelor is not a CYP2C9 inhibitor and unlikely to alter the CYP2C9 mediated metabolism of medicinal products like warfarin and tolbutamide. Ticagrelor may affect renal excretion of rosuvastatin, increasing the risk for rosuvastatin accumulation. Co-administration of ticagrelor and levonorgestrel and ethinyl oestradiol increased ethinyl oestradiol exposure approximately 20% but did not alter the pharmacokinetics of levonorgestrel. No clinically relevant effect on oral contraceptive efficacy is expected when levonorgestrel and ethinyl oestradiol are co-administered with ticagrelor. Due to observations of mostly asymptomatic ventricular pauses and bradycardia, caution should be exercised when administering ticagrelor concomitantly with medicinal products known to induce bradycardia. Due to reports of cutaneous bleeding abnormalities with SSRIs (e.g. paroxetine, sertraline and citalopram), caution is advised when administering SSRIs with ticagrelor as this may increase the risk of bleeding. Pregnancy and lactation: Patients of childbearing potential should use appropriate contraceptive measures to avoid pregnancy during ticagrelor therapy. Ticagrelor is not recommended during pregnancy. Regarding lactation, a risk to newborns/infants cannot be excluded. A decision must be made whether to discontinue breast-feeding or to discontinue/abstain from ticagrelor therapy taking into account the benefit of breastfeeding for the child and the benefit of therapy for the patient. Effects on ability to drive and use machines: Ticagrelor has no or negligible influence on the ability to drive and use machines. Dizziness and confusion have been reported with treatment, therefore, patients who experience these symptoms should be cautious while driving or using machines. Adverse reactions: Thrombotic thrombocytopenic purpura, hypersensitivity including angioedema, syncope, and haemorrhage (including intracranial, ear, eye, gastrointestinal, retroperitoneal). Very Common: Blood disorder bleedings, hyperuricaemia, and dyspnoea. Common: Gout/gouty arthritis, dizziness, headache, vertigo, hypotension, respiratory system bleedings, diarrhoea, nausea, dyspepsia, constipation, subcutaneous or dermal bleeding, rash, pruritus, urinary tract bleeding, blood creatinine increased, post procedural haemorrhage, and traumatic bleedings.

Consult the Summary of Product Characteristics in relation to other side effects. Overdose: In the event of an overdose, any of the above listed adverse reactions could occur, as well as prolonged duration of bleeding risk associated with platelet inhibition. ECG monitoring should be considered. There is currently no known antidote to reverse the effects of ticagrelor, and ticagrelor is not dialysable. Treatment of overdose should follow local standard medical practice. If bleeding occurs other appropriate supportive measures should be taken. Platelet transfusion is unlikely to be of clinical benefit in patients with bleeding.

Legal category: POM. Marketing Authorisation Number: PA1986/123/001. Marketing Authorisation Holder: Teva B.V., Swensweg 5, 2031GA Haarlem, Netherlands. Job Code: MED-IE-00092. Date of Preparation: May 2025

Presentation: Each film-coated tablet contains 90mg ticagrelor. Indications: Ticagrelor Teva coadministered with acetylsalicylic acid (ASA), is indicated for the prevention of atherothrombotic events in adult patients with acute coronary syndromes (ACS), or a history of myocardial infarction (MI) and a high risk of developing an atherothrombotic event. Dosage and administration: For oral use. Patients taking Ticagrelor Teva should also take a daily low maintenance dose of ASA 75-150mg, unless specifically contraindicated. Adults: ACS: Should be initiated with a single 180mg loading dose (two tablets of 90mg) and then continued at 90mg twice daily. Treatment with Ticagrelor Teva 90mg twice daily is recommended for 12 months in ACS patients unless discontinuation is clinically indicated. Adults: History of MI: 60mg twice daily is the recommended dose when an extended treatment is required for patients with a history of MI of at least one year and a high risk of an atherothrombotic event. Treatment may be started without interruption as continuation therapy after the initial one-year treatment with Ticagrelor Teva 90mg or other adenosine diphosphate (ADP) receptor inhibitor therapy in ACS patients with a high risk of an atherothrombotic event. Treatment can also be initiated up to 2 years from the MI, or within one year after stopping previous ADP receptor inhibitor treatment. Children: Not suitable for use in patients under 18 years of age. Elderly: No dose adjustment is required. Renal impairment: No dose adjustment is necessary.

In patients with ACS, it is recommended that renal function is also checked one month after initiating the treatment with ticagrelor, paying special attention to patients ≥75 years, patients with moderate/severe renal impairment and those receiving concomitant treatment with an angiotensin receptor blocker (ARB).

Hepatic impairment: No dose adjustment is necessary for patients with mild hepatic impairment. No dose adjustment is not recommended for moderate hepatic impairment, but ticagrelor should be used with caution. Ticagrelor has not been studied in patients with severe hepatic impairment and its use in these patients is contraindicated. Contraindications: Hypersensitivity to the active substance or to any of the excipients. Active pathological bleeding. History of intracranial haemorrhage. Severe hepatic impairment.

Co-administration of ticagrelor with strong CYP3A4 inhibitors (e.g. ketoconazole, clarithromycin, nefazodone, ritonavir and atazanavir), as co-administration may lead to a substantial increase in exposure to ticagrelor. Precautions and warnings: The use of ticagrelor in patients at known increased risk for bleeding should be balanced against the benefit in terms of prevention of atherothrombotic events.

Ticagrelor should be used with caution in the following patient groups: Patients with a propensity to bleed (e.g. due to recent trauma, recent surgery, coagulation disorders, active or recent gastrointestinal bleeding) or who are at increased risk of trauma. Patients with concomitant administration of medicinal products that may increase the risk of bleeding (e.g. non-steroidal anti-inflammatory drugs (NSAIDs), oral anticoagulants and/or fibrinolytics) within 24 hours of ticagrelor dosing. Patients should be advised to inform physicians and dentists that they are taking ticagrelor before any surgery is scheduled and before any new medicinal product is taken. If a patient is to undergo elective surgery and antiplatelet effect is not desired, ticagrelor should be discontinued 5 days prior to surgery. ACS patients with prior ischaemic stroke can be treated with ticagrelor for up to 12 months. Patients with an increased risk of bradycardic events (e.g. patients without a pacemaker who have sick sinus syndrome, 2nd or 3rd degree AV block or bradycardic-related syncope) have been excluded from the main studies evaluating the safety and efficacy of ticagrelor. Therefore, due to the limited clinical experience, ticagrelor should be used with caution in these patients. Caution should be exercised when administering ticagrelor concomitantly with medicinal products known to induce bradycardia. Bradyarrhythmic events and AV blocks have been reported in the post-marketing setting in patients taking ticagrelor, primarily in patients with ACS, where cardiac ischemia and concomitant drugs reducing the heart rate or affecting cardiac conduction are potential confounders. Dyspnoea was reported in patients treated with ticagrelor. Dyspnoea is usually mild to moderate in intensity and often resolves without need for treatment discontinuation. Central sleep apnoea including Cheyne-Stokes respiration has been reported in the post-marketing setting in patients taking ticagrelor. If central sleep apnoea is suspected, further clinical assessment should be considered. Hyperuricaemia may occur during treatment with ticagrelor. Caution is advised in patients with history of hyperuricaemia or gouty arthritis. As a precautionary measure, the use of ticagrelor in patients with uric acid nephropathy is discouraged.

Thrombotic Thrombocytopenic Purpura (TTP) has been reported very rarely with the use of ticagrelor. It is characterised by thrombocytopenia and microangiopathic haemolytic anaemia associated with either neurological findings, renal dysfunction or fever. TTP is a potentially fatal condition requiring prompt treatment including plasmapheresis. Co-administration of ticagrelor and high maintenance dose ASA (>300mg) is not recommended. Premature discontinuation of treatment should be avoided, as this could

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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

Date of Preparation: May 2025 | Job Code: GEN-IE-00139

Further information is available on request or in the SmPC. Product Information also available on the HPRA website.

60

Osteoporosis

Advances in Osteoporosis Therapy: Romosozumab Written by Dr Donal Fitzpatrick, Consultant Physician & Geriatrician, Mater Misericordiae Hospital, Dublin, Dr Kevin McCarroll, Consultant Physician & Geriatrician, Bone Health Unit, St James’s Hospital, Dublin. osteoporotic fracture, very low T-scores (e.g. < –3.0) or multiple clinical risk factors. For these patients, most guidelines recommend an “anabolic-first approach” using agents like romosozumab to achieve a more rapid rise in BMD and reduction in fracture risk.

In Ireland, romosozumab is indicated for postmenopausal women with severe osteoporosis: the larger FRAME trial did not detect any significant signal for cardiovascular events.

However, (T-score ≤lower –2.5 at hip, lumbar spine it included patients who were marginally younger, had a slightly prevalence of or distal forearm where latter not hypertension and less severe osteoporosis. Reassuringly, a recentavailable) study (n=11,220) using realand who have sustained a recent major osteoporotic world data that compared romosozumab and teriparatide/abalopartide reported fewer fracture (hip, vertebral, proximal Dr Donal Fitzpatrick Dr Kevin McCarroll cardiovascular events with romosozumab. humerus, or distal radius) within the past 24 months (see Table In Europe, the EMA contraindicates romosozumab in any patient1).with a history myocardial It is available asof a high-tech in other countries (e.g. Japan) have prescription under a HSE Managed Background infarction or stroke. Clinicians must balance the benefits of fracture risk reduction against extensive experience with its use Access Programme and can Osteoporosis affects an estimated where there is a should growing body of cardiovascular risk before using it.

Caution be exercised in those with established be prescribed by consultants 300,000 to 500,000 people real-world clinical evidence. in a specialism relevant to in Ireland. Fragility fractures cardiovascular disease and in other patients, clinical risk factors such as hypertension, osteoporosis (e.g. geriatricians, Which patients should be are a serious consequence diabetes, hyperlipidaemia, smoking and family history need to be considered. rheumatologists) endocrinologists, considered for romosozumab? with approximately 32,000 who are registered and approved. annually and are associated Osteoporosis guidelines (e.g.

MRONJ and AFF are very romosozumab treatment.

In the FRAME and ARCH trials, with significant morbidity, loss rare with How is it administered?

IOF, AACE) increasingly of independence andreported impaired (two NOGG, three AFFs were in prior bisphosphonate users) and three MRONJ cases (one advise on stratifying patient quality of life. Furthermore, there Romosozumab is administered each in prior alendronate users).

Hypocalcaemia was also rare (<0.1%) and fracture risk into the categories is an approximate 24% one-yearand denosumab once monthly (dose of 210 mg) as of ‘high-risk’ or ‘very high-risk’ mortality Irishadvised adults following patientsinare to have adequate calcium and vitamin D intake. two consecutive subcutaneous to guide decisions on optimal hip fracture. This fracture burden injections in the abdomen, thigh therapy.

In general, anabolic or imposes significant economic costs or upper arm for a total of 12 Conclusion more potent antiresorptive agents estimated to be ¤1 billion in Ireland. months. The drug is stable for up are advised for those with the to one month at room temperature Romosozumab advancement in osteoporosis treatment, uniquely greatest fracture risk. The concept Romosozumab is arepresents monoclonal a significant though longer storage requires of “imminent fracture risk” is antibody that targets sclerostin, a combining potent anabolic and mild antiresorptive effects. By targeting patients atIfthe highest refrigeration (2–8°C). refrigerated, also core to this approach, as the protein that inhibits bone formation it should sit repeated at room temperature risk of fracture, romosozumab has the potential to interrupt the cycle of fractures, highest risk for re-fracture and also promotes bone resorption for 30 minutes prior to use to avoid (> 10%) occurs in the first two caution through inhibition of the Wnt/βand associated morbidity.

However, its use warrants in individuals with high injection discomfort. Disposable years after a fragility fracture. In catenin pathway. By blocking prefilled autoinjector pens facilitate cardiovascular risk and longer-term safety data remain necessary.

Ireland, approximately 30% of sclerostin, romosozumab is unique easy administration and the older adults with a fragility fracture company provides training for in having both anabolic (bone At present,and strict eligibility criteria prevents many are at very high fracture risk have a history of prior patients fracture, who patients stimulating) antiresorptive and carers. underscoring thefrom need for prompt romosozumab. However, in the (inhibiting (e.g. verybone lowbreakdown) T-scores but no recent fracture) accessing intervention. effects, making it the most potent How effective is it and how does pivotal FRAME trial, similar antifracture efficacy and BMD increases were observed in patients osteoporosis therapy developed it compare to other treatment “High risk” patients are typically to date. options? at high risk who had no prior fragility fracture . defined as those meeting minimum intervention thresholds While approved by the FDA and Romosozumab is regarded as the Fracture liaison services (FLS) play a criticaland rolewhere in identifying patients at the highest fracture for treatment first line EMA in 2019, romosozumab most potent agent for increasing therapy is generally antiresorptives was BMD and reducing fracture risk. risk only whomade mayavailable benefitinfrom anabolic therapies such as romosozumab.

The development of a such as bisphosphonates.

Ireland in November 2024 for In the FRAME trial, one year of national osteoporosis strategy could help in delivering timely, effective treatment to all at-risk In contrast, “very high risk” postmenopausal females with romosozumab therapy resulted individuals. includes patients with additional severe osteoporosis who meet in a 13.3% gain in BMD at the certain criteria. However, clinicians factors such as a recent major lumbar spine and 6.8% at the

Table 1: Criteria for prescribing (all must be met) Postmenopausal woman Major osteoporotic fracture* within the last 24 months T-score ≤ -2.5 on DXA (at hip, spine or forearm if latter not available) *Major osteoporotic fracture is a fragility fracture of the hip, vertebrae, proximal humerus, or distal radius.

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total hip, with a 73% reduction in new vertebral fractures and a 36% reduction in clinical fractures. By contrast, potent bisphosphonates or denosumab typically yield around a 3% annual increase in lumbar spine BMD.9, 10 Romosozumab is not only superior at increasing BMD compared to bisphosphonates and denosumab, but also teriparatide, the only other bone-forming therapy available in Ireland.

When compared directly with alendronate in the ARCH trial, one year of romosozumab followed by alendronate for another year led to a 38% lower incidence of hip fractures and 48% reduction in vertebral fractures versus continuous alendronate. In the FRAME and FRAME Extension studies, romosozumab for 12 months followed by denosumab for 12 months was compared with 24 months of denosumab and resulted in a 9.3% greater improvement in BMD at the spine, 4.4% at the total hip and nearly 50% fewer vertebral fractures. In fact, the mean increase of T-score after one year of romosozumab followed by 12 months of denosumab was 1.1 at lumbar spine and 0.45 at total hip.

Studies also show its superiority over teriparatide. A meta-analysis of four small head-to-head trials comparing both agents found greater increases in spine and total hip BMD with romosozumab.

In a recent observational study, romosozumab also resulted in greater 12-month rises in BMD than teriparatide (femoral neck: 4.8% vs. 0.2%, total hip: 5.7% vs. 0.3%, lumbar spine: 13.7% vs. 9.3%).

Romosozumab’s greater effect on cortical bone versus teriparatide probably accounts for the larger hip BMD gains. Additionally, while pooled analysis of randomised trials suggests that teriparatide reduces hip fracture risk, this is not conclusively proven.

Romosozumab is not licensed for use in males in Europe or the US. While there is relatively little data on its use in men, the BRIDGE trial (n=245) demonstrated similar BMD gains. Further studies may pave the way for its future use in males, where it is currently permitted in Japan.

61 on alendronate. In contrast, the larger FRAME trial did not detect any significant signal for cardiovascular events. However, it included patients who were marginally younger, had a slightly lower prevalence of hypertension and less severe osteoporosis.

Reassuringly, a recent study (n=11,220) using real-world data that compared romosozumab and teriparatide/abalopartide reported fewer cardiovascular events with romosozumab.

What treatment should follow are after completing a one-year course of romosozumab?

Without subsequent therapy after romosozumab, BMD gains dissipate so it must be followed by an antiresorptive agent such as a bisphosphonate or denosumab. A potent intravenous bisphosphonate (e.g. zoledronic acid) is generally considered prudent in this setting though alendronate and ibandronate are also shown to further increase BMD. Transitioning to denosumab is an alternative option and results in even greater BMD gains of up to 5.6% at the lumbar spine and 3.9% at the total hip. Indeed, in the FRAME study, one year of romosozumab followed by denosumab for 12 months achieved BMD gains at the total hip and spine equivalent to nearly 7 years of denosumab in the FREEDOM study. However, the decision to use denosumab needs to be carefully considered, as if stopped at a future point, bisphosphonates may not prevent subsequent bone loss.

Do other prior osteoporosis therapies affect its response?

Romosozumab results in the greatest BMD gains in treatment-naïve patients, with prior antiresorptive therapy partially blunting its anabolic effect. This is relevant as in clinical practise, patients with severe osteoporosis are those most likely to be considered for romosozumab, though often have had prior bisphosphonate or denosumab therapy.

However, studies show that romosozumab after bisphosphonates still results in

substantial rises in BMD at the spine (7.5 - 10.2%) and total hip (up to 4.3%). In the most recent Swiss study, improvements of 10.1% at the lumbar spine and 2.9% at the total hip were identified compared to 14.6% and 5.0% in treatment naïve patients. Longer bisphosphonate exposure though was correlated with a diminished romosozumab response. Data also suggests that romosozumab as opposed to teriparatide is a better option after bisphosphonate therapy.

In the STRUCTURE trial, women switching from bisphosphonates (mean of 5.6 years) to romosozumab achieved greater BMD gains at the lumbar spine (+9.8%) and total hip (+2.6%) compared to those switching to teriparatide (+5.4% and –0.6%, respectively).

The use of romosozumab after denosumab is more questionable, with evidence showing that this results in a greater attenuation of its effect (by up to 50% or more). This appears to occur as the rebound increase in bone resorption on stopping denosumab is only partially mitigated by romosozumab.

A recent study of patients on denosumab for a median of two years found that switching to romosozumab still increased lumbar spine BMD by 6.8%, compared to 3.3% for those continuing denosumab. However, there was no increase in total hip BMD. While there is almost no data on switching directly from long-term denosumab to romosozumab, case reports suggest an even larger blunting of its effect and in some patients a decline in BMD.

For patients who remain at high fracture risk despite denosumab therapy, adding romosozumab has been suggested. In a small case control study this was found to produce greater increases in lumbar spine, but not hip BMD after 6 months compared to continuing denosumab only therapy. However, more studies are needed to investigate this.

Some patients who may have completed teriparatide therapy may also remain at high risk of fracture. While data is limited, in four observational studies switching from teriparatide to romosozumab was still associated with significant increases in BMD at the spine (9.1 - 13.3%) and total hip (1.9 - 7.5%) though with gains less than seen in treatment naïve patients.

What are the adverse effects?

Romosozumab is well tolerated with only about 5% discontinuing the drug due to adverse effects.

These include injection site reactions (5.0%), nasopharyngitis (10%) and arthralgia (10%).

The main concern around use is a possible increase in cardiovascular events which were identified in one of the pivotal trials. The potential mechanism is unclear and may involve sclerostin mediated pathways, that might increase the risk of vascular calcification. However, studies on the effect of sclerostin on cardiovascular risk are conflicting and it remains to be seen whether the drug is implicated.

In the ARCH trial, 2.5% of romosozumab-treated patients had major adverse cardiovascular events in the first 12 months of use compared to 1.9% of those

In Europe, the EMA contraindicates romosozumab in any patient with a history of myocardial infarction or stroke. Clinicians must balance the benefits of fracture risk reduction against cardiovascular risk before using it. Caution should be exercised in those with established cardiovascular disease and in other patients, clinical risk factors such as hypertension, diabetes, hyperlipidaemia, smoking and family history need to be considered.

MRONJ and AFF are very rare with romosozumab treatment.

In the FRAME and ARCH trials, three AFFs were reported (two in prior bisphosphonate users) and three MRONJ cases (one each in prior alendronate and denosumab users). Hypocalcaemia was also rare (<0.1%) and patients are advised to have adequate calcium and vitamin D intake.

Conclusion Romosozumab represents a significant advancement in osteoporosis treatment, uniquely combining potent anabolic and mild antiresorptive effects. By targeting patients at the highest risk of fracture, romosozumab has the potential to interrupt the cycle of repeated fractures, and associated morbidity.

However, its use warrants caution in individuals with high cardiovascular risk and longer-term safety data remain necessary.

At present, strict eligibility criteria prevents many patients who are at very high fracture risk (e.g. very low T-scores but no recent fracture) from accessing romosozumab.

However, in the pivotal FRAME trial, similar antifracture efficacy and BMD increases were observed in patients at high risk who had no prior fragility fracture .

Fracture liaison services (FLS) play a critical role in identifying patients at the highest fracture risk who may benefit from anabolic therapies such as romosozumab.

The development of a national osteoporosis strategy could help in delivering timely, effective treatment to all at-risk individuals.

References available on request

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62

Asthma

Breathing Easy: Exercise and Asthma – Understanding, Managing, and Thriving Written by Dr Laura Monoghan Respiratory SpR and Prof. Patrick D. Mitchell, Consultant Respiratory Physician, Tallaght University Hospital and School of Medicine, Trinity College Dublin

Prof. Patrick D. Mitchell

Asthma, a chronic respiratory condition characterised by inflammation and narrowing of the airways, affects over 400 million people worldwide.

It leads to symptoms such as wheezing, breathlessness, and coughing. Asthma can limit physical activity both through its direct physiological effects and through psychological barriers stemming from fear of triggering symptoms. For many, the idea of exercise with asthma might seem daunting, conjuring fears of triggering an attack or worsening symptoms. However, the reality is far more empowering: with proper management, exercise is not only safe but also a vital component of asthma care. Regular physical activity offers a wide array of health, lifestyle, and wellness benefits, helping individuals with asthma not just manage their condition but truly thrive. It opens up all sorts of avenues from the local gym, sports club and beyond.

Let’s explore how exercise can transform the lives of those with asthma, with a particular focus on understanding and managing exercise-induced asthma (EIA), also known as exercise-induced bronchoconstriction (EIB) whilst also focusing on the importance of asthma control at a person’s baseline. Research over decades has demonstrated that lung expansion, as prompted by aerobic exercise, has positive effects

on lung health. As such, current guidelines strongly recommend that all patients with chronic diseases, including asthma, participate in regular physical activity for overall health benefits.

Despite this recommendation, patients with asthma are significantly less physically active than gender matched controls.

Describing the risks and benefits of physical activity in asthma patients is necessary to improve and implement recommendations regarding this lifestyle intervention.

Patients with asthma need both robust assurance of the positive benefits of exercise and tailored management plans to enable them thrive in an exercise environment. Long-term asthma control is determined both by adherence to an appropriate pharmacologic regimen and by lifestyle contributors. Aerobic exercise is a prominent example of how healthy lifestyle choices can affect the disease course of asthma. Patients with asthma who consistently engage in physical activity have improved disease control, quality of life, and lung function parameters. On the other hand, low levels of physical activity in asthma are associated with increased health care utilization and associated costs.

Most asthma providers recognise the positive effects of physical activity and recommend that their patients engage in it but this could be improved upon. It is also important to stress that individuals with difficult to control asthma (compliance with medications, access to appropriate medication, severe asthma and other confounding factors) should not feel stigmatized by being unable to exercise but rather encouraged.

Exercise-induced bronchoconstriction (EIB) refers to the temporary narrowing of the airways triggered by physical activity, a phenomenon that

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affects 80–90% of individuals with persistent asthma and 5–20% of those without a formal asthma diagnosis. Among elite athletes, particularly those in endurance or cold-weather sports like cross-country skiing, prevalence can soar as high as 50%. Symptoms typically emerge during or shortly after exercise, within 5–20 minutes, and include shortness of breath, chest tightness, wheezing, coughing, fatigue, and reduced exercise performance. These symptoms, which usually resolve within an hour, can be distressing, often leading individuals to shy away from physical activity altogether.

An effective management plan can be developed with these individuals that can include taking their rescue inhaler 15-45 minutes prior to exercising as well as – if needed – adhering to a maintenance regimen.

But why does exercise trigger asthma? Minute ventilation, the volume of air inhaled or exhaled from a person's lungs per minute, rising with exercise. EIB probably results from changes in airway physiology triggered by the large volume of relatively cool, dry air inhaled during vigorous activity. This is supported by several studies finding that EIB is attenuated when the inspired gas is more fully humidified and closer to body temperature. The effect of large-volume dry air inhalation on airway surface osmolality may be the primary stimulus responsible for bronchoconstriction. This is also to be borne in mind when advising patients on management strategies (i.e. a scarf covering the mouth and nose on cold days).

Certain factors heighten the risk of EIB. These including having allergic rhinitis, exercising in cold, dry air, exposure to pollutants such as ozone, high levels of triggering allergens, high-intensity aerobic activities like running or cycling, and even swimming in heavily chlorinated pools, where increased levels of trichloramine can irritate airways. Trichloramine is responsible for the distinctive 'chlorine smell' associated with swimming pools, where the

compound is readily formed as a product from hypochlorous acid (in swimming pools) reacting with ammonia and other nitrogenous substances in the water, such as sweat and urea from urine (hence one the main the reason for showering before swimming).

Recent respiratory infections also increase susceptibility.

Recognising these risk factors is the first step toward effective management, ensuring that individuals with asthma can engage in exercise safely and are equipped with the knowledge to make informed decisions on exercising.

Accurate diagnosis of EIB is crucial to distinguish it from other causes of exertional breathlessness, such as poor fitness, vocal cord dysfunction, or cardiovascular issues so it is important to keep these differentials in mind.

Diagnosis typically begins with a detailed clinical history, focusing on symptom onset, patterns, and response to bronchodilators. Objective tests, although not usually needed, such as spirometry before and after exercise or bronchoprovocation testing (e.g., eucapnic voluntary hyperventilation), can confirm the diagnosis, providing clarity for tailored management.

Managing EIB involves a combination of pharmacological and non-pharmacological strategies. On the pharmacological front, short-acting beta-agonists (SABAs) like salbutamol, taken 15–30 minutes before exercise, are the commonest used cornerstone of prevention, offering protection for up to four hours. However there has been a move toward using a combination reliver including and inhaled corticosteroid and beta agonist 30 minutes before execising. The ICS component is antiinflammation and targeting inflammation is essential in most patients with asthma. For those with persistent asthma, inhaled corticosteroids (ICS), often combined with long-acting beta-agonists (LABAs), helps reduce airway hyperresponsiveness over time, improving overall asthma control.

63 Non-pharmacological approaches are equally important. A progressive 10–15-minute warm-up can induce a refractory period, making airways less reactive during exercise. Breathing techniques, such as nasal breathing to warm and humidify air or pursed-lip breathing for post-exercise recovery, can also help. Environmental adjustments are key: exercising in warm, humid environments, avoiding high-pollution or pollen days, and using face masks or scarves in cold weather can minimize triggers. Choosing sports with intermittent exertion, like volleyball or baseball, rather than continuous high-intensity activities like long-distance running, can reduce symptom risk. However – patients should be encouraged to pursue their sport of choice.

Additionally, maintaining hydration and gradually improving physical conditioning through aerobic exercise can further decrease the severity of EIB over time.

The Transformative Power of Exercise in Asthma Far from being a limitation, exercise should be viewed as a cornerstone of asthma management, offering a multitude of benefits that extend well beyond the lungs. Physiologically, regular physical activity enhances aerobic capacity, strengthens respiratory muscles, and improves breathing efficiency, leading to better asthma symptom control and reduced reliance on rescue medications. A 2021 metaanalysis in Thorax found that moderate aerobic exercise (e.g., 30 minutes, three times a week) improved forced expiratory volume in 1 second (FEV1) by 5–10% in asthma patients over 12 weeks, demonstrating its direct impact on lung function.

children. The provided text highlights that children with poorly controlled asthma often avoid exercise, leading to decreased fitness and a higher risk of obesity, which can exacerbate asthma through inflammatory pathways.

A 2023 cohort study in American Journal of Respiratory and Critical Care Medicine found that asthmatic children engaging in regular physical activity (150 minutes per week) had a 30% lower obesity incidence over five years compared to sedentary peers. By breaking this cycle, exercise not only improves asthma control but also lowers the risk of comorbidities like diabetes and hypertension.

Exercise also bolsters the immune system, reducing the frequency of respiratory infections—a common asthma trigger. A 2021 study in Allergy found that asthmatic patients who exercised regularly had a 20% lower incidence of upper respiratory infections over one year, highlighting the protective role of physical activity.

This is particularly crucial for children, whose asthma control is often assessed by activity limitations, school absenteeism, and social engagement, as noted in the text.

Exercise, Sleep, and Overall Wellness One often-overlooked benefit of exercise in asthma management is its impact on sleep. Many individuals with asthma experience nocturnal symptoms that disrupt sleep, leading to fatigue and reduced quality of life. Regular physical activity helps people fall asleep faster by lowering body temperature post-exercise and

reducing arousal and anxiety.

It also increases time spent in restorative deep sleep, reduces nighttime awakenings, and improves overall sleep efficiency.

These effects are invaluable for asthma patients, as better sleep enhances daytime energy, mood, and resilience to symptom triggers.

Empowering Children with Asthma For children with asthma, the stakes of exercise avoidance are particularly high. As the text emphasizes, evaluating asthma control in children involves assessing not just symptoms and medication use but also limitations in daily activities, including sports, play, and social life. Children with poorly controlled asthma may avoid strenuous exercise to prevent symptoms, leading to decreased fitness, weight gain, and a misleading impression of disease control. This can result in social isolation, reduced school attendance, and long-term health consequences like obesity.

Clinicians must actively explore these impacts and support safe engagement in physical activity, ensuring children can enjoy the physical, social, and emotional benefits of an active lifestyle.

The Asthma Society is Encouraging People to ‘Get Active for Asthma’ This World Asthma Day The Asthma Society of Ireland is leading the charge this World Asthma Day (7 May) with an inspiring new campaign: Get Active for Asthma. Running throughout Asthma Awareness Week (5-9 May), this initiative aims to encourage people with asthma to embrace physical activity as

a vital component of asthma management, with support from the charity’s expert nurses and physiotherapist.

The Asthma Society’s e-referral system allows health professionals to connect patients with the Asthma Adviceline, where they can access specialist advice on managing symptoms, medication use, and the benefits of an active lifestyle. The e-referral form can be found on asthma.ie.

This World Asthma Day let’s work together to break down the barriers to physical activity for people with asthma. Join the movement and help spread the message: asthma should never hold anyone back.

Get involved, stay informed, and get #ActiveForAsthma!

Final Thoughts: Thriving with Asthma Exercise-induced asthma, while common, is highly manageable with the right strategies. Through accurate diagnosis, personalized treatment plans, and lifestyle adjustments, individuals with asthma can lead active, healthy lives. Rather than viewing asthma as a barrier, we should see it as an opportunity to harness the transformative power of exercise.

From improving lung function and mental health to reducing obesity risk and enhancing sleep, the benefits of physical activity for asthma patients are profound and far-reaching. With the right approach, asthma need not limit one’s ability to enjoy sports, achieve fitness goals, or live fully.

Exercise should be a considered cornerstone in the management of asthma.

The psychological benefits are equally compelling. Exercise is a proven mood enhancer, reducing anxiety and depression—common challenges for those with asthma, who often face stress related to their condition. A 2023 study showed that children with asthma who participated in a six-month exercise program reported a 20% reduction in anxiety scores, alongside improved self-esteem and body image. These mental health gains translate to better adherence to asthma management plans, empowering individuals to take control of their health.

Metabolically, exercise helps manage weight, reducing the risk of obesity—a significant concern for asthma patients, particularly

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64

News

RCSI Ranks Top for ‘Good Health and Well-being’ RCSI University of Medicine and Health Sciences has ranked number one in the world for SDG 3 ‘Good Health and Well-being’ in the Times Higher Education (THE) University Impact Rankings 2025. This is the third time RCSI has achieved the world-leading position, having previously ranked number one in 2020 and 2023.

The THE University Impact Rankings recognise universities around the world for their social and economic impact based on the United Nations' 17 Sustainable Development Goals (SDGs). 1,788 universities participated in the SDG 3 ranking, an almost threefold increase since RCSI first achieved the number one position in 2020.

RCSI is also in the top 50 for SDG 17 ‘Partnerships for the Goals’, ranking joint 44 in 2025.

RCSI has maintained its overall position in the Impact Ranking at 201-300 in the world out of more than 2,300 universities.

RCSI is Ireland’s only university wholly dedicated to education, training and research in health sciences. Its continued strong performance in this ranking reflects the strength of the university’s

partnerships and engagement with national and international networks and communities to have a positive impact on human health and to embed sustainability in the curriculum and across its operations.

staff and students, we are deeply committed to sustainability through our education, research, outreach and university operations, and to building greater understanding of the relationship between human health and planetary health.

Professor Cathal Kelly, RCSI Vice Chancellor, said, “At a time when global universities are under increasing pressure to demonstrate tangible societal value and sustainability, I am incredibly proud of RCSI’s world number one ranking for UNSDG 3. This global leading position is a testament to our drive towards our mission to educate, nurture and discover for the benefit of human health which underpins our commitment to achieving the UNSDGs.

“I am grateful to everyone in the RCSI community our students, academic and professional staff, clinicians, community and health services partners for their efforts and also to the many partners we work with in addressing the global challenges outlined by the UNSDGs, which are more urgent than ever in these turbulent times.”

“We place a particular emphasis on nurturing the well-being of our

Key initiatives over the past year included the launch of a free continuous professional development (CPD) course to empower health professionals to apply the principles of sustainable

healthcare in their own practice to reduce the environmental impact of healthcare.

Nationally and globally, the university's impact is far-reaching.

Through the free RCSI MyHealth series, RCSI academics, in partnership with patient advocates, empowered people with sciencebacked insights on topics including coping strategies for life with cancer and the dangers of cannabis use on young minds. RCSI’s Institute of Global Surgery, in collaboration with the Global Surgery Foundation and the United Nations Institute of Training and Research (UNITAR), supported training in 165 countries through the SURGhub e-learning platform and was recognised as Technological Innovation of the Year at the 2024 Times Higher Education Awards.

Arok Healthcare receives EU MDR certification for Medical Device products Arok Healthcare, an emerging pharmaceutical and healthcare company, is delighted to announce that it has obtained EU MDR certification for its medical device products.

CEO at Arok Healthcare, Conor O’Daly

This certification marks a pivotal moment for Arok Healthcare and confirms the conformity of our medical device products with the strict requirements of the Medical Device Regulation (MDR).

Delivering high-quality Medical Devices in Europe and worldwide The EU Medical Device Regulations (EU MDR 2017/745)

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is recognised internationally and sets quality standards for medical devices sold in the European Union, with an emphasis on safety, risk management and postmarket surveillance. It replaces the former Medical Device Directive 93/42/EEC (MDD), introducing a more stringent framework and heightened requirements for continued access to the European market. Obtaining the EU MDR certificate highlights Arok’s mission to ensure access to medical devices while upholding the highest standards of regulatory compliance.

With this certification, Arok Healthcare will continue to supply and market its CE-marked medical

devices portfolio in the European Union and internationally.

Annette Dolan, Person Responsible for Regulatory Compliance noted “Obtaining this certification is not only a significant achievement and milestone for Arok but I am proud of our teams hard work and ongoing commitment to quality and regulatory compliance standards.”

CEO at Arok Healthcare, Conor O’Daly, further commented "Receiving the new CE certification for our Relactagel and Regelle brands under the EU MDR is a testament to the dedication and hard work of the entire team. I want to congratulate the team for this remarkable achievement.

This accomplishment reflects our unwavering commitment to delivering high quality, safe and reliable medical devices to our customers and patients. We are excited to continue serving our European and International distributors while exploring new opportunities with this certification."

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Topic Team Training – Acute Pain A community pharmacy environment that fosters teamwork ensures high levels of consumer satisfaction.

This series of articles is designed for you to use as a 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.

Acute pain may be described as: • Sharp • Dull • Stabbing • Throbbing (sign of inflammation) • Shooting or shock-like (sign of nerve involvement) A successful outcome from GP visits should be a pain management plan. It is highly likely that as part of this, some form of pain-relieving medication will be prescribed.

Ideally, advise on promotion of self-help, self-management, and other treatments to help improve their condition and add value to the benefit offered by medication.

Given the wide and varied nature of acute and chronic pain, there is a myriad of medication options.

The effectiveness of medication depends on the nature and severity of the pain.

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

The cause of pain is sometimes difficult to determine and there are often many aspects to consider.

Chronic pain can be more difficult to determine the cause; acute pain more often has a more clearly identifiable cause (e.g.) muscle injury. It is the indeterminate nature that can present the biggest obstacle to health professionals to establishing proper diagnosis of the condition.

Acute pain starts quickly and lasts a short period of time. The

definition of acute pain is pain that improves within one to three months of onset. Pain that lasts longer than 6 months is considered chronic pain and will require more specialist treatment from a pain expert. The period between 3 and 6 months is classified as the time of transition from acute pain to chronic pain. Patients require more specialist evaluation and treatment at this stage rather than just taking painkillers to avoid transitioning into chronic pain.

Acute pain can be felt in a specific body area such as the neck or back or the patient may have widespread pain with conditions such as a viral illness.

Regarding treatment of acute pain caused by headache (ie, migraine), in addition to standard paracetamol and NSAIDs, triptans are considered the most effective to combat acute attacks if ordinary analgesics do not work.Cochrane reviews (39 in total) of randomised controlled trials on effectiveness of OTC analgesics in acute pain found reliable evidence to indicate that simple, inexpensive, and common analgesics give good pain relief to many patients with acute pain, such as headache, toothache, Key Points:  The causes of acute pain, including the various types of injury  What types of pain can be considered for management in the pharmacy

Consider:

 Which customers should be referred to the pharmacist

 Is the pharmacy team fully trained on the indications and benefits of all products for the treatment of acute pain?

 The use of the PRICE method

 How are pain relief products (oral and topical) displayed in the pharmacy?

 The importance of not taking certain oral analgesics for longer than three days without referral

 Do we make the most of the potential for linked sales (e.g. oral and topical analgesics, food supplements, complementary therapies, support bandages)  Am I up to date with the latest guidance?  Am I aware which preparations are recommended first-line?

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sprains, and strains. Data demonstrated the most efficacious OTC drugs used were ibuprofen/ paracetamol combinations in respective 400mg/1000mg and 200mg/500mg doses.

These formulations gave effective relief in seven out of ten patients.

Fast-acting ibuprofen 200mg and 400mg was effective in at least five out of ten patients.

Paracetamol alone was effective in four out of ten patients.

The patient’s needs will affect treatment choice so pharmacists and pharmacy teams should have available (and understand) a range of guidance and literature to best advise patients about the most effective treatment for them.

Regular review of the continued suitability of all medications used by those with both acute and chronic pain is vital. For many, the pharmacy is becoming the first port of call when a health problem, especially pain-related, arises.

Using some of the ideas regarding questions, pain diary etc will really help in enabling people to make better informed decisions about their own next step. Becoming familiar with local resources like physio’s, support groups, condition specific charities and sign posting these will only add value to a positive perception.

Actions: Ensure support staff understand the following key points:  The common types of acute pain  The characteristics of a good analgesic for OTC use in the treatment of acute pain  The benefits and limitations of OTC medicines  The importance of what outcome a patient presenting with pain wants  Lifestyle issues that may impact on pain recovery, and tips on improving lifestyle

 Questions to ask the customer

 What approaches are recommended by the World Health Organisation (WHO) analgesic ladder

 The role of dietary supplements

 When to refer customers to the pharmacist.

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AVAILABLE FROM PHARMACY *Based on absorption data when compared to standard paracetamol tablets. To verify contact: verify@perrigo.com Solpa-Extra 500mg/65mg Soluble Tablets contains paracetamol and caffeine. For the treatment of mild to moderate pain. Adults and adolescents over 16 years: 1-2 tablets dissolved in water every 4-6 hours. Max 8 tablets a day. Adolescents aged 12-15 years: 1 tablet dissolved in water every 4-6 hours. Max 4 tablets a day. Not suitable for children under 12 years. Contraindications: Hypersensitivity to the ingredients. Precautions: Particular caution needed under certain circumstances and medical advice sought for renal or hepatic impairment, Gilbert’s Syndrome, chronic alcoholism, glucose-6-phosphatedehydrogenase deficiency, haemolytic anaemia, glutathione deficiency, malnutrition or dehydration, the elderly, patients weighing less than 50kg. Precautions needed in asthmatic patients sensitive to acetylsalicylic acid, patients on a controlled sodium diet and with rare hereditary problems of fructose intolerance. Patients should be advised not to take other paracetamol containing products concurrently. Immediate medical advice should be sought in the event of overdose even if the patient feels well because the risk of irreversible liver damage. Excessive intake of caffeine should be avoided while taking this product. Interactions: warfarin and other coumarin, other medicines following the same metabolic pathway, cholestyramine, probenecid, chloramphenicol, metoclopramide, domperidone, sedatives, tranquilizers, flucloxacillin and some decongestants. Pregnancy and lactation: Not recommended during pregnancy and breastfeeding. Side effects: Rare: allergies. Very rare: thrombocytopenia, anaphylaxis, bronchospasm, hepatic dysfunction, cutaneous hypersensitivity reactions, very serious skin reactions, TEN, drug-induced dermatitis, SJS, AGEP, sterile pyuria. Unknown: nervousness, dizziness, neutropenia, leukopenia. Further information is available in the SmPC. Product not subject to medical prescription. PA 1186/017/001. MAH: Chefaro Ireland DAC, The Sharp Building, Hogan Place, Dublin 2, Ireland. Date of preparation: Feb 2023. SPC: https://www.medicines.ie/medicines/solpa-extra-soluble-tablets-33783/spc MAT9346

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Awards

Spoonfuls of Self-Care Excellence

Awards The Irish Pharmacy

MGK9299 Haleon Trade Ads.pdf

2025

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Spooner’s CarePlus Pharmacy in Templeogue has been awarded Introducing... the prestigious Haleon Self-Care Award, recognising its outstanding contribution to health promotion, patient empowerment, and proactive self-care within the community. The accolade celebrates the pharmacy’s innovative approach to tackling health inequalities, particularly through the design and delivery of its groundbreaking Health Assessment Service—a project that has set a new benchmark for accessible, community-led healthcare.

Mark Byrne, Customer Business Manager, Haleon with Cormac Spooner, Spooners CarePlus Pharmacy

The Haleon Self-Care Award is presented to the individual or team that demonstrates the most significant impact on patient experience through accessible, well-designed health initiatives.

Spooner’s CarePlus Pharmacy stood out for its commitment to early intervention, preventive care, and holistic wellness, offering an inspiring example of how pharmacies can go beyond the traditional role of dispensing medicine to become health hubs for their communities.

The Vision: A Health "NCT" for the Community Under the leadership of Supervising Pharmacist Shaunagh Galgey, the pharmacy team at Spooner’s CarePlus identified a recurring trend: many customers were coming in with general concerns around cholesterol, blood pressure, sleep, gut health, and stress. Rather than treating each issue in isolation, Shaunagh envisioned a comprehensive service—a kind of "NCT for your health"—that would proactively screen for multiple conditions in one appointment and provide personalised, actionable advice.

This vision came to life as the Health Assessment Service, now one of the pharmacy’s core offerings and a trusted tool for improving local health outcomes.

From its inception, the Health Assessment Service was designed with accessibility in mind. Patients can book appointments online, over the phone, or in person, ensuring that everyone—including older adults or those less confident with technology—can benefit from the service. This inclusive

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design reflects the pharmacy’s deep understanding of community needs and its commitment to removing barriers to care.

Once an appointment is booked, patients complete a detailed Health Assessment Questionnaire, covering lifestyle habits such as diet, exercise, smoking, alcohol use, sleep quality, and mental Haleon, formerly part of GSK well-being. This is followed by a thorough in-person screening including cholesterol testing, blood pressure monitoring, Type 2 diabetes screening, BMI calculation, waist measurement, and gut health evaluation.

Empowerment Through Personalised Action Plans What sets Spooner’s CarePlus Pharmacy apart is not just the data they collect, but how they use it. After the assessment, the pharmacist sits down with the patient to discuss the results in detail. Together, they identify risk areas and co-develop a personalised action plan—a roadmap to better health that may include lifestyle adjustments, improved nutrition, stress management techniques, or referrals to a GP for further evaluation.

This collaborative, patient-centred approach transforms what could be an intimidating experience into an empowering one. Patients leave with clear next steps, a renewed sense of control, and confidence in their ability to manage their own health.

The Health Assessment Service has shifted the focus of Spooner’s CarePlus Pharmacy from reactive treatment to preventive care. By identifying potential health risks early—before they escalate into more serious conditions—the pharmacy is helping to reduce the burden on local GPs and hospitals, while also improving long-term health outcomes for its patients.

69 The Pharmacy team from Spooners CarePlus Pharmacy

In a time where healthcare systems are under increasing pressure, this kind of frontline preventive intervention is invaluable. It highlights the evolving role of community pharmacies as key partners in public health delivery.

Education at the Core Education is central to Spooner’s CarePlus Pharmacy’s ethos.

In addition to structured assessments, the pharmacy team use every interaction as a chance to inform and empower.

Staff are trained to offer advice on medication safety, lifestyle changes, and over-the-counter product use, always ensuring that patients fully understand their options and how to manage their own care.

The team also run monthly health campaigns aligned with national health priorities—such as Heart Month or Women’s Health Awareness—using instore displays and point-of-sale materials to share practical, engaging information. Each display combines educational messages with recommended products, helping customers connect knowledge with action.

Investment in Training and Development To deliver such a high standard of service, Spooner’s CarePlus Pharmacy has invested significantly in staff training.

All team members participate in continuous professional development, including monthly in-house workshops and bimonthly online training provided by the CarePlus Support Office.

These sessions cover topics like seasonal health trends, symptom management, drug interactions, and communication techniques.

Practical training—such as role-playing common patient scenarios—ensures that staff are prepared to handle sensitive health conversations with confidence and empathy. This hands-on, patientfocused approach helps build trust and ensures consistent, highquality advice.

The success of the Health Assessment Service is also rooted in Spooner’s CarePlus Pharmacy’s embrace of digital tools. The service is seamlessly integrated into the CarePlus online platform and mobile app, where patients can book appointments, receive reminders, and access personalised digital health reports.

These reports are written in clear,

jargon-free language and include specific next steps—whether that’s making lifestyle changes or following up with a GP. To raise awareness, the pharmacy partnered with the CarePlus Support Office Marketing team to create a video walkthrough of the Health Assessment process.

Promoted via social media, this engaging content demystified the service and helped bring new patients through the door.

A Measurable Impact The results speak for themselves.

Spooner’s CarePlus Pharmacy has seen a notable increase in repeat visits, positive patient feedback, and word-of-mouth referrals.

More importantly, patients are becoming more engaged in their health journeys. They are making lifestyle changes, monitoring their health more regularly, and seeking help earlier—before conditions become serious.

The pharmacy also analyses anonymised data from the assessments to identify community health trends. This allows them to tailor their services even more precisely—whether that means running targeted campaigns for blood pressure management or offering follow-up services for patients identified as high-risk.

Looking Ahead Winning the Haleon Self-Care Award is a proud milestone for

Spooner’s CarePlus Pharmacy— but it’s also just the beginning.

The team is exploring ways to expand the Health Assessment Service further, including targeted follow-up programs, more frequent health awareness events, and additional screenings based on emerging needs.

They remain committed to continuous improvement, using patient feedback and health data to evolve their offerings and ensure they remain relevant, impactful, and patient-centred.

Spooner’s CarePlus Pharmacy has redefined what it means to be a community pharmacy. Through their Health Assessment Service, robust patient education programs, and dedication to accessible, proactive care, they have become not just a place to pick up prescriptions, but a trusted partner in the journey to better health.

Their work exemplifies the values celebrated by the Haleon Self-Care Award—innovation, accessibility, and a deep commitment to improving lives. By equipping patients with the tools, knowledge, and support they need, Spooner’s CarePlus Pharmacy is helping build a healthier, more empowered community—and setting a new gold standard for pharmacy-led healthcare.

Congratulations to the entire team at Spooner’s CarePlus Pharmacy on this well-deserved recognition.

Cormac Spooner, Spooners CarePlus Pharmacy said after accepting their trophy, “Winning this is very humbling, to have been awarded the title amongst all the fellow nominees who are all incredibly worthy recipients. We are delighted that the services we provide have been recognised and have been of value to our patients.”

Pharmacist Anne Moore added, “We place a great importance on exceptional customer care with a vision to try and treat health poverties before they arise, whether that’s through vaccination or through health assessment and providing customers with the information to help them look after their own health.”

Mark Byrne, Customer Business Manager with Haleon said, “It is once again an honour for Haleon to sponsor the Self-Care Award and recognise the outstanding work done in this area, throughout the retail pharmacy sector.

“At Haleon, our purpose is to deliver better everyday health with humanity. Our brands play a vital role for people right across Ireland in a sector that is growing and more relevant than ever.

Health matters and taking care of something as important as our everyday health needs to be simpler and we believe Haleon is well positioned to become a leader in this space.”

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Awards

Awards

The Irish Pharmacy

2025

A Visionary in Community Care: Michael is Perrigo Superintendent Pharmacist of the Year

In a profession defined by trust, care, and excellence, few embody those principles more completely than Michael Maher. At a glittering ceremony attended by leaders in pharmacy and healthcare from across the country, Michael was officially recognised as the Perrigo Superintendent Pharmacist of the Year 2025 — a richly deserved honour celebrating over a decade of innovation, leadership, and unwavering dedication to patient care.

Michael Maher, Mahers totalhealth Pharmacy

SOPs, robust audit processes, and proactive risk management.

Nowhere is this more evident than in his management of high-risk areas such as controlled drugs, documentation, and cold-chain products — all held to the most stringent standards.

But compliance, for Michael, is not just about ticking boxes — it's about creating a culture.

A culture where accountability, professionalism, and safety are second nature for every member of the pharmacy team. His approach ensures that safety and excellence aren’t isolated events, but everyday realities.

Innovation with Purpose What truly sets Michael apart is his unique ability to harness technology for the benefit of patients. Long before it became common practice, he recognised the potential of robotic dispensing systems to improve accuracy, reduce human error, and free up pharmacists’ time for meaningful patient interactions.

As Superintendent Pharmacist and Owner of Mahers TotalHealth Chemist in Drogheda, Co. Louth, Michael has not only transformed his own practice but raised the bar for what community pharmacy can and should be.

Under his stewardship, Mahers has evolved from a trusted local pharmacy into a cutting-edge community health hub — one

that combines compassion with clinical precision, and tradition with visionary progress.

Setting the Gold Standard At the heart of Michael’s leadership is a deep, meticulous commitment to patient safety and regulatory excellence. His operation is defined by meticulously maintained

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Today, Mahers TotalHealth Chemist operates with a seamless robotic workflow that blends cutting-edge automation with human insight — a balance that ensures the highest standards of safety and care.

His implementation of the PillPac roll blister packing system has been equally transformative, particularly for elderly and vulnerable patients. The system’s intuitive design has dramatically

improved medication adherence, reduced hospitalisations, and restored independence to patients managing complex regimens.

These innovations have earned praise not only from patients but also from GPs and healthcare partners throughout the region.

Championing Chronic Care and Preventive Health Michael’s vision for community pharmacy goes far beyond dispensing. He has been instrumental in transforming his practice into a multi-faceted health hub, proactively addressing some of Ireland’s most pressing public health challenges.

From in-pharmacy vaccination clinics and chronic disease management programs to health education campaigns and private consultation services, Michael has embedded health promotion into the very DNA of the pharmacy. His leadership during the COVID-19 pandemic was particularly exemplary. Faced with clinical, operational, and emotional challenges, he remained a calm, decisive force — reorganising workflows, securing PPE, and rapidly launching a free delivery service to maintain care continuity.

Under his direction, Mahers became one of the first pharmacies in the region to deliver COVID-19 vaccinations on-site, providing protection for hundreds of vulnerable patients and playing a critical role in the national response.

Mentorship One of the most powerful testaments to Michael’s leadership lies in the words of his colleagues — especially the younger pharmacists and staff he mentors.

Described as “supportive, open,

71 Michael Maher, Mahers totalhealth Pharmacy with Anne Marie O’Neill, Field Sales Manager, Perrigo and transformative”, his mentoring approach combines structure and personalisation. Every team member at Mahers benefits from a tailored professional development plan, access to CPD, and regular coaching grounded in real-world clinical scenarios.

He’s also cultivated a culture where every team member is empowered to voice ideas, raise concerns, and contribute to innovation. He leads by example, fosters open dialogue, and celebrates both individual and team successes. The result is a work environment where professional pride, mutual respect, and shared purpose are not the exception but the norm.

As one of his mentees put it: “His mentorship doesn’t just shape better pharmacists — it builds future leaders.”

Beyond the pharmacy walls, Michael is a tireless advocate for the profession. Through his work with the Irish Pharmacy Union (IPU) as a member of the Pharmacy Contractors’ Committee, he has helped shape national policy, advocating for the vital role community pharmacists play in medication management, chronic disease support, and preventive care.

He also regularly collaborates with local HSE and public health authorities, ensuring clear communication and timely rollout of public initiatives — from vaccination drives to patient education campaigns. He is a bridge between policymakers and practitioners, ensuring that the voices of frontline pharmacists are not just heard but valued.

Legacy of Excellence — And Still Building Michael Maher’s journey in pharmacy began in 2007, when he joined the family-run Mahers TotalHealth Chemist as a newly qualified pharmacist. In 2011, he stepped into the role of Superintendent Pharmacist — a role that he has not just fulfilled, but redefined.

From implementing robotics and blister packing systems to championing chronic disease programs, Michael has made every decision with one thing in mind: improving patient outcomes. He understands that behind every prescription is a person — and he has committed his career to serving those people with integrity, skill, and heart.

Michael’s influence extends beyond his immediate pharmacy and patient base. Through his willingness to share knowledge, support peers, and lead by example, he has become a trusted guide for pharmacists across Ireland navigating an increasingly complex healthcare landscape.

Whether it’s helping a colleague optimise their workflows or advocating for funding support through the IPU, he has made it his mission to elevate the profession as a whole. In doing so, he has inspired a generation of pharmacists — and reminded us all what leadership in healthcare truly looks like.

The Perrigo Superintendent Pharmacist of the Year Award is reserved for those who demonstrate exceptional governance, visionary innovation, impactful mentorship, and unwavering dedication to patient care. In naming Michael Maher the 2025 recipient, the judging panel has not only honoured one individual — they have shone a light on what’s possible when pharmacy is practiced at its highest level.

As Superintendent Pharmacist of the Year, Michael stands not just as a winner — but as a standard-bearer for excellence in Irish pharmacy.

A Community’s Pride, A Profession’s Inspiration As news of Michael’s award ripples through Drogheda and beyond, one thing is clear: this recognition is deeply deserved.

Patients, colleagues, local healthcare providers, and national stakeholders alike have long known what this award now affirms — that Michael Maher is one of Ireland’s most outstanding pharmacy leaders.

His story is not only one of professional success, but of service, innovation, and humanity. In every decision he makes, every patient he advises, and every team member he mentors, Michael demonstrates that pharmacy is more than a profession — it is a calling.

And in answering that call, Michael Maher has set a standard that will resonate far beyond 2025.

On accepting his Award Michael said, “Receiving this Award feels surreal, I definitely wasn’t expecting it. I am delighted. The atmosphere here is unbelievable, the calibre of all the professionals in the room is inspiring and always enjoyable to be a part of. To have even been nominated for this I feel is real recognition and feedback that I am doing something right. At the end of the day we are a team and it’s what we do together that enables us to achieve what we achieve.”

Anne Marie O’Neill, Field Sales Manager with Perrigo said, “Perrigo is a global leading provider of over the counter (OTC) solutions for health and wellness.

With our healthcare landscape facing continual change, consumers are increasingly looking for self-care products that will improve their health and wellbeing and allow them to take proactive steps in making their lives better.

“We are committed to producing the highest quality products and solutions possible. It’s why our brands are trusted and valued by consumers. Well done to all the finalists and of course Michael on this great achievement.”

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Awards

Harold’s Cross Hero – Meadhbh wins PKF Brenson Lawlor Young Pharmacist of the Year

Awards The Irish Pharmacy

2025

In a profession where excellence is measured not only in clinical knowledge but in compassion, leadership, and innovation, few young pharmacists stand out as brightly as Meadhbh Honohan. This year, the pharmacy profession has proudly recognised her extraordinary achievements by naming her the Reckitt Young Community Pharmacist of the Year 2025.

Meadhbh Honohan, Boots Pharmacy Harold’s Cross

quiet confidence and visionary thinking, determined to shape the pharmacy into a trusted healthcare destination.

Within months, she had done just that. Patients quickly began praising her empathetic style — her habit of taking the time to listen carefully, explain treatments thoroughly, and even follow up after consultations. The personal touch mattered. It built trust, loyalty, and community connection, and it quickly set Harold’s Cross apart.

This patient-first ethos was most visible during flu vaccination season. In a store with no existing vaccine records or systems in place, Meadhbh led the charge. She built an efficient, welcoming workflow that allowed the pharmacy to deliver an extraordinary volume of vaccinations daily — boosting public health and putting Harold’s Cross on the map as a serious player in community care.

Innovation and Impact

Just over two years into her professional journey, Meadhbh has already made a transformative impact — not only within the walls of Boots Harold’s Cross, where she has been instrumental since its launch in February 2023, but also across the broader healthcare community. With her inspiring blend of empathy, innovation, and ambition, she represents the very future of pharmacy in Ireland.

A New Pharmacy, A New Standard of Care When Boots Harold’s Cross opened its doors in early 2023, it entered a competitive healthcare landscape — with no existing patient base, limited name recognition, and no established vaccination history. That didn’t faze Meadhbh. From day one, she approached the role with

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For Meadhbh, innovation is never about novelty — it's about meeting needs. Whether introducing patient loyalty initiatives that improved adherence to medication, or flagging operational issues to the Pharmacy Office that could affect service delivery, she approaches challenges with a proactive, solutions-focused mindset.

Her forward-thinking strategies didn’t just improve patient care — they transformed service

expectations. By streamlining workflows, enhancing accessibility, and creating seamless, patientfriendly systems, she helped Harold’s Cross transition from a startup pharmacy to a fully functioning health hub — and all within its very first year.

And patients noticed. Repeat prescription uptake rose sharply, vaccination clinics grew in reputation, and the pharmacy’s reputation as a “go-to” centre for community healthcare became well established. This wasn’t just growth — it was purposeful, people-centred progress.

A Mentor in the Making Perhaps most impressive of all is Meadhbh’s deep commitment to professional mentorship and development. Despite being early in her own career, she has already trained 13 Healthcare Assistants, four new-to-Boots pharmacists, and multiple new recruits — effectively transforming Harold’s Cross into a “School of Boots” within the region.

Her influence has already inspired two colleagues to pursue formal pharmacy careers, and several more to take on expanded roles within healthcare. Her coaching sessions are thoughtful and empowering, combining clinical accuracy with kindness and encouragement.

When the supervising pharmacist went on maternity leave during the store’s first financial year — a notoriously challenging period for any new business — Meadhbh didn’t hesitate to step up. She took the reins of operations, maintained service quality, and led the team through a complex year with confidence and composure.

Her leadership earned consistent

73 Meadhbh Honohan, Boots Pharmacy Harold’s Cross with Jason Bradshaw, Partner, PKF Brenson Lawlor

praise during internal governance visits, with assessors noting the store’s excellent organisation, morale, and clinical standards.

Commitment to Excellence Behind Meadhbh’s day-to-day achievements is a relentless drive for continuous improvement.

Sponsored by Boots, she recently earned a distinction in the Cardiology in Clinical Pharmacy Practice postgraduate module at Trinity College Dublin — an impressive academic accomplishment that speaks volumes about her commitment to staying on the cutting edge of pharmacy practice.

But for Meadhbh, learning doesn’t stop at her own development.

She shares her knowledge with colleagues through structured coaching, informal mentoring, and collaborative problem-solving.

She engages with national-level training programmes and works closely with Boots’ Pharmacy Office to ensure that any system inefficiencies are quickly addressed and improved.

Her approach combines academic rigour with real-world application, ensuring her patients receive upto-date, evidence-based care — and her team continues to evolve in skill and confidence.

Recognition from Every Angle Colleagues across the Boots network — from line managers to locum pharmacists — have praised Meadhbh not just for her intelligence and capability, but for her character and compassion.

She creates a work culture defined by openness, positivity, and mutual respect — a rare quality that inspires loyalty and excellence in equal measure.

One patient, in a heartfelt piece of feedback, described Meadhbh as “one of the best people I have ever met,” capturing what many in her orbit already know: that she is not just a pharmacist, but a genuine force for good in her community.

The Future of Pharmacy, Here and Now The Reckitt Young Community Pharmacist of the Year Award recognises early-career professionals who are redefining the standard of care through innovation, advocacy, and clinical excellence. In Meadhbh, the judging panel found a pharmacist who has already achieved all of this — and more — within her first two years of practice.

She is a true multi-hyphenate: a clinician, a mentor, a strategist, a community advocate, and a natural leader. Her impact is felt in every aspect of Harold’s Cross — from the smiling patients leaving her consultation room, to the inspired colleagues now charting their own careers in healthcare.

But Meadhbh’s story is still just beginning. Her trajectory suggests

a future full of even greater influence — not only within Boots, but across the wider profession.

Whether it's through policy, education, or clinical leadership, Meadhbh is poised to become one of the defining pharmacy voices of her generation.

A Deserved Honour for an Exceptional Talent In naming her the Reckitt Young Community Pharmacist of the Year 2025, the profession has rightly recognised Meadhbh Honohan’s rare combination of skill, vision, and heart. Her work is already reshaping the patient experience, advancing public health, and inspiring those around her.

And yet, to those who know her best, this award is not a surprise — it is a natural acknowledgment of the passion and purpose that define everything she does.

As Meadhbh herself would no doubt say: this is just the beginning.

After Accepting her Award Meadhbh stated, “What a feeling to be recognised by my peers and colleagues across the wider

profession. I was so honoured to be among the finalists, never mind actually winning the title. I am only three years qualified and to have this under my belt already is a huge driver of my ambition. I really feel now like there is no limit to what I can achieve and I have been so inspired by all the stories of innovation and dedication I have heard here tonight.”

Jason Bradshaw, Partner, PKF Brenson Lawlor said, “PKF Brenson Lawlor provide a range of services from buying and selling pharmacies to advice on overall business strategy. Over the years, I have had the pleasure of meeting many pharmacists and seeing many of our pharmacy clients develop and grow.

“Young pharmacists have an evergrowing role, and we have been able to meet many of them while providing business lectures to the pharmacy students at the Royal College of Surgeons (RCSI) and University College Cork (UCC).

PKF Brenson Lawlor provide awards and bursaries for the pharmacy colleges as we believe young pharmacists are the future of pharmacy.”

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Awards

Legacy in Motion: Brogans totalhealth Lead the Way in Technology

Awards The Irish Pharmacy

2025

In a year marked by innovation and advancement across Irish community pharmacies, one story stood apart — not just for its technological success, but for the heart and humanity that drove it forward. At the 2025 awards ceremony, Brogans Totalhealth Pharmacy in Loughrea, Co. Galway was named the recipient of the Lynked Excellence in Technology Award, in recognition of its outstanding use of automation to transform patient care, streamline operations, and honour the enduring legacy of a visionary leader.

Scott Flanagan, CEO, Lynked Loyalty, Patricia Amalia Sanchez Vega, Brogans totalhealth Pharmacy and Adnan Ishaq, Head of Sales, Lynked Loyalty

Where once a single technician was dedicated full-time to packing medications manually, the robot has now streamlined the entire process. Weekly packs that once consumed days of labour can now be prepared in just one to two days. The system allows the team to work a full week ahead, dramatically reducing stress, improving organisation, and freeing up staff time for other roles. It has also improved morale, introducing greater job variation and a stronger sense of control and calm across the week.

And for patients — especially those managing complex or chronic conditions — the change has been life-altering.

This Award is a celebration of resilience, collaboration, and the quiet power of purposeful technology. But it is also a tribute — to the late Jack Staunton, the pharmacy’s supervising pharmacist and co-owner, whose passion for innovation lives on in every pouch dispensed by the Yuyama robotic blister pack system he carefully researched and installed.

A Vision Realised Through Grief and Grit In May 2024, a game-changing piece of technology arrived at Brogans Pharmacy: the Yuyama Robot, a state-of-the-art blister packing system designed to improve patient compliance and

streamline workflow. But on the very same day it was delivered, Jack received a devastating cancer diagnosis.

Though he passed away later that year, Jack’s vision for what this technology could achieve became a guiding light for the pharmacy. Every wire, canister, and touchscreen was chosen by him with care — from the logistics of where the robot would be placed in the dispensary, to how it would fit into the team’s day-today operations. He had visited other pharmacies, studied every feature, and even commissioned renovations to make room for its optimal use.

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After his passing, the team — led by Supervising Pharmacist Lisa Jackson and supported by Jack’s wife Amber, now Pharmacy Manager — rallied around the robot as both a practical solution and a legacy to protect. The result is a service that now delivers blister-packed medication to over 100 patients with unprecedented precision, clarity, and reliability.

Technology That Truly Changes Lives The impact of the Yuyama Robot has been nothing short of transformative — not just for the pharmacy team, but for patients and families across the Loughrea community.

One patient with Parkinson’s disease, who requires six doses of medication per day, recently called the pharmacy to express her gratitude. The new robotproduced pouches now align precisely with her medication schedule: 8am, 10am, 2pm, 4pm, 7pm, and 9pm. “It takes the guesswork out of it,” she said — a testament to the robot’s role in restoring independence, improving accuracy, and elevating the therapeutic experience.

Streamlined Workflow, Reduced Errors, Better Stock Management The award judges also recognised Brogans Pharmacy for its holistic embrace of what modern pharmacy technology can offer.

75 Scott Flanagan, CEO and Adnan Ishaq, Head of Sales, Lynked with winners of the Excellence in Technology Award Brogans totalhealth Pharmacy, Loughrea,Marie O’Brien, Lisa Jackson, Amber Staunton and Patricia Amalia Sanchez Vega

The Yuyama system: • Streamlines processes, allowing pre-planning and better time management.

• Reduces errors through sensorbased verification — only matching canisters and scanned medications are accepted, with pharmacists still performing final checks.

• Improves stock control by precisely calculating weekly and monthly quantities needed, eliminating overordering and reducing waste.

With 112 canisters on rotation, the team now operates a rolling refill system that ensures consistent supply without tying up capital in unnecessary stock. It's a level of logistical sophistication rarely seen in independent pharmacies — made possible by embracing automation with strategy and care.

The journey to implement this system wasn’t without hurdles.

Staff training was complex.

With a busy work environment, coordinating sessions proved difficult. But thanks to the commitment of the robot supplier (PillPacPlus) — who stayed overnight locally and provided flexible, after-hours support — the team were gradually trained and supported through every step.

Ongoing video support, phone consultations, and live chat have helped smooth the process.

Patient education was equally important. Every initial pouch came with a personalised note and counselling. Within just a few packs, most patients had adapted fully and were thrilled with the new system. Key features — such as clearly printed medication names, strengths, and times — have made adherence more manageable and confidence higher than ever before.

There was, of course, the significant upfront cost. But as Lisa explains, the value it’s brought to the business and its patients has already proven itself. “We’ve gained new customers who were referred by word of mouth,” she notes. “That confidence — for patients and carers alike — is worth so much more than the hardware itself.”

Amber’s Role and Jack’s Legacy After Jack’s passing, his wife Amber returned to the pharmacy as manager and technician. Lisa trained her on the robot, and she now plays a crucial role in ensuring it is restocked weekly, fast-moving items are always available, and production runs are maintained with precision. Amber, Lisa says, has taken to the system “like a duck to water,” and her dedication has been central to keeping Jack’s vision alive.

Amber fills 28 canisters a week to maintain rotation and supports new staff training. The team, Lisa adds, have all been remarkably supportive — but Amber’s strength, presence, and contribution stand out as a driving force behind the technology’s continued success.

“This award would mean so much to her — and to all of us — as we look to operate in a technologydriven world without Jack to assist.

We still think of him as our ‘tech guy,’ and I know he’d find it funny and touching that we’ve won this award so soon after he’s gone.”

A Fitting Honour for a Pharmacy That Leads With Heart The Excellence in Technology Award is about more than gadgets or upgrades — it’s about purposeful implementation, measurable outcomes, and impact on the lives of real people.

Brogans Totalhealth Pharmacy has delivered all three. They’ve used automation to drive clinical safety, patient independence, team wellbeing, and financial

sustainability — all while navigating grief, transition, and new responsibilities.

They’ve shown that in the right hands, technology doesn’t just improve process — it deepens trust, strengthens care, and preserves the legacy of those who believed in its potential.

Looking Ahead With Pride and Purpose As Lisa reflects on the journey from installation to integration, one thing is clear: this is only the beginning.

More staff will be trained. More patients will benefit. More stories — like the woman with Parkinson’s — will unfold. And as Brogans continues to evolve, it will do so grounded in a rare combination of technical excellence and human connection.

totalhealth Pharmacy. I would like to dedicate to this to our boss and Supervising Pharmacist Jack, who sadly passed away just before Christmas. He was instrumental to this change we brought about within the pharmacy. Jack carried out all the research, he financed it and he really brought it to fruition but died before he was able to see it up and running. He would be deeply honoured and humbled so this really means a lot to us.

“Credit must be given to our Pharmacy Manager and Owner Amber, Jack’s wife who is bringing us all into this new normal and who is an incredible inspiration to the whole team. I know Jack would be so proud and I know we can upload his legacy and move forward in continuing to provide the best service we possibly can.”

To win the Excellence in Technology Award 2025 is to be recognised for outstanding achievement. But for the team at Brogans, it’s more than a title. It’s a tribute, a healing step, and a public affirmation of the power of passion-led innovation.

Scott Flanagan, CEO of Lynked Loyalty, said, “We’ve always been inspired by the opportunity to bring real value to customers within the community pharmacy space. Our loyalty technology is used by many pharmacy brands to enhance customer engagement and retention.

As Lisa beautifully put it: “The moment I saw the nomination, it brought a smile and a tear. I made it my mission to make sure this system succeeded — to make Jack proud.”

It’s so important to recognise technological achievements in pharmacy, given the tangible benefits they bring—from saving time to driving footfall and boosting revenue.

Mission accomplished

One key takeaway from tonight’s event is the importance of continued innovation. It’s innovation that will make the industry more efficient, and ultimately, create better experiences for both staff and customers.”

Lisa Jackson accepted the Award saying, “It is a huge honour to accept the Excellence in Technology Award on behalf of the entire team at Brogans

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Awards

Transforming Patient Care Through Excellence in Training and Development

Awards The Irish Pharmacy

In the ever-evolving world of pharmacy, where new medicines, regulations, and patient needs continually emerge, maintaining a well-trained, motivated, and knowledgeable team is paramount. At Adrian Dunne Pharmacy Rush, this belief forms the cornerstone of their operational philosophy. Their dedication to continuous training and development has not only elevated staff performance but also significantly enhanced patient care — a commitment recently recognised by the prestigious Uniphar Training and Development Award.

Jacqui Leonard, Business Development Manager with Uniphar presents the Award to Erik Garajkowstii, Adrian Dunne Pharmacy Group

A Culture Built on Continuous Learning At the heart of Adrian Dunne Pharmacy Rush is a team-wide commitment to professional growth. Recognising that both dispensary and over-thecounter (OTC) departments play vital roles in delivering quality healthcare, the pharmacy offers a comprehensive range of internal and external training opportunities tailored to meet the needs of every team member.

Dispensary technicians regularly attend sessions at the pharmacy’s support office, where they stay abreast of the latest medicines, regulatory changes, and efficiencyenhancing techniques. Meanwhile, the OTC team engages actively in internal training programs like Revive and Fexo. These courses deepen product knowledge, sharpen customer service skills, and empower team members to provide informed, personalised advice, ensuring customers receive the best possible care tailored to their individual needs.

Beyond internal training, the pharmacy encourages staff to pursue external courses, broadening their skills and introducing fresh communication methods and patient care techniques. This holistic approach benefits not only the team but also directly enhances the overall customer experience.

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A DIVISION OF

Leadership Development as a Catalyst for Change A key driver of the pharmacy’s training success is its focus on leadership development. The General Manager, Eric, recently completed the Management People Cycle course—a threeday intensive program delivering practical tools for motivating staff, improving communication, and streamlining daily operations—all underpinned by a patient-centred approach.

The impact of this training was transformative. Eric introduced daily team huddles to improve communication and align everyone’s focus. Task delegation and tracking were clarified, ensuring each team member understood their responsibilities.

Daily priorities were set with patient care at the forefront, and staff became actively involved in setting and reviewing daily targets, fostering a culture of accountability and engagement.

The results were immediate and far-reaching. Operational efficiency improved, stock management became more effective, product availability increased, and in-store displays were refreshed to better serve customers. Staff ownership of their roles deepened, with a clearer understanding of how their contributions drive the pharmacy’s success.

More importantly, patient care was elevated to the centre of the pharmacy’s operations.

Team members responded more swiftly to patient needs, resolved concerns with greater confidence, and genuinely invested themselves in creating positive, lasting experiences for every individual who visited.

77 A Structured, Proactive Approach to Training Adrian Dunne Pharmacy Rush takes a systematic and personalised approach to staff development. Daily huddles serve as a platform to reinforce operational updates, assess team knowledge, and identify any learning gaps. Regular OTC knowledge checks and quizzes ensure ongoing competency, while peer-led training sessions bring experienced colleagues from other branches to share expertise on targeted topics, fostering collaboration and knowledgesharing across the network.

Each team member’s progress is carefully tracked in individual training records, promoting transparency and consistency in development. Biannual Personal Development Reviews (PDRs) provide an opportunity for reflection, goal-setting, and alignment of training with both professional aspirations and patient care needs.

This comprehensive, responsive approach ensures every staff member receives tailored support, cultivating a culture of continuous learning and excellence in patient service.

Innovative Training Innovation is at the core of the pharmacy’s training ethos. Internal expert-led sessions, featuring specialists in key therapeutic areas, provide interactive learning experiences, equipping the team with up-to-date clinical knowledge to enhance patient consultations.

To motivate and engage staff, the pharmacy has introduced sales and service challenges focused on specific product categories, such as supplements that complement prescribed medications. These challenges encourage confident product recommendations that support patient health outcomes.

Post-challenge reviews celebrate successes, discuss impacts on patient care, and foster team motivation through shared achievements.

Peer-led departmental reviews further reinforce best practices.

Teams conduct detailed assessments of stock levels, expiry dates, and merchandising while refreshing their product knowledge.

Follow-up huddles allow findings and ideas to be shared across the team, encouraging accountability, collaboration, and consistent high standards throughout the pharmacy.

Together, these innovative methods have created an engaged, knowledgeable team passionate

Marty Whelan, Erik Garajkowstii and Clare Rafferty, Adrian Dunne Pharmacy Group with Jacqui Leonard, Business Development Manager, Uniphar

about continuous improvement and delivering exceptional patient care.

Personal Transformation and Leadership in Practice The story behind the pharmacy’s success is also a story of personal growth and leadership. Transitioning from a different retail background into the pharmacy sector was a significant challenge for the manager. Yet, through dedicated learning, hands-on leadership, and a focus on staff development, he has reshaped the team’s culture and operational approach.

The People Management Cycle course was a turning point, providing the skills to motivate the team, identify individual development needs, and nurture a culture based on trust, collaboration, and learning.

Since completing the course, the manager has implemented structured training schedules, daily huddles, peer reviews, and goal-oriented communication—all designed to build staff confidence and improve patient engagement.

Working alongside the team daily has been vital. This close interaction has fostered unity and empowerment, enabling team members to take initiative, share ideas, and embrace their responsibilities fully. Clarity around tasks and goals has boosted efficiency and performance, while a shared sense of purpose has flourished.

The Impact on Patients and the Community The true measure of success lies in the impact on patients, and here the results are clear and inspiring.

Returning customer numbers have risen, and many patients openly express appreciation for the care and advice they receive. The staff’s role has evolved from simple product dispensing to becoming trusted healthcare advisors who actively listen and build meaningful relationships.

Audit results have improved markedly, reflecting consistent, high pharmacy standards aligned with best practices. The overall atmosphere within the pharmacy has transformed: positivity, engagement, and motivation among staff are palpable and are felt by every patient who walks through the door.

This transformation demonstrates that investment in tailored training and leadership development directly enhances not only operational performance but also the patient experience and community trust.

Conclusion: Training as an Investment in Patient Care Adrian Dunne Pharmacy Rush’s achievement in winning the Uniphar LinkUp Consumer Training & Development Award is a testament to the power of continuous professional development and strong leadership in pharmacy practice. By fostering a culture of learning, collaboration, and patient focus, they have created a thriving workplace where staff excel and patients benefit from outstanding care.

Their approach highlights how structured training programs, innovative learning methods, and empowered leadership can transform both a team and the care they provide. It’s a model for others to follow—one that underscores the critical link between investing in people and elevating healthcare outcomes.

As the pharmacy continues to build on this success, it stands as a shining example of how dedication to training and development is not just a strategic choice but a commitment to excellence and compassion in healthcare.

Accepting the Award on behalf of the team, Erik Garajkowstil commented, “We’re absolutely honoured to receive this award.

Training and development have always been at the heart of what we do—because when we invest in our team, we invest in better care for our patients. This recognition is a reflection of the hard work, passion, and commitment our entire team brings every day. We’re proud to be building a culture where learning never stops and where every member of staff is empowered to grow and make a difference.”

Jacqui Leonard, Business Development Manager with Uniphar said after presenting the trophy, “Uniphar is proud to support the Training & Development Award, which embodies our dedication to excellence and progress within the pharmacy sector. As a proudly Irish-owned healthcare company with over 50 years of experience, we understand the essential role pharmacy professionals play in communities. This Award allows us to honour the commitment, resilience and continuous investment in training that enhances patient care and rives the future of healthcare. “

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News

¤6.5m Horizon Europe Bone Regeneration Project Dr Ciara Murphy, Senior Lecturer from the RCSI Department of Anatomy and Regenerative Medicine, the Research Ireland Centre for Advanced Materials and BioEngineering Research (AMBER) and RCSI Tissue Engineering Research Group, has been named a partner on a prestigious €6.5 million Horizon Europe grant.

Dr Ciara Murphy, Senior Lecturer, RCSI

“What sets HYDROHEAL apart is the integration of intelligent biomaterials with advanced drug delivery systems,” said Dr Murphy. “Our goal is to create eco-friendly, scalable solutions that don’t just support healing – they actively enhance it, improving outcomes for patients with serious skeletal injuries.”

The funding will support HYDROHEAL, an ambitious research initiative aimed at developing smart, sustainable biomaterials to transform the treatment of bone loss and fractures.

As part of the international HYDROHEAL consortium,

Dr Murphy will advance the development of injectable hydrogels made from natural, renewable sources. These hydrogels are designed not only to support bone healing – particularly in the spine and jaw – but also to deliver therapeutics precisely when and where they are needed, activated by external signals.

The project addresses a significant clinical need. Fractures caused by injury, infection, osteoporosis or cancer remain a major global health challenge, and current treatments such as bone grafts and bone cement have limitations in effectiveness and safety. HYDROHEAL’s bioengineered hydrogels will incorporate features to support healing, fight bacterial infection, and enable real-time treatment monitoring. They will also be enhanced through machine

learning and digital design tools, helping ensure sustainable, cost-effective production at clinical scale.

In addition to scientific innovation, HYDROHEAL will be informed by public and patient involvement (PPI). Patient groups affected by spinal and jawbone injuries will be directly engaged through focus groups, surveys, and consultation activities. The project aims to collaborate with at least five patient associations, ensuring that patient needs and priorities guide the research.

Professor Fergal O’Brien, Deputy Vice Chancellor for Research and Innovation at RCSI, welcomed the award, “This Horizon Europe funding reflects the outstanding calibre of Dr Murphy’s work and the strategic impact of RCSI’s regenerative medicine research.

HYDROHEAL is an excellent example of how scientific innovation, when grounded in clinical need and sustainability, can drive meaningful change in healthcare.”

Diabetes Ireland DICE Event Almost 450 healthcare professionals and researchers attended the Diabetes Ireland Conference and Exhibition (DICE) in Croke Park on 22nd of May 2025, where they heard from a top line-up of international and national speakers presenting on the day.

From a paediatric diabetes care perspective, excellent presentations were delivered by international and national experts covering diabetes education, sports performance and type 1 diabetes, managing different types of diabetes in children and learning from the National Childhood Diabetes Register.

Highly renowned, Professor Klemen Dovc from Slovenia discussed the benefits of technology in paediatric diabetes, and UK Psychologists, Drs Corah Lewis and Mary Owen, outlined the challenges associated with living with type 1 diabetes and neurodiversity.

In the pregnancy stream, complex and complicated cases were explored, alongside presentations on resources to support women with diabetes. The importance of nutrition in gestational diabetes was discussed, as well as strategies for preparing for pregnancy with pre-existing diabetes, presented

by Ms Cathy Jones (UK) and the significance of mental health during pregnancy was also highlighted.

In the acute stream, the importance of integrating psychology services into diabetes clinics was emphasised by Dr Rose Stewart and Dr Steve Stanaway from Wales, who explained both the rationale and practical steps for implementation.

Expertise was also shared on managing Type 1 diabetes in individuals who follow alternative diets, and a presentation outlined the key concerns and priorities of people living with Type 1 diabetes.

In the community stream, Ms Una O’Neill highlighted the need for awareness around Latent Autoimmune Diabetes in Adults (LADA) in primary care. Hormonal influences on diabetes, particularly in relation to menopause, were explored, and the role of dietitians in supporting people with diabetes within the Chronic Disease Model of Care was also highlighted.

Dr PJ Boyle shared his expertise on engaging effectively with minority groups. Dr. Amar

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Puttanna (UK) discussed diabetes complications, screening, and the often-overlooked link with oral health. Finally, Dr. Mark Davies (Belfast NHS Trust) addressed the critical issue of burnout among professionals working in diabetes care, offering insights on prevention and support The Keynote Lecture was delivered by a real diabetes trailblazer and one of the most recognised researchers in the field of diabetes, the president of the European Association for the Study of Diabetes (EASD), Professor Chantal Mathieu. Professor Mathieu’s talk on the ‘New Face of Diabetes’ outlined where we are and where we are going with managing and living with diabetes and its prevention. This excellent talk gave hope to many that the health and well-being of people living with diabetes or at risk of diabetes are continuously improving, and the research work is ongoing, bringing us closer to finding the cure for diabetes.

Following the keynote lecture, the youngest-ever DICE presenter, Ms. Hazel O’Grady, who along with her group were highly commended at the BT Young Scientist and Technology Exhibition this year for their project “Plastic not so fantastic: Sustainability in diabetes management”, was joined by Professor Michael O’Grady to explore the oftenoverlooked topic of diabetes and the environment. Their discussion served as a powerful reminder of the importance of environmental sustainability in healthcare and encouraged all attendees to take steps toward going green.

The event concluded with a series of short national updates, including: an overview of Diabetes Ireland activities, progress on the Language Matters initiative, insights from the National Paediatric Diabetes Audit (presented on behalf of the National Office for Clinical Audits), and an update on the National Diabetes Registry by its national lead.

Clinical Profiles NATIONAL CARDIOVASCULAR PLAN 2025 HSE West and North West is pleased to announce a significant new development in cardiac rehabilitation services as part of the National Cardiovascular Plan 2025. This initiative marks a major investment in the health and well-being of patients across the Galway-Roscommon and Mayo Regional Health Areas (RHAs).

As part of the implementation of the Integrated Model of Care for Cardiac Rehabilitation, funding has been allocated for 13 whole-time equivalent (WTE) positions. These positions will span key disciplines including nursing, physiotherapy, dietetics, psychology, and administrative support, ensuring a comprehensive and multidisciplinary approach to cardiac rehabilitation.

This enhanced programme will be delivered through a coordinated model of care, integrating both hospital and community services under a single governance structure. The end goal is to provide a fully connected, end-toend cardiac rehabilitation pathway for patients across the region and to: • Reduce waiting times for cardiac rehabilitation • Improve patient access and experience • Deliver better long-term health outcomes The launch of this integrated service model represents a key milestone in the delivery of the National Cardiovascular Plan 2025, and reflects the HSE’s commitment to high-quality, accessible, and patient-centred care.

service to empower individuals to take positive action to look after their cardiovascular health.”

Patient Denis Goggin welcomed the initiative, saying, “As someone who has directly benefited from cardiac rehabilitation, I know how vital these services are. Expanding and improving access means more patients will get the support they need to recover and stay well.”

“I felt very privileged and grateful to be invited onto the programme — not only for its valuable content, but also for the sense of continuity it gave me in maintaining a healthier lifestyle."

Ann Cosgrove, Integrated Healthcare Area Manager for Galway and Roscommon said, “This initiative reflects the HSE’s commitment to delivering highquality, accessible, and personcentred care. It also strengthens regional collaboration and brings us closer to achieving the goals of the National Cardiovascular Plan 2025.”

virtual care initiative for COPD patients. The initiative, which leverages remote patient monitoring technology, was recognised with the award for ‘Best Use of Information Technology’.

The COPD virtual care pathway which launched in April 2024, has redefined how care is delivered to patients experiencing a COPD exacerbation. The model enables patients to recover at home, supported by a multidisciplinary clinical team, fostering greater patient empowerment and continuity of care.

To date, 95 episodes of care have been delivered through the virtual pathway, resulting in the saving of 545 hospital bed days. The average length of stay under virtual care has been reduced to 6.01 days, compared to the national inpatient average of 7.5 days for COPD patients in Ireland.

GALWAY TEAM HONOURED FOR VIRTUAL COPD CARE INITIATIVE AT IRISH HEALTHCARE CENTRE AWARDS

Through a user-friendly application, MyPatientSpace, patients are empowered to report their daily symptoms and monitor key health metrics from the comfort of their homes. Equipped with a pulse oximeter, they can track vital signs such as oxygen saturation and heart rate on a daily basis. The system is designed to detect any deviations from target ranges or emerging concerning patterns, triggering real-time alerts for the clinical team. This enables rapid intervention and the development of personalised care plans, helping to address issues early and prevent escalation.

The Respiratory Integrated Care Team, Galway City Integrated Care Hub, and the HIVE Laboratory at the University of Galway were honoured at the Irish Healthcare Centre Awards recently, for their

Professor Sinead Walsh, Consultant Respiratory Physician, University Hospital Galway and Respiratory Lead for the Galway City Integrated Care Hub said, “This pathway has been transformative in how we

Mary Warde, Integrated Healthcare Area Manager for Mayo added, “This is a major step forward for cardiac care in Mayo and beyond. By enhancing local service capacity and improving integration between hospital and community care, we are helping patients access timely, effective rehabilitation closer to home.”

Dr Susan Connolly, Consultant Cardiologist at Galway University Hospitals and Galway City Integrated Care Hub, and Clinical Lead for the initiative, commented, “Cardiac rehabilitation (CR) is a life-saving treatment for patients recovering from cardiovascular events whilst also improving quality of life and reducing the risk of future hospital admissions. This investment will be transformative in how we deliver CR across the region.”

Dr Sarah O’Brien, National Clinical Advisor and Group Lead (NCAGL) Office of the NCAGL for Chronic Disease commented, “Expanding access to cardiac rehabilitation services as part of a strengthened preventative approach to cardiovascular disease is a key component of the National Review of Cardiac Services. Expansion of cardiac rehabilitation services in the region will ensure timely and equitable access to this critical

Jack Nagle, Head of judging panel; Emma Burke, Respiratory Advanced Nurse Practitioner; Denise Dunne, Operational Lead; Professor Sinead Walsh, Consultant Respiratory Physician; Clare Connolly, Respiratory Clinical Nurse Specialist; Fergal Moore, Senior Respiratory Physiotherapist, Ruth Kelly, Respiratory Clinical Nurse Specialist and Dr David Tiernan, Research physician, HIVE lab

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care for patients with COPD. It allows us to detect deterioration earlier, provide timely interventions, and support patients to recover safely in their own homes. The feedback from patients has been overwhelmingly positive—they feel more in control of their health and reassured by the daily connection with the care team.”

"This digital health initiative demonstrates how innovation happens through collaboration.

Professor Sinead Walsh, Consultant Respiratory Physician and her clinical team including Emma Burke, Respiratory Advanced Nurse Practitioner worked with Dr David Tiernan and the HIVE Lab research team at the University of Galway to develop and implement a novel digital health solution to improve COPD patient care", added Professor Derek O'Keeffe, Consultant Physician, University Hospital Galway and Director of the HIVE Lab, University of Galway.

This award-winning initiative reflects a broader shift toward digitally enabled, patient-centred care, demonstrating how technology can enhance clinical outcomes, optimise resources, and improve patient experience in chronic disease management.

NOVO NORDISK PRESENT FRONTIERS RESULTS Novo Nordisk has presented results from the phase 3b FRONTIER5 trial showing that a direct switch to investigational Mim8 (denecimig) prophylaxis from emicizumab treatment, without a washout period or Mim8 loading dose, was well-tolerated with no safety concerns in adults and adolescents living with haemophilia A, with or without inhibitors.

Additionally, a FRONTIER5 PatientReported Outcomes (PROs) assessment found the Mim8 peninjector easy to use, with an overall strong user preference for the peninjector compared to the previous emicizumab injection system.

The results were presented at the International Society on Thrombosis and Haemostasis (ISTH) Congress in Washington, D.C. In the study, the first Mim8 maintenance dose was administered on the next planned emicizumab dosing day. Patients were given the option of switching to once-monthly, once every two weeks or once-weekly dosing frequencies of Mim8, regardless of their prior dosing frequency.

Steady-state Mim8 concentration was achieved by Week 16, and emicizumab elimination was completed by Week 26. Switching to Mim8 led to a sustained increase in thrombin peak levels without an exaggerated thrombin response.

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“Continuous prophylactic coverage is critical to avoiding breakthrough bleeds in people living with haemophilia; with new non-factor therapeutic options, many people could have hesitations about switching treatment options. These data demonstrate that switching to Mim8 from emicizumab can be done without requiring a washout period,” said Allison P. Wheeler, MD, Washington Center for Bleeding Disorders, Seattle, WA. “This is critical in ensuring that individuals maintain continuous protection against bleeding events as we seek to help address the ongoing needs of people living with this complex disease.”

The open-label phase 3b FRONTIER5 study consisted of 61 adults and adolescents, aged 12 years and older, with haemophilia A. Mim8 was welltolerated with no safety concerns.

No thromboembolic events, hypersensitivity reactions, or treatment-emergent adverse events (TEAEs) leading to discontinuation were observed, and there was no clinical evidence of neutralising anti-Mim8 antibodies.

The PROs data from FRONTIER5 indicated a strong overall preference for the Mim8 peninjector, with 97% (n=57/59) of patients reporting a “very strong” or “fairly strong” preference in comparison to their previous emicizumab injection system. Of the participants who completed the Haemophilia Device Handling and Preference Assessment (HDHPA) questionnaire at week 26, 98% (n=58/59) found the Mim8 pen-injector “very easy” or “easy” to use, and 95% (n=56/59) found it “much easier” or “easier” compared with their previous administration method.

All participants (100%) were “extremely confident” or “very confident” in using the pen-injector correctly, and most participants (83%; n=49/59) found it “very easy” to inject the dose.

phase 3 FRONTIER programme will be disclosed at upcoming congresses and in publications in 2025 and 2026.

ALL-ISLAND PRIVATE HEALTHCARE EXCELLENCE AWARDS Mark Regan, CEO of Kingsbridge Healthcare Group, has been recognised for his outstanding contribution to the healthcare sector across the island of Ireland.

Mr Regan accepted the award at the inaugural All Island Private Healthcare Excellence Awards which took place recently in Belfast, and also recognised the exceptional clinics, practitioners, service providers and private hospitals providing outstanding care throughout Northern Ireland and the Republic.

Mark joined Kingsbridge, which now operates four private hospitals with two in Belfast, and others in Derry/Londonderry and Sligo, in 2005 after several years as a radiographer with the NHS and in medical innovation with Phillips.

He was part of the team that sold the first CT Scanner to 3fivetwo Healthcare, which later became the Kingsbridge Healthcare Group.

The highly esteemed independent judging panel, headed up by Dr Tom Black FRCGP, were keen to recognise Mark’s continued drive and mission for the private sector to supplement the NHS as it continues to face daily challenges.

Events, with expert guidance from clinical advisor Dr Jenny Addley.

Dr Devlin commented; “We set up the Awards to facilitate collaborative, cross border shared learning opportunities, and help shine a light on practices and individuals who are delivering outstanding care and sharing improved medical knowledge North and South of Ireland.

Everyone in the room on Saturday night, and beyond, will know of Mark Regan’s passion and commitment towards access to healthcare across Ireland.

“Mark has been a pioneer in revolutionising not only private healthcare services through Kingsbridge, but also the provision and access of such services, communicating how those needing non-urgent care can advocate for themselves and access it efficiently. He is an advocate for both the NHS and private services, and has demonstrated a respect and learning for both that we can all aspire towards.”

Kingsbridge Healthcare Group recently signed a new agreement with Vhi, Ireland’s largest health insurer, that will enable its 1.2 million members to access Kingsbridge’s services in Belfast, a move that brings the accessibility of cross border care to so many more.

The Private Healthcare Excellence Awards were founded by one of Northern Ireland’s leading NHS GPs and owner of two private health clinics, Dr Carla Devlin and Sarah Weir, Managing Director of Weir

Vhi was also a winner on the night, picking up the awards for Excellence in Patient Care, one of the most hotly contested categories, for its Hospital at Home services in Dublin, and Mental Health Initiative of the Year for their Paediatric Mental Health Occupational Therapy Services in Dublin.

Outstanding Contribution to the Industry - Mark Regan, CEO, Kingsbridge Healthcare Group

Alanna Denny, Paediatric Clinical Nurse Education Facilitator at Vhi Health & Wellbeing also won the Nursing & Midwifery Project of the Year for the Essentials in Paediatrics project.

“The FRONTIER5 safety and patient-reported outcomes data support Mim8 as a potential future treatment option for people living with haemophilia A and demonstrate our continued commitment to developing innovative treatment options for this community”, said Stephanie Seremetis, chief medical officer and CVP for Haemophilia at Novo Nordisk. “These results give valuable insights into haemophilia A management, highlight the feasibility of directly switching to Mim8 from emicizumab, and reveal a strong patient preference for the Mim8 pen-injector device.”

Novo Nordisk expects to submit Mim8 for regulatory review during 2025. Data from the ongoing

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Marble Arch Health picked up the Excellence in Cross Border Collaboration award for its Project Healthcare Without Borders operation in Enniskillen, providing all-island expert care and support for women dealing with complex health issues.

Other winners on the night included Dr Patrick Campbell for Excellence in Female Healthcare and Gentle Dental & Implant Clinic in Newry, which took home both the Excellence in Patient Care (Cosmetic Medicine/Dental) and Dental Practice of the Year awards.

Anna Gunning of Cosmed Medical Aesthetics Training Academy in Dublin was recognised with the Excellence in Leadership award, and Dr Steven Kinnear of Dundonald Consulting Rooms in East Belfast won Excellence in Patient Care (General Practice).

Newry Private Clinic won Medical Clinic of the Year while Loughview Health, Lurgan won Private General Practice of the Year and St. Vincent’s Private Hospital, Dublin won Private Hospital Innovation of the Year. (See full list of winners and highly commended in notes to editors.)

DUPIXENT APPROVED IN THE US AS THE ONLY TARGETED MEDICINE TO TREAT PATIENTS WITH BULLOUS PEMPHIGOID The US Food and Drug Administration (FDA) has approved Dupixent (dupilumab) for the treatment of adult patients with bullous pemphigoid (BP).

BP primarily affects elderly patients, and is characterized by intense itch, painful blisters, and lesions, as well as reddening of the skin. It can be chronic and relapsing with underlying type 2 inflammation. The blisters and rash can form over much of the body and cause the skin to bleed and break down, resulting in patients being more prone to infection and affecting their daily functioning.

Available treatment options are limited and can add to overall disease burden by suppressing a patient’s immune system.

The FDA approval is based on data from the pivotal ADEPT phase 2/3 study that evaluated the efficacy and safety of Dupixent compared to placebo in adults with moderateto-severe BP. Patients were randomized to receive Dupixent 300 mg (n=53) or placebo (n=53) added to standard-of-care oral corticosteroids (OCS). During treatment, all patients underwent a protocol-defined OCS tapering regimen if control of disease activity was maintained. During the FDA review, the analyses were updated; the FDA-approved results at 36 weeks in the label for Dupixent compared to placebo are:

81 • 18.3% of patients experienced sustained disease remission compared to 6.1% (12.2% difference; 95% confidence interval: -0.8% to 26.1%), the primary endpoint

Centre will make a real difference to people in Galway.”

For the first time in the West of Ireland, Vhi members will have walk-in access to a Vhi Urgent Care Clinic. The six-bay Urgent Care Clinic aims to assess patients quickly and discharge them within 90 minutes. Follow-up care with orthopaedic consultants or wound care nurses is also available on-site.

• 38.3% of patients achieved clinically meaningful itch reduction compared to 10.5% • Median cumulative OCS dose was 2.8 grams compared to 4.1 grams In this elderly population, the most common adverse events (≥2%) more frequently observed in patients on Dupixent compared to placebo were arthralgia, conjunctivitis, blurred vision, herpes viral infections, and keratitis. Additionally, one case of acute generalized exanthematous pustulosis was reported in one patient treated with Dupixent and zero patients treated with placebo.

George D. Yancopoulos, MD, PhD Board co-Chair, President, and Chief Scientific Officer at Regeneron said, “This approval extends the remarkable ability of Dupixent to transform treatment paradigms for people living with a variety of diseases with underlying type 2 inflammation, from common conditions like asthma and atopic dermatitis, to rarer ones such as eosinophilic esophagitis and prurigo nodularis, and now including bullous pemphigoid. Dupixent has shown the potential to improve the most challenging effects of bullous pemphigoid, while helping some patients achieve sustained disease remission and decreased oral corticosteroid use.

Additionally, this approval further reinforces the demonstrated safety profile of Dupixent in a broad age range of patients, from infants to elderly people, and across dermatological, respiratory, and gastrointestinal diseases.”

The FDA evaluated Dupixent under priority review, which is reserved for medicines that represent potentially significant improvements in efficacy or safety in treating serious conditions. Dupixent was previously granted orphan drug designation by the FDA for BP, which applies to investigational medicines intended for the treatment of rare diseases that affect fewer than 200,000 people in the US. Additional regulatory applications are also under review around the world, including in the EU, Japan, and China.

The facility is open seven days a week, 10am to 7pm, and joins existing Vhi 360 Health Centres in Dublin, Cork, and Limerick.

Members of the Proceive team proudly took part in the Vhi Women’s Mini Marathon in support of Féileacáin a not-for-profit organisation that provides support to anyone affected by the death of a baby during or after pregnancy.

Féileacáin offers vital services such as counselling, memory boxes, and nationwide support groups, providing comfort and care to families during an unimaginably difficult time.

As a brand dedicated to supporting individuals and couples on their fertility and pregnancy journeys, Proceive recognises that while this path can be full of hope, it can also involve heartbreak. Supporting Féileacáin reflects the brand’s deep commitment to families at every stage of this journey.

This cause holds both professional and personal significance for the team at Proceive. A team member has experienced Féileacáin’s support first-hand, making the brand’s involvement in the initiative especially meaningful.

Participating in the Mini Marathon was a way to honour those affected by baby loss and to raise awareness of the essential work Féileacáin does across Ireland.

The Proceive team has raised over ¤2,500 for the charity. To learn more or make a donation, visit www.feileacain.ie.

PROCEIVE SUPPORTS FÉILEACÁIN IN THE VHI WOMEN’S MINI MARATHON

VHI 360 HEALTH CENTRE OFFICIALLY OPENS IN GALWAY EXPANDING AVAILABILITY OF VHI SERVICES IN THE WEST OF IRELAND

On Sunday 2nd June, members of the Proceive team proudly took part in the Vhi Women’s Mini Marathon in support of Féileacáin,

Vhi has officially opened its new 360 Health Centre in Galway today, marking a major milestone in its nationwide healthcare network.

The opening of the redeveloped and enhanced Health Centre introduces Vhi’s 360 model of care to the West of Ireland, aiming to provide an integrated approach to patient health and wellbeing to ultimately improve health outcomes.

To celebrate the opening, Síle Seoige, Galway native and ambassador for the Vhi 360 Health Centre in Galway, toured the facility, learning more about the range of services now available to Vhi members in the region.

Situated on the Headford Road, Vhi 360 Health Centre offers access to Vhi’s integrated clinical services including: • Urgent Care for minor injuries and illnesses, available 365 days a year without appointment • X-ray and diagnostics • Medical Screening by appointment The Vhi 360 Health Centre in Galway also serves as a hub for Vhi’s Hospital@Home, a referralonly service where expert nurses and doctors deliver care directly to members in their homes, with the team already supporting patients in the region. In addition, members can access specialist services such as paediatrics and women’s health care as part of Vhi’s suite of integrated services.

Speaking about her visit to the Vhi 360 Health Centre in Galway, Síle Seoige said: “As a Galway native, living in the area with my young family, I’m thrilled to see Vhi’s 360 Health Centre open in Galway.

This new facility will allow people to access expert care, support and information in one welcoming space close to home. Having faced my own health challenges in the past, I am passionate about proactive health and wellness, and I believe that the availability of services through Vhi’s 360 Health

At the opening of Vhi’s 360 Health Centre in Galway, Anne O’Connor, Managing Director of Vhi Health and Wellbeing, said: “Today marks an important milestone for Vhi and our members in the West of Ireland as we open our new Vhi 360 Health Centre. This facility brings our connected model of healthcare to the region, offering access to a multidisciplinary team and integrated clinical services.

With services including urgent care for minor illnesses and injuries, as well as medical screenings that support early detection, our members will benefit from timely, expert care focused on achieving the best possible health outcomes.

This opening reflects our ongoing commitment to helping our members live longer, stronger, and healthier lives.”

Vhi’s 360 Health Centre in Galway is now open and can be found by searching Eircode: H91 E2R8. Urgent care is available to Vhi members seven days a week, 365 days a year from 10am to 7pm. For more information on services available at Vhi 360 Health Centre in Galway, please visit www.vhi.ie/360.

NEW VITAL RESOURCE LAUNCHED FOR WOMEN NAVIGATING MENOPAUSE AND DIET AFTER CANCER Recently, on International Day of Action for Women’s Health, a new vital and innovative resource has been launched for women affected by cancer, who are experiencing a treatment-induced menopause.

Menopause, Diet & Cancer is designed to offer practical, evidence-based guidance on how dietary and lifestyle choices can alleviate menopausal symptoms and enhance overall well-being.

Developed by CORU-registered dietitians Dr. Samantha Cushen and Ms Katie Johnston from School of Food and Nutritional Sciences and Cancer Research @ UCC, University College Cork, in partnership with the Irish Cancer Society, the book emerged from the Women’s Health Initiative

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Clinical Profiles Family members will always be consulted before any action is taken and if they do not agree, then the donation will not proceed.

Those who do not wish to donate their organs, for whatever reason, and have recorded their objection on the new National Organ Donation Opt-Out Register will have their wishes respected, and their family will not be approached on the issue of organ donation.

The Act also provides a framework for living donation and will, for the first time, provide a way for people who wish to donate a kidney to someone they don’t personally know, the opportunity to do so.

This is known as non-directed altruistic donation. They are donating an organ for someone on a waiting list who needs it.

Katie Johnston & Samantha Cushen “Linking You with Support and Advice” (LYSA) Trial.

Cancer treatments can sometimes trigger a sudden, intense menopause, often leading to more severe symptoms than those of natural menopause. For some, these symptoms are manageable, while others may find them overwhelming. They can impact quality of life and compound the physical and emotional burdens many women face during and after their cancer journey.

The resource integrates lived experiences, sound scientific evidence, and the invaluable perspectives of patients themselves, making it a trusted companion for women embarking on this complex journey.

Samantha Cushen, Lecturer in Human Nutrition and Dietetics & co-author of Menopause, Diet & Cancer said: “Navigating menopause after cancer is hard enough—finding clear nutrition advice shouldn’t be. For too long, women have been left to piece together guidance from too many, often conflicting, sources. In a world full of nutrition misinformation, this book brings it all together—offering clarity, compassion, and credible answers in one evidence-based guide designed to support, inform, and reassure.”

Katie Johnston, Oncology Research Dietitian & co-author of Menopause, Diet & Cancer said: “There is a serious lack of dedicated dietetic support for women managing the longterm, often debilitating, effects of cancer and treatment-induced menopause. All too frequently, my colleagues and I found ourselves in clinic, reaching for a resource that simply did not exist—one our patients clearly needed. Shaped by the voices of 16 women who

helped design what they needed most – Menopause, Diet and Cancer is not a clinical manual; it’s a book designed to be part of your everyday life—and your kitchen.”

Jointly, the authors state: “The launch of Menopause, Diet and Cancer marks a crucial breakthrough in Ireland, where dietetic support for cancer survivors is virtually non-existent.

This resource takes an important step toward making trusted dietetic advice a standard part of care for women after cancer—but much more needs to be done to ensure every woman has access, and we are determined to make that a reality.”

“This is the first Irish publication that has truly made me feel seen—not just in terms of my diagnosis, but in the full complexity of what I’m dealing with. Beyond understanding, this book offers clear, science-based nutritional advice and practical strategies I hadn’t been able to find elsewhere.”

HUMAN TISSUE ACT 2024 The HSE has welcomed the Human Tissue Act 2024 Part 2 which now provides a national legislative framework for organ donation and transplant services in Ireland for the first time.

The donation of an organ is an incredible gift that is life changing for the recipient and their families.

Consent is the cornerstone of this new legislation. Under this new legislation, all adults in Ireland will be considered to have agreed to be an organ donor when they die, unless they have recorded a decision not to donate on the National Organ Donation Opt-Out Register or are in one of the excluded groups. This is commonly referred to as a soft opt-out organ donation system.

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Speaking on the register, Dr Colm Henry, CCO, HSE said, “The opt-out organ donation system will bring us in line with international best practice. Organ transplantation is one of the great advances in modern medicine.

It offers a second chance at life to people with life-threatening illnesses or injuries to their vital organs. Every year, more than 200 people in Ireland have their lives improved or saved by the gift of organ donation. At any given time, approximately 600 people in Ireland are on waiting lists for organ transplants. I encourage you to have a conversation with your family or next of kin and let them know your wishes around organ donation.”

Dr Brian O'Brien, National Director, HSE Organ Donation Transplant Ireland added: "Not everyone who dies is a potential organ donor.

A donor needs to be in hospital and on a life support machine. All organs donated go to people most in need of a transplant. Consent is at the heart of this change.

When someone dies, their family must agree to donate their organs. It is important to inform

your family and friends about your decision regarding organ donation, as they will always be consulted and your wishes should be central to any decision.

The Act sets out who is considered a “designated family member” and this is usually the family member who has been the main point of contact for clinicians in their treatment of the deceased. This is the person who has to provide consent to the organ donation.

If no consent is received or no designated family member is found then the donation will not proceed.’’

The HSE is running an information campaign to inform the public of the changes around organ donation and how to access the opt-out register.

THE HEART OF THE MATTER – SIBLINGS UNDERGO SAME LIFE-SAVING HEART PROCEDURE University Hospital Galway (UHG) achieved a significant milestone in cardiac care last October by becoming the first hospital in Ireland and the UK to implant the Avalus Ultra biological aortic valve, a major advancement in the field of valvular heart surgery.

The ground-breaking procedure was first performed on Noel O’Brien from County Galway, marking the hospital’s inaugural use of the innovative valve. In a remarkable turn of events, Noel’s brother, Michael, underwent the same life-changing procedure, becoming the eighth patient to receive the implant last month.

Both surgeries were successfully carried out by Professor Alan Soo and his team at UHG.

Noel and Michael O’Brien from Tynagh in County Galway with Professor Alan Soo, Consultant Cardiothoracic Surgeon, University Hospital Galway

83 Both Noel and Michael O’Brien had experienced symptoms commonly associated with aortic valve disease, a condition where the valve narrows or leaks, forcing the heart to work harder to pump blood. If untreated, the condition can lead to heart failure and other serious complications. Patients with aortic valve disease, either stenosis (blocked) or regurgitant (leaky), often require valve replacement The Avalus Ultra valve is a next-generation aortic valve replacement that offers improved durability, enhanced surgical handling, and easier placement.

Its introduction places UHG at the forefront of cardiac surgical innovation in Ireland.

Professor Alan Soo, Consultant Cardiothoracic Surgeon praised the development, stating, “The introduction of the Avalus Ultra valve represents a new chapter in heart valve surgery. We are proud to lead the way in offering our patients the very latest in cardiac technology, ensuring better outcomes and improved quality of life.”

The successful adoption of this advanced valve system underscores UHG’s commitment to pioneering treatments and delivering world-class cardiac care to patients across Ireland.

CÚRAM AND B. BRAUN COLLABORATE ON SIMULATED VASCULAR ACCESS RESEARCH A research collaboration is to deploy cutting-edge simulation technologies to redefine best practices training and innovation for vascular access – the process of inserting a small tube or catheter into a vein to administer medication, fluids or take blood.

The project involves CÚRAM the Research Ireland Centre for Medical Devices at University of Galway - and B. Braun, a global leader in medical technology. It leverages B. Braun’s expertise in medical device development and University of Galway’s leadership in clinical simulation research to deliver evidence-based advancements in vascular access training. Known as the SIMETRIC project (Simulation and Imaging Methods for Eye Tracking and Recording Intravenous Catheter Insertion), it is harnessing cuttingedge simulation technologies to enhance clinical protocols, ensuring safer and more effective patient care. The initiative integrates eye-tracking systems, high-resolution video, wearable devices and motion analysis tools to assess and refine clinician performance in real-time.

This level of precision training is expected to significantly

support the need for more blood, platelet and plasma donations in Ireland. The experiences aim to reduce fear in donors and encourage more younger people to donate.

Only 3% of people eligible in Ireland donate blood, yet 3,000 blood donors are needed every week and one in four people in Ireland will require donated blood at some point in their lifetime.

Just one donation can save up to three lives. Critically, there is no substitute for human blood[1].

Dr Orlaith Hernon, Assistant Professor, School of Nursing and Midwifery; Dr Peter Carr, Associate Professor, School of Nursing and Midwifery; Dr Jing Wang, Post Doctoral Researcher, School of Nursing and Midwifery; Ms Jiaxin Deng, PhD Scholar, School of Nursing and Midwifery; and Dr Brian Deegan, Lecturer in Electrical and Electronic Engineering. Photo: Andrew Downes enhance competency, safety, and patient care standards.

The study, led by Dr Peter Carr, CÚRAM Funded Investigator and Associate Professor at the School of Nursing and Midwifery, University of Galway, will evaluate how simulation-based training can enhance clinician performance in ultrasound-guided long peripheral catheters.

The project will assess clinicians using three types of ultrasoundguided long peripheral catheters, including an innovative device from B. Braun´s long peripheral catheter (Deep Access) range. Dr Carr said: “Strong partnerships drive real change in healthcare.

By combining clinical expertise, cutting-edge technology and industry collaboration, we are shaping the future of vascular access training and device innovation.” The SIMETRIC project highlights the importance of interdisciplinary collaboration, bringing together nurses, vascular access specialists, biomedical engineers and researchers.

B. Braun said: “At B. Braun, we firmly believe that industryacademic-clinical collaboration is essential for advancing healthcare innovation and improving patient outcomes. By fostering strong partnerships between these sectors, we can leverage diverse expertise, drive groundbreaking research and develop cutting-edge medical solutions. Guided by our vision to protect and improve the health of people around the world, we are committed to collaborative efforts that enhance the quality of care and ensure a healthier future for all.” This partnership aligns with B. Braun’s commitment to advancing healthcare through innovation, creating new opportunities to collaborate with frontline clinicians and academic experts to develop smarter training solutions and cuttingedge medical devices.

Dr Carr said: “This project will aim to ensure that the new device is underpinned by robust evidence before it can be adopted in a clinical setting. We also want to demonstrate how technology can be leveraged by clinical academics to provide training simulation that leads to improved clinical and patient care. Nurses and vascular access specialists play a pivotal role in this study and their clinical expertise is invaluable in the development and evaluation of new technologies.”

Vascular access is considered a routine yet high-risk procedure in healthcare. Problems can arise from improper catheter insertion and ensuring healthcare workers have the highest level of skill, precision, and real-time feedback is critical for improving patient outcomes.

In response to growing demand from clinical partners, University of Galway is launching three new micro-credential modules based on the project’s findings. These courses will focus on ultrasoundguided cannulation and advanced vascular access techniques, supporting the increasing adoption of ultrasound-guided long peripheral catheters across a wider range of patient groups.

The outcomes of SIMETRIC will contribute to academic training, real-world clinical applications, and the future of vascular access education. By investing in collaborative research and professional development, the University of Galway and B. Braun are setting new benchmarks for innovation in medical training and patient care.

ABBOTT INTRODUCES MIXED REALITY EXPERIENCES TO DRIVE BLOOD DONATIONS IN IRELAND Abbott, the global healthcare company, today unveils two new mixed reality experiences to

A study with two blood centers in the US found that the use of mixed reality decreased anxiety in 68% of donors and 89% of donors reported they were very or extremely likely to donate again 2.

Participants wear lightweight headsets with a translucent visor, so the eyes of donors are always visible to clinical staff, ensuring constant monitoring and evaluation. Intergalactica is a new experience designed using gaming engagement principles in which donors build a team of robots to explore planets, solve puzzles, and defeat enemies – and Irish donors will be the first in the world to experience it. In another mixed reality experience called Zen Garden, donors listen to soothing music while planting seeds. Both experiences will be piloted in partnership with the Irish Blood Transfusion Service for a limited time, between May and June.

Joana Araujo, Global Marketing Director, Transfusion Medicine, Abbott said: "As a global leader in health technology, Abbott is always exploring new ways in which innovations can help improve the donor experience.

These headsets balance complex computing with a simple insight – many people fear donating blood and mixed reality technology makes it easier to donate blood by giving the donors something else to focus on while they give blood. We hope that the improved experience leads to more people wanting to donate blood in Ireland."

Paul McKinney, Director of Donor Services and Logistics, IBTS said: "This innovative technology introduces a gaming-like experience which evidence and feedback suggests makes blood, platelet and plasma donation less intimidating and more fun for the donor. We also hope it will encourage many people, of all ages, who want to donate but have been nervous about doing so in the past."

The pilot initiative will run between May and June in a number of IBTS donation centres in Dublin and Cork.

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