IPN November 2024

Expansion of Pharmacy Places Welcomed ¤30m for new CONFERENCE: ICO Eye Care FEATURE: Priorities for Type I Diabetes Page 24

MEN'S HEALTH: Understanding UTIs in Men Page 26 CPD: Cold and Flu Page 41 PEOPLE’S PHARMACIST: The Finalists for 2024 Page 48

Page 4: Two Awards for Life Pharmacy

Page 6: IIOP launch Cancer Care Hub for Pharmacists

Page 8: Budget for new medicines significant for patients

Page 12: Empowering Pharmacists through Accessible Conversations

Page 32: National Parenting Product Awards

Page 46: Pharmacy Role in RSV Awareness

Page 48: The Finalists for the 2024 People’s Pharmacist

Page 78: Revolutionising Pharmacy Management

PUBLISHER:

IPN Communications

Ireland Ltd.

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

MANAGING DIRECTOR

Natalie Maginnis n-maginnis@btconnect.com

EDITOR

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

SALES MANAGER

Amy Evans | amy@ipn.ie 0872799317

EDITORIAL/ EVENTS & MARKETING EXECUTIVE

Aoife Hunter: aoife@ipn.ie

CONTRIBUTORS

Sinead Fitzgerald

Donna Cosgrove

Javier Gonzalez

Aaron Hengist

Dylan Thompson

Bernie Carter

Laura Keaver

Adam Esa

Dr Niamh Corcoran

Professor Austin Stack

Helen Lake

Michele O’Brien

DESIGN DIRECTOR

Ian Stoddart Design

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.

Foreword

The pharmacy profession has welcomed the announcement of three new university programmes to provide education to the next generation of pharmacists. The Irish Pharmacy Union say the announcement will help Ireland overcome the critical shortfall of pharmacists and the country’s overreliance on Britain or the North of Ireland for training.

The Minister for Further and Higher Education, Innovation, Research and Science, Patrick O’Donovan TD has today announced the establishment of the new programmes in Atlantic Technological University, South East Technological University, and University of Galway. In total this is set to double Ireland’s education of pharmacists each year.

Welcoming the development, IPU President Tom Murray said, “Community pharmacies in Ireland have been struggling to recruit for several years. This is a result of not training enough pharmacists in Ireland. The issue was highlighted in an IPU workforce survey in 2022[1], which recommended that the Department of Health and the Department of Further and Higher Education, Research, Innovation and Science should undertake a detailed review of current pharmacy undergraduate places to determine if adequate numbers of pharmacists are being trained to meet future pharmacy workforce demands.”

Turn to page 4 to read more.

Meanwhile, on page 8, The Irish Pharmaceutical Healthcare Association (IPHA), the representative body for the research based biopharmaceutical industry in Ireland, has welcomed the allocation of ¤30 million for new medicines in Budget 2025.

Commenting on Budget 2025 allocation for new medicines, Oliver O’Connor, Chief Executive of IPHA said, “We welcome the funding of ¤30 million for new medicines which will greatly improve patient standards of care by ensuring they can avail of the latest innovative medicines available. We also welcome reported progress on the online medicines’ application tracker which will give everyone concerned greater visibility and transparency.”

This issue also carries the Finalists for the 2024 People’s Pharmacist Award. Co-ordinated by IPN, The People’s Pharmacist Award seeks nominations from across the country, giving customers the opportunity to recognise and salute their local pharmacist. Through this Award, we are enabling the public to have a voice in recognising the unwavering support and spirit that makes pharmacists the backbone of our health service in every community across Ireland.

As the scope and prominence of this Award has increased with each passing year, it has added even more value to the profession of pharmacy; through the strong and positive messages, not to mention, recognition given to the vital and impressive work being done by all the nominees, in their communities.

Over 700 nominations were received and after a strenuous shortlisting process, we feature the shortlisted finalists on pages 48-55.

I hope you enjoy the issue.

Regulars

FEATURE: MANAGEMENT OF OSTEOPOROSIS

FEATURE: SUGAR AND CARBOHYDRATES

FEATURE: ANAEMIA IN CHRONIC KIDNEY DISEASE P80

HSE Primary Care Reimbursement Scheme

The HSE has published the PCRS 2023 Statistical Analysis of Claims and Payments Report. It provides an overview of over €4bn in reimbursements and payments made in 2023, representing a €260m increase over 2022.

These payments were made through primary care schemes, including the GMS, Drugs Payment, Dental Treatment, Long Term Illness, and Community Ophthalmic schemes, and in relation to High-Tech drugs.

According to Shaun Flanagan Assistant National Director PCRS, “The PCRS Annual Statistical Report provides us with the data and analysis of the real impact and difference the services provided by our partners in the community such as GPS and pharmacists are making for our patients.

“In addition, these schemes provide more drugs in the community and hospitals for our patients and service users, making life-enhancing improvements for them. The HSE is funding more high-tech drugs than ever before; there is also more funding for

hospital cancer drugs and MS drugs. Our patients and services users can access more services than ever with increases in GP access and care.”

Key report findings include:

• 42% of the population now has access to free GP care, thanks to the expansion of the eligibility criteria in 2023.

• Universal GP visit card access was extended to all children under 8 years of age from 11th August 2023, with a change in the means assessment threshold to extend eligibility to those on or below the median income came into effect towards the end of 2023.

This report also highlights the number of pharmacy items dispensed and payments to

Two Awards for Life Pharmacy

suppliers and manufacturers of High-Tech drugs, including an additional ¤4.95m spend on hightech patient care fees. It details hospital payments in relation to Oncology Drugs and Medicines with over ¤36m more funding available in 2023, the National Hepatitis C Treatment Programme and a further ¤8.2m provided for Multiple Sclerosis Services. There was also an increase in investments in GP developments, with an additional ¤300,000 provided compared to 2022.

PCRS supports the delivery of a wide range of services to the general public through approximately 6,550 primary care contractors (general practitioners, dentists, pharmacists and optometrists/ophthalmologists) across a range of community health schemes.

Retail pharmacy brand celebrates top customer service accolade and milestone of 100 stores, marking three years of rapid progress.

Life Pharmacy, a member of the Uniphar Group, has been named the No. 1 retail brand for customer service in Ireland and the No. 2 overall brand in the 2024 Customer Experience Insight (CXi) Report, compiled by the CX Company. The accolade represents an outstanding achievement, highlighting Life Pharmacy’s impressive progress in just three years since first joining the survey and testament to its commitment to customer service excellence.

Since entering the CXi survey in 2022, Life Pharmacy has consistently demonstrated its dedication to exceptional customer care, moving from No. 9 in its first year to No. 6 in 2023, and now claiming the top position among retail brands. The remarkable rise coincides with Life Pharmacy’s recent milestone of welcoming its 100th store in Killeagh, Co Cork earlier this year.

Commenting on the results, Mairead Reen, Chair of the Life Pharmacy, said, “Life

Katie Flanagan, Lesley McCarthy, and Paddy Byrne of Byrne’s Life Pharmacy, Ballsbridge

Pharmacy is incredibly proud to be acknowledged as Ireland’s leading retail brand for customer service. This achievement reflects the passionate commitment of our pharmacy teams who strive every day to enhance the patient experience and keep us close to our communities. We are deeply grateful to every individual involved in making Life Pharmacy a compassionate and trusted name in communities across Ireland.”

Louise Martin, Retail Director at Uniphar, congratulated Life Pharmacy stating, “Uniphar is delighted to see Life Pharmacy recognised as the No. 1 retail brand for customer service in the CXi rankings and No.2 in the overall brand awards. Life Pharmacy's ongoing dedication to excellent patient care underlines our commitment to outstanding customer service and the continuous setting of new benchmarks in the retail pharmacy sector across Ireland. We are immensely proud of the collective effort that has helped position Life Pharmacy as Ireland’s topperforming retail brand.”

National Breastfeeding Week

National Breastfeeding Week took place from 1 to 7 October, and to mark the occasion the HSE has published the Breastfeeding Action Plan Progress Report for 2016 to 2023. Key highlights include:

• almost a fourfold increase in the number of dedicated infant feeding specialists available to support mothers (increasing from 15 to 59 since 2017)

• new National Infant Feeding Education programme underway for HSE staff

• an 18.6% increase in the percentage* of babies breastfed at the 3 months developmental check-up since 2015

• almost 22,000 queries answered via the HSE online breastfeeding support service since 2016.

This year the theme for National Breastfeeding Week is ‘Supporting you from Bump to Baby and Beyond.’ Sheila Lucey, infant feeding specialist in West Cork, said:

Skilled breastfeeding supports are available in all maternity units and hospitals, in local health services, and online where parents can ask breastfeeding experts questions at mychild. ie. Since 2015 almost 22,000 questions have been answered online by HSE experts.

Common questions include:

• is baby getting enough?

• how to settle baby?

• how to treat sore nipples?

• how best to express and store milk?

• can I take certain medication while breastfeeding?

Helping more mothers to breastfeed is crucial to improve long term population health and we must continue our efforts to support parents who want to breastfeed their children. We all have a role to play to promote breastfeeding; within our communities, in public services, in the workplace, along with the invaluable support of volunteer breastfeeding groups and dedicated staff in the health service.”

Pharmacy Musculoskeletal Pain Resource

At a recent International Pharmaceutical Federation (FIP) Digital Event, three new resources for pharmacists on using heat therapy to manage musculoskeletal pain were released: a guidance document, a summary guide, and a CPD Bite. They cover assessment, red-flag signs and management plans for non-specific lower back pain, non-specific neck pain, and hip, knee and/or hand osteoarthritis.

Musculoskeletal pain is a prevalent condition that affects millions of people worldwide, leading to decreased quality of life and increased healthcare costs. It is a frequent reason for consultation in community pharmacies, where pharmacists are often the first point of contact for patients seeking relief from symptoms. Given the key role community pharmacists play in healthcare delivery, there is a need to enhance their ability to effectively manage musculoskeletal pain.

This FIP guidance aims to support community pharmacists to conduct a thorough patient assessment, gathering information about signs, symptoms, medical history, and potential red flags that may require referral to a physician.

To guide effective management strategies, it is important to understand both the underlying mechanisms and classification of musculoskeletal pain. The sections within the above documents l explore the classification of pain according to pathophysiology and duration, which lay the foundation for the therapeutic approaches discussed.

In November 2023, FIP convened an international insight board with community pharmacists, policy experts, and researchers to explore the global role of pharmacists in managing musculoskeletal pain. This insight board specifically discussed pharmacological and non-pharmacological approaches, with a focus on heat therapy and strategies for effective patient engagement. A follow-up insight board, held in August 2024, involved multidisciplinary experts and further examined the role of heat therapy as a standalone treatment or in combination with pharmacological options.

Expansion of pharmacy education places welcomed

The Irish Pharmacy Union (IPU) has welcomed the announcement of three new university programmes to provide education to the next generation of pharmacists. The IPU say the announcement will help Ireland overcome the critical shortfall of pharmacists and the country’s overreliance on Britain or the North of Ireland for training.

The Minister for Further and Higher Education, Innovation, Research and Science, Patrick O’Donovan TD has today announced the establishment of the new programmes in Atlantic Technological University, SouthEast Technological University, and University of Galway. In total this is set to double Ireland’s education of pharmacists each year.

Welcoming the development, IPU President Tom Murray said, “Community pharmacies in Ireland have been struggling to recruit for several years. This is a result of not training enough pharmacists in Ireland. The issue was highlighted in an IPU workforce survey in 2022[1], which recommended

that the Department of Health and the Department of Further and Higher Education, Research, Innovation and Science should undertake a detailed review of current pharmacy undergraduate places to determine if adequate numbers of pharmacists are being trained to meet future pharmacy workforce demands.”

We are delighted that our efforts in highlighting this issue have been recognised in today’s announcement at a time when there are exciting opportunities within the sector with the role pharmacists play in frontline healthcare expanding. It also aligns with the Expert Taskforce recommendation which called

for an increase in the number of university undergraduate pharmacy places.

Ireland already has a great reputation in training pharmacists in our three existing pharmacy schools with Irish trained pharmacists renowned for their expertise and professionalism, which is reflected in the trust that patients have in their pharmacist.

“We welcome today’s announcement that this shortfall is to be comprehensively addressed, and we look forward to working with each of the higher education institutions as they establish their programmes.”

McCabes Pharmacy Places Top 10

McCabes Pharmacy has recently placed 7th in the Top 10 retail brands for Customer Service Excellence in Ireland.

Pictured is Aine McCabe with a McCabes Pharmacy customer

This recognition comes from the latest annual report by The CX Company which highlights an important theme: "Human over Hardware." The 2024 CXi Customer Experience report celebrates ten years of benchmarking Ireland's leading organisations CX scores.

Posting a statement on social media a representative stated, “At McCabes Pharmacy, we believe in the power of personal connection, and for every digital service we offer, there’s always a friendly, caring McCabes Pharmacist ready to connect, whether it’s through email, over the phone, or in-store. Our teams go beyond delivering

prescriptions; they deliver peace of mind, compassionate care, and a meaningful difference in our customers’ lives.

“We couldn’t be prouder of our amazing teams who continue to set the standard for patient care across Ireland. Your dedication is truly making an impact.”

IIOP Launch Cancer Care Hub for Pharmacists

The National Cancer Control Programme (NCCP) are delighted to have collaborated with the Irish Institute of Pharmacy (IIOP) to develop the IIOP Cancer Care Hub. The IIOP Cancer Care Hub is an online information resource hub for pharmacists which is focused on the care of patients with cancer. Although the Hub is intended to be a resource for all pharmacists, it is anticipated that it will be especially useful to community pharmacists.

The National Cancer Control Programme (NCCP) is a directorate within the HSE that works with health service providers and other partners to prevent cancer, treat cancer, and increase survival and quality of life for those who develop cancer, by converting the knowledge gained through research, surveillance and outcome evaluation into strategies and actions (www.hse.ie/eng/ services/list/5/cancer/).

The pharmacist’s role in supporting patients with cancer (in particular the community pharmacist) is evolving due to increasing numbers of patients on systemic anti-cancer therapy (SACT) receiving supportive care medicines from their community pharmacist and also due to the

increased use of oral anti-cancer medicines (OAM), which are largely dispensed in the community. Hence, community pharmacists have a significant role to play in supporting patients receiving treatment for cancer and living with and beyond cancer. Furthermore, they play a significant role in supporting the public to reduce their cancer risk and act on potential symptoms of cancer. It is also known from research carried out by Red C Research and Marketing in May 2023 that community pharmacists would welcome increased educational support on the topic of cancer.

It is envisaged that the IIOP Cancer Care Hub will support pharmacists in providing optimal care to patients with cancer who are receiving

PMI Christmas Lunch

cancer medicines, including OAMs. It is also hoped that the Hub will support pharmacists to answer cancer-related queries which may arise in everyday practice or when preparing for conversations with patients receiving cancer treatment.

The IIOP Cancer Care Hub also supports a number of the recommendations from key national documents including the National Cancer Strategy 2017-2026, the NCCP Oncology Medication Safety Review 2014, the NCCP OAM Model of Care 2018, the NCCP Systemic AntiCancer Therapy (SACT) Model of Care 2022 and the Sláintecare Action Plan 2023.

Description of the resource

The IIOP Cancer Care Hub has been designed to be an easily accessible single location where pharmacists can find information resources relating to cancer care. The content within the Hub has been organised into six main pillars which reflect the cancer care continuum, from prevention and detection, through to treatment and management of side effects, and then on to palliative care and survivorship. Within each pillar, resources have been organised into three categories:

- Pharmacist information (immediate)

- Pharmacist further education opportunities

- Information for patients.

The Pharmacist information (immediate) categories contain links to resources which it is hoped will help pharmacists quickly access information to answer queries which may arise in everyday practice or when preparing for conversations with patients on cancer treatment.

The Pharmaceutical Managers’ Institute Annual Christmas Charity Lunch takes place on December 12th in The Round Room, Mansion House, Dublin.

The charity partner for this year is the Alice Leahy Trust, who are a social and health service for people who are homeless. The Annual Charity Lunch is proudly supported by United Drug, Force and TCP Homecare. Visit www.thepmi.com for further details.

The Pharmacist further education categories contain links to resources which require more time commitment, e.g. a course or webinar. The Information for patients categories contain links to resources that pharmacists may find useful to share with their patients.

Since a single resource may contain information which is relevant to more than 1 of the 6 main pillars, some brief signposting has been included to direct pharmacists to the most useful section in that resource.

The IIOP website hosts other resource hubs on its website but this is the first hub that is focused on the topic of cancer. It is also the first IIOP hub to feature information resources that have been organised into a pathway of care and then sub-categorised to allow users to quickly locate the most appropriate resource.

In summary, the IIOP Cancer Care Hub has been developed to empower all pharmacists (in particular community pharmacists) to enhance the care they provide to the general public and to their patients with cancer. Another aim of the Hub is to motivate and engage pharmacists through opportunities to learn and develop new competencies, i.e. CPD. In addition, it is hoped that the Hub will help pharmacists to further build on strong relationships with their patients.

The resource is the foundation for further exciting work and collaboration between the IIOP and the NCCP. The IIOP Cancer Care Hub was officially launched on World Pharmacist Day on 25th September 2024 and can be found at this link: www.iiop.ie/ content/cancer-care-hub

Budget 2025: ¤30m for new medicines is significant for patients as it will allow for the continuous flow of new life-enhancing treatments

The Irish Pharmaceutical Healthcare Association (IPHA), the representative body for the researchbased biopharmaceutical industry in Ireland, welcomes the allocation of €30 million for new medicines in Budget 2025.

Advances in medicines development are steadily growing and IPHA members expect to make applications for reimbursement for 36 medicines in 2025. Arising from this budget allocation, as many as 3,700 patients, along with their families and carers, could now benefit from access to therapeutic advances. These medicines would improve the standard of care for patients suffering from a number of diseases such as cancer –breast cancer, leukaemia, prostate cancer, multiple myeloma and others – Alzheimer’s, stroke, women’s health conditions, migraine, dermatitis, asthma, ulcerative colitis, type 2 diabetes and liver disease.

IPHA also welcomes in Budget 2025 the introduction of a Chicken Pox vaccination programme. Vaccination and immunisation programmes play a vital role in protecting people’s health and, as vaccines are the most effective preventative measure against infectious diseases, they have a positive impact on the wider healthcare system.

As an industry we have been calling for greater transparency in the reimbursement system for quite some time. Therefore, we also welcome reports that an online medicines’ application tracker will be launched on the HSE website shortly. The purpose of this tracker will be to detail when a pricing application is received by the HSE and whether the application is progressing through the process. This level of transparency in the reimbursement process is vital for patients, clinicians and industry who will now be able to track a medicine as it progresses through each stage of the process.

While welcoming reported progress on the tracker, it is important that further steps are made to implement ‘indicative timelines’ for the completion of each stage of the reimbursement process. With this further initiative it should be possible for the all to see the HSE reaching a decision on the reimbursement of a lifeenhancing medicine within the legal requirement of 180 days, as set out in the Health Act 2013.

Commenting on Budget 2025 allocation for new medicines, Oliver O’Connor, Chief Executive of IPHA said, “We welcome the funding of ¤30 million for new medicines which will greatly improve patient standards of care by ensuring they can avail of the latest innovative medicines available. We also welcome reported progress on the online medicines’ application tracker which will give everyone concerned greater visibility and transparency.

“IPHA members are very conscious of their responsibilities in ensuring a faster and continuous flow of life-enhancing new medicines for patients in Ireland.

Improving Access to Biologic Drugs

We believe that doctors should have the right medicine available for prescription for their patients at the right time. We are calling for parties in their General Election Manifestos to give a new voice for doctors in prioritising new medicines for patients. We believe that Involving clinicians from the outset of the process will allow medicines to be available for patients faster.

“We will continue to work with all stakeholders to improve the process and enhance healthcare outcomes for patients in Ireland.”

Minister for Health Stephen Donnelly met with Peter Goldschmidt, CEO of European medicines manufacturer STADA, to discuss how competition can improve patient access to cutting-edge biologic drugs, as well as STADA’s investments in Ireland through its Clonmel Healthcare affiliate.

Minister for Health Stephen Donnelly met with Peter Goldschmidt, CEO of European medicines manufacturer STADA, to discuss how competition can improve patient access to cutting-edge biologic drugs

Along with the head of STADA’s Irish subsidiary, Clonmel Healthcare, Donagh O’Leary, the Minister and Goldschmidt explored how biosimilar alternatives enable the health system to treat considerably more patients at the same or lower costs. The conversation also included investment opportunities in Ireland, following Clonmel’s recent opening of a ¤3 million warehouse in its home town.

New Research on Steroid Tablets in Asthma

The Asthma Society of Ireland has recently revealed the results of new research into the dispensing of steroid tablets across Irish retail pharmacies.

The market research is published as colder, damper weather approaches, and residential fuel burning and increased viral infections trigger asthma symptoms and exacerbations.

The research, conducted by IQVIA, which used longitudinal retail pharmacy prescription data, revealed that in the period October–November 2022 an average of 258,202 people were dispensed medication licensed for asthma and/or COPD in Ireland. Within that group, almost 1 in 5 (18%) – 45,551 – were prescribed two or more courses of steroid tablets in the previous 12 months. The findings also revealed that nearly a quarter of asthma patients that were prescribed more than two courses of steroids tablets within the past year were under the age of 18.

Clinical best practice indicates that where an asthma patient requires multiple courses of steroid tablets within a 12-month period their asthma may be uncontrolled and they require a medical review. Uncontrolled asthma, if left untreated, can result in serious exacerbation, unscheduled GP visits, hospital admissions or even fatalities.

While steroid tablets are an effective and inexpensive treatment for acute asthma

symptoms, asthma should be routinely managed with inhaled steroids that treat the underlying inflammatory disease and are far less potent. A medical review would assess whether the person with asthma is on the right inhaler, receiving the right dosage and that they are taking their inhaler properly.

Steroid tablets are associated with significant adverse side effects and should be prescribed at the lowest effective dose for the shortest possible time. Longterm use can lead to cataracts, glaucoma, hypertension, diabetes, and depression. Even short-term use risks sleep disturbance, reflux, hyperglycaemia, sepsis, and increased risk of infection.

The research, conducted by IQVIA, used longitudinal retail pharmacy prescription data, and was reviewed by the Asthma Society of Ireland’s Medical Advisory Group. Dr Maitiú Ó Faoláin, Meathbased GP and member of the Asthma Society’s Medical Advisory Group, said, "Winter can be particularly challenging for people with asthma because cold air, mould in damp walls, pollutants from fuel-burning, and respiratory viruses can all trigger and worsen symptoms. The first step to staying well with asthma

Hand Hygiene Essential

While hand hygiene training is readily available, the HSE recently introduced mandatory training for all HSE staff and all staff in HSE funded services. Ahead of International Infection Prevention Week 2024, the HSE highlights the importance of effective hand hygiene, which is essential in preventing the spread of infection.

Dr Eimear Brannigan, HSE Clinical Lead for Infection Prevention and Control (IPC) says, “Our focus is on supporting the diverse range of staff who work to protect the health of patients in our services across the country. While hand hygiene training is available widely, it is significant that the HSE has recently introduced mandatory ‘hand hygiene’ training for all HSE staff and staff in HSE funded services. Good hand hygiene is the single most important way to help prevent the spread of infection and this comprehensive e-learning training will further support staff in their work.”

is to take your steroid inhaler as prescribed to calm and control any inflammation in your airways.

“GP surgeries are busier than ever, and we want to minimise time spent in waiting rooms or, indeed, on hospital trolleys. Ideally, GPs would take a proactive approach to scheduling regular asthma reviews, especially with their most vulnerable asthma patients.”

Eilís Ní Chaithnía, CEO of the Asthma Society, continued, “Earlier this year, a survey 2 we conducted among our members indicated alarming rates of symptoms, like night waking and limited activity, which signify poor asthma control among the patient population. This new market research, commissioned by AstraZeneca, has prompted the Society to again speak up about the risks of uncontrolled asthma and call for proactive and standardised care of people with asthma.

The inclusion of asthma in the HSE’s Chronic Disease Management Programme was a substantial step forward in the way asthma is treated in primary care. It is now time to expand the programme to tackle the persistently high rates of poorly controlled asthma in Ireland and our overreliance on steroid tablets in response to that challenge.”

The new mandatory training programme for HSE staff involves completing an eLearning module designed by the HSE’s Antimicrobial Resistance & Infection Control (AMRIC) team. With this new training staff are required to complete the module by 31 December 2024, with refresher training every two years.

Dr Brannigan continues, “All staff, not just those working in the field of infection, prevention and control (IPC), must be advocates for, and understand why, good IPC practices are so important throughout our services. Staff are supported through training, professional development, access to infection prevention resources and to ensure a consistent approach to IPC across all healthcare settings such as hospitals, residential services, community services and laboratories.

“It’s vital that we continue to strive to implement best practices across the country and to ensure that every patient receives the same high standard of infection prevention, regardless of where they receive their care.”

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"UD Talks" – Empowering Pharmacists through Accessible Conversations

In the ever-evolving world of healthcare, United Drug’s new podcast series, UD Talks, is a timely and muchneeded initiative. Hosted by Denis O'Driscoll, Superintendent Pharmacist for LloydsPharmacy Ireland, the podcast sets out to address some of the most pressing topics in community pharmacy.

Denis O'Driscoll, Superintendent Pharmacist, LloydsPharmacy Ireland

It’s more than just another industry podcast; UD Talks aims to create a platform where pharmacists and healthcare professionals can come together to engage with critical healthcare issues in an accessible, informative, and practical way.

From discussions about Naloxone use and sepsis awareness to conversations on the future of pharmacy, long COVID, and trans healthcare in community pharmacy, UD Talks covers a wide range of subjects that are often misunderstood in everyday practice. With Denis at the helm,

the podcast not only benefits from his vast experience but also brings in a diverse lineup of experts who provide fresh perspectives on these crucial issues. UD Talks also explores sexual health, a subject that community pharmacists often find themselves addressing in real-time with patients. The series doesn't shy away from sensitive topics, and that’s a testament to its commitment to making pharmacist education more open and accessible for all.

One thought provoking episode featuring Joanne Kissane, Registrar of PSI, also an experienced pharmacist and a forward-thinking voice in the industry, discussing the future of pharmacy. As the role of pharmacists continues to expand, Joanne’s insights into what lies ahead for the profession are both timely and necessary. Her expertise, combined with Denis’s practical understanding of the challenges faced by pharmacists on the ground, creates an engaging and educational dialogue.

Another critical area the podcast addresses is trans healthcare—a subject that is often neglected in both medical education and practice. By bringing this topic to the forefront, UD Talks demonstrates a commitment to inclusivity, ensuring that pharmacists are well-equipped to meet the needs of all patients, regardless of their gender identity or sexual orientation.

By providing easy-to-understand, evidence-based information on a range of topics, UD Talks equips pharmacists to have informed, impactful conversations with their patients, which could ultimately improve patient care. UD Talks creates a space for continuous learning and development—one that will benefit both healthcare professionals and the patients they serve.

UD Talks is available on Spotify and Apple Podcasts. For more information, please contact the marketing department at UDWMarketing@united-drug.com

Discussing UWWTD Impact on Pharma Sector

As a participating member of Medicines for Ireland (MFI), Donagh O’Leary, Managing Director at Clonmel Healthcare along with John Donnelly had the pleasure to meet with MEP Barry Andrews in conjunction with Paul Neill, Chairperson of MFI and Eimear O’Leary, Director of Communications and Advocacy at the Irish Pharmaceutical Healthcare Association (IPHA).

The meeting was held at the new European Parliament office in Dublin.

Discussed at the meeting was the Urban Wastewater Treatment Directive (UWWTD), the impact on the pharmaceutical sector and what we believe to be the potential negative implications the Directive will have if introduced in Ireland for the industry.

Paul Neill (MFI), MEP Barry Andrews, Eimear O’Leary (IPHA), Donagh O’Leary, Clonmel Healthcare, John Donnelly, Clonmel Healthcare

DispenSense: A catalyst for positive change in the pharmacy industry

Navi Group’s newest dispensary software, DispenSense, is the latest breakthrough in pharmacy technology, designed to revolutionise and simplify the dispensing process and workflow management.

Since its launch in December 2022, pharmacies using DispenSense have dispensed over 2.5 million items.

Navi Group has consistently led the charge in introducing innovative IT solutions to the pharmacy market in recent years. With DispenSense, the core focus of developing the software was to simplify and enhance the dispensing experience. The incorporation of state-of-the-art technologies within DispenSense ensures that it is not just a software solution; it’s a catalyst for positive change within the pharmacy landscape. This cutting-edge software with unrivalled features and modules being added continuously, strives to make dispensing more reliable, safe, and efficient. DispenSense empowers pharmacy teams to overcome everyday workflow challenges and efficiency blockers, in turn maximising their focus on patient care.

For a firsthand look at the impact of DispenSense, the customer testimonials below attest to its efficacy.

Pharmacies interested in experiencing the future of pharmacy operations can book a demo or explore more about DispenSense at dispensense.ie or by calling 01 4433884. DispenSense is not just another dispensary system. It’s a partner in supporting you to navigate the ever evolving landscape of dispensary management.

I have to say hats off to the team looking after DispenSense. There was a certain feeling that I was going blind into something new, but all was very relaxed and stress-free thanks to the DispenSense training team putting our staff very much at ease. Integration is seamless and imported data is displayed as though it was entered into DispenSense De Novo, so there is no old and new, just a bold step forward into the future of pharmacy dispensing software. A fantastic product implemented by a fantastic team. Highly recommended!

Cormac Deasy, Deasy’s Pharmacy Group, Cork

This was a big change for our team and for me in particular. I am very pleased to make the change though and have really got to grips with all the many benefits of DispenSense. Our monthly claiming processes seemed to be getting more and more complicated to interpret every month and DispenSense is a massive help for my team and I to maximise our payments and to minimise our rejected claims. DispenSense is helping us be more proactive every month and I am very happy to recommend it to all my colleagues who may be thinking of changing systems.

Tomás Conefrey, Conefrey’s CarePlus Pharmacy, Pearse St, Dublin 2

Install was seamless. The support from the DispenSense team is incredible, they are so quick and responsive on any queries raised. The system is very straightforward when it comes to monthly claims too. I would highly recommend DispenSense. Christopher O’Sullivan, Liberties CarePlus Pharmacy, Dublin 8

The installation of the DispenSense dispensary software and TillSense EPOS system went flawlessly. The DispenSense team has been incredibly responsive and supportive, always quick to address any questions. DispenSense is a well needed step forward in pharmacy dispensing software. The system is very straightforward when it comes to monthly claims too!

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ICO Eye Care in Focus Conference 2024

The annual Eye Care in Focus Conference, hosted by the Irish College of Ophthalmologists, took place on Tuesday, 1st October at The Gibson Hotel, Dublin.

The 1-day clinical education meeting is designed for the multidisciplinary eye care team working across community and hospital care in Ireland. It provides a unique opportunity for ophthalmologists, optometrists, orthoptists, ophthalmic nurses and technicians to come together to discuss current eye care pathways and developments, and facilitate a forum for shared learning across the disciplines..

Cataract Clinical Session

Talks at the cataract session outlined efficiencies and improvements to patient waiting times and care as a result of new cataract pathways in operation in Dublin North East (CHO9) and in Dublin South, Kildare and Wicklow (CHO7) regions. The pathway was reviewed under five areas to highlight how the process improvements were made in terms of referrals, referral management, pre-op assessment, day of surgery and post-op clinic.

Optometry Ireland President, Tania Constable gave key advice on how optometrists can improve their referrals to ensure the right patients are seen in the cataract clinics and that they are prioritised according to their visual needs.

Paediatric Ophthalmology Clinical Session

At the paediatric session

Dr Geraldine Comer discussed the policies and procedures developed in the HSE CHOWest/ Galway region to facilitate the development of a modernised integrated paediatric eye care pathway. The pathway has ensured children in the west are seen in a timely manner in the most appropriate setting. Dr Christine Bourke outlined the new pathways and services developed at CHI for children with Retinopathy of Prematurity, including links between tertiary and primary care. She highlighted the pathology of other eye conditions affecting premature children in the long term, namely cortical visual impairment (CVI) which is a commonly encountered condition.

Ms Tania Constable, Clinical Optometrist, CHO7 spoke to delegates about the considerations for adults with intellectual disabilities, who may have less contact with preventative services than the general population. Her presentation provided guidance on how to assess and manage

adults with additional needs in the community with the aim of improving access to eye care, also discussing alternative clinical testing, different communication approaches, and management strategies.

Clinical Programme in Ophthalmology

The presentations provided a progress update on the strategy for eye care and developments following the implementation of new integrated care pathways that have significantly reduced patient waiting times in cataract and paediatric ophthalmology.

The development and support of the role of orthoptics, specialist and advanced nursing and a new ophthalmic technician grade as integral to the integrated eye care team were also discussed at the clinical programme update session.

Making your Practice more Sustainable

The ophthalmic field, like many others in healthcare, has a significant environmental footprint. Cataract surgery is the highest volume surgery performed in Ireland. From the disposal of single-use instruments to the energy consumption of diagnostic equipment, the impact is considerable. This session aimed to highlight the simple and practical steps eye care professionals can take in their clinics to help reduce their carbon footprint.

It follows the focus on sustainability at the ICO’s Annual Conference in May this year, and demonstrates the College’s commitment to placing a spotlight and ‘call to action’ on the impact of the specialty's carbon footprint to the full eye care team. The ICO has developed a new sustainability education resource on its members portal, aimed at sign posting educational resources and providing helpful advice and practical tips on ways to reduce the carbon footprint in ophthalmology

Guest speaker Professor John Nolan, Director of the Nutrition Research Centre Ireland (NRCI) at the South East Technological University, discussed the role and evidence for targeted nutrition to improve visual function and also outlined plans for a New School of Optometry at South East Technological University in Waterford.

at the Irish College of Ophthalmologists ‘Eye Care in Focus’ Conference, The Gibson Hotel, Tuesday 1 October, Ms Aoife Doyle, HSE National Clinical Lead for Ophthalmology and Consultant Ophthalmic Surgeon, Royal Victoria Eye and Ear Hospital and St James's Hospital, Dublin, Ms Cathríona Ennis, Director of Nursing, Royal Victoria Eye and Ear Hospital, Dublin and Ms Sarah Spain, Senior Orthoptist, Health & Social Care Professions Lead for the National Clinical Programme in Ophthalmology

Keynote speakers at the Cataract Clinical Session, Dr Margaret Morgan, Consultant Ophthalmologist, CHO7 and Royal Victoria Eye and Ear Hospital, Dublin, Ms Lisa McAnena and Mr Tim Fulcher, Consultant Ophthalmologists, Mater Hospital and Beaumont Hospital, Mr John Doris (chair) President of the ICO, Ms Chriosa O'Connor, Clinical Optometrist, and Ms Tania Constable, Clinical Optometrist

Ms Tania Constable, Clinical Optometrist, CHO7 and President, Optometry Ireland, Dr Geraldine Comer, Consultant Ophthalmologist, University Hospital Galway CHO2 West and Dr Christine Bourke, Paediatric Ophthalmology Clinical Fellow, Children's Health Ireland at Temple Street and Crumlin Hospitals, Dublin

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Seasonal Ailments in Pharmacy

It’s no coincidence that more people get ill over the holiday period than at any other time of year. Parties, late nights, bad weather, over-indulgence in food and drink, not to mention concerns about the bank balance, all take their toll on people’s bodies.

With the winter season just around the corner, now is the time for community pharmacists and their teams, to be promoting the message that consumers should visit them first, for advice and treatment of common winter ailments.

Research shows that 18% of GP appointments are for minor ailments. Community pharmacists are in fact, best placed to advise on these conditions and over-the-counter available and appropriate medications.

Furthermore, the winter months provide the perfect opportunity for pharmacy to drive home the self-care message and ease the pressure on GP surgeries and A&E departments.

The Government has previously stated that the range of medicines provided without a prescription will continue to expand as part of the drive towards a National Health Service that promotes self-care and greater public choice. However, self-medication may not be appropriate for every patient in view of pre-existing medical conditions or because of interactions with other prescription

and non- prescription medications. This reinforces the importance of pharmacists, who have been trained to ask the right questions so they can give appropriate advice.

It has been previously revealed that treatment results for common ailments such as coughs and sore throats were equally good regardless of whether patients were treated at a pharmacy, A&E or GP practice, highlighting community pharmacy as a solution to the increasing burden on a stretched health service.

Community pharmacy can have an extremely positive impact on the health of the communities it serves due to the engagement pharmacy teams have with their patients every day. Pharmacists will offer advice on conditions and medications, and if appropriate, they will refer a patient to their GP if they feel it necessary.

Emphasis of Self-Care

Research indicates that, despite good intentions, many people do not know how to self-treat conditions such as coughs and colds and therefore visit their GP or A&E for advice.

Visiting pharmacy as an alternative could save up to 950,000 GP consultations every year. Pharmacies need to be aware of the crucial role they can play in educating customers about relieving symptoms of minor winter ailments.

Self care is a healthcare philosophy which emphasises the role of ordinary people in taking ownership of their health and wellbeing and includes taking actions to prevent and decrease the likelihood of disease and to restore health after illness or injury.

It is the first step and first choice for Irish people who are taking an increasingly active role in their healthcare and looking to improve their health and wellbeing.

Research from Behaviour & Attitudes1 confirms that there is a clear desire from the majority of people (92%) to be involved in decisions about their own health and medication, with 80% expressing their view that they see their pharmacist as a key partner in maintaining their health.

The role of community pharmacists is pivotal to the successful development of self

care and its more widespread adoption, according to the Irish Pharmacy Union (IPU) and the Irish Pharmaceutical Healthcare Association (IPHA), who, at the end of last year, launched a self care awareness campaign, entitled ‘Be Well this Winter – Think Pharmacy’.

The campaign was rolled out through the extensive deployment of social media, as well as a series of posters displayed nationwide in retail pharmacies.

Winter campaigns are frequently run on an annual basis by many major pharmaceutical companies, encouraging customers to selfcare when suffering from colds, flu, sore throats and other associated symptoms. It is important therefore that pharmacists are aware of these and educated in the key, core messages.

Preparing monthly displays about particular subjects, or a dedicated winter health display could be a perfect opportunity to promote self-care for colds, coughs and other winter ailments. Look out for printed leaflets and booklets that can be displayed on a healthy living pharmacy display table and handed out to customers or attached to prescription bags.

Engage with those ‘at-risk’

Using Self-Care and targeted campaigns as a tool to drive footfall to the pharmacy also gives you the perfect opportunity to engage with those people who are most at risk of flu.

For people aged 65 and over and those with long-term health conditions, including diabetes and kidney disease, flu can be particularly dangerous. If you feel that a customer falls into one of those categories, it might be worth advising them to book in for a flu jab as soon as possible to reduce their risk. Remind them that your pharmacy can offer this service, particularly if they are eligible for a free vaccine.

Although the World Health Organisation works to produce timely vaccines based on information available at the time, if the strain of flu mutates it may not be as effective. That’s why it’s also important that you take the time to advise people on how to tell the difference between symptoms of flu and symptoms of a common cold, so that they can treat

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20 Winter Health

themselves accordingly with the right OTC medicines if they fall ill. If someone has a lot of symptoms and asks for advice on what medicines to take, it might be worth recommending an OTC medicine that can treat a number of symptoms e.g. temperature and muscle aches at once. However, it’s important to remind them not to ‘double dose’ on paracetamol or ibuprofen if the flu medication also contains these.

Efficient Merchandising

The cough and cold season could also provide the perfect opportunity to reorganise fixtures in your pharmacy with a clear merchandising plan featuring beacon brands in both the P and GSL sections.

You really need to think about the winter season and make a proper planogram, that provides a merchandising tool on a tablet, so that any member of staff can scan the fixture and see what it should look like. Make sure that you feature the national bestsellers, as these beacon brands act as visual clues for customers and direct them to the products they are looking for.

There needs to be some offers that make the pharmacy look competitive and it is crucial that staff are trained to provide advice on seasonal ailments and OTC products.

Staff should also deliver public health messages by reminding customers to have a flu jab (see Panel) and, for example, when selling cough medicine finding out if the customer is a smoker and whether they would like help to quit. They won’t necessarily think the water tablets they are taking for their blood pressure are important but they could react with the decongestant in a cold remedy and cause problems. This could be a cue for the pharmacist to check through their medication records to ensure they are getting appropriate advice.

Ailment Overview

Common Cold

The common cold is a condition that is prevalent in the community and is associated with a variety of symptoms. Typically, it is an acute, self-limiting viral infection of the upper respiratory tract that is most frequently caused by rhinoviruses.

Symptoms commonly associated with the common cold include coughing, nasal congestion, low-grade fever, and fatigue, usually presenting 1 to 2 days after exposure. Generally, most

symptoms subside within 7 to 10 days, although some symptoms can persist for up to 3 weeks. The common cold is often mistaken for the flu. The flu is caused by the influenza virus, classified as type A, B, or C. Types A and B affect humans, with type A generating more severe symptoms. The influenza virus can be dangerous in older people and in those patients who are immunocompromised. Nevertheless, people with influenza are sicker than those experiencing common cold symptoms and commonly manifest such signs and symptoms as temperatures greater than 102°F, chills, headaches, myalgia, and malaise.

Sore Throat

Sore throat is a hallmark symptom of both viral and bacterial infections of the upper respiratory tract. Sore throat is a self-limiting complaint, resolving within three days in 40% of sufferers and within one week in 85% of people - even in those cases with a bacterial aetiology. The key symptom of sore throat is pain at the back of the mouth, which can vary from localised mild discomfort to intense pain on swallowing.

For sore throat sufferers presenting in pharmacy, regular use of paracetamol or ibuprofen-based products can be recommended to relieve pain (soluble analgesics can be gargled to provide targeted pain relief). Customers can also be advised to use simple mouthwashes at frequent intervals (e.g. warm, salty water) until the discomfort and swelling subsides. Sucking pastilles or lozenges stimulates saliva secretion, which lubricates the throat, and many throat sweets also contain soothing ingredients, such as glycerine and honey, to help relieve irritation.

Nasal Congestion

Nasal congestion is a blocked, stuffy or bunged-up feeling in the nose. Depending on the cause, it can last a short while (a few days) or can be persistent. In adults and children it is usually an annoying symptom rather than a serious one. In babies, however, a blocked-up nose may make it difficult to breathe or feed.

Some of the causes of nasal congestion include:

• Infections: the common cold and other respiratory tract infections, including influenza (flu) and sinusitis.

• Allergies, including hay fever.

• Persistent rhinitis.

Sinusitis

The sinuses are small, air-filled spaces inside the cheekbones and forehead which drain into the nose. Sinusitis means inflammation of a sinus. Most bouts of sinusitis are caused by an infection. Most cases of sinusitis are acute (lasting 1-4 weeks) but some may go on to a more persistent (chronic) sinusitis. The symptoms of sinusitis are mainly nasal congestion, and pain in the area of the affected sinus. This is most commonly in the forehead or cheeks on one or both sides of the nose. The pain may be worse on bending down. Other symptoms which may occur are dizziness and fever.

Sinusitis is usually treated with painkillers and decongestants.

Indigestion

The holidays aren’t the holidays without an overload of food. Indigestion can cause heartburn, nausea and discomfort or even pain in the chest shortly after eating. Over-the-counter

Medication Summary:

remedies can relieve the pain, but those getting regular bouts or experiencing other symptoms such as loss of weight, persistent vomiting, difficulty swallowing or blood in their vomit or stool, should be referred.

Alcohol Consumption

The festive season often means endless parties, catching up with old friends, eating and drinking. Research has found people drink much more than the annual monthly average during December. Regularly drinking above the daily unit guidelines during Christmas can cause temporary effects, such as headaches, sickness, diarrhoea and may also negatively affect mood, weight and sleep. Frequently consuming alcohol can also lead to liver damage. Advise on drinking responsibly, staying within the safe daily unit guidelines , to drink water or soft drinks between each alcoholic drink and to eat a filling meal before alcohol consumption.

Decongestants - These help to reduce nasal congestion by constricting the dilated blood vessels in the nasal mucosa. This reduces swelling and oedema of the nasal mucosa, making it easier to breathe. Decongestants are not suitable for pregnant and breastfeeding women and patients with hypertension. Nasal sprays and oral tablets should not be used concurrently.

Oral analgesics - Analgesics and antipyretics help to reduce pain and fever associated with sore throats and colds. Ibuprofen also reduces inflammation, which can help if sinuses are inflamed. Paracetamol and ibuprofen can be used in conjunction with one another but should be taken two to three hours apart for maximum benefit.

Combination products - Can contain ingredients such as a decongestant, analgesic, cough suppressant, antihistamine or an expectorant. These can be used up to their maximum dose for up to seven days unless they contain sedating antihistamines, when they should only be used for up to three days. Antihistamines work by drying up nasal secretions and should be used with a decongestant as they are relatively ineffective on their own. They can also cause drowsiness, so are often found in combination products to aid insomnia associated with having a cold.

Inhalants, vapour rubs and saline products - Inhalants work by helping to clear the nasal passages, while steam inhalation will help ease nasal congestion by loosening mucus. Saline preparations relieve congestion by helping to liquefy mucous secretions. Inhalants, rubs and saline products can be used daily until symptoms are cleared. They can be used as an alternative by patients who cannot tolerate decongestants.

Sore throat treatments - Most sore throats are caused by a viral rather than a bacterial infection, so don’t need antibiotics. Medicated lozenges or anaesthetic sprays can help relieve the symptoms of sore throat. Gargling regularly with an antibacterial mouthwash or warm, salty water can reduce any swelling and inflammation, while sucking pastilles or lozenges will stimulate saliva secretion to lubricate the throat and help relieve irritation.

Cold sore treatments - Cold sores usually clear up without treatment within seven to 10 days but antiviral creams, such as aciclovir or penciclovir, can be used to ease symptoms and speed up the healing time. Antiviral tablets are generally more effective than creams at treating severe cold sores, but are usually only prescribed in more intractable cases. Patches that contain a hydrocolloid gel can be placed over the cold sore to hide the affected area while it heals.

One solution for muscle and joint pain

Reduces pain and inflammation to improve physical function

Diclofenac gel provides superior pain relief compared with ibuprofen gel*

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

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

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

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

22 Winter Health

Vitamins for Immunity

Multivitamins have become increasingly popular not only during the winter months but also throughout the year with customers acknowledging the role and benefits they in supporting the body throughout the year.

The convenience of only having to take one tablet or sachet per day to receive a selection of vitamins and minerals is appealing to customers rather than having to take multiple tablets per day.

As mentioned above, there is a substantial choice of products available which have been specifically tailored for men and women.

Women’s supplements contain a higher dose of iron which is beneficial due to the loss of blood during the menstrual cycle.

The majority of supplements contain Vitamin C, Vitamin D, Vitamin B12, Vitamin E, Magnesium, Folic Acid, Zinc and Iron. Some then contain extra ingredients such as Ginseng which would be targeted for those who lead a very active lifestyle and need the surplus energy boost.

Supplements can be taken at any stage of life, however there are age specific products available such as those targeted for the over 50’s age cohort which have an increased focus on bone health which is very important in this population. Thus, they have extra Calcium and Vitamin D and we can see Lutein in certain supplements which is advantageous with regards to preventing age-related macular degeneration.

Vitamin D:

Vitamin D has become a mainstay with regards to the health and wellbeing of the population here in Ireland. As the pandemic progressed and the emergence of more information and research about the Coronavirus emerged, there was a significant increase in the requests for Vitamin D. Since then, there has been lots of engagement with the public who are eager to know more about the role of Vitamin D.

Vitamin D helps regulate antimicrobial proteins that can directly kill pathogens as well as Vitamin D also regulates many other cellular functions in your body. Its anti-inflammatory, antioxidant and neuroprotective properties support immune health, muscle function and brain cell activity

Vitamin D also has a significant role in the absorption of calcium which the body needs for building and maintaining healthy bones.

Vitamin D isn't naturally found in many foods, but it can be found

in from fortified milk and fatty fish such as salmon, mackerel and sardines. Direct sunlight is significant as the body makes Vitamin D by converting a chemical in the skin into an active form of the vitamin (calciferol).

With the weather here in Ireland and the significant decrease in sunlight as we come into the winter months, it is easy to see how the demand for Vitamin D has increased here and why Vitamin D has been recommended at all stages of life including newborn infants.

The recommended daily amount of vitamin D is 400 international units (IU) for children up to age 12 months, 600 IU for people ages 1 to 70 years, and 800 IU for people over 70 years.

Vitamin D is available in a wide range of formulations providing a greater variety of choice depending on the patient’s preference. Oral drops and sprays are available for infants and for adults which can result in quicker absorption. Chewable and gummy formulations may increase the compliance amongst younger children. Tablets are readily available, and some patients may prefer the convenience they provide.

Vitamin C:

Vitamin C (ascorbic acid) is a nutrient the body needs to form blood vessels, cartilage, muscle and collagen in bones. Vitamin C is also vital to the body's healing process.

It is an antioxidant that helps protect cells against the effects of

free radicals which are produced when the body breaks down food or is exposed to tobacco smoke and radiation from the sun, X-rays or other sources. Free radicals might play a role in heart disease, cancer and other diseases. Vitamin C also helps the body absorb and store iron.

Vitamin C can be obtained from a healthy diet as it is present in citrus fruits, berries and spinach. Vitamin C deficiency is more likely in people who:

Severe vitamin C deficiency can lead to a disease called scurvy, which causes anemia, bleeding gums, bruising and poor wound healing.

Vitamin C is available in many formulations ranging from chewable tablets, oral tablets and effervescent tablets. It is common to see Vitamin C products also containing zinc to help the immune system and there definitely is an increase in requests for such products coming into the winter months.

Zinc:

Zinc is essential for the body's growth and development and wound healing. It also helps regulate immune function, exhibits antioxidant activity, and helps support a balanced inflammatory response in the body.

It helps the immune system and metabolism function and is also important for wound healing and sense of taste and smell.

The immune system needs zinc to function properly. A zinc deficiency

reduces your ability to eliminate pathogens, mount a response against threats, and produce antibodies. It has been shown that if zinc is taken soon after cold symptoms appear, it may also shorten the length of a cold.

Zinc is available on its own mainly in tablet form but is quite popular in a chewable form combined with Vitamin C. The combination products appear to be more popular amongst customers due to ease of taking a single tablet.

Magnesium:

Magnesium keeps the immune system strong, helps strengthen muscles and bones, and supports many body functions from cardiac functions to brain functions.

The amount of magnesium recommended is 270mg a day for women (19 to 64 years).

Care should be taken as high doses (more than 400mg) for a short time has been shown to cause diarrhoea. Having 400mg or less a day of magnesium from supplements is unlikely to cause any harm.

Magnesium is available in tablet form at varying strengths and also in sachet form as a soluble powder for consumption.

All the above vitamins and minerals are commonly contained in multivitamins, and it is crucial to check with the patient if they are taking any vitamins and minerals before recommending products to ensure that they do not exceed the recommended dose.

Priorities for Adults with Type I Diabetes

A new research paper titled “The Top Ten Priorities in Adults Living with Type 1 Diabetes in Ireland and the United Kingdom – A James Lind Alliance Priority Setting Partnership” has been published, shedding light on the most pressing concerns and priorities of adults living with Type 1 diabetes. This study builds on the work done by the James Lind Alliance and partners in 2011 and the ongoing efforts of Diabetes Ireland, Diabetes UK and Breakthrough T1D to bring person-centred care to the heart of diabetes research and ensure that the voices of those living with type 1 diabetes are heard and acted upon.

The paper comes as we approach World Diabetes Day, held on November 14th each year. This date marks the birthday of Sir Frederick Banting – one of the founding fathers of insulin. Insulin is a treatment that has saved millions of lives around the world. On this day over 100 years ago Frederick Banting and John Mcleod also won a Nobel Peace Prize for their discovery.

This year the theme for World Diabetes Day is ‘Empowering Global Health’. This theme not only centres on individual health but also stresses the importance of communities working together to combat this global issue.

The study, conducted through a collaborative effort by people living with diabetes, their families, diabetes charities and clinical professionals across Ireland and the United Kingdom, utilized the James Lind Alliance (JLA) Priority Setting Partnership (PSP) approach. This method brings together patients, caregivers, and clinicians to identify and prioritize the most critical uncertainties in healthcare that require research attention, the JLA PSP approach ensured that the voices and experiences of those living with Type 1 diabetes were central to determining the most pressing research questions and care priorities.

Key Findings

The study revealed the top ten priorities for adults living with Type

1 diabetes, reflecting a range of concerns from daily management to long-term outcomes. These priorities are expected to shape the future of diabetes research and healthcare policy in the region.

Dr Newman the lead author of the study, emphasized the importance of these findings: “This study is a powerful example of how Public and Patient Involvement can shape the future of healthcare. This work highlights the real-world challenges and unmet needs of adults living with Type 1 diabetes. By focusing on these top ten priorities, we can ensure that future research and healthcare services are aligned with what truly matters to those affected by the condition.”

Top Ten Priorities

1. Can the use of artificial intelligence or fasting acting insulins help achieve fully closed loop insulin delivery?

2. Is time in range a better predictor of diabetes management and complications compared to HbA1c (an average reading of blood sugar over a 3-month period)?

3. What impact do hormonal phases such as the perimenstrual period and menopause play in glycaemic management and what treatments are most effective for managing glucose levels around these times?

4. What interventions are the most effective for reducing diabetes related distress and burnout?

5. What are the long-term implications of frequent hypoglycaemia on physical and mental health?

6. What impact does type 1 diabetes (including frequent low blood sugar) have on memory and cognition in older adults?

7. How can health care professionals better take into account the physical, psychological and social aspects of type 1 diabetes in clinics?

8. How can access to potential therapies like stem cell therapy, transplants and medications that modify the immune systems be improved so that everyone with type 1 diabetes can be guaranteed access?

9. Why do some people with type 1 diabetes become insulin resistant and does resistance increase with the number of years a person has diabetes and if so, why?

10. Can technology assist to accurately count carbohydrates without having to weigh or measure all foods and drink?

Implications for Future Research and Policy

The identified priorities will serve as a roadmap for researchers, funders, and policymakers, guiding future studies and interventions aimed at improving

the lives of those living with Type 1 diabetes. This work underscores the critical need for patient involvement in research and highlights the value of the JLA PSP process in addressing complex healthcare challenges.

Significance for Research and Policy

The study’s PPI-driven approach ensures that the identified priorities are not only reflective of the community’s needs but are also poised to inform and direct future research, funding, and healthcare policy. This collaboration highlights the importance of engaging patients and the public in the research process, ensuring that outcomes are meaningful and relevant.

Public and Patient Involvement (PPI) is an approach that places patients and the public at the heart of research and healthcare planning. PPI is research done with or by the public rather than to/for/about them. By placing people with lived experience front and centre, PPI centred research ensures that research priorities and healthcare strategies are aligned with the real needs and concerns of those affected by specific conditions.

The James Lind Alliance is a nonprofit initiative that aims to bring patients, caregivers, and clinicians together to identify and prioritize the most important research questions affecting their health. By focusing on patient-centered outcomes, the JLA PSP approach ensures that research efforts are directed toward areas that will have the greatest impact on those living with the condition.

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Date Prepared: October 2024

Understanding UTIs in men is crucial for effective diagnosis, treatment and prevention

Urinary tract infections (UTIs) are one of the most common bacterial infections globally, affecting millions of people each year. It is estimated that UTIs account for over 150 million cases annually worldwide. UTIs are a frequent cause of GP consultations, particularly among women.

Written by Helen Lake RN, UTI Information Nurse, The Urology Foundation

Email: nurse@theurologyfoundation.org

Helpline: 0808 801 1108

(Tues and Thurs 10am-12noon)

Resources: nurse@theurologyfoundation.org

Why specific strategies are needed for UTIs in men

Nearly 50% of women will have at least one UTI in their lifetime. While UTIs are more prevalent in women, they also represent a significant health concern for men, particularly as they age. The incidence of UTIs in men is lower than in women; however, when men do develop UTIs, these infections are often more severe and associated with underlying anatomical abnormalities, such as prostate enlargement, which can complicate treatment and increase the risk of recurrence.

The global and national burden of UTIs has been rising, partly due to the increasing prevalence of antibiotic-resistant pathogens, which complicates treatment and leads to higher healthcare costs. The complexity of managing UTIs in men, coupled with the growing challenge of antibiotic resistance, underscores the need for ongoing research and tailored management strategies. Understanding UTIs in men is

crucial for effective diagnosis, treatment and prevention. That’s why it is important for nurses to be given comprehensive information on the subject, to help improve patient care and encourage critical thinking about the unique challenges and considerations in managing UTIs in men.

Anatomy & Physiology

As a recap, the male urinary system includes the kidneys, ureters, bladder and urethra. Notably, the male urethra, which extends through the penis, is significantly longer than the female urethra. This anatomical difference provides a natural barrier to infection because the greater length of the male urethra makes it more difficult for bacteria to travel from the external environment to the bladder. However, the presence of the prostate gland introduces another layer of complexity in male urinary health. These anatomical features can create barriers to effective urine flow, contributing to a higher likelihood of complications such as prostatitis, urethral strictures and incomplete bladder emptying, all of which can increase the risk of recurrent infections.

Causes & Risk Factors

UTIs in men are commonly caused by bacterial infections, with E. coli being the most frequent pathogen. Other bacteria, such as Proteus, Klebsiella and Enterococcus, can also cause UTIs. The category of adult male UTIs encompasses conditions including urethritis, prostatitis, orchitis, epididymitis, cystitis and infections related to urinary catheters.

Older men are more susceptible to UTIs due to several factors.

Conditions such as neurological conditions, benign prostatic hyperplasia (BPH) and bladder neck muscular obstruction (BNO) can obstruct urine flow, leading to retained urine in the bladder and increasing the risk of infection. An incomplete bladder may lead to the formation of bladder stones, which can act as a reservoir for bacteria, increasing the risk of recurring UTIs and making it difficult to clear the infection. Kidney stones can also sometimes act as a reservoir for bacteria.

Men who use indwelling or selfcatheterisation need to ensure good standards of hygiene, a ‘no touch’ technique and regular reviews to monitor compliance to minimise UTI occurrence. There is evidence to suggest that men often struggle with compliance with intermittent self-catheterisation (ISC), considering it a nuisance and time-consuming, and also struggle with toilet facilities when out and about. This is an important factor to consider when supporting male patients with ISC.

Additionally, a weakened immune system, often due to autoimmune conditions, or cancer, and health issues such as poorly controlled diabetes, can impair immune function and bladder emptying. It’s important to remember that several of these factors can coexist.

Dehydration is another significant risk, particularly in older patients. As we age, the sense of thirst can become blunted, partly due to changes in the regulation of antidiuretic hormone (ADH). This leads to a reduced ability to concentrate urine, which accelerates dehydration. Constipation is also a contributing

factor as it can put pressure on the urinary tract, leading to incomplete bladder emptying. Both constipation and diarrhoea can cause bacterial contamination of the perineum increasing the risk of UTI.

Incidence of UTIs in

Men

UTIs are a significant health issue, especially over the age of 50 with the incidence increasing with age. Older men experience higher rates of infection due to associated risk factors, such as an enlarged prostate and a weakened immune system. Recurrent UTIs in men are a concern, though specific recurrence rates are hard to capture and can vary based on individual health factors and underlying conditions.

Symptoms & Diagnosis

Men with UTIs may experience frequent urination, an urgent need to urinate and a pain or burning sensation during urination (dysuria). They may also experience lower abdominal, pelvic, and rectal pain, along with cloudy, foul-smelling, or bloody urine. If the infection reaches the upper urinary tract, symptoms may include fever and chills.

• Urinalysis – Limitations: While urinalysis can detect signs of infection, such as the presence of white blood cells (leukocytes) and nitrites, it does not directly detect bacteria. The reliability of urinalysis is increasingly coming under scrutiny due to its potential for false positives and negatives, which can lead to either unnecessary treatment or missed infections. False positives can occur due to contamination, while false negatives can occur if the bacteria are not present in sufficient concentrations in the sampled urine.

• Urine Culture and Diagnostic Challenges: Urine cultures, which identify the specific pathogen and determine antibiotic sensitivity, remain the gold standard for diagnosis. However, it’s important to note that some culturing can be problematic if the laboratory’s

parameters for bacterial count are set too high. For example, a common threshold for significant bacteriuria is 100,000 colony-forming units (CFU) per millilitre (10^5 CFU/mL). This threshold can sometimes miss infections in symptomatic patients who may have lower bacterial counts, such as 1,000 CFU/ mL (10^3 CFU/mL) or 10,000 CFU/mL (10^4 CFU/mL), which are still clinically significant. Laboratories can lower the threshold based on clinical context and patient symptoms to improve diagnostic accuracy.

• Emerging diagnostic methods: PCR (polymerase chain reaction) testing and advanced microbial analysis, are being explored for their potential to offer more accurate and rapid detection of urinary pathogens. Nurses should stay informed about these developments and their local availability to ensure the most effective diagnostic strategies are employed. Additionally, when interpreting culture results, it’s crucial to consider the patient’s symptoms and clinical history to make informed treatment decisions.

• Physical Examination: Physical examinations, including checking for prostate tenderness or enlargement, are crucial. If indicated, imaging tests like ultrasound or CT scans help detect any obstructions or abnormalities in the urinary tract. Flexible cystoscopy is an essential diagnostic tool that should be routinely

considered when evaluating men with suspected urinary tract obstructions or recurrent infections.

Treatment & Management

Treatment typically involves antibiotics such as trimethoprimsulfamethoxazole, ciprofloxacin, levofloxacin, or nitrofurantoin, tailored to the specific bacteria and resistance patterns. Unlike women, men generally require a longer antibiotic course, often 7-14 days, this is because good antibiotic penetration into the prostate tissue is a challenge, and the prostate is a likely reservoir for bacteria in the male urinary tract. A 3-day course of antibiotics in male patients should always be challenged. Pain relief with over-the-counter analgesics like ibuprofen can help alleviate discomfort during urination.

Follow-up care ensures the infection is cleared, often through repeat urine tests. Completing the entire course of antibiotics, even if symptoms improve, is crucial so as to increase the likelihood of successful elimination of the UTI and reduce the risk of recurrence/ resurgence. Patients should be educated on maintaining proper hydration, especially older men who may have a blunted sense of thirst. Encouraging good hygiene and avoiding irritants like caffeine and alcohol are also important.

Prevention Strategies

Preventing UTIs in men involves several strategies, some of which

help flush out any bacteria that may have entered the urethra during sexual activity.

• Catheter Care: Men who use indwelling or self-catheterisation should practise good standards of hygiene, using a ‘no touch’ technique and not breaking the connections between drainage systems unnecessarily. It’s important to be aware of the signs of UTI and not necessarily go from the colour of the urine. Asymptomatic bacteriuria that is routinely picked up should not be treated with antibiotics.

are similar to those recommended for women, but with additional considerations specific to men:

• Hydration and Diet: Staying well-hydrated helps flush bacteria from the urinary tract. Addressing constipation with diet and lifestyle changes is important to prevent additional pressure on the urinary tract. Instructing patients and their carers or family members on the importance of ensuring fluids are made available and encouraging regular intake.

• Hygiene: Good personal hygiene, particularly after bowel movements, is optimal. Uncircumcised men should be vigilant about gently pulling back the foreskin and washing the head of the penis with warm water daily. There is evidence that uncircumcised males have a greater lifetime risk of UTI than men who are circumcised as infants. While the use of non-perfumed soaps and products is often recommended for women to avoid irritation, similar precautions can be beneficial for men, particularly those with sensitive skin or recurring infections.

• Sex: Safe sexual practices are crucial. Couples who have anal sex should use condoms to reduce the risk of introducing bacteria into the urinary tract. Additionally, washing the genital and anal areas thoroughly before and after sex can help minimise the risk of bacterial contamination and infection. Urinating after intercourse can

• Flow Issues/Prostate Health: Men should be encouraged to check in with their GP if they experience urinary flow issues or discomfort, as these symptoms may indicate problems such as benign prostatic hyperplasia (BPH), prostatitis, or urethral stricture. Addressing these symptoms can help identify and manage conditions that contribute to incomplete bladder emptying and increase the risk of UTIs. Encouraging the use of the double void technique can be beneficial to men as well as women, to help with bladder emptying and thus helping to prevent UTIs.

• General Health: Managing underlying conditions such as diabetes and maintaining a healthy immune system and gut health, through a balanced diet and regular exercise, can help reduce the risk of UTIs.

Criteria for Complex UTIs in Men

Recurrent Infections: Frequent UTIs suggest underlying structural or functional abnormalities that require thorough investigation, including cystoscopy, imaging, flow studies and often long-term management strategies, which may include surgical intervention/correction.

Antibiotic-Resistant Pathogens: UTIs caused by multidrug-resistant organisms are more challenging to treat, necessitating alternative antibiotic regimens and sometimes longer durations of therapy.

Structural Abnormalities: The presence of anatomical issues such as strictures, stones or congenital abnormalities often requires surgical intervention or specialised treatments.

Immunocompromised Status: Conditions like diabetes, HIV the use of immunosuppressive medications for chronic conditions such as rheumatoid arthritis or chemotherapy significantly increase the risk of complications and treatment failures.

Complicated Clinical Presentation: Symptoms extending beyond the lower urinary tract, such as fever, chills, flank pain and systemic symptoms, indicate a more severe infection that requires immediate and comprehensive treatment. Importantly, while women generally experience more cases of complicated and upper-tract UTIs (such as pyelonephritis), men can face a higher risk of mortality from these infections. Aside from men being less likely to seek medical intervention when ill, it is postulated that the increased risk may be influenced by sex hormones, with testosterone potentially dampening immune responses, while oestrogen in women may offer some protective effects. Additionally, millions of men suffer from acute and chronic bacterial prostatitis, further contributing to the overall burden of UTIs in male populations.

Why UTIs in Men are Considered Complex

The complexity of UTIs in men stems from anatomical, physiological, and clinical factors. The longer urethra and the presence of the prostate gland, which can become inflamed or enlarged, often complicate infections. Conditions like BPH, prostatitis, urethral strictures, kidney stones and bladder stones obstruct urine flow and increase infection risk. Bladder dysfunction, including neurogenic bladder dysfunction, also contributes to incomplete emptying and bacterial growth. Diagnosing UTIs in men often requires differentiating them from sexually transmitted infections, which have different treatment protocols.

Clinical Presentation and Diagnostic Challenges in Men

Men treated for UTIs and recurrent UTIs in primary care settings may have underlying conditions such as bladder cancer that can be missed without prompt referral and investigation. While the greater risk appears to be older women in a missed diagnosis scenario, men are also at risk of delayed referral. These patients need to be referred more quickly for cystoscopy to ensure accurate diagnosis and appropriate management. Additionally, bladder pain in men can often overlap with symptoms of chronic prostatitis, making differential diagnosis challenging. Infection may also be present in these cases, further complicating the clinical picture. Men often sit

on symptoms for longer or may not be aware that their urinary symptoms are significant. This delay in seeking treatment can lead to complications.

Alternatives to Antibiotics for recurrent/chronic UTIs

Managing recurrent or chronic UTIs in men often requires exploring alternatives to traditional antibiotic therapies. Several non-antibiotic treatments and future prospects are being studied, although many have not been extensively researched in men:

Vitamin C: Vitamin C is believed to acidify the urine and create an inhospitable environment for bacteria. However, clinical evidence supporting its efficacy in preventing UTIs is limited, and again not specifically studied in men.

D-Mannose: D-mannose, a type of sugar, has been suggested to prevent bacteria from sticking to the walls of the urinary tract. Recent research indicates that D-mannose may not be effective in preventing recurrent UTIs in women in a primary care setting. The study findings cannot be applied to more complex cases highlighting the need for further investigation.

Methenamine Hippurate: Methenamine acts as a urinary antiseptic by releasing formaldehyde in acidic urine. While it is used to prevent recurrent UTIs, its efficacy in men specifically has not been well-studied and requires further research.

Bladder Instillations: Intravesical treatments, where medications are directly instilled into the bladder, can include agents containing sodium hyaluronate and/or chondroitin sulphate. These treatments aim to reduce bacterial adherence and inflammation, although more research is needed to confirm their effectiveness. In complex cases intravesical administration of Gentamicin may also be used. Direct instillation into the bladder has the benefit of limited systemic absorption/ side-effects and does not come with the additional concern of antibiotic resistance. Further studies are ongoing.

Uromune Vaccine: This vaccine is aimed at preventing recurrent UTIs by stimulating the immune system. It is composed of a combination of inactivated whole bacteria commonly associated with UTIs - Escherichia coli, Klebsiella pneumoniae, Enterococcus faecalis and Proteus vulgaris. It is

taken daily as a sublingual spray for 3 months. Currently, in the UK, it is only available via specialist NHS recurrent UTI clinics or on private prescription. More research is required to determine its longterm efficacy.

Phage Therapy: This treatment utilises bacteriophages, viruses that infect and kill bacteria, as a potential treatment for antibioticresistant infections. This innovative approach shows promise but needs extensive clinical trials.

Other Vaccines: Research into new vaccines targeting UTIcausing pathogens is ongoing, with the hope of providing longterm prevention.

Interdisciplinary Collaboration is Key

Managing UTIs in men often requires collaboration across various urological subspecialties and primary care. Nurses should get to know their fellow specialists and work closely with them to enhance patient outcomes. Collaboration with urologists, nephrologists, infectious disease specialists, endocrinologists, radiologists, microbiologists, community-based nurses and GPs is essential. Regular interdisciplinary meetings and open communication channels are ideal for successful management, along with improved collaboration with GPs and Primary Care.

Conclusions

Understanding UTIs in men is essential for providing effective nursing care, as these infections are often more complex and require a highly individualised approach. Nurses play a crucial role in educating patients, delivering targeted treatments and implementing both prevention strategies and prompt interventions tailored to each patient’s unique circumstances. Continuous education and heightened awareness of the complexities associated with UTIs in men can significantly improve patient outcomes and reduce the incidence of these infections.

This includes how men engage with health services and their reluctance to seek help promptly. The complexities discussed in this article underscore the need for ongoing research and a more nuanced understanding of UTI manifestations in men.

It is hoped that this article has stimulated further thought and

discussion in this critical area of urology, encouraging nurses to consider the specific needs of male patients when addressing UTIs. The Urology Foundation’s UTI Information Service is here to help

The Urology Foundation appreciates the challenges associated with UTIs and is dedicated to providing resources and guidance needed. That’s why we launched a dedicated nurseled UTI Information Service to support and guide both patients and healthcare professionals. It offers valuable resources for healthcare professionals seeking advice and information as well as a telephone helpline.

Do you have ideas for research on UTIs?

The Urology Foundation is committed to driving change in the field of UTIs and to improving the lives of and outlook for patients and their families. UTIs have been identified as one of the research priorities in our Research Strategy 2024 – 2028. Thanks to the generosity of a donor, The Urology Foundation has a fund of £250,000 to support research into UTIs. Expressions of interest are due on 15th November 2024 and we would be delighted to hear from those with ideas.

About The Urology Foundation

The Urology Foundation is the UK’s only charity representing all urological diseases including prostate, bladder, kidney and male reproductive cancers and non-malignant conditions including incontinence, urinary tract infections, erectile dysfunction and kidney stones. We are committed to improving outcomes, quality of life and saving lives through investing in cuttingedge urology research; providing and supporting education and training programmes for the medical and scientific urology community; and achieving impact through awareness raising, improving understanding and driving change through policy and campaigns. Working with researchers, urologists, nurses and allied healthcare professionals, influencers and decision makers, patients and their families and those with an interest in urological diseases, we are leading the fight against urology disease.

https://www.theurologyfoundation. org/

ABBREVIATED PRESCRIBING INFORMATION

Please refer to Summary of Product Characteristics (SmPC) before prescribing Viagra Connect (sildenafil) 50 mg film-coated tablets

Indications, Dosage and Administration: Indications: For erectile dysfunction in adult men. Dosage and Method of use: Adults: one 50 mg tablet taken with water approx. one hour before sexual activity. The maximum dosing frequency is once per day. The onset of activity may be delayed if taken with food. Patients should be advised that they may need to take Viagra Connect a number of times on different occasions (max of one 50 mg tablet per day), before they can achieve a penile erection satisfactory for sexual activity. If patients are still not able to achieve a sufficient penile erection they should be advised to consult a doctor. Elderly: no dosage adjustments required (≥ 65 years old).

Renal Impairment: No dosage adjustments for patients with mild to moderate renal impairment. Dosage adjustments required for those with severe renal impairment, see SmPC. Hepatic Impairment: Dosage adjustments required for those with mild-moderate hepatic impairment, see SmPC. Viagra Connect is contraindicated for patients with severe hepatic impairment (see contraindications). Presentation: Film-coated tablets containing sildenafil citrate equivalent to 50 mg of sildenafil. Contraindications: Hypersensitivity to the active substance or to any of the excipients. Co-administration with nitric oxide donors (such as amyl nitrite), nitrates, ritonavir, guanylate cyclase stimulators (such as riociguat) is contraindicated. Agents for the treatment of erectile dysfunction, including sildenafil, should not be used by those men for whom sexual activity may be inadvisable, and these patients should be referred to their doctor. This includes patients with severe cardiovascular disorders such as a recent (6 months) acute myocardial infarction (AMI) or stroke, unstable angina or severe cardiac failure. Sildenafil should not be used in patients with severe hepatic impairment, hypotension (blood pressure < 90/50 mmHg) and known hereditary degenera tive retinal disorders such as retinitis pigmentosa (a minority of these patients have genetic disorders of retinal phosphodiesterases). Sildenafil is contraindicated in patients who have loss of vision in one eye because of non-arteritic anterior ischaemic optic neuropathy (NAION), regardless of whether this episode was in connection or not with previous PDE5 inhibitor exposure. Viagra Connect should not be used in patients with anatomical deformation of the penis (such as angulation, cavernosal fibrosis or Peyronie's disease). Viagra Connect is not indicated for use by women. The product is not intended for men without erectile dysfunction. This product is not intended for men under 18 years of age. Warnings and precautions: Erectile dysfunction can be associated with a number of contributing conditions, e.g. hypertension, diabetes mellitus, hypercholesterolaemia or cardiovascu lar disease. As a result, all men with erectile dysfunction should be advised to consult their doctor within 6 months for a clinical review of potential underlying conditions and risk factors associated with erectile dysfunction (ED). If symptoms of ED have not improved after taking Viagra Connect on several consecutive occasions, or if their erectile dysfunction worsens, the patient should be advised to consult their doctor. Cardiovascular risk factors: Since there is a degree of cardiac risk associated with sexual activity, the cardiovascular status of men should be considered prior to initiation of therapy. Agents for the treatment of erectile dysfunction, including sildenafil, are not recommended to be used by those men who with light or moderate physical activity, such as walking briskly for 20 minutes or climbing 2 flights of stairs, feel very breathless or experience chest pain. For a list of patients who are considered at low cardiovascular risk from sexual activity see SmPC. Patients previously diagnosed with the following must be advised to consult with their doctor before resuming sexual activity: uncontrolled hypertension, moderate to severe valvular disease, left ventricular dysfunction, hypertrophic obstructive and other cardiomyopathies, or significant arrhythmias. Sildenafil has vasodilator properties, resulting in mild and transient decreases in blood pressure. Patients with increased susceptibility to vasodilators include those with left ventricular outflow obstruction (e.g. aortic stenosis), or those with the rare syndrome of multiple system atrophy manifesting as severely impaired autonomic control of blood pressure. Priapism: Patients who have conditions which may predispose them to priapism (such as sickle cell anaemia, multiple myeloma or leukaemia), should consult a doctor before using agents for the treatment of erectile dysfunction, including sildenafil. Prolonged erections and priapism have been occasionally reported with sildenafil in post-marketing experience. In the event of an erection that persists longer than 4 hours, the patient should seek immediate medical assistance. Concomitant use with other treatments for erectile dysfunction is not recommended. Effects on vision: Patients should be advised that in the event of any sudden visual defect, they should stop taking Viagra Connect and consult a physician immediately. Concomitant use with CYP3A4 inhibitors: patients should be advised to consult a doctor before taking Viagra Connect as a 25 mg tablet may be more suitable for them. Concomitant use with alpha-blockers: Caution is advised when sildenafil is administered to patients taking an alpha-blocker, as the co-administration may lead to symptomatic hypotension in a few susceptible individuals. This is most likely to occur within 4 hours post sildenafil dosing. In order to minimise the potential for developing postural hypotension, patients should be hemodynamically stable on alpha-blocker therapy prior to initiating sildenafil treatment. Thus, patients taking alpha blockers should be advised to consult their doctor before taking Viagra Connect. Treatment should be stopped if symptoms of postural hypotension occur, and patients should seek advice from their doctor on what to do. Effect on bleeding: the use of sildenafil is not recommended in those patients with history of bleeding disorders or active peptic ulceration, and should only be administered after consultation with a doctor. Hepatic impairment: Patients with hepatic or renal impairment must be advised to consult their doctor before taking Viagra Connect, since a 25 mg tablet may be more suitable for them. Lactose: The film coating of the tablet contains lactose. Viagra Connect should not be administered to men with rare hereditary problems of galactose intolerance, total lactase deficiency or glucose-galactose malabsorption. Sodium: This medicinal product contains less than 1 mmol sodium (23 mg) per tablet. Patients on low sodium diets can be informed that this medicinal product is essentially ‘sodium-free’. Use with alcohol: Drinking excessive alcohol can temporarily reduce a man's ability to get an erection. Men should be advised not to drink large amounts of alcohol before sexual activity. Interactions with other medicinal products and other forms of interaction: Individuals receiving concomitant treatment with CYP3A4 inhibitors must be advised to consult their doctor before taking Viagra Connect, dosing adjustments may be required, see SmPC. Patients receiving alpha blocker treatment should be stabilised on therapy prior to initiating sildenafil treatment and must be advised to consult their doctor before taking Viagra Connect as dosing adjustments may be required, see SmPC. Caution when sildenafil is initiated in patients treated with sacubitril/valsartan, see SmPC. Fertility, pregnancy and lactation: There was no effect on sperm motility or morphology after single 100 mg oral doses of sildenafil in healthy volunteers. Viagra Connect is not indicated for use by women. Undesirable effects: Very common (≥1/10): headache. Common (>1/100, <1/10): dizziness, visual colour distortions, visual disturbance, vison blurred, flushing, hot flush, nasal congestion, nausea, dyspepsia. For details of uncommon, rare and very rarely reported adverse events and those of unknown frequency, see SmPC.

film-coated

L UE PIL L

Reporting of adverse reactions: Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via HPRA Pharmacovigilance, Website: www.hpra.ie. Adverse reactions/events should also be reported to the marketing autorisation holder at the email address: pv.ireland@viatris.com or phone 0044(0)8001218267.

Legal Category: Not subject to medical prescription. Supply through pharmacies only. Marketing Authorisation Number: PA23055/016/001 Marketing Authorisation Holder: Upjohn EESV, Rivium Westlaan 142, 2909 LD Capelle aan den IJssel, Netherlands. Full prescribing information available on request from: Viatris, Dublin 17. Phone 01 8322250 Date of Revision of Abbreviated Prescribing Information: 01 Feb 2024 Reference Number: IE-AbPI-ViagraConnect-v004

www.viagraconnect.ie

Men’s Health

Erectile Dysfunction

Erectile dysfunction (ED) is a common condition occurring in males over 40 years of age, although it can occur earlier. It is estimated that at least 150 million men globally have ED. It is difficult to obtain accurate values for the true prevalence of erectile dysfunction however, as many patients fail to seek medical attention, and many clinicians are reluctant to ask patients about their sexual health.

Erectile dysfunction is the inability to achieve or maintain an erection for satisfactory sexual performance, and affects a considerable proportion of men at least occasionally. It is often treatable, however, if left untreated, ED can be a source of severe emotional stress for both the man and their partner.

Although most men will experience periodic episodes of erectile dysfunction, it tends to become more frequent with advancing age. Many factors can contribute to sexual dysfunction in older men, including physical and psychological conditions, comorbidities and polypharmacy. Aspects of an ageing man’s lifestyle behaviour and androgen deficiency, most often decreasing

testosterone levels, can affect sexual function.

While ED is associated with ageing, many studies and largescale surveys have concluded that ED is a major health concern among young men.

The condition can be caused by any disease process which affects penile arteries, nerves, hormone levels, smooth muscle tissue, corporal endothelium, or tunica albuginea. It is closely related to cardiovascular disease, diabetes mellitus, hyperlipidaemia, hypertension, and endothelial dysfunction.

Besides cardiovascular disease, there are strong correlations between ED and hyperlipidaemia, diabetes, hypogonadism,

obesity, smoking, alcoholism, benign prostatic hyperplasia (BPH) with lower urinary symptoms (LUTS), depression, and premature ejaculation.

Numerous medications are listed with erectile dysfunction and/ or a decreased libido as a side effect. Drugs that can cause ED include hydrochlorothiazide’s and betablocking agents. Medications used to treat depression, particularly the SSRIs such as citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine and sertraline, can also contribute to ED. The severity of erectile dysfunction is often described as mild, moderate or severe according to the five-item International Index of Erectile Function (IIEF-5) questionnaire, with a score of 1–7 indicating

Cialis for men® Now Available OTC

severe, 8–11 moderate, 12–16 mild–moderate, 17–21 mild and 22–25 no erectile dysfunction.

A thorough medical history, detailed sexual history, and physical examination are required before commencing treatment or further investigations. It is important to distinguish between psychological and organic causes of ED, as well as to ensure that the patient has erectile dysfunction and not another disorder. History that points towards a psychological aetiology include, sudden onset of erectile dysfunction especially if it is related to a new partner or a major life-changing event, situational ED, normal erections with masturbation or a different partner, presence of morning erections and high daily variability in erectile rigidity.

Clonmel Healthcare, in conjunction with Opella, Sanofi’s consumer healthcare business unit are pleased to announce that Cialis for men® 10mg film-coated tablets tadalafil is now available over the counter (OTC), without prescription in Irish pharmacies for the treatment of erectile dysfunction (ED). This marks a significant development in the management of ED, providing an accessible, pharmacist-supervised alternative to previous OTC treatments.

Cialis for men® offers a new OTC approach to managing ED with its active ingredient, tadalafil, which increases blood flow to the penis, helping men achieve and maintain an erection when sexually aroused. Its effect, lasting up to 36 hours, allows for greater flexibility and reduces the pressure on

timing, thereby improving patient experience and satisfaction. Available exclusively in pharmacies throughout Ireland from today, Cialis for men® requires pharmacist oversight to ensure patient safety and suitability, providing guidance on the proper use of the medication.

Pictured at the launch of Cialis for men OTC at Boots Pharmacy on Dawson Street is Pharmacist Said Danishani, Regulatory Affairs Manager Boots Ireland, Olivia Reilly Marketing Manager at Clonmel Healthcare and Barry Fitzpatrick, Director of Sales at Clonmel Healthcare

Recent research highlights the prevalence of ED in Ireland, with nearly 3 in 10 Irish men reporting experiences with the condition. Despite the availability of treatments, awareness of overthe-counter options remains low, with 50% of men unaware of such solutions. The launch of Cialis for men® directly addresses this gap, offering a longer-lasting, accessible treatment that does not require a prescription, thereby removing barriers that may prevent men from seeking help.

The availability of Cialis for men® in pharmacies positions pharmacists at the forefront of men's health, enabling them to

play a critical role in supporting patients experiencing ED.

Longford-based Pharmacist Paula Reilly comments: “With medications like Cialis for men® now available directly through pharmacies, men no longer need to visit their GP for treatment, which has removed a significant barrier to seeking help. This ease of access is paving the way to make a real difference in promoting better health outcomes for men and their partners."

The research also revealed critical insights into the state of men's sexual health in Ireland. More than 7 in 10 men believe there is still a significant stigma surrounding the discussion of men's sexual health, however, making treatment options more accessible and raising awareness about the commonality of these conditions can help reduce that stigma. The study also highlights the impact of social media and online content, including pornography, on men's perceptions of sexual performance.

National Parenting Product Awards 2024

The National Parenting Product Awards (NPPA) is the only independently-tested consumer awards of products and services for young families in the Irish marketplace.

The 2024 results have been announced marking the 11th year anniversary of the NPPA where 2,869 parents and 15 experts evaluated 185 products, resulting in 150 category wins.

From nursery items to baby car products, travel systems to parenting services, the NPPA helps to support parents looking to buy the best products for their young families.

The winners were announced during a ceremony at the Westbury Hotel in Dublin last month as over 2,800 parents across Ireland voted.

This year’s Awards were the first as part of the DMG Media portfolio and were hosted by television presenter Anna Daly.

A survey of almost 3,000 Irish parents found that two-thirds are five times more likely to choose a product if it had won an NPPA award than if it has been recommended by a social media influencer.

“The National Parenting Product Awards are another important part of the DMG Media brand portfolio," said Paul Henderson, CEO of DMG Media Ireland.

"They fulfil a critical role in our highly engaged community of parents. For the brands and companies in this sector, they set a standard.

"Combined with the power and reach of our parenting brands everymum and RollerCoaster. ie they allow our Mum Marketing platform give brands and companies access to 75% of the mothers in Ireland."

Naomi Staff, managing director at Core Research, added: "We are delighted to partner with DMG Media, to manage the research

that determines the winners of this year's much anticipated NPPA. "Each product has undergone a rigorous evaluation process by parents, as well as a panel of expert judges. These awards recognise parenting and baby products that have earned parents' trust and approval for their safety, value, reliability, and positive influence on family life.”

Over the next few pages Irish Pharmacy News showcases some of the 2024 winners.

2. Preferred Baby Pain Relief for Teething: CALPOL 120mg/5ml Sugar Free Oral Suspension Cathy Donoghue and Tilly Lonergan pictured at the National Parenting Product Awards 2024 at the Westbury Hotel, Dublin. Pic: Tom Honan

3. Anna Daly and Rebecca Horan at the National Parenting Product Awards 2024

4. Essential Support for Baby/Toddler Digestion: Optibac Babies & Children

Sarah Jayne Tobin, Madeleine Walsh Lauren Byrne Mairead Talbot pictured at the National Parenting Product Awards 2024 at the Westbury Hotel, Dublin. Pic Tom Honan

5. Best Baby Product for Sleep (including Mattresses): Calpol Vapour Plug Regina Hinds and Tilly Lonergan. Pic Tom Honan

1. Best Pregnancy Skincare Product: Bio-Oil Skincare Oil - Cathy Donoghue and Miriam Velluti pictured at the National Parenting Product Awards 2024. Pic: Tom Honan

The end of erectile problems? Touch wood.

Available over the counter. No prescription required. Always read the leaflet. Available in a 4 or 8 pack.

ABBREVIATED PRESCRIBING INFORMATION

Product Name: Sidena 50 mg Tablets.

Composition: Each tablet contains, 50 mg sildena l (as citrate) .

Description: Light blue, round, slightly dotted tablets. Cross breaking notch on one side and marked ‘50’ on the other side. Can be divided into equal quarters. (Only two quarters of the 50 mg is covered by posology).

Indication(s): Treatment of men with erectile dysfunction, which is the inability to achieve or maintain a penile erection su cient for satisfactory sexual performance.

Dosage: Adults and elderly: 50 mg taken as needed approximately one hour before sexual activity. Dose may be decreased to 25 mg. Max dose: 50mg once daily. Impaired renal and hepatic function: Sildena l clearance is reduced in hepatic and severe renal impairment. Consider a dose of 25 mg. Dose may be increased step-wise to 50 mg if tolerated. Children and adolescents below 18 years of age: Contraindicated. Use in patients using other medicines: Starting dose of 25 mg with CYP3A4 inhibitors (not advised to use with ritonavir). To minimise postural hypotension in patients receiving and alpha-blocker, stabilise patient rst on the alpha blocker and use a starting dose of 25 mg sildena l. Contraindications: Hypersensitivity to sildena l or any of the excipients. Concomitant with ritonavir, nitric oxide donors or nitrates in any form, guanylate cyclase stimulators e.g. riociguat. In patients that sexual activity is inadvisable (e.g. severe cardiovascular disorders such as a recent (6 months) acute myocardial infarction (AMI) or stroke, unstable angina or severe cardiac failure). Refer these patients to a doctor. Patients with loss of vision in one eye due to NAION. Known hereditary degenerative retinal disorders. Severe hepatic impairment. Hypotension. Anatomical deformation of the penis. Not intended if no erectile dysfunction. Women. Warnings and Precautions for Use: First diagnose erectile dysfunction and determine potential underlying causes (e.g. hypertension, diabetes mellitus, hypercholesterolaemia or cardiovascular disease), before considering pharmacological treatment. Consider the cardiovascular status of patients, since there is a degree of cardiac risk associated with sexual activity. Serious cardiovascular events, including myocardial infarction, unstable angina, sudden cardiac death, ventricular arrhythmia, cerebrovascular haemorrhage, transient ischaemic attack, hypertension and hypotension have been reported post-marketing in temporal association with the use of sildena l. Most, but not all, of these patients had pre-existing cardiovascular risk factors. Sildena l has vasodilator properties, resulting in mild and transient decreases in blood pressure. Caution: Patients with anatomical deformation of the penis (such as angulation, cavernosal brosis or Peyronie’s disease), or in patients who have conditions which may predispose them to priapism (such as sickle cell anaemia, multiple myeloma or leukaemia). Advise patients that in case of priapism, prolonged erections (longer than 4 hours) or sudden visual defect, they should stop taking sildena l and consult a physician immediately. Administer to patients with bleeding disorders or active peptic ulceration only after careful bene t-risk assessment, as there is no safety information available. Interactions: See SPC for detailed information. Inhibitors of the cytochrome P450 (CYP) isoforms 3A4 (major route) and 2C9 (minor route) isoenzymes such as CYP3A4 inhibitors: Itraconazole, ketoconazole, erythromycin, cimetidine, HIV protease inhibitor saquinavir: May reduce sildena l clearance and increase sildena l plasma levels. Consider a starting dose of 25 mg. Strong CYP3A4 inducers e.g. rifampicin may increase sildena l clearance and decrease sildena l plasma concentrations. Grapefruit juice: May give rise to modest increases in plasma levels of sildena l. Nicorandil (Hybrid of potassium channel activator and nitrate): Due to the nitrate component it has the potential to have serious interaction with sildena l. Sildena l potentiates the hypotensive e ect of nitrates. Alpha blocker: Concomitant administration of sildena l may lead to symptomatic hypotension in a few susceptible individuals. Patients should be hemodynamically stable on alpha-blocker therapy prior to initiating sildena l treatment. Sildena l potentiates the antiaggregatory e ect of sodium nitroprusside in vitro. Not recommended in patients with a history of bleeding disorders or active peptic ulceration. Not recommended to use with other pulmonary arterial hypertension treatment containing sildena l. Caution when sildena l is initiated in patients treated with sacubitril/valsartan. May result in a increase of bosentan availability. Ability to Drive and Use Machinery: Minor in uence, dizziness and altered vision were reported. Patients should be aware of how they react to sildena l before driving or using machinery. Undesirable E ects: Very common: Headache. Common: Dizziness, visual disorders, visual colour distortion, vision blurred, ushing, hot ush, nasal congestion, nausea, dyspepsia. See SPC for more adverse e ects.

Marketing Authorisation Holder: Rowex Ltd, Bantry, Co. Cork. Marketing Authorisation Number: PA 0711/170/002. Further information and SPC are available from: Rowex Ltd., Bantry, Co. Cork. Freephone: 1800 304 400 Fax: 027 50417

E-mail: rowex@rowa-pharma.ie

Legal Category: Not subject to medical prescription. Date of Preparation: Jan 2024

of preparation: (10-24) CCF: 26643

Preferred Baby Treatment for Relief of Colic –Silver: Colief Infant Drops

Colief Infant Drops is a completely safe, natural remedy for infant colic trusted by mums and healthcare professionals for over 25 years. Colief treats temporary lactose intolerance in babies suffering from colic. It relieves the severe digestive discomfort, bloating and gas caused by undigested lactose in food. Suitable from birth, the drops help break down the lactose in milk into simpler sugars, glucose and galactose, making it easier for baby to digest milk whilst reducing discomfort. They contain the naturally occurring enzyme lactase which helps relieve colic symptoms caused by temporary lactose intolerance – common in babies as their digestive systems develop. Adding a few drops to infant formula or mum’s expressed breast milk helps to break down the lactose in the milk, making it easier to digest. Colief can be safely used from birth onwards. It can be used at every feeding. Just add drops to breast milk or warm formula. Trusted by moms and recommended by healthcare professionals, Colief has been clinically proven to reduce crying time by up to 45% in more than a third of babies with colic.

Best Product for Breastfeeding (Excluding Breast Pumps) –Gold: Multi-Mam Compresses

Described as a 'life saver' by breastfeeding mums, Multi-Mam Compresses provide direct and immediate relief for breastfeeding discomforts such as sore or cracked nipples, infections such as mastitis and sensitivity. The compresses, which are placed on the affected nipple, form a soft and comfortable pad on the sore nipple. They are impregnated with a natural bio-active gel containing the 2QR-complex which is derived from the leaves of the Aloe plant. This unique gel supports the natural healing process and reduces the chance of infection. It generates moistness, forms a physical barrier for harmful bacteria. The gel is non-toxic, and no preservatives have been added, so it is completely safe for baby and doesn’t need to be removed prior to breastfeeding.

With no other product like it, Multi-Mam Compresses are the number one recommendation by midwives and lactation consultants who, in many cases, have used them themselves and trusted by mums to support their breastfeeding journey.

Essential Support for Baby/Toddler Digestion –Bronze: Colief Multibiotic Drops

Colief Multibiotic Drops are created to help maintain a baby’s natural gut flora. They contains 1.1 billion live cultures of Lactobacillus rhamnosus, LGG®, the most researched gut-loving bacteria strain in the world and has been described in more than 250 publications of human studies, as well as Bifidobacterium infantis, a scientifically proven friendly bacteria for babies and children. The combination of the two live cultures offers a host of advantages for infants’ health. Lactobacillus rhamnosus, LGG®, is known for its positive impact on digestive health, bolstering the gut’s natural defences and promoting a balanced gut microbiome. It helps infants maintain a healthy digestive system and aids in nutrient absorption. Bifidobacterium infantis contributes to the digestion of breast milk and formula, ensuring that infants receive optimal nutrition and it plays a vital role in reducing colic and constipation, providing comfort and relief for little ones. Moreover, these friendly bacteria strains work together to strengthen the infant’s immune system, potentially lowering the risk of allergies and promoting overall well-being. Suitable for breastfed and formula fed babies, from birth onwards. Colief® Multibiotic Drops may be used on an ongoing basis.

Colic relief from Colief®

Adding Colief® Infant Drops to baby milk is a natural way to ease colic symptoms caused by lactose.

Infant colic can have many causes. In some cases it is caused by temporary lactose intolerance. This occurs when babies are unable to fully digest the lactose in milk, resulting in discomfort and extended periods of crying. Suitable from birth, Colief Infant Drops contain lactase enzyme, which breaks down lactose into glucose and galactose, reducing the lactose in milk and making it easier for babies to digest

INFANT DROPS

Colief® Multibiotic Drops, For a happy gut

Mums know to call on Colief® facebook.com/ColiefCare www.colief.com

Tel: 01 2968080 | orders@oceanhealthcare.ie | www.oceanhealthcare.ie

Your baby’s gut health is incredibly important as it sets the stage for their growth, immunity, and digestion. A healthy gut helps them absorb nutrients, stay protected from infections, and can help ease digestive discomfort such as constipation, diarrhoea and colic, contributing to your baby’s comfort and well-being.

Suitable for breastfed and formula fed babies, from birth onwards Colief® Multibiotic Drops can be taken once daily and contain 1.1 billion live CFU of Lactobacillus rhamnosus, LGG® and Bifidobacterium infantis, scientifically proven friendly bacteria for delicate stomachs.

Essential Support for Baby/ Toddler Digestion –Gold: Optibac Babies and Children

Optibac Probiotics, the brand of friendly bacteria supplements most trusted by parents in Ireland, are delighted to scoop their second Gold award at the National Parenting Product Awards (NPPA) for the supplement, Babies & Children. Coming out top in the ‘Essential Support for Digestion for Babies, Toddlers and Kids’ category, this win recognises this supplement’s role in supporting digestive and immune health for babies, toddlers and children up until aged 12.

Formulated with three of the most researched probiotic strains including the world’s most researched strain, Lactobacillus rhamnosus GG, this formulation delivers natural gut support backed by science. It also contains the daily recommended intake of Vitamin D3 to promote healthy immune function.

What really sets Babies & Children apart though, is its tailored approach to a child’s unique gut microbiome. The world-renowned strains in this formulation have been trialled in over 5,000 children to give parents confidence they are giving their little ones the best friendly bacteria, backed by gold-standard science.

Each daily sachet contains an easy-to-take, flavourless powder can be mixed into water, milk or yoghurt, making it simple for parents to give their children natural gut and immune support. Free from added sugar, artificial flavours, gluten, dairy, and soy, it’s a gentle, allergen-friendly option carefully created to help children rise and shine every morning.

Available in pack sizes 10, 30 & 90 from Wholefoods Wholesaler

Available in pack size 30 from Uniphar Wholesale

Best Product for Sleep (Including Mattresses) –Gold: CALPOL Vapour Plug

For the restless child, try using a soothing vapour plug, such as Calpol Vapour Plug and Nightlight to create a relaxing environment. Calpol Vapour Plug and Nightlight is an electrical plug-in device that emits a blend of aromatic oils including lavender, chamomile, menthol, and eucalyptus to soothe and comfort babies and children, helping to promote a relaxing environment. The nightlight emits a soft orange light to help comfort the child and guide parents in the room so that they don't disturb their sleeping child. This product helps clear and ease breathing, to aid a restful night’s sleep. The plug comes with 3 refill pads, and each pad provides up to 8 hours soothing night-time comfort. The nightlight is activated once the lights go out. Non medicine. Always read the label.

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

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

120

per

Plus Oral

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: Calpol Six Plus Oral Suspension:

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

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

Calpol

Paracetamol

mg

5 ml. Calpol Six

Suspension

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.

Preferred Baby Treatment for Relief of Colic –Bronze: BioGaia ProTectis Baby Probiotic Drops

Best Pregnancy Skincare Product –Gold: Bio-Oil Skincare Oil

Bio-Oil Skincare Oil was the first oil to undergo clinical trials and demonstrate its effectiveness in improving the appearance of scars and stretch marks. Thanks to the unique properties of oil, which nourishes and enhances skin, Bio-Oil has become the world's leading product for treating scars and stretch marks, recommended by both dermatologists and midwives. This multi-purpose oil features PurCellin Oil, a breakthrough ingredient that ensures better absorption. It also contains a blend of carefully selected plant extracts, including Chamomile, Lavender, Rosemary, and Calendula—known for their healing, anti-inflammatory, and soothing qualities. In addition, Bio-Oil is enriched with Vitamins A and E to help improve uneven skin tone, reduce signs of ageing, and address dehydration.

Bio-Oil’s versatility extends beyond scar and stretch mark care. With regular use, it helps even out skin tone caused by hormonal changes or excessive sun exposure. It also deeply moisturises, enhancing the skin’s texture and appearance while minimizing fine lines and wrinkles. By replenishing the skin’s natural oils, which can be stripped away by environmental factors, Bio-Oil restores balance and vitality. Clinical trials have shown that after just 8 weeks of consistent use, 92% of participants experienced an improvement in the appearance of scars, and 95% noticed a visible reduction in stretch marks.

BioGaia ProTectis Baby Drops are a trusted solution for parents seeking relief for their infants suffering from colic. As the most clinically researched probiotic strain in the world for infant colic, BioGaia ProTectis has been proven to support digestive health and reduce colic-related crying episodes. Its key ingredient, Lactobacillus reuteri Protectis, is a naturally occurring, beneficial probiotic strain that helps balance the gut flora in infants, promoting better digestion and easing common issues like gas, constipation, and colic.

BioGaia ProTectis Baby Drops are easy to administer, with just five drops a day needed to support your baby’s digestive comfort. The formula is safe for newborns and infants, making it an ideal option for early digestive care. Extensive research and clinical trials back its effectiveness, with studies showing significant reductions in crying time for colicky babies after using the drops.

Parents across the globe trust BioGaia ProTectis Baby Drops for their gentle yet effective support. The product is free from artificial additives, preservatives, and allergens, ensuring the best for your little one’s health. With BioGaia ProTectis, you can offer your baby the world’s leading probiotic care and find relief from the stress of colic.

National Parenting Award 2024 winning BioGaia Protectis baby probiotic drops Best supplement for babies from the Pregnancy and baby fair Awards 2024

35 years, 4 pioneering skincare products.

AUTHOR: Donna Cosgrove PhD MPSI

41 CPD: Cold and Flu

Donna graduated with a BSc in Pharmacy from the Royal College of Surgeons in Ireland. She then returned to university to complete a MSc in Neuropharmacology. This led to a PhD investigating the genetics of schizophrenia, followed by a postdoctoral research position in the same area. Currently Donna works as a pharmacist in Galway, and as a clinical writer.

60 Second Summary

The common cold and flu are both viral upper respiratory tract infections. Symptoms are generally self-limiting, with symptoms of a cold including blocked or runny nose, sneezing, cough and sore throat.

Symptoms of flu include fever, fatigue, body aches, headache, dry cough and nausea. Patients should be screened for warning signs or complications associated with respiratory tract infections. Pharmacists and pharmacy staff should carry out a structured approach to each consultation to ensure each patient receives appropriate counselling, treatment and referral if necessary.

Prevention is important in reducing the spread of flu, with vaccination the best approach in preventing and reducing severity of symptoms. Hand hygiene and other measures can also be effective in reducing transmission of respiratory viruses. The diagnosis of cold and flu is generally based on symptoms and physical examination, with laboratory tests used only if necessary.

Antibiotics are not effective in treating cold and flu, and their use can lead to the development of antimicrobial resistance. Antimicrobial stewardship is a set of measures to counteract resistance and pharmacists have an important role in this process. Depending on the symptoms; analgesics, antihistamines, decongestants, antitussives and expectorants can be used to provide symptomatic relief. Nonpharmacological treatment and self-care can also play a role in the treatment of cold and flu. Antiviral treatment may be initiated within 48 hours of

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

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

3. PLAN - If I have identified a

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

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

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

4 previous steps, log and record your findings.

Published by IPN. Copies can be downloaded from www.irishpharmacytraining.ie

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

Solpa has no editorial oversight of the CPD programmes included in these modules

Management of Cold & Flu in Pharmacy

Introduction and epidemiology

The common cold and flu are both upper respiratory tract illnesses caused by viral infections. They both tend to be acute, self-limiting and may sometimes involve the lower respiratory tract.1 Both the common cold and flu are contagious respiratory illnesses but are caused by different viruses; flu is caused by different influenza viruses and the common cold can be caused by coronaviruses, rhinoviruses, adenoviruses and parainfluenza viruses.1 The incidence of the common cold and flu is subject to seasonal variation, with a higher incidence in winter compared to summer. The common cold is the most common illness in the world, with an average of 6-8 episodes per year in children, decreasing to 2-4 episodes per year in adults. It can have a large economic burden due to absenteeism at work and school.2

Symptoms

The common cold and flu

of cold are usually limited to the upper respiratory tract (nose and throat) and flu symptoms generally affect more than just the upper respiratory tract, with symptoms of flu usually much more severe than those of a cold. Symptoms of a cold can include blocked or runny nose, sneezing, cough, sore throat and fever.3 Symptoms of flu can include fever, fatigue, body aches, headache, difficulty sleeping, loss of appetite, dry cough and nausea. Runny nose and sore throat are also possible, but less common than with the common cold.4, 5 Influenza can be classified into uncomplicated and complicated. Uncomplicated flu is characterised by the sudden onset of the typical symptoms outlined above, with symptoms generally resolving in less than two weeks. Complicated flu occurs when the viral infection causes a potential wide range of complications that can result in severe disease.6

Complications and Warning Signs

The common cold and flu are generally self-limiting in healthy individuals and usually will resolve within two weeks. However, flu and complications of flu can lead to serious illness. In children, otitis media (middle ear infection) and respiratory complications including croup and bronchiolitis are most common. Rarer complications in

children can include myocarditis, pericarditis, encephalopathy, encephalitis and Reye’s syndrome. The most common complications of flu in adults are pneumonia and bronchitis, which can lead to respiratory failure, acute respiratory distress syndrome, septic shock or multi-organ failure. Flu can often cause dehydration, which can exacerbate underlying chronic medical conditions.6 Patients that are aged 65 years or older, pregnant or have a longterm medical condition are at an increased risk of complications from flu. As patients with asthma, COPD, diabetes and heart failure are at a higher risk of complications, there may be a need to refer to a medical doctor for further treatment. Pharmacists and pharmacy staff should be aware that patients may need referral to a doctor if their symptoms don’t improve after 7 days or they have a weakened immune system, due to HIV or chemotherapy.7

In the event of patients experiencing any warning sign symptoms, then they should seek medical attention immediately. Pharmacies are often the first port of call for patients with symptoms, pharmacy staff should recognise when referral is necessary. Some of the more common of these warning signs are outlined in the

Solpa C&F Strip ad for CPD v2 (HIRES).pdf

Warning Signs

Coughing up blood

Worsening of chronic medical conditions

Difficulty breathing or shortness of breath

Seizures

Pain or pressure in the chest or abdomen

Persistent dizziness or confusion

Not urinating or dehydration

Fever or cough that improves but returns or worsens

Bluish lips or face

Community Pharmacy Role in Cold and Flu

Community Pharmacy Role in Cold and Flu

of improving the appropriate use of antimicrobials. It does this by ensuring the correct antimicrobial treatment is selected for the appropriate infection, as well as the correct duration of therapy, dosage and route of administration.14 Antimicrobial stewardship has been shown to reduce a pathogen’s resistance to antimicrobials without having a negative effect on clinical outcomes such as duration of illness, length of hospital stays, morbidity or mortality. Antimicrobial stewardship will also ensure a reduced risk in the development of superbugs.12

of the common cold, it is not possible to vaccinate against this illness. Simple measures including regular handwashing with soap, avoiding touching the face and cleaning surfaces that people regularly touch can help prevent spread of respiratory viruses. Covering coughs and sneezes with a tissue and discarding the tissue immediately after use, improving ventilation in buildings and avoiding close contact with other people when symptomatic are all also practical measures that patients can be counselled on to reduce spread of common cold and flu.17, 18

Vaccination

are necessary to counsel each patient and communication style may be required to be tailored to each patient. Pharmacists should oversee consultations to ensure correct treatment options are selected or patients are referred if necessary.9

Antimicrobials and Antimicrobial Stewardship

Community pharmacy is often the first port of call for patients when they have symptoms of cold or flu. Most symptoms can be effectively treated by using over the counter (OTC) medicines from community pharmacies, which can help reduce the burden on other primary care providers and emergency departments. A systematic approach to each consultation should be implemented to ensure a consistent high-level of care to each patient presenting with cold and flu symptoms. A patient-centred approach should be followed in community pharmacy. All pharmacy staff should be fully trained and competent in conducting OTC consultations. There is a great importance in tailoring each consultation to reflect the different role, responsibility and knowledge of the staff members. Pharmacy staff should know when to refer to the pharmacist when carrying out each consultation (9).

Community pharmacy is often the first port of call for patients when they have symptoms of cold or flu. Most symptoms can be effectively treated by using over the counter (OTC) medicines from community pharmacies, which can help reduce the burden on other primary care providers and emergency departments. A systematic approach to each consultation should be implemented to ensure a consistent high-level of care to each patient presenting with cold and flu symptoms. A patientcentred approach should be followed in community pharmacy. All pharmacy staff should be fully trained and competent in conducting OTC consultations. There is a great importance in tailoring each consultation to reflect the different role, responsibility and knowledge of the staff members. Pharmacy staff should know when to refer to the pharmacist when carrying out each consultation.9

Antimicrobial resistance (AMR) occurs when bacteria, viruses, fungi and parasites adapt over time and are no longer treatable by antimicrobials. This makes infections much more difficult to treat and increases the spread of disease, morbidity and mortality.10 Antibiotics are not effective in treating viral infections such as the common cold and influenza and therefore should not be used in the treatment of these illnesses. Overuse of antibiotics can lead to the development of antibiotic-resistant pathogens.11

Effective consultations between pharmacy staff and patients are fundamental to ensure appropriate recommendations are made and desired patient outcomes are achieved. Optimal management of these consultations require effective information gathering from the patient, with proper use of a framework essential for retrieving information. Who is the patient, What are the symptoms, How long has the patient had the symptoms, Action to date and other existing Medication being taken (WWHAM) is the most common framework used in information gathering. Effective communication skills are necessary to counsel each patient and communication style may be required to be tailored to each patient. Pharmacists should oversee consultations to ensure correct treatment options are selected or patients are referred if necessary (9).

Effective consultations between pharmacy staff and patients are fundamental to ensure appropriate recommendations are made and desired patient outcomes are achieved. Optimal management of these consultations require effective information gathering from the patient, with proper use of a framework essential for retrieving information. Who is the patient, What are the symptoms, How long has the patient had the symptoms, Action to date and other existing Medication being taken (WWHAM) is the most common framework

Antimicrobials and Antimicrobial Stewardship

Studies have estimated that approximately half of antibiotic use is either unnecessary or inappropriate. Therefore, there are major concerns about potential adverse effects from overuse of antibiotics, as well as the selection of antibiotic-resistant pathogens. The slowing of the development of new antimicrobials have left fewer treatment options for antibiotic-

Pharmacists can play an important role in antimicrobial stewardship, particularly in the context of cold and flu. Encouraging hand hygiene techniques and vaccination reduces transmission of viral infections and therefore reduces inappropriate prescribing of antibiotics. Pharmacists can have discussions with prescribers about the inappropriate prescribing of antimicrobials for viral infections such as the common cold and flu. Pharmacists can mention the lack of effectiveness of antibiotics in treating cold and flu, with potential for adverse effects and development of antibiotic resistance. As drug experts, pharmacists can contribute to antimicrobial stewardship by influencing those crucial prescribing decisions. Pharmacists can discuss other treatment options with the prescriber that focus on symptomatic relief for the patient.15 The HSE have thorough guidelines on antibiotic prescribing for community infections that is very useful.16 Pharmacists are also ideally placed to counsel patients on the lack of effectiveness of antibiotics on viral infections and potential risks associated with their use. Pharmacists can effectively communicate to patients that these illnesses are generally self-limiting and symptomatic treatment can be much more useful that antibiotic treatment.15

Prevention

Antimicrobial resistance (AMR) occurs when bacteria, viruses, fungi and parasites adapt over time and are no longer treatable by antimicrobials. This makes infections much more difficult to treat and increases the spread of disease, morbidity and mortality (10). Antibiotics are not effective in treating viral infections such as the common cold and influenza and therefore should not be used in the treatment of these illnesses. Overuse of antibiotics can lead to ). Studies have estimated that approximately half of antibiotic use is either unnecessary or inappropriate. Therefore, there are major concerns about potential adverse effects from overuse of antibiotics, as well as the lowing of the development of new antimicrobials have left fewer treatment options for antibiotic resistance pathogens, leading to an increase in duration of illness, hospital stay, cost, morbidity and mortality ( Antibiotic resistance is a major threat and a concerted effort, including not prescribing antibiotics for cold and flu, must be made (

Prevention is key in reducing the burden of cold and flu in society. Pharmacists are trusted healthcare professionals and therefore can reshape patient perceptions and reinforce the messaging around prevention of infection. Vaccination is an important preventative measure against influenza. Unfortunately, due to many different serotypes

Vaccination is the best method of protection against flu.19 Vaccines contain weakened or inactive parts of a pathogen that triggers an immune response in the body, that will produce antibodies and offer protection if exposed to the pathogen later.20 The flu vaccine should be administered annually as the antibodies reduce over time, as well as the fact that flu strains can change from year to year. The vaccine is generally available from October to April, but it is ideal to get it as early as possible, before the commencement of flu season. Vaccination generally reduces the risk of getting flu by 40% to 60% and can also reduce intensity and duration of symptoms. There are usually two vaccines available in Ireland; the quadrivalent influenza vaccine (QIV) which is generally used for over 18 years old and the live attenuated influenza vaccine (LAIV) which is used for those aged 2 to 17 years old.21 The preferred administration site for the QIV is in the deltoid muscle via intramuscular injection.22 The LAIV is administered nasally, with half of the dose administered via a spray in both nostrils.23 Mild side effects are possible and can include fever, fatigue, soreness or swelling at injection site, body aches and headaches. Nasal congestion is also common with nasal administration of the vaccine. These are generally self-limiting and will resolve within 48 hours. Taking paracetamol and resting are advised if these side effects are experienced. More serious side effects are rare and should be

A wide number of people in Ireland are eligible for a free flu vaccination in Ireland and these are outlined in the table below.24

Solpa C&F Strip

resolve within 48 hours. Taking paracetamol and resting are advised if these side effects are experienced. More serious side effects are rare and should be reported to the HPRA (24).

A wide number of people in Ireland are eligible for a free flu vaccination in Ireland and these are outlined in the table below (24)

A person is eligible for a free flu vaccination if they are:

age 65 years and older

age 2 to 17 years

a healthcare worker

Pregnant

living in a nursing home or other long-term care facility in regular contact with pigs, poultry or waterfowl

someone with a health condition that puts you at higher risk of flu which includes:

- chronic heart disease

- chronic liver disease

- chronic kidney failure

- chronic respiratory disease

- chronic neurological disease

- diabetes

- Down syndrome

- haemoglobinopathies

- a body mass index (BMI) over 40

- immunosuppression due to disease or treatment

- children with a moderate to severe neurodevelopmental disorder

- children on long-term aspirin therapy

- any condition that can compromise respiratory function

living with someone who has a health condition that puts them at higher risk of flu a carer for someone who has a health condition that puts them at higher risk of flu

tachycardia, nausea and dysrhythmia. Decongestants can also be used in combination with a first-generation oral antihistamine. Xylometazoline is a decongestant that can be used topically to reduce nasal symptoms. Side effects of nasal decongestants can include irritation of nasal membranes, rebound congestion and nosebleeds.31

Cough medicines

Codeine is an opioid antitussive and used to be the gold standard treatment for cough. It is no longer recommended due to lack of evidence of efficacy and many side effects associated with its use including dependence, drowsiness and constipation.

33

Dextromethorphan is a non-opioid antitussive and does have efficacy in suppressing cough caused by upper respiratory tract infections.

Diagnosis

Pharmacists have been providing a seasonal influenza vaccination service in community pharmacies since 2011.25 Flu vaccination service in community pharmacies has been reported to improve uptake of the vaccine. Recommendations from healthcare workers have also shown to greatly improve vaccination rates. As patients visit their community pharmacy much more often than their primary care physician, pharmacists have a very important role in this. Pharmacist can counsel patients on the benefits of vaccination, risks of not getting vaccinated and ease patient concerns regarding potential side effects.26

Diagnosis

that stimulate an immune response. Molecular assays that detect genetic material of influenza can be used and are more accurate than RIDTs. Both tests take less than 20 minutes to perform. Specialised laboratory tests such as polymerase chain reaction (PCR) tests can be used for diagnosing influenza. These tests are usually not required but can be useful in differential diagnosis between common cold, influenza and other respiratory infections including Covid-19. Reliability can be an issue for all these methods of diagnosing.28 Therefore, diagnostic tools are not very useful, and treatment can be initiated if required based on clinical symptoms, patient history and physical examination.29

useful in treating aches and pains, as well as lowering fever associated with the viral infection.30

Antihistamines

31 Expectorants and mucolytics have efficacy in treating productive cough caused by acute upper respiratory tract infections. They work by increasing the volume of sputum in the airway and decreasing the viscosity, which promotes effective clearance of mucus. Clinical studies have shown the efficacy of expectorants in treating acute upper respiratory tract infections, where excess mucus and cough are symptoms.

Pharmacists have been providing a seasonal influenza vaccination service in community pharmacies since 2011 (25). Flu vaccination service in community pharmacies has been reported to improve uptake of the vaccine. Recommendations from healthcare workers have also shown to greatly improve vaccination rates. As patients visit their community pharmacy much more often than their primary care physician, pharmacists have a very important role in this. Pharmacist can counsel patients on the benefits of vaccination, risks of not getting vaccinated and ease patient concerns regarding potential side effects (26).

First-generation antihistamines such as brompheniramine and chlorpheniramine have been shown to provide some symptomatic relief. This involves a reduction in symptoms such as sneezing and nasal discharge, as well as a reducing the duration of symptoms. Side effects associated with diphenhydramine include drowsiness, dry mouth and blurred vision.31 Second-generation antihistamines are ineffective in treating symptoms of cold and flu.32

Decongestants

34 Carbocisteine (from 2 years and older) and guaifenesin (from 6 years and older) are available OTC in Ireland.35, 36

Non-pharmacological treatment

The diagnosis of common cold and flu is generally based on symptoms and physical examination. As these illnesses are usually self-limiting, symptoms can be examined by a physician and a diagnosis made without need for further diagnostic tools (27). Rapid influenza diagnostic tests (RIDTs) can be used to diagnose influenza by detecting antigens that stimulate an immune response. Molecular assays that detect genetic material of influenza can be used and are more accurate than RIDTs. Both tests take less than 20 minutes to perform. Specialised laboratory tests such as polymerase chain reaction (PCR) tests can be used for diagnosing influenza. These tests are usually not required but can be

The diagnosis of common cold and flu is generally based on symptoms and physical examination. As these illnesses are usually self-limiting, symptoms can be examined by a physician and a diagnosis made without need for further diagnostic tools. Rapid influenza diagnostic tests

Decongestants have been shown to have clinical effectiveness in reducing symptoms of rhinorrhoea, nasal congestion and sneezing.31 Pseudoephedrine and Phenylephrine are two decongestants that are licensed for OTC use in those aged 12 years and older in Ireland. Potential side effects can include agitation, hypertension,

Daily administration of zinc has effectiveness in reducing the number of colds per year, particularly in children. Other supplements such as vitamin C, vitamin D and garlic have mixed results, with studies showing no benefit versus placebo. Natural products including ginseng and echinacea showed no clear evidence of benefit. Homeopathy also does not have a positive effect on preventing or treating the common cold or flu.37 Honey may be useful in treating nighttime cough in children but should not be used in children under 12 months due to the risk of infant botulism. Bulb suction with saline drops can be useful in relieving nasal symptoms in children. Vapour rub containing ingredients such as eucalyptus, camphor and levomenthol may provide symptomatic relief in children over

Solpa Cold & Flu Multi Relief Max Powder for Oral Solution. Paracetamol 1000 mg, Guaifenesin 200 mg, Phenylephrine Hydrochloride 12.2 mg. See SmPC for full list of side effects and further information. Product not subject to medical prescription. MAH: Chefaro Ireland DAC, The Sharp Building, Hogan Place, Dublin 2, Ireland.

Solpa

camphor and levomenthol may provide symptomatic relief in children over 2 years old (38).

Self

Pharmacists and pharmacy staff should ensure patients are counselled on the importance self care in the treatment of cold and flu. Patients should be advised to keep warm, avoid smoking and eat well. Getting plenty of rest and sleep are important in sel care treatment, with the patient advised not to return to normal activities until they feel well enough to do so.

Patients should be counselled to drink plenty of water as dehydration can lead to complications. Urine should be a light yellow or clear col

Antiviral treatment

Self-Care

Flu can also be treated orally with Oseltamivir (Tamiflu) and by inhalation with Zanamivir (Relenza). These are both antivirals of the neuraminidase inhibitor class, which have activity against both influenza A and B. Previously healthy patients with no underlying condition generally do not need antiviral therapy, unless the clinician feels the patient is at risk of developing complications. Symptomatic treatment is generally recommended for these patients. Patients who are deemed to be at risk of complications should be commenced on Oseltamivir as soon as possible, even without laboratory confirmation of diagnosis. Oseltamivir is also recommended for treating flu in pregnancy due to potential adverse clinical outcomes for this patient group. Initiating antiviral treatment within 48 hours of symptom onset can reduce risk of complications including pneumonia and respiratory failure. It can also reduce risk of hospitalisation, morbidity and mortality (39).

Antiviral treatment

Pharmacists and pharmacy staff should ensure patients are counselled on the importance of self-care in the treatment of cold and flu. Patients should be advised to keep warm, avoid smoking and eat well. Getting plenty of rest and sleep are important in self-care treatment, with the patient advised not to return to normal activities until they feel well enough to do so. Patients should be counselled to drink plenty of water as dehydration can lead to complications. Urine should be a light yellow or clear colour.3

Flu can also be treated orally with Oseltamivir (Tamiflu) and by inhalation with Zanamivir (Relenza). These are both antivirals of the neuraminidase inhibitor class, which have activity against both influenza A and B. Previously healthy patients with no underlying condition generally do not need antiviral therapy, unless the clinician feels the patient is at risk of developing complications. Symptomatic treatment is generally recommended for these patients. Patients who are deemed to be at risk of complications should

be commenced on Oseltamivir as soon as possible, even without laboratory confirmation of diagnosis. Oseltamivir is also recommended for treating flu in pregnancy due to potential adverse clinical outcomes for this patient group. Initiating antiviral treatment within 48 hours of symptom onset can reduce risk of complications including pneumonia and respiratory failure. It can also reduce risk of hospitalisation, morbidity and mortality.39

If oseltamivir resistance is suspected, zanamivir can be initiated within 48 hours of symptom onset. The recommended dose is 10mg (2 inhalations) every 12 hours. The product is authorised for use in the EU but as it is not marketed in Ireland, it is only available as an unlicensed product. Specialised advice should be sought if considering initiating zanamivir.39 References available on request

The recommended treatment dose of Oseltamivir is 75mg twice daily for adults and adolescents aged 13 years and over, with a body weight of greater than 40kg. In infants and children aged from 1-12 years, the weight-adjusted dosing regimen outlined in the table below is recommended.

The recommended treatment dose of Oseltamivir is 75mg twice daily for adults and adolescents aged 13 years and over, with a body weight of greater than 40kg (see table left). In infants and children aged from 1-12 years, the weight-adjusted dosing regimen outlined in the table below is recommended.

3 mg/kg twice daily is the recommended dose for infants 0 - 12 months of age. However, this dosing regimen is not suitable for infants with a post-conceptual age less than 36 weeks.40 of treatment is usually 5 days, with 10 days for oseltamivir in immunocompromised adults and adolescents recommended.

Questions and Answers

What are the main warning symptoms of cold and flu that require referral for immediate medical attention?

What is a pharmacist’s role in antimicrobial stewardship in the context of cold and flu?

How effective is vaccination in protecting against cold and flu?

Who is eligible for a free flu

What antiviral treatments are available to treat cold and flu?

3 mg/kg twice daily is the recommended dose for infants 0 12 months of age. However, this dosing regimen is not suitable for infants with a post conceptual age less than 36 weeks 10 days for oseltamivir in immunocompromised adults and adolescents If oseltamivir resistance suspected, zanamivir can be initiated within 48 hours of symptom onset. The recommended dose is 10mg (2 inhalations) every 12 hours. The product is authorised for use in the EU but

O N LY

TRIPLE

ACTIVE FORMULATION

Solpa Cold & Flu Multi Relief Max Powder for Oral Solution, Paracetamol 1000 mg, Guaifenesin 200 mg, Phenylephrine Hydrochloride 12.2 mg.

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

Pharmacy Role in RSV Awareness

This article has been produced and funded by Sanofi.

With the incidence of RSV on the rise, pharmacists will often be faced with questions regarding the virus, the common symptoms and when parents or caregivers should be concerned.

The community pharmacy can play a key role in managing RSV by providing education, support and early intervention to reduce the spread and impact of the virus.

Sanofi has released findings from a recent survey conducted to assess awareness and understanding of respiratory syncytial virus (RSV) among parents and expectant parents in Ireland.

The online survey, which included 500 adults who are either pregnant or have children, aimed to gauge their knowledge of RSV—a common virus that causes colds and coughs and can lead to infections in the lower respiratory tract, known as lower respiratory tract infections (LRTIs).2

Results show that just over half (51%) of Irish parents are aware of RSV and the risks it poses to infants and young children, while nearly one in five (19%) are not familiar with the virus. General practitioners (GPs) are the primary source of information on children’s health for 81% of respondents, followed by the HSE website at 61% and public health nurses at 52%.1

Dr Máire Finn, a GP at Ennis Centric Health, explained, "Most RSV infections in infants are mild and will resolve within a few weeks. However, some cases can become more severe, potentially requiring hospitalisation.”

She highlighted some of the early symptoms of RSV which

Dr Máire Finn, a GP at Ennis Centric Health

household cleaning products, can further help prevent transmission.

Seán Brennan, Head of Medical, Sanofi Ireland told Irish Pharmacy News, “This new research from Sanofi highlights the reality that only half of Irish parents know about Respiratory Syncytial Virus (RSV) and how serious it can be for young children. With 90% of children encountering RSV before they turn two, it’s so important that parents have easy access to information that can help keep their little ones protected.

- their nostrils are getting wider as they breathe, or their ribs are sucking in; has gone blue on their lips or tongue; will not stay awake or wake up; has long gaps in breathing (more than 10 seconds at a time or regular short gaps in breathing of 5 to 10 seconds), or who is pale and sweaty.2

Where to go for more information

include fever, sniffles, wheezing, reduced appetite, or ear infections and which can resemble a common cold.

For pharmacists with concerned parents or carers in the pharmacy she says, “If symptoms worsen to include feeding difficulties, long stretches without wet nappies, rapid breathing, persistent high fever despite treatment, or unusual fussiness, I would suggest to parents and carers to contact their GP. In cases where an infant has noticeable difficulty breathing or significant pauses in breathing, urgent medical attention is needed, and calling 999 is crucial."

Around 90% of children contract RSV by age two, making it the leading cause of lower respiratory tract infections (LRTIs) in babies.3,4 RSV is a seasonal virus, spread through coughs, sneezes, or close contact, with Ireland's RSV season generally beginning in early October and peaking in December and January.6

Lower respiratory tract infections, including bronchiolitis, pneumonia, or pneumonitis, are most likely to develop during a child's first encounter with RSV.6

To help protect infants, precautionary measures are recommended. Frequent and thorough handwashing is the most effective step in preventing RSV transmission. When someone has cold or flu-like symptoms, it is essential they cover their nose and mouth with a tissue when coughing or sneezing and wash their hands for at least 10 seconds afterward. Avoiding the sharing of items like cups, glasses, and utensils with those who are ill with RSV can also reduce the risk of spreading the virus.

Additionally, cleaning surfaces that may be contaminated with RSV, such as door handles, using regular

“Our Together Against RSV campaign is here to fill that gap, offering parents, expectant parents, and caregivers the support and resources they need to better understand this common, but potentially serious virus. We encourage parents to visit www. togetheragainstrsv.ie , where you’ll find helpful information that works hand-in-hand with HSE guidance on RSV.”

When to Refer:

• Baby has had less than 3 to 4 wet nappies in a 24 hour period

• Baby has gone 12 hours without having a wet nappy

• Baby has no energy to breastfeed, or if they are refusing to feed. Or if the baby is too breathless to attach to the breast

• Mums who are bottle feeding and who notice baby is taking less than half of what they would normally take

• A child with a temperature of 38 degrees Celsius or higher that does not settle or improve

• A child that seems short of breath

• A child with no energy or is irritable

Furthermore, the HSE recommends immediately calling 999 or 112 for an ambulance or go to the nearest emergency department if a parent or caregiver notices that their baby is having visible difficulty breathing

Sanofi has an informative website www.togetheragainstrsv.ie that provides information about RSV to complement HSE advice. The survey and website form part of a nationwide RSV campaign, Together Against RSV.

1. Research survey was conducted by Empathy on behalf of Sanofi Ireland. Sample size 500. The survey took place across August and September 2024.

2. Health Service Executive (HSE). RSV (respiratory syncytial virus). (Last reviewed 9 February 2023). Retrieved September 2024. https://www2.hse.ie/conditions/ rsv/

3. Wennergren, G. and Kristjånsson, S. Relationship between respiratory syncytial virus bronchiolitis and future obstructive airway diseases. Eur Respir J. 2001; 18:1044–1058 DOI: 10.1183/09031936.01.00254101

4. Zar, H. J., Nduru, P., Stadler, J. A. M., Gray, D., Barnett, W., Lesosky, M., Myer, L., Nicol, M. P. (2020). Early life respiratory syncytial virus lower respiratory tract infection in a South African birth cohort: epidemiology and effect on lung health. The Lancet. Global Health, 8(10), e1316–e1325

5. Guo, Ling et al. (2024). Respiratory syncytial virus seasonality, transmission zones, and implications for seasonal prevention strategy in China: a systematic analysis. The Lancet Global Health, Volume 12, Issue 6, e1005 - e1016

6. Health Protection Surveillance Centre (HPSC) website. Respiratory Syncytial Virus (RSV). (Last reviewed: 20 August 2024). Retrieved August 2024, from Health Protection Surveillance Centre Website: https:// www.hpsc.ie/a-z/respiratory/ respiratorysyncytialvirus/ factsheet/ MAT-IE-2400338 (V1.0) Oct 2024

IPHA Launches ‘Innovate for Life’

The Irish Pharmaceutical Healthcare Association (IPHA), which represents the international research-based biopharmaceutical industry, has launched a new campaign consisting of films and podcasts documenting the personal stories from patients who, because of new medicines, were able to experience moments in their lives which otherwise wouldn’t have been possible. Innovate For Life, which is in its sixth cycle, is the industry’s digital campaign demonstrating the impact of medicines innovation.

This year the campaign consists of photo montages of moments – both mundane and special – from the lives of patients which were possible because of new medicines. These are accompanied by podcasts from these same patients telling their personal stories.

The campaign, featuring four international biopharmaceutical companies with a presence in Ireland, centres around:

1. Pfizer’s work towards the cancer moonshot goal and how clinical trials can accelerate these breakthroughs. Featured is Patrick who, because of a successful cancer clinical trial, won’t miss a single precious family moment. During the podcast we hear Patrick tell his story to Pfizer Country Medical Director Orlaith Gavan, who also explains Pfizer’s cancer moonshot goal and the importance of clinical trials.

2. Novo Nordisk has a long history in the development of medicines to treat chronic disease. Featured is Carmel who, since 1997 when she was first diagnosed, has experienced firsthand how new treatments have significantly improved her management of type 1 diabetes. She speaks to Professor Fidelma Dunne in the podcast on how new treatments have given her a sense of freedom and improved her quality of life.

3. Roche’s scientists are committed to finding new treatments that reduce the burden on patients with retinal diseases, which are a leading cause of sight loss. In these films Mary tells her story of how, because of access to new medicines, she can continue to be independent and enjoy doing what she loves most. During the podcast she discusses with Neil Ward, Fighting Blindness’ Head of Advocacy and Communications,

Walsh Celebrates 40 Years of PR

how new medicines in ophthalmology can mean the difference between people losing and keeping their sight.

4. AbbVie’s researchers are driven to ensure that migraine sufferers have the option of new treatments that can help them live full lives. Featured in this campaign are Jen and Leona who, because of advanced migraine medicines, have both been able to experience more of life’s important little moments. In the podcast, they openly share their experiences of how migraine once impacted their lives – on being a mother, on their careers, on their relationships – and how transformational their treatment has been.

Eimear O’Leary, IPHA’s Director of Communications and Advocacy, said, “This Innovate For Life campaign is aimed at telling the personal stories of innovation and how new medicines can

Walsh:PR, one of Ireland’s most trusted and established PR agencies, marked forty years in business with their clients at an intimate event in the Merrion Dublin last month. The event, MC’d by broadcast journalist Sarah McInerney, celebrated the agency’s significant milestone and offered clients across the food, health, sustainability and NGO sectors the opportunity to hear from a leading expert in behavioural change marketing, Peter Mitchell of Marketing for Change. Pictured at the event were Caroline Heywood of Walsh (centre) with Fiona Clancy and Niall Faul of Perrigo.

National Cancer Registry Report

literally change the trajectory of someone’s lives. Unfortunately, patient care in Ireland is not as good as it could be. IPHA believes that every patient in Ireland should have fast and fair access to the latest treatments available. To give them a chance at creating new memories, like the people featuring in these films.

“This campaign illustrates why IPHA are calling for a New Medicines Pledge to be adopted by the next Government– where doctors can have the right medicine available for prescription for their patients at the right time; where the number of clinical trials in Ireland are doubled; and where there is a levelling-up of care for patients with rare diseases.

“We are very grateful to the film’s eight-member cast who shared their personal stories and brought to life the impact of new medicines.”

The new National Cancer Registry of Ireland (NCRI) report highlights increased survival and decreasing death rates among people living with blood cancers in Ireland.

The proportion of people surviving at 5 years following diagnosis has significantly increased and death rates from blood cancers have fallen according to a new report published by the National Cancer Registry of Ireland today.

Prof. Deirdre Murray, director of NCRI, and professor of epidemiology at University College Cork, noted that five-year survival for blood cancers has increased from 53% (1994-2007 cases) to 67% (2008-2021), and ongoing increases in survival are reflected in reductions in mortality.

Compared to a peak in blood cancer death rates in the late 1990s mortality has since declined by over 1% annually.

Blood cancers are responsible for 10% of all new cancer diagnoses and over 8% of cancer deaths every year. Approx. 2,400 people are diagnosed with blood cancer each year in Ireland, with this number set to increase to over 3,000 new cases annually by 2030. There are many different types of blood cancer, and this is the first report of its kind to provide comprehensive data across these

different blood cancer types. The most commonly diagnosed blood cancers were non-Hodgkin lymphoma, leukaemia, and multiple myeloma. From the mid-2000s leukaemia incidence rates declined significantly, and non-Hodgkin lymphoma rates stabilised from the mid-2010s.

Professor Deirdre Murray said, “The report sheds light on the diversity in incidence and outcomes for blood cancers providing important data to better address the burden of blood cancer in the Irish population. The

significant increases in survival and reductions in mortality reflect diagnostic and therapeutic innovations. Genetic testing has been increasingly applied to improve diagnosis and better target treatments for patients with blood cancers.”

“The advances in diagnosis and treatment over the last decades are reflected in the favourable blood cancer trends overall but more focus is needed for certain subtypes of blood cancer for which outcomes are less favourable such as acute myeloid leukaemia.”

Brian Fitzgerald, Mari Mina Pharmacy, Toomevara, Co. Tipperary Finalist

Syrian refugee Fa

Brian Fitzgerald is a Pharmacist at Mari Mina Pharmacy in Toomevara.

Brian’s nomination stems from his exceptional dedication as a community pharmacist, consistently going above and beyond to serve his village.

One person nominating Brian described his commitment, saying, “Brian is always so kind and attentive whenever I visit his pharmacy. He truly goes above and beyond every single day. Nothing is ever too much trouble for him. Such a wonderful addition to the village."

Beyond his role as a pharmacist, Brian was also recognised for his charitable contributions.

Earlier this year, during a charity mission to Africa, he generously sponsored the necessary medications for the entire team, even going as far as mailing supplies to those unable to visit his pharmacy. His actions, both at home and abroad, reflect his unwavering commitment to his community and his profession.

The nominee added, “In our community, Brian has become a treasured presence, known for his unwavering professionalism, courtesy, sensitivity, and genuine desire to help others. His dedication to his clients

In association with

consistently goes above and beyond, whether he's collaborating with medical professionals, sourcing specific items, or simply lending a listening ear.

Brian’s exceptional commitment to the field of health and medicine deserves our deepest appreciation and recognition. We are fortunate to have someone as devoted as Brian in our village, and we thank him wholeheartedly for his service.”

Reflecting on his recent nomination, Brian shared his surprise and gratitude, saying, "I was surprised but humbled to be recognised by the community." As a dedicated pharmacist, he prioritises the well-being of his patients each day, whether by addressing questions, providing guidance, or helping them understand their prescribed medications. "For many, the pharmacy is often their first stop for advice and support," Brian explained. "My job is to make sure they receive the best care possible."

Looking to the future, Brian envisions pharmacists playing an even greater role in healthcare. "I believe we'll see pharmacists stepping up to prescribe more, which can ease the strain on GP practices, shorten wait times, and help people access the care they need more quickly."

Finalist

Philip

Philippa Beeley, known as P

Chanel Geoghegan, Hickey’s Pharmacy, Clones, Co. Monaghan

Chanel Geoghegan, Pharmacist with Hickey’s Pharmacy Clones was overwhelmed to have been nominated for The People’s Pharmacist 2024.

“Chanel is a true pillar of her community, consistently going above and beyond in her role as a pharmacist,” said one nominee.

“From personally delivering medications to patients’ homes to traveling to administer flu vaccines and checking in on elderly clients, Chanel’s dedication is unwavering. For families going through palliative care, she provides her personal mobile number, making herself available 24/7—even taking calls on her days off. Balancing her demanding role with raising three young boys, Chanel continues to put her patients first, never taking extended holidays and often putting others’ needs before her own.

“Her commitment to patient care is seen not only in her actions but also in her priorities. When medications are in short supply, Chanel often sources them from alternate wholesalers, absorbing any extra costs instead of passing them on to her customers. She is deeply committed to her patients' well-being, valuing their health over profit margins—a rare trait in any business owner.

“Chanel’s compassion, dedication, and integrity have made her a true standout in her profession, a unicorn in the world of pharmacy owners. Her community is not only grateful but also inspired by the exceptional care and kindness she brings to every aspect of her work.”

Chanel shared her delight, saying, “I was so pleasantly surprised to be recognised by our community for the role we play in pharmacy. Being patient-facing is truly my favourite part of the job—I love being able to help people when they need it most. It’s also important to recognise that this is a team effort. I have a fantastic team behind me, and none of this would be possible without their support.”

She continued, “Helping people through tough times is genuinely fulfilling. Community pharmacists are uniquely positioned to support the most vulnerable, whether they’re local families or patients who’ve lived here their entire lives. Having grown up here myself, I feel deeply connected to the community and understand the needs of both younger and older generations alike.”

Paul Burns, Dargle Valley

Pharmacy,

Bray, Co. Wicklow Finalist

Syrian refugee Fa

Paul Burns is Supervising Pharmacist with Dargle Valley Pharmacy in Bray. Paul and his dedicated team have gone above and beyond to ensure exceptional support and care for their patients, offering invaluable assistance during some of life’s most challenging moments.

One nominee told us, “For me, Paul was more than a pharmacist—he became a lifeline as I navigated treatment for bilateral breast cancer. With the complexity of my condition, I was prescribed numerous medications, including specialised high-tech treatments, all of which required meticulous management and timing. Paul and his staff were unwavering in their commitment to ensure that I always had the medication I needed, precisely when I needed it, making my treatment journey significantly less stressful.

“One of the most remarkable aspects of Paul’s service is his accessibility and dedication. He even gave me his personal contact number, reassuring me that I could reach him anytime. On occasions when the pharmacy was closed, he made himself available to open the store if I ever ran short on medication or needed an extra supply.

In association with

“Beyond providing medications, Paul also took the time to walk me through the intricacies of the Drugs Payment Scheme. As someone who was not entitled to a medical card, understanding this scheme helped me manage the financial side of my healthcare more effectively.”

On receiving news of his nomination, Paul said, “Our team has proudly served the Bray community with pharmacy services for nearly 30 years, driven by a deep passion for all aspects of pharmacy. Over the years, we’ve expanded our offerings to meet the diverse needs of our entire community, striving to make healthcare accessible and supportive for everyone.

“Seeing our nomination for this award sparked tremendous excitement for all of us. It’s a meaningful acknowledgment of the dedication we bring to our work and the level of care we provide each day. We at Dargle Valley Pharmacy believe in being accessible, approachable, and available to every customer, taking time to connect and ensure each person feels informed and supported on their journey to wellness. We don’t just dispense medications—we empower our customers to play an active role in their health, making every interaction a meaningful step toward well-being.”

Finalist

Philip

Philippa Beeley, known as P

Deirdre O’Rourke, Adrian Dunne Pharmacy Kilbarrack, Dublin

Inspiring resilience shines through in Deirdre O’Rourke’s nomination.

Deirdre is Supervising Pharmacist at Adrian Dunne Pharmacy in Kilbarrack.

At just 41, her nominee, a stroke survivor living with aphasia, reflects on the journey that began when she was 37, shortly after the birth of her son. Navigating life with aphasia brings unique challenges, but having the support of compassionate healthcare professionals has made an immense difference. Lisa shares that, throughout her experience, Deirdre and her team have been nothing short of exceptional: "Simple things like aphasia support were always there for me!"

Reflecting on the impact Deirdre has had, her nominee describes her as a pharmacist who goes the extra mile. "I couldn’t put it into words about Deirdre," she says. "She is the kindest and most caring chemist I have ever met." For her nominee, Deirdre's genuine care and patient approach are invaluable, making a meaningful difference in her life.

Deirdre ensures that every visit feels unhurried, offering detailed explanations for each medication and always willing to repeat information as often as needed.

“Nothing is an issue for her,” she continues. This commitment means that Deirdre’s pharmacy

has become more than a place to pick up prescriptions—it’s a place where customers and patients feel truly supported and seen. Deirdre’s kindness and patience are a reminder of the profound impact that compassionate care can have on a person’s journey to healing and adaptation.

Deirdre said on receiving her nomination, “In Kilbarrack, a community known for its closeknit nature, being recognised for my contributions is a meaningful honour, especially I have only recently become part of the community over the last few years,” she shared, reflecting on the pride that comes with being appreciated by her patients.

Central to this appreciation is the personal connection built with customers. Deirdre notes that these relationships are the most rewarding part of the job, as each customer genuinely values the familiarity and personal care they receive from the team.

"Getting to know the customers is definitely the most rewarding aspect of my work here; they really appreciate being known by the team," she said.

Keith Brennan, Brennans Pharmacy, Ballyfermot, Dublin Finalist

Syrian refugee Fa

Described as ‘the embodiment of a community-focused pharmacist, always ready to offer advice, support, and compassion to those who come through his door,’ Keith Brennan, Pharmacist at Haven Pharmacy in Ballyfermot, is a Finalist for the 2024 People’s Pharmacist.

His nominee explained, “Keith’s dedication goes far beyond filling prescriptions—he is committed to ensuring that every patient feels heard, valued, and cared for. No matter how busy his day may be, Keith makes a point of stopping whatever he’s doing to assist any customer who asks to speak with him, giving them his undivided attention and expertise. This personal commitment has made him a trusted figure in the community, a role he takes to heart.

“One of the most striking examples of his dedication came during a recent shortage of medications. Despite the challenges, Keith went above and beyond to source a continuous supply of chemotherapy medication for my husband. He spent countless hours working with suppliers and searching for alternative options to make sure we had enough to get us through each week, providing us with peace of mind during an incredibly difficult time.

His tenacity and compassion during that period left a lasting impression, and it’s clear he would do the same for anyone in need.

“Beyond his role in the pharmacy, Keith is a vital part of the community in other ways. He is known for his commitment to the elderly, taking extra time to ensure they understand their medications and helping them manage their health needs. Additionally, he is an enthusiastic supporter of local youth, sponsoring several youth clubs and investing in activities that give young people a sense of belonging and purpose.”

Being highly regarded within his community was a surprise for this Ballyfermot pharmacist, who was both honoured and moved by the recognition. Reflecting on the nomination, he shared, “It was a lovely surprise to be nominated, and it’s really nice to know that there are people out there who appreciate what you do. It was a real shot in the arm for me and my team,” he remarked with warmth and appreciation.

“The most rewarding thing in my workday is seeing someone come into my pharmacy with a problem to be solved, interacting with me or a member of my team, and then leaving feeling a little better than when they came in. Having a positive impact on someone’s day is what it’s all about.”

Finalist

Philip

Philippa Beeley, known as P

Laura Reynolds, LloydsPharmacy, Rathmines, Dublin

Laura Reynolds is the Supervising Pharmacist with LloydsPharmacy in Rathmines. Upon hearing of her nomination, Laura told us the surprise and excitement filled not just her store, but her home as well. She said, “I am truly grateful for the support and recognition I've received, which reflects the wonderful community here in Rathmines. This nomination underscores the vital role community pharmacists play locally, and it’s humbling to be acknowledged in this way.

“I feel fortunate to love what I do and to be able to make a real difference in people’s lives. Knowing that my patients are happy and feel well cared for brings a great sense of achievement, making this recognition a true delight. It feels like all the hard work has not gone unnoticed, even on those tougher days, as community pharmacy certainly comes with its challenges.

“The most rewarding part of being a community pharmacist is the relationships I’ve built with my patients. Since joining the Rathmines branch in 2009, I've

developed strong ties within the community. Supporting patients in managing their health, answering their questions, and seeing the positive impact we can make on their lives is deeply fulfilling. I find great satisfaction in knowing that we play an essential role in their healthcare journey. I strive to make my patients' lives a little easier, from managing prescription orders in advance to coordinating deliveries.”

This year, for the first time, Laura provided vaccinations at her daughter’s school, covering 150 children.

One of her nominees said of Laura, “Laura is always greeting her customers with a smile, and is always happy to assist in any way. She ensures that we all leave the pharmacy feeling at ease and knowing that exceptional care has been and will follow throughout your/any heath journey. Her beautiful, enigmatic and professional nature epitomises the brilliance of what it is to be a pharmacist.”

Martin Kelly, Kelly’s StayWell Pharmacy, Dundalk, Co. Louth Finalist

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Martin Kelly is a Pharmacist at Kelly’s StayWell Pharmacy in Dundalk. Martin was nominated for his unwavering commitment and exceptional service.

“As a dedicated community pharmacist, Martin consistently goes beyond his professional responsibilities to provide unparalleled care and support to every patient,” said one nominee.

“Martin is more than just a pharmacist; he is a cornerstone of our community. His dedication to patient well-being shines through in each interaction, whether he’s delivering expert advice, offering comfort and reassurance, or ensuring that patients fully understand their medications and treatment plans.

“A defining quality of Martin’s practice is his genuine ability to make each patient feel valued and understood. He approaches every interaction with empathy, taking the time to listen, address concerns, and offer personalised guidance that has a profound impact on patients' lives. His compassion and commitment have played a vital role in enhancing the health and well-being of our community.

“Martin’s contributions are especially evident during challenging times. Throughout

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recent health crises, he has worked tirelessly to ensure that all patients had consistent access to necessary medications and accurate health information. Beyond his role in the pharmacy, Martin is actively involved in local health programs and support groups, continuously striving to uplift and improve the overall wellbeing of our community.”

"Being highly regarded by our community is truly a privilege,” says Martin. “Working in pharmacy can be challenging at times, so receiving positive feedback and knowing that the effort everyone at Kelly’s Pharmacy puts in is appreciated means a lot to us.

“The most fulfilling part of being a community pharmacist is forming strong relationships with patients. We get to know people on a personal level—meeting their families, caring for multiple generations, and supporting them in anyway we can. There’s nothing more rewarding than seeing positive health outcomes, knowing our care has helped people lead happier, healthier lives.

“Our role continues to evolve, and I’m excited about the ways we can continue making a difference.”

Finalist

Philip

Philippa Beeley, known as P

Ultan McKeon, Quin’s Pharmacy Bray, Bray, Co. Wicklow

Supervising Pharmacist with Quinn’s Pharmacy in Bray. Ultan McKeon was nominated for the 2024 People’s Pharmacist by one nominee who describes him as ‘an incredible support.’

“Ultan has been an incredible support to me and my family,” they said. “When my husband underwent a major operation two years ago, Ultan managed all of his new prescriptions and supplies, ensuring we had everything we needed.

“On Christmas Eve, he went above and beyond by sourcing essential supplies for us and even carried them to my car, as I had my baby with me at the time. He has also met us after hours when we've urgently needed prescriptions and is always available by text for any questions or concerns. His dedication and kindness are truly remarkable!”

Ultan told Irish Pharmacy News, “Receiving this nomination means so much to not only me but our entire team. It shows us how much our contributions are valued by the community, and that our work truly makes a difference. Sometimes, we don’t realise the impact we

have until we see messages on social media or receive a heartfelt thank you from a patient.

“Recently, a customer wrote a touching article expressing gratitude for our efforts to source a crucial product for their child on Christmas Eve—it’s moments like these that highlight how meaningful our work is. This nomination is the icing on the cake and serves as a wonderful reminder of why I love helping our community.”

He added, “Starting a new business seven years ago, we’ve focused on building trusting relationships with our patients and their families. Supporting people in challenging situations—whether they’re managing long-term illnesses, dealing with end-of-life care, or simply handling health challenges alone—is incredibly rewarding. Doing everything possible for them is deeply important to me and to our team. Being able to offer that kind of support and care is, in itself, the most fulfilling part of our work.”

Awards

Championing Excellence in Self-Care

The Irish Pharmacy

Awards 2024

Introducing...

Winning his first Award of the night at the annual 2024 Irish Pharmacy Awards, Mark McPhillips of Mark’s StayWell Pharmacy in Ardee won the Haleon Self-Care accolade.

Mark's Pharmacy in Ardee embodies the spirit of community healthcare, delivering exceptional service, innovation, and a strong family-centred ethos. Nestled in the heart of a town celebrated for its community spirit and historical richness, Mark’s Pharmacy has become an essential part of the local landscape.

Led by a dedicated family team, the pharmacy stands out for its personalised customer service. Beyond dispensing medications, the team at Mark’s Pharmacy is committed to building lasting relationships, taking the time to understand each customer’s unique health needs. This personalised

approach, combined with expert health advice, has established Mark’s Pharmacy as a trusted healthcare provider in Ardee.

Innovation is a cornerstone of Mark’s Pharmacy’s services. Their emphasis on vaccination services has addressed a critical health need within the community, making essential immunisations more accessible and convenient for residents. This service underscores the pharmacy’s commitment to enhancing public health and safety. The pharmacy continually introduces advanced healthcare solutions tailored to meet the evolving needs of the Ardee

community. From chronic condition management to wellness consultations, their proactive and compassionate approach to healthcare reflects a deep understanding of the community they serve.

More than a business, Mark’s Pharmacy is a trusted health partner for the people of Ardee. With a unique blend of highquality service, innovative healthcare offerings, and a familydriven touch, Mark's Pharmacy has become an integral, cherished part of the community, supporting the well-being of Ardee’s residents every day.

Mark's Pharmacy has shown a strong commitment to advancing self-care services, tailoring initiatives to the specific health needs of the community. Recognising the growing awareness and demand for proactive health management, the pharmacy has launched several innovative self-care projects aimed at enhancing community health and well-being.

In response to rising concerns around cardiovascular health, Mark's Pharmacy actively participated in the Healthy Heart Month campaign. During this initiative, the pharmacy extended its services beyond its physical location, setting up a Blood Pressure (BP) clinic at key sites in Ardee, including SuperValu, Ardee Credit Union, and the Bank of Ireland. This strategic outreach not only promoted heart health awareness but also made critical health check-ups more accessible, reinforcing the pharmacy’s dedication to preventive care.

In addition to its cardiovascular efforts, Mark's Pharmacy prioritised immunisation by offering in-store vaccination clinics and extending these services to local large employers. By making vaccinations easily accessible, the pharmacy strengthened community health resilience and contributed significantly to local disease prevention efforts.

Continuing its expansion of healthcare services, the pharmacy introduced an in-store ear microsuction clinic. This addition provides a safe and

Maria McClafferty, Pharmacy Channel Controller, Haleon with Mark's Pharmacy Ardee

Haleon,

effective solution for ear health—a frequently overlooked component of personal care. By offering a specialised service focused on ear health, the pharmacy demonstrated its commitment to meeting a wide range of healthcare needs within the community.

Addressing respiratory health, Mark's Pharmacy established an Asthma Review Clinic with a targeted, innovative campaign: “If you use more than 4 Ventolins in a year, your asthma may not be under control.” This clinic provided peak flow readings, reviewed inhaler techniques, and offered essential guidance on when to seek further medical help. The asthma clinic has not only improved respiratory health but also provided critical education and support for asthma management.

Further enhancing its healthcare offerings, the pharmacy introduced a 24-hour blood pressure monitor rental service, allowing community members to access comprehensive blood pressure monitoring in a convenient manner. This service reflects the pharmacy’s dedication to empowering individuals with the tools needed for continuous health monitoring.

Through these strategic initiatives, Mark's Pharmacy has effectively addressed the self-care needs of the Ardee community. Each project reflects a deep understanding of local health requirements, a proactive approach to wellness, and an unwavering commitment to innovative healthcare solutions. Mark's Pharmacy continues to be an essential partner in advancing community health and well-being.

Mark’s Pharmacy is more than a healthcare provider—it serves as a cornerstone of the Ardee community. Fully attuned to the unique needs of its local population, it offers services that go well beyond dispensing medications. Initiatives such as blood pressure screenings at local businesses, asthma clinics, and outreach to traditionally underserved groups, including local farmers, underscore the pharmacy’s commitment to the well-being of every individual in the community.

The pharmacy has also demonstrated significant innovation in the use of healthcare resources, effectively filling critical gaps in local healthcare availability. By introducing services like an in-house ear microsuction clinic and dermatologist-led mole skin checks, Mark’s Pharmacy eases pressure on traditional healthcare services. Additionally, services like 24-hour blood pressure monitoring and advanced respiratory care ensure patients

have access to essential health tools, keeping pace with modern healthcare practices.

Mark’s Pharmacy is equally committed to improving the patient experience, adopting a personalised approach to every service it offers. This patientfocused model, evident across services from blood pressure assessments to skin health checks, fosters a welcoming and supportive environment. Their remarkable 98% customer satisfaction rating reflects this dedication, further reinforced by community engagement activities like informative sessions for the Ardee Active Retirement group.

Preventive medicine is at the heart of the pharmacy’s mission. Through early detection of high blood pressure in 72 patients, as well as the identification of atrial fibrillation and other health concerns, the pharmacy plays a crucial role in preventing serious health issues within the community. Health promotion campaigns and educational outreach underscore the importance of early detection, transforming these services into potentially life-saving interventions. The range of innovative services offered, such as the Asthma Review Clinic and in-store ear microsuction, showcases the

pharmacy’s forward-thinking approach. These specialised offerings, not commonly available in community pharmacies, highlight Mark’s Pharmacy as a leader in delivering unique, patientcentric healthcare solutions.

Education is another critical pillar of Mark’s Pharmacy’s approach, as it continually raises community awareness on health management and disease prevention. By enhancing health literacy in Ardee, the pharmacy supports a culture of informed decision-making and encourages proactive self-care.

Collaboration with health professionals is an essential part of the pharmacy’s integrated healthcare approach. Through the sharing of comprehensive patient reports with local GPs, Mark’s Pharmacy ensures continuity of care and promotes a seamless healthcare experience for its patients.

Looking ahead, Mark’s Pharmacy shows a strong commitment to sustainability and continued improvement in self-care services. With a focus on adapting to evolving healthcare needs, it promises to be an enduring asset to the Ardee community.

Mark said on the night, “This Award of Self-Care means a lot to us as this is something we strive to prioritise every day for our

Mark’s Pharmacy Team celebrate their success

patients. Self-care is a vital aspect of pharmacy and whilst we always strive to make sure we are offering optimum service in this field, it’s always for the betterment of patient care. Receiving recognition for our work makes it all so worthwhile.

“These Awards mean so much to community pharmacy. It’s the coming together which makes us all one big team, and these Awards celebrate that and celebrate all the work we are actively doing as a group.”

Maria McClafferty, Pharmacy Channel Controller with Haleon said, “This is a really important Award within the pharmacy industry so firstly a huge congratulations to all the Finalists and of course Mark and his team on winning.

“Self-care is all about empowering consumers to take action to improve their health and wellbeing and at Haleon we are about better health everyday for consumers. So this Award category is a perfect fit that aligns with our values and we are delighted to be associated with it.”

Mark Scoops a Double at Irish Pharmacy Awards

The

Irish Pharmacy

Awards

Mark McPhillips, Pharmacist with Mark’s StayWell Pharmacy scooped the 2024 Perrigo Superintendent Pharmacist of the Year Award, marking his second accolade of the evening.

Mark McPhillips’ contributions to public health over the last year are extensive and multifaceted, highlighting his role as a community leader in healthcare. In summary,

his role has been exemplary in promoting public health. His mentoring of pharmacists and interns, involvement in setting professional standards, introduction of specialised health services, commitment to community education, and pursuit of professional development, collectively underscore his profound

“Mark exemplifies excellence in pharmacy leadership, innovation, and community service. Over the past year, he has implemented transformative initiatives that have improved business performance, patient care, and public health outreach, setting a high standard for the pharmacy profession”

impact on community health and the pharmacy profession.

Mark’s impact on Mark's Pharmacy and the Ardee community over the past year has been significant and multifaceted. His leadership and innovations have led to measurable improvements in both business performance and community health outcomes.

Mark McPhillips has demonstrated exemplary dedication to public health and pharmacy practice, profoundly impacting both his local community and the broader pharmacy profession. Through a range of initiatives, Mark has established himself as a proactive force in community engagement, accessible healthcare, and professional development.

One of Mark’s hallmark initiatives has been the creation of blood pressure screening clinics in community-focused locations, such as local banks, supermarkets, and even cattle markets. By choosing accessible venues, he has made health monitoring convenient for people who might not otherwise engage in regular health checks. This initiative has increased awareness

about cardiovascular health, encouraging early detection and treatment, and promoting overall well-being across diverse segments of the population.

Mark has consistently prioritised health literacy through outreach programmes tailored to different community groups. He has conducted health talks and interactive sessions for organisations like the Active Retirement Group, Diabetes support groups, and nursing homes. By addressing common health concerns in these settings, Mark has provided accessible health information, empowering residents to make informed health choices and elevating overall community health literacy.

Recognising unmet healthcare needs, Mark introduced specialised services at his pharmacy, including ear microsuction and mole skin scanning. These services have filled critical gaps in local healthcare accessibility, making essential treatments more readily available without the need for long-distance travel. This proactive approach not only

Anne Marie O'Neill, Field Sales Manager at Perrigo with Mark McPhillips, Mark's Pharmacy

addresses immediate health needs but also reflects a forward-thinking attitude toward comprehensive community wellness.

Under Mark's leadership, the pharmacy’s vaccination services have expanded beyond Ardee to seven other counties, demonstrating his commitment to increasing accessibility for vital vaccinations, such as flu and COVID-19.

Furthermore, his commitment to fostering future pharmacy leaders is evident through his roles in the IIOP Pharmacist Mentoring Scheme and as a mentor to a pharmacy intern. By supporting and guiding the next generation of pharmacists, he contributes to sustaining high standards in healthcare and ensures the community will continue to benefit from skilled, knowledgeable professionals.

One of Mark's most measurable achievements has been a 25% increase in dispensary turnover compared to the previous year. This growth reflects the pharmacy’s enhanced operational efficiency, along with an increase in patient services that better meet community needs. This increase in turnover is more than just a

financial metric—it represents the community’s growing reliance on Mark’s Pharmacy as a trusted healthcare provider.

Said a colleague of Mark’s, “Mark exemplifies excellence in pharmacy leadership, innovation, and community service. Over the past year, he has implemented transformative initiatives that have improved business performance, patient care, and public health outreach, setting a high standard for the pharmacy profession.

“His commitment to modernising pharmacy practice is evident in his forward-thinking approach to technology. By adopting Zoho CRM and Zoho Forms, Mark successfully transitioned the pharmacy from paper-based to fully digital records, streamlining workflows and reducing the administrative burden on his team. This technological shift has not only improved operational efficiency but has also fostered a more engaged, less stressed staff—enhancing both job satisfaction and patient care.

Mark’s dedication to adopting innovative practices has positioned Mark’s Pharmacy as a leader in digital health solutions and efficient patient care.

“Mark’s participation in the PSI’s Professional Practice Committee further demonstrates his dedication to upholding high standards within the pharmacy sector. His involvement in this committee reflects a commitment to ensuring that patient safety and quality care remain paramount, setting a positive example for his colleagues across the industry.

“His contributions over the past year showcase a remarkable blend of leadership, innovation, business acumen, and dedication to community health and professional standards. His transformative initiatives in pharmacy operations, his impactful public health efforts, and his commitment to mentoring the next generation of pharmacy professionals highlight the qualities of a true leader in healthcare.”

Speaking after receiving his Award, Mark said, “I am thrilled with this Award. The whole concept of the Awards for us at Mark’s Pharmacy increases staff morale, creates excitement within the pharmacy. To win is the icing on the cake but I have to say without a win it is still always worth it. There is no such thing in my book as a loser, everyone here tonight is winning within the profession.

Walking up: Mark McPhillips, winner of the 2024 Perrigo Superintendent Pharmacist of the Year Award

“These Awards really raise the standard among pharmacy and also provide us all with a great networking event to meet our fellow colleagues and learn more about what’s happening in other pharmacies across Ireland. That aspect of shared learning is so important.”

Anne Marie O’Neill, Field Sales Manager at Perrigo said, “Congratulations to all the Finalists. This is a fantasstic honour for Perrigo to sponsor this Award and to recognise the work Superintendents are doing; we have 3 amazing nominees.

“Perrigo is at the hub of pharmacy, with pharmacy being the main portion of our business. Pharmacists are a central part of all communities so it’s very important for us that we have our brands with these professionals who are caring for customers and offering services to those who don’t often have access anywhere else in the community.”

World Osteoporosis Day – Time for a Check

World Osteoporosis Day – Time for a Check

Written by Michele O'Brien, CEO, Irish Osteoporosis Society

he told to “come back when you have fractured”.

Written by Michele O'Brien, CEO, Irish Osteoporosis Society

people living in Ireland. This is to help prevent people at high risk ending up disfigured, losing their independence and their care costing far more than the ¤120 to do a DXA scan on them.

Research shows that most fractures happen between a T score of -1. 5 to -2.49 which is the moderate to marked Osteopenia range. If a patient with bone loss is refused a DXA scan and/or a treatment and then fractures, who is responsible for them fracturing and possibly losing their independence?

A person knowing they are high risk for vertebral fractures which will leave them with skeletal damage that are not reversible, is at risk for high cortisol levels and anti-depressants, which many cause bone loss, which results in further bone loss, see figure 1 below.

World Osteoporosis having taken place on 20th October, the Irish Osteoporosis Society are asking everyone to check to see if they have risk factors for bone loss.

With World Osteoporosis having taken place on 20th October, the Irish Osteoporosis Society are asking everyone to check to see if they have risk factors for bone loss.

Why prevention of Fractures is common sense as well as economical

Worldwide, up to 37 million fragility fractures occur annually in people over 55, the equivalent of 70 fractures per minute. A fragility fracture is a broken bone from a trip and fall that if the persons bones were healthy, the fracture would not have occurred.

1 in 2 women over age 50 will experience osteoporosis fractures, and 1 in 4 men aged over 50, even though research shows that most fractures are preventable. A recent survey in Ireland showed that over one third of Irish adults over 40, had experienced a fragility fracture. The level of fractures in the survey would generally be expected/assumed by most people to be amongst the older age groups.

prevention of Fractures is common sense as well as economical

Osteoporosis Society on 20th October, the Irish Osteoporosis if they have risk factors for bone loss.

The Irish Osteoporosis Society who are the National experts in Osteoporosis (IOS) find that a person who is high risk to fracture and especially those who have witnessed a family member who suffered from Osteoporosis, are usually the most proactive about their bone health. There was a person in Ireland who sadly committed suicide and in the note that was left, the person said that they could no longer live with the pain they were in. We are not a third world country and the fact that treatments are available this type of situation should never occur.

Research shows that most fractures happen between a T score of -1. 5 to -2.49 moderate to marked Osteopenia range. If a patient with bone loss is refused a DXA and/or a treatment and then fractures, who is responsible for them fracturing and losing their independence?

Worldwide, up to 37 million fragility fractures occur annually in people over 55, the equivalent of 70 fractures per minute. A fragility fracture is a broken bone from a trip and the persons bones were healthy, the fracture would not have occurred.

many

Normal bone Image

There are some in Ireland who believe that DXA scans should only be done on those 65 and older, as they are the highest risk group. Considering the rate of fragility fractures in this survey was highest amongst 40 to 54-year-olds shows that prevention of fractures not only is common sense, but financially for our health service and for the overall wellbeing of

sense as well as economical occur annually in people over 55, the fragility fracture is a broken bone from a trip and fall fracture would not have occurred. Bone image with bone loss

The Irish Osteoporosis Society who are the leading experts in Osteoporosis recommend anyone who has one or more risk factors for bone loss, be referred for a DXA scan, as many will more than likely already have bone loss. Prevention is much cheaper for our health service and certainly less painful for patients then to treat them for fractures, which we all know in the first place can be life threatening. 20% of Irish people who fracture their hip will die within 6 to 12 months, 50% will lose the their independence, why would anyone not take preventing fractures more seriously.

A person knowing they are high risk for vertebral fractures which will leave them damage that are not reversible, is at risk for high cortisol levels and anti-depressants

cause bone loss, which results in further bone loss

Bone image with bone loss

The images show the progression of vertebral fractures that are not reversible

There is no other disease in the world that the IOS are aware off, where patients are discouraged from being proactive in preventing a disease. Recently a 33 year old male with T scores of -3.4, -3.6, -3.4 and -2.6 in his spine, with young children but due to back pain was unable to work, was refused a follow up DXA scan. He ended up paying privately for one and the DXA scan showed his results had declined, was sadly

women over age 50 will experience osteoporosis fractures, a men aged over even though research shows that most fractures are preventable recent survey in Ireland showed that over one third of Irish adults over 40, had experienced a fragility fracture in the survey would generally be expected/assumed by most people to be

here are some in Ireland who believe that DXA scans should only be done on those 65 as they are the highest risk group. Considering the rate of fragility fractures in this

osteoporosis fractures, and

Bone image with bone loss

Normal bone Image

Figure 1: The images show the progression of vertebral fractures that are not reversible

Using the World Health Organization definition of osteoporosis, the disease affects approximately 6.3% of men over the age of 50 and 21.2% of women over the same age range globally. Based on the world population of men and women, this suggests that approximately 500 million men and women worldwide may be affected. Across Europe in 2019 (European Union, plus Switzerland & the UK) 32 million individuals age 50+ are estimated to have osteoporosis, which is equivalent to 5.6% of the total European population age +50, or approximately 25.5 million women (22.1% of women aged +50) and 6.5 million men (6.6% of men aged +50).

These statistics are why prevention of bone loss and earlier diagnosis is crucial not only so that people in Ireland age gracefully but also in order that billions is not used to treat fractures, when a fraction of that cost could be used to prevent them in the first place.

By 2050, the worldwide incidence of hip fracture is projected to increase by 310% in men and 240% in women, compared to rates in 1990. The greatest number of hip fractures occur between 75 and 79 years of age for both sexes. For all other fractures, the highest number occur between 50-59 years which is why the IOS believe that not preventing fractures is not acceptable in this day and age. Hip fractures cause chronic pain, reduced mobility, disability, loss of independence and in 20% of cases in Ireland premature death. The secondary effects of a hip fracture are a blood clot, pneumonia or infection. Less than half those who survive the hip fracture regain their previous level of function.

In Caucasian women worldwide, the lifetime risk of hip fracture is 1 in 6, compared with a 1 in 9 risk of a breast cancer diagnosis.

Vertebral fractures are the most common osteoporotic fractures that occur. A woman 65 years of age with one vertebral fracture has a one in four chance of another fracture over 5 years, which can be reduced to one in eight by them being investigated and placed on an Osteoporosis treatment. Prescribed Osteoporosis treatments have been shown to significantly reduce patients risk of fractures, which is why it is such a shame that the diagnosis rate is so poor not only in Ireland but worldwide.

Vertebral fractures can lead to back pain, loss of height, irreversible deformity of the skeleton, immobility, increased

number of bed days, reduced pulmonary function and premature death. Their impact on quality of life can be profound as a result of loss of self-esteem, distorted body image and depression. Vertebral fractures significantly impact the person’s ability to be able to wash and dress themselves and even to be able to look up see where they are actually walking in order to prevent themselves from falling. Dowagers hump place them at higher risk of falling as their centre of gravity has altered and skeletal changes from vertebral fractures can cause the person to avoid socializing as they are embarrassed regarding how they now look.

Vertebral fractures are associated with an increased risk of further vertebral fractures but also nonvertebral fractures. Women who develop a vertebral fracture are at substantial risk for additional fracture within the following 1-2 years.

It is estimated that only one third of vertebral fractures are actually diagnosed and under diagnosis of vertebral fracture is not just in Ireland it is a worldwide issue. The proportion of vertebral fractures that go undiagnosed, during the assessment of a thoracolumbar lateral radiograph, is as high as 46% in Latin America, 45% in North America, and 29% in Europe/South Africa/Australia. The incidence of vertebral fractures increases with age in males and females. Most studies indicate that the prevalence of vertebral fracture in men is similar to, or even greater than, that seen in women up to age 50 to 60. Research shows that over

age and is highest in the first year after a fracture. Over the first 6 months, the mortality rate in men approximately doubled that in similarly aged women.

A forearm fracture is an early indicator of male skeletal fragility. In aging men, wrist fractures carry a much higher risk for a hip fracture than spinal fractures in comparison to women. These statistics are why not only women in Ireland need to be proactive regarding their bone health, but men need to be more proactive and should be discouraged from doing so.

Personal and Economic affects of Osteoporosis

55% of patients with hip fractures have evidence of a prior vertebral fracture, which is why screening of people for signs and symptoms of undiagnosed bone loss as well as for risk factors for bone loss is essential.

When a decline in bone loss occurs on a DXA scan it is crucial that the causes of why the decline has occurred is investigated and addressed, not assumed. Changing their treatment without investigating the cause/s is not the solution, as 10% loss of bone mass in the vertebrae can double the risk of vertebral fractures.

Why are women affected by bone loss more than men?

There are many reasons why women are more at risk, one of the main reasons is that women tend to have more hormonal issues, as they have ovaries and go through the menopause, when significant bone loss occurs.

So what about Men?

Bone loss is one disease that men are at a significant disadvantage as it is considered by most people to be “An old woman’s disease”. This is a myth as it is estimated that men’s lifetime risk of a fragility fracture is greater than developing prostate cancer. The overall number of fragility fractures is higher in women, but men generally have higher rates of fracture related mortality.

Research shows that more men die then women post hip fractures and that Men account for 25% of hip fractures occurring in the over 50 population. Similar to women, the mortality rate in men after hip fracture increases with

In Europe, the disability due to osteoporosis is greater than that caused by all cancers, except lung cancer. It is comparable or greater than that lost to a variety of chronic noncommunicable diseases, such as rheumatoid arthritis, asthma and high blood pressure related heart diseases.

Fragility fractures are the fourth leading cause of chronic disease morbidity in Europe. The only ones preceding are ischemic heart disease, dementia and lung cancer.

Finding causes of bone loss

The Irish Osteoporosis Society recommends that everyone fill in a risk factor boen loss questionnaire, which is available from the charity by emailing info@irishsoteporosis.ie causes of bone loss are found by How is bone loss (Osteoporosis /Osteopenia) screened for or diagnosed?

• A DXA scan is the only test the Irish Osteoporosis Society recommend to screen or diagnosis Osteoporosis

• A DXA scan takes approximately 15 minutes

• A DXA scan is painless

• A DXA scan is not claustrophobic

• A DXA scan costs approximately ¤120

Repeat DXA scanning is important to monitor your bone health

• If you are losing bone, you will not feel bone loss

• A DXA scan does NOT contain excessive radiation

• A DXA scan contains 10% radiation of a regular Chest X-Ray

• A person flying from Dublin to New York is exposed to more radiation than a DXA scan

bone loss and is not diagnosed or treated.

Osteoporosis

Did you know there are approximately 200 causes of bone loss?

The Irish Osteoporosis Society, the National experts in Osteoporosis, believe that every woman and man need to make their bone health a major priority. Research shows that fractures are preventable in most people, which is why the IOS believe people should not neglect their bone health, as you need healthy bones to sit up and walk.

Can senior citizens actually improve their bone health? YES

The woman below had become wheelchair bound due to vertebral fractures when her son phoned the Irish Osteoporosis Society. Sadly her son had been told that nothing could be done to help his mother.

To the Irish Osteoporosis Society Charity

I wanted to thank your organisation for the help and guidance I received from you regarding my mum’s Osteoporosis.

A person can look perfectly fine on the outside and have severe bone loss inside their bones

• Postural change - Your head starting to protrude forward from your body

What weight bearing exercises are safe for you should be based on the following:

The improvement has been substantial and together with the practical steps we took to adapt her house, her quality of life has improved substantially to the point that she is mobile and active again. We recently took her to Bath, UK to celebrate her 90th birthday and she will go on a Mediterranean cruise with my sister next month!

My Mum and I are extremely grateful for your guidance that has truly given her a new lease of life.

Well done and keep up the great work.

Best Regards, Vincent C

What are the signs and symptoms of Bone Loss?

There are NO signs or symptoms (warning signs) prior to a person fracturing.

NOTE: A person can exercise daily and have a healthy diet, but still develop or have bone loss. Only 19% of people with bone loss are diagnosed, are you or a loved one or any of your customers in the 81% undiagnosed?

• Postural change - A hump developing on your back.

What type of exercise is recommended for bone health?

Are there Signs and Symptoms of Undiagnosed Osteoporosis?

• Your body shape changingExample a pot belly developing

• You are losing height

Yes, if you or a loved one have one or more of the following signs/symptoms, you may have undiagnosed bone loss

The image above (figure 2) shows the irreversible changes that occur when a person develops bone loss and is not diagnosed or treated.

If you have already broken bones or are high risk to break bones, your age, the results from your DXA scan report, your medical history and your fitness level. It is much safer to slowly build up your bone strength, then take the risk of breaking bones.

Touching your toes while in the sitting position or standing position, excessive bells, yoga, jumping off boxes, stopping your feet when walking, trampolines

What type of exercise is recommended for bone health?

A person with bone loss should be individually assessed by a chartered physiotherapist a special interest in bone health, to see what exercises are safe and appropriate do. Please contact the Irish Osteoporosis Society as there appears to be many issues area.

• A broken bone/s (fracture) from a trip and fall or less, even if on ice or cement

• Upper, middle or low back pain, intermittent or constant back pain

• Postural changes - Your shoulders starting to become rounded

A person with bone loss should be individually assessed by a chartered physiotherapist with a special interest in bone health, to see what exercises are safe and appropriate for them to do. Please contact the Irish Osteoporosis Society as there appears to be many issues in this area.

THOSE WHO HAVE BONE LOSS NEED TO BE VERY CAREFUL WHAT EXERCISES THEY DO AS THEIR MUSCLES MAY BE STRONG, BUT WHEN A STRONG MUSCLE PULLS ON A WEAK BONE, IT CAN FRACTURE.

As mentioned already, research shows that most broken bones occur in the Osteopenia range. This is why the Irish Osteoporosis Society recommend that senior citizens who have never lifted weights, start out actively without them and slowly build up to lifting

What weight bearing exercises are safe for you should be based on the following:

If you have already broken bones or are high risk to break bones, your age, the results your DXA scan report, your medical history and your fitness level. It is much safer build up your bone strength, then take the risk of breaking bones.

THOSE WHO HAVE BONE LOSS NEED TO BE VERY CAREFUL WHAT EXERCISES THEY DO AS THEIR MUSCLES MAY BE STRONG, BUT WHEN A STRONG MUSCLE PULLS ON A WEAK BONE, IT CAN FRACTURE.

As mentioned already, research shows that most broken bones occur in the Osteopenia range. This is why the Irish Osteoporosis Society recommend that senior citizens never lifted weights, start out actively without them and slowly build up to lifting weights. is to ensure that they do not end up really sore or with fractures. Those that prior diagnosis had lifted weights should start out with low weights and slowly build up, worth the risk of the person fracturing

The following are some of the many exercises the Irish Osteoporosis Society recommend for those with bone loss:

Figure 2

weights. This is to ensure that they do not end up really sore or with fractures. Those that prior to their diagnosis had lifted weights should start out with low weights and slowly build up, as it is not worth the risk of the person fracturing.

At the foot of the page are some of the many exercises the Irish Osteoporosis Society do not recommend for those with bone loss:

Touching your toes while in the sitting position or standing position, excessive weights, kettle bells, yoga, jumping off boxes, stopping your feet when walking, trampolines or swiss balls.

Did you know that all senior citizens need to ensure that they make their homes safe to reduce their risk of falling in their home?

It is very important that throw rugs are removed from floors, that people wear a good pair of walking shoes in their home versus slippers as many give no support. A handrail should be placed on steps into homes and handrails on both side of your stairs can make it much easier and safer for you. Clothes should be between hip and eye level in cupboards and any clothes that have not been worn in 5 years should be donated. The reason being that if you or a loved one has trouble finding clothes or when trying to pull an item out, you have difficulty, you have too many items. There are so many people who are not in this position and would be forever grateful to receive clothing. There have been multiple incidences where senior citizens with bone loss have actually fractured vertebrae while attempting to manoeuvre clothes out of a wardrobe.

More than one out of four older people fall each year, but less than half actually tell their doctor. The Irish Osteoporosis Society believe from feedback this is due to embarrassment and also many are concerned they may be sent to a nursing home. Research shows that falling once doubles the person’s risk of falling again and that more than 95% of hip fractures are caused by falling, usually by falling sideways.

What makes walking with a cane or rollator much more difficult?

One of the major issues with those who use canes or rollators is that they are adjusted to high. If either are too high, they can cause, neck, shoulder and back pain and make it more difficult for a person to walk.

How to check if your cane or rollator is too high – you will need someone to help you

A person needs to stand up as straight as they can, with their arms down by their sides, preferable with a chair behind them in case they need to sit down. It is important that the person looks straight ahead because if they look down to see what the person is doing their arm will lengthen. The handle of the cane or rollator should be level with the small bone on your wrist.

Did you know that there are major advances in the area of incontinence?

75% of people can completely recover and the other 25% can significantly improve the issue. This is so important because most people when they begin to have leakage of urine (or bowel), they start to reduce the amount of fluids they drink because they

do not want to have an accident. Most people area not aware of the consequences of decreasing fluid intake.

Reducing the amount of fluids you drink can place you at risk of falls for several reasons.

• Slipping and falling from rushing to the bathroom or having an accident while trying to get there, can cause fractures.

• If you ever feel thirsty studies show that you only need to be 1% dehydrated to experience a 5% decrease in cognitive function, which can place a person at risk of falling. A 2% decrease in brain hydration can result in short term memory loss.

• You can develop kidney issues which can affect your overall health but also can affect the ability for a person to take some Osteoporosis treatments.

How much fluids should you drink?

8 regular glasses of fluids. Your body is made up of water, so it is essential for your overall health. By including fortified milk with Vitamin D, not only are you helping your bone health but also your overall health as Vitamin D is essential for your immune system. You should reduce caffeine intake to 2 a day.

Treatments for Bone Loss

The patient’s treatment plan should be based on

• The patient’s risk of fracture or re-fracture

• The results of their DXA scan of the spine and hips.

• The cause/s of why they developed low bone density

• Their age

• Their lifestyle

• Their medical history

Treatments available are the following

Bisphosphonates - Weekly or monthly tablets. A person should only take for maximum 5 years, not 5 years on different ones.

HRT - HRT is appropriate for menopausal symptoms but should not be taken just to protect bone, except in certain cases in premenopausal women.

Denosumab, brand name Prolia - Twice yearly injection. Should not be stopped without closing off the action of it with a bisphosphonate to prevent significant bone loss occurring.

Zoledronic Acid, brand name Aclasta - once a year IV bisphosphonate

Teriparatide – Daily injection for severe Osteoporosis.

Summary as to why everyone should be checking to see if they have risk factors for bone loss!

It is very important that everyone take their bone health seriously if they want to stay independent as they age, as a prior fracture is associated with an 86% increased risk of a further fracture occurring. The risk of a subsequent fracture is particularly increased in the first two years after an initial fracture. Research evidence suggests that many women who sustain a fragility fracture are not appropriately diagnosed and treated for osteoporosis. The great majority of individuals at high risk (possibly 80%), who have already had at least one osteoporosis fracture, are neither identified nor treated.

An IOF survey, conducted in 11 countries, showed denial of personal risk by postmenopausal women, lack of dialogue about osteoporosis with their doctor, and restricted access to diagnosis and treatment before the first fracture resulting in under diagnosis and under treatment of the disease.

A second hip fracture occurs in approximately one in four patients after any previous osteoporotic fracture, and in one in three patients who have sustained a hip fracture, on average within one and a half years.

For additional information, you can check our website at www.irishosteoporosis.ie

Or Email info@irishosteoporosis.ie

BioGaia Prodentis: The Probiotic Revolution for Oral Health

Oral health plays a crucial role in overall well-being, and the importance of maintaining a balanced oral microbiome is becoming increasingly evident. One innovative product that has garnered attention in recent years is BioGaia Prodentis, a probiotic supplement specifically designed to promote oral health. This product is not just a passing trend, it’s backed by substantial clinical research and has proven benefits that make it a compelling addition to everyone’s daily oral routine.

BioGaia Prodentis is a probiotic supplement developed by the Swedish biotech company BioGaia. It contains two strains of the beneficial bacterium Lactobacillus reuteri, namely Lactobacillus reuteri DSM 17938 and Lactobacillus reuteri ATCC PTA 5289. These strains have been carefully selected for their ability to naturally inhabit the human oral cavity, making them ideal for restoring balance to the oral microbiome.

While most probiotics target gut health, BioGaia Prodentis is uniquely formulated for oral care, addressing issues such as gum disease, bad breath, and overall oral hygiene. The supplement typically comes in the form of lozenges, which dissolve in the mouth, ensuring direct delivery of the probiotic strains to the oral cavity.

BioGaia Prodentis is not just another probiotic on the market; it’s supported by extensive clinical research that underscores its effectiveness. Numerous studies have demonstrated that

the Lactobacillus reuteri strains in BioGaia Prodentis have a significant impact on oral health.

Periodontitis, or gum disease, is one of the most common oral health issues affecting adults worldwide. It’s caused by the buildup of harmful bacteria that inflame the gums, leading to bleeding, receding gums, and, in severe cases, tooth loss. Clinical studies have shown that daily use of BioGaia Prodentis can help reduce inflammation and bleeding of the gums in individuals with mild to moderate periodontal disease. In a double-blind, placebocontrolled trial, participants who used BioGaia Prodentis showed a significant reduction in gum inflammation and a decrease in the number of harmful bacteria in the mouth compared to those who did not use the supplement.

Plaque buildup is another leading cause of oral health problems, contributing to tooth decay and gum disease. Research has found that Lactobacillus reuteri in BioGaia Prodentis can reduce plaque levels and limit the growth of pathogenic

bacteria. By restoring a healthy balance of microorganisms in the mouth, BioGaia Prodentis can help reduce the formation of plaque and improve overall oral hygiene.

Halitosis, or bad breath, is often caused by an overgrowth of certain bacteria in the mouth that produce foul-smelling sulfur compounds. Studies have indicated that the probiotic strains in BioGaia Prodentis can significantly reduce bad breath by competing with these odor-causing bacteria and creating a more balanced oral environment. This makes BioGaia Prodentis an excellent choice for individuals struggling with chronic bad breath.

The two strains of Lactobacillus reuteri found in BioGaia Prodentis have been shown to inhibit the growth of harmful bacteria like Streptococcus mutans, which is a key player in tooth decay. By promoting the growth of beneficial bacteria, this probiotic supplement helps protect against common oral infections, making it a valuable preventive tool.

Written by Sinead Fitzgerald, Owner, HappyTummy.ie / HappyGummy.ie

BioGaia Prodentis Should Be Part of Your Daily Oral Routine

Given the research-backed benefits of BioGaia Prodentis, it’s clear that incorporating this probiotic into your daily routine can have a positive impact on your oral health. Traditional oral care practices like brushing and flossing, while essential, may not be enough to maintain optimal oral health. BioGaia Prodentis goes a step further by targeting the root cause of many oral health problems - an imbalanced oral microbiome.

With consistent use, this probiotic supplement helps promote healthy gums, reduce plaque buildup, and improve breath quality. Furthermore, it’s easy to usesimply dissolve one lozenge in your mouth daily after brushing for lasting results.

To summarize, BioGaia Prodentis offers a natural, scientifically proven way to enhance your oral health. With benefits ranging from improved gum health to fresher breath, it’s an excellent addition to anyone’s oral hygiene routine. The clinical research supporting its efficacy makes it a reliable, safe, and effective solution for maintaining a healthy oral microbiome, helping you to prevent common oral health issues before they arise. With over 60 clinical studies in 2,355 individuals, BioGaia Prodentis is the probiotic most studied for oral health. Of these studies, 48 were randomized, double-blind/blind, and placebo controlled. We have our teeth for longer these days thanks to the dentists and dental hygienists. How are you taking care of your teeth and gums?

BioGaia Prodentis is available online @HappyGummy.ie and HappyTummy.ie and will be rolling into Pharmacies and Health stores around the country via Wholefoods Wholesalers. Also available for Practitioners via Pure & Natural.

Optimising Health in Menopause

The average age of menopause in women in the UK is 51. The onset of perimenopause is around 45. Some women may however go into menopause earlier than this. Menopause between 40-45 is referred to as early menopause. Premature ovarian insufficiency (POI) is when menopause occurs below the age of 40.

Early menopause and POI are defined as the loss of normal ovarian activity. Ovulation is diminished and the ovaries produce insufficient levels of estrogen. This clinical syndrome is characterised by erratic or absent periods, raised gonadotrophins (FSH and LH) and low estradiol levels. The prevalence of POI is approximately 1%.

An early menopause may be spontaneous or induced/iatrogenic. The etiology of spontaneous POI is wide ranging, including chromosomal and genetic defects (like Fragile X syndrome and Turner syndrome), autoimmune disorders, infections, exposure to environmental toxins and idiopathic. Iatrogenic causes include radiotherapy, chemotherapy and surgery (oophorectomy).

What are the symptoms of early menopause?

The most common symptoms of POI and early menopause are loss of periods and vasomotor symptoms (hot flushes and night sweats). Other symptoms include mood changes, insomnia, genitourinary symptoms and brain fog. However up to 14% of women with POI will not experience symptoms.

Hot Flashes

Hot flashes are the most common vasomotor symptom (VMS) associated with perimenopause and menopause, the stages when ovarian function declines, leading to the cessation of menstruation. During a hot flash, patients typically experience a sudden sensation of intense heat, especially in the face, neck, and chest, often accompanied by significant sweating and a subsequent feeling of chills.

Hot flashes can be different for everyone. Some people may not have symptoms that bother them, while other people have symptoms that affect their daily lives. However, common symptoms may include:

• Feelings of intense, internal heat

• A lot of sweating (When it happens at night, it's called night sweats, and it may wake you up.)

• Flushing (skin becomes hot and red), especially in the face, neck, and chest

• Chills after the hot flash is over due to excessive loss of body heat

• Increased heart rate of about 7-15 beats per minute

• Feelings of anxiety

The severity and frequency of hot flashes vary widely among patients. If lifestyle adjustments are not providing adequate relief, additional strategies may be considered.

Supplements and Complementary Therapies

Many patients explore supplements and alternative therapies to manage menopausal symptoms. It’s important to remember that supplement quality, purity, and safety can differ significantly among products. Patients should consult with their healthcare provider before starting any supplement, as some may interact with other medications. While some individuals find benefit from acupuncture or relaxation techniques, current evidence supporting these methods for menopause symptom relief remains limited.

Benefits of Sage

Sage (Salvia), a member of the mint family with over 900 species, includes types like Salvia officinalis and Salvia lavandulifolia that are widely used in cooking

and are also present in some dietary supplements.

Known for its antioxidant and anti-inflammatory properties, sage has a history in traditional medicine, though research on its effectiveness specifically for menopause symptoms remains limited. Sage is commonly used by patients seeking relief from menopausal symptoms such as night sweats, hot flashes, and mood fluctuations.

Menopausal symptoms affect up to 80% of women, often including fatigue, decreased bone density, and weight gain. Many patients explore botanical remedies like sage for symptom management.

Extracts from sage herb, like A.Vogel Menoforce® Sage tablets, have become a popular natural option for managing menopause symptoms. They are commonly used to help reduce excessive sweating, hot flashes, and night sweats.

Menoforce® is a traditional herbal medicinal product designed to relieve excessive sweating associated with menopausal hot flashes, including night sweats. Its use is based on a longstanding tradition rather than clinical trial evidence.

Menoforce® is suitable for women over 18 experiencing menopausal symptoms, including hot flashes and night sweats. The recommended dosage is one tablet daily.

Contraindications

Menoforce® Sage tablets should not be used if:

• A patient has an allergy to sage herb or any of the tablet’s ingredients.

• They are pregnant or breastfeeding.

• Their symptoms worsen, or if they do not experience improvement within 4 weeks— refer to GP in these cases.

• They have been diagnosed with a rare sugar intolerance condition, such as fructose intolerance, glucose-galactose malabsorption, or sucraseisomaltase insufficiency. Menoforce® Sage tablets may not be suitable for these conditions.

Keep your cool with Menoforce

• Registered herbal remedy for relieving menopausal hot flushes & night sweats

• Convenient once-a-day dose

• Can be taken alongside

• Contains extracts of harvested,

Topic Team Training – Cough

Following on from the October issue Continuing Professional Development on the Pharmacy Role in the Management and Treatment of Cough, this 5-Minute Learning Module is designed to enhance the community pharmacy team's understanding and ask further questions as to how you can support and advise patients.

Cough is a common symptom and complaint, particularly during the winter months, and is associated with a wide variety of aetiologies and clinical conditions. A cough is one of the most common medical complaints, and is the most common symptom for which people seek advice at their community pharmacy.

A cough can be described as either productive (chesty), where sputum is produced, or nonproductive (dry, tickly or irritating), where no sputum is produced. Non-productive coughs may be the result of increased throat irritation due to sensitisation from a virus, and a productive cough results from increased mucosal secretions. During a cold, a cough is often caused by a nasal drip irritating the back of the throat. Steam inhalations can be a useful hometreatment, particularly in productive (chesty) coughs. Hot drinks such as lemon and honey can also provide a soothing effect. Sugarfree versions of cough mixtures are also available for diabetics.

A cough can often accompany other symptoms such as rhinorrhoea, fever, sore throat, earache and general aches and pains. Most coughs are selflimiting and will usually self-resolve within 3 weeks, however, it is important for the person to see or be referred to the GP, if the cough lasts more than 3 weeks, or if the person is coughing up blood.

An acute cough, of less than three weeks’ duration, is often caused by a viral respiratory tract infection, and is one of the most common reasons for accessing healthcare in the community. The most common causes of acute cough in adults are acute viral upper respiratory tract infections (URTIs), such as the common cold.

Consider:

A class of blood pressure medication called ACE inhibitors can cause a persistent dry cough in some people. Examples include ramipril, perindopril, and Lisinopril. Certain cough remedies however, made with mainly natural ingredients including traditional herbal medicinal products (THRs) are licenced for sale in Ireland, available in pharmacies nationwide, and suitable to use for children over 12 months old. A range of products are specifically formulated for children from 1 year of age, and can be used to treat dry or chesty coughs.

Opioid derivatives are commonly sold as cough suppressants / antitussives to suppress the cough reflux from the medulla in the brain stem to provide relief from frequent coughing. Common drugs include dextromethorphan, pholcodine, dihydrocodeine, and codeine. Preparations may be sold as syrups, medicated lozenges, tablets or capsules.

 Have I, or any of my team, established the type of cough?

 Can I, or any of my team, explain the benefits of each cough medication?

 Is the pharmacy team aware of the guidelines for children under the age of 6?

 Is the pharmacy team confident in informing pharmacy customers on the recommended treatment?

 Is the pharmacy team educated and knowledgeable on the dosage and contra-indications for all cough medications?

 Is there any further training required to assist the team discussing cough remedy advice with customers?

Productive coughs present as a cough where mucus is expectorated when coughing. Medication licensed for the management of productive coughs fall into two categories: expectorants (protussives) and mucolytics. Like antitussives, these drugs come as syrups, medicated lozengers, tablets or capsules. Expectorants, such as guaifenesin, stimulate the secretion of mucus in the airways and reduce adhesion to improve the efficacy of coughing in clearing mucus. Mucolytics, for example, bromhexine, act to thin the mucus to facilitate easier clearance.

Herbal medicines are popular in the treatment of minor medical conditions, including coughs. Herbal medicinal products on

Key Points:

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

 Customers that should be referred to the pharmacist.

 Those with persistent cough that should be referred to their GP.

 Lifestyle and smoking habits which may need considered in product selection.

 Customers should be advised of nonpharmacological measures, such as adequate hydration and proper rest.

the Irish market must be either authorised or registered with the HPRA. A range of medical devices for coughs and respiratory symptoms are available at pharmacies nationwide, including humidifiers, inhalers, and nebulizers among other products. A nebulizer is a type of breathing device that can be used to inhale medicated vapours. While not always prescribed for a cough, nebulizers may be used to relieve coughs and other symptoms caused by respiratory illnesses.

Actions:

 Prior to recommending OTC cough products, pharmacists should ascertain whether selftreatment is appropriate.

 Pregnant and lactating women and those with chronic medical conditions should always consult their GP before using any OTC cough medication.

 Those with a smoker’s cough should be advised to take part in the pharmacy smoking cessation programme.

 Update the team’s knowledge of available cough remedies by type/ cause, indications and doses to ensure appropriate product selection for each customer.

 Train the team to meet all the above considerations.

COOL, CALM & TO THE RESCUE

Are you tired of dealing with parched, flaky or damaged skin? Look no further! Our Intensive Rescue Range is your perfect solution to dryness, saving your skin from the clutches of dehydration and itchiness. The multi-awarding winning trio is like a chill pill for your skin, breaking the itch-scratch cycle in an instant and giving ultimate nourishment to allow your skin to restore, rebalance and rejuvenate. Whether you struggle with eczema, dermatitis, psoriasis, or just need an everyday dose of hydration, our Intensive Rescue Range is the answer to your skincare needs..

Formulated with up to 19 essential oils and extracts, as well as prebiotic ingredients, the triple-action triad encompasses everything the skin needs to power its self-healing capabilities by promoting skin regeneration and nourishing new skin cells. It feeds and strengthens the microbiome - the skin’s natural layer of good bacteria that covers the epidermiswhich, when disturbed or damaged, can result in a wide range of skin health concerns such as e,czema, dermatitis, psoriasis, acne and very dry, dehydrated skin.

With hydrating Pentavitin, our Intensive Rescue Range delivers moisture-locking technology for up to 72 hours making it an effective and reliable solution for sensitive skin. Anti-irritant oat extract, ceremide-rich jojoba, soothing aloe vera, omega-rich sea buckthorn and detoxifying zeolite help to relieve and reduce redness, inflammation and itching, as well as irritation caused by pollutants. YOUR 3-STEP ROUTINE

1. INTENSIVE RESCUE FACE LOTION

A lightweight, daily lotion, expertly crafted to combat dry, itchy skin and sensitive skin around the face and eyes, leaving no greasy residue. Apply 3-5 times a day,

or whenever you need an instant boost of hydration or a moisturised base. Once your skin feels relieved and calm, reduce to twice daily in the AM and PM for long-term skin health management.

2. INTENSIVE RESCUE SPRAY

A colloidal spray that revives dryness and soothes your skin with speedy itch relief to help heal and regenerate damaged areas. Keep three to five centimetres away from your skin and spritz generously over your body’s craving zones. Massage into your skin and voila! Instant relief anytime and anywhere.

3. INTENSIVE RESCUE MOISTURISER

A fast-absorbing, mineral detox for your body, eliminating toxins and allergens to give you relief from irritation. Calming plant oils give your skin the TLC it craves, leaving it soft, smooth, and comfortable. Start with Sorted Skin Intensive Rescue Spray to halt that troublesome itch. Then, layer on our soothing Intensive Rescue Moisturiser to the more damaged areas. Repeat two to three times a day. Once you’ve tamed those symptoms, you can cut back to once a day or as needed, to keep your skin happy and avoid any surprise flare-ups.

Microbiome-based skincare brand, Sorted Skin, is made in the UK and born out of 35 years of skincare experience. Developed for topto-toe problem skin, the complete collection features an Intensive Rescue range for dry, dehydrated and eczema-prone skin on the face and body, an Intimate Hygiene range to soothe and protect delicate intimate skin and the 5 in 1 Anti-Redness Day Cream SPF50 for red, sensitive and reactive skin. All Sorted Skin products are dermatologically approved, hypoallergenic, natural, vegan and cruelty-free.

Comparing Sugar and Carbohydrate Restriction Fat

Loss Benefits with Divergent Effects on Cholesterol, Glucose Tolerance, and Gut Microbiome

Written by Javier Gonzalez, Aaron Hengist and Dylan Thompson

The World Health Organization recommends that people should restrict their intake of free sugars to reduce the risk of overweight, obesity and dental caries. An alternative approach to prevent weight gain, growing in popularity, is a restriction of overall carbohydrates by following a low-carbohydrate or ‘ketogenic’ diet. A recent study published in Cell Reports Medicine from the Centre for Nutrition, Exercise, and Metabolism at the University of Bath compared these two dietary approaches to a control diet which reflects what people in the UK are consuming currently, revealing their divergent effects on metabolism, cholesterol, glucose tolerance, and the gut microbiome.

Javier Gonzalez

The findings of this study, led by Dr. Aaron Hengist and Dr. Russell Davies, and overseen by Professor Javier Gonzalez and Professor Dylan Thompson, shed light on how each diet impacts fat loss and cardiometabolic health, offering critical insights for healthcare providers.

The study enrolled 53 healthy adults who were randomly assigned to follow one of three dietary regimens for 12 weeks: 1) a moderate-sugar control diet (around 50% of energy from carbohydrates and 20% of energy from free/added sugars), 2) a low-sugar diet (similar in overall carbohydrates, but less than 5% of calories from sugar), and 3) a ‘ketogenic’ low-carbohydrate diet (less than 8% of calories from carbohydrates, both sugar and overall carbohydrates restricted).

‘Free sugars’ refers to added sugars, plus sugar naturally present in fruit and vegetable juices, purees, pastes, and similar products in which the structure has been broken down. They are a component of carbohydrates,

which can also refer to larger and more complex chains of sugar molecules that are not digested and absorbed as easily (like starch and fiber).

Researchers monitored changes in body fat, fuel use, cholesterol levels, the ability to control blood

sugar levels after eating, and gut microbial diversity. The goal was to evaluate how these diets impact energy expenditure (calories burned) and energy intake (calories eaten), and how these diets impact metabolic health beyond mere weight loss, with a focus on their

The three diets tested by researchers manipulated the proportion of energy coming from each macronutrient. MODSUG, moderate-sugar control diet; LOWSUG, a low-sugar diet similar in carbohydrates but free-sugar restricted; and LOWCHO, a ‘ketogenic’ low-carbohydrate diet with both sugar and overall carbohydrates restricted.

effects on cholesterol levels and the gut microbiome.

Key Findings

1. Fat Loss: Both Diets Lead to Fat Loss

Both sugar-restricted and ketogenic diets resulted in fat loss. Participants on the ketogenic diet experienced an average reduction of 2.9 kg in fat mass over 12 weeks, while those on the sugar-restricted diet lost an average of 2.1 kg. Importantly, these reductions in body fat occurred without significant changes in energy expenditure or physical activity levels. This finding suggests that adherence to these dietary modifications alone, without an increase in exercise, can effectively drive fat loss by spontaneously reducing energy intake. Whilst these diets were effective over 12 weeks, weight loss is unlikely to continue at the same rate in the long-term.

2. Cholesterol: Ketogenic Diet Raises Concerns

A surprising and potentially concerning finding was the effect of the ketogenic diet on cholesterol levels. Despite the

Dylan Thompson

Aaron Hengist

before use with any other medication. Antacids may interact with certain medications. Patients with renal or hepatic impairment should consult a physician before using Pepcid Duo Chewable Tablets. In case of renal failure, monitoring of serum magnesium and calcium should be undertaken. Pepcid Duo is contraindicated in patients with severe renal failure. As some serious underlying conditions can have symptoms in common with simple indigestion, it is recommended patients seek medical advice in case of: indigestion symptoms accompanied by unintentional weight loss, difficulty swallowing, persistent abdominal discomfort, heartburn occurring for the first

reduction in fat mass, participants on the ketogenic diet experienced an increase in atherogenic lipoproteins, specifically apolipoprotein B (apoB), which is associated with plaque buildup in arteries. Additionally, there was a rise in small and mediumsized low-density lipoprotein (LDL) particles. These changes, if sustained over a longer period, could increase the risk of cardiovascular diseases, including heart attack and stroke.

In contrast, the sugar-restricted diet significantly reduced LDL cholesterol levels, offering a more favorable lipid profile for long-term cardiovascular health.

Given the rise in popularity of ketogenic diets, healthcare providers should consider monitoring lipid profiles in patients who are interested in following this diet pattern, particularly for individuals with pre-existing cardiovascular risk factors. Educating patients on the potential long-term effects of a ketogenic diet on cholesterol may help mitigate future health complications.

3. Glucose Tolerance: The Keto Diet Reduces the Body’s Ability to Handle Carbohydrates

Another finding was the reduction in glucose tolerance observed in participants on the ketogenic diet. Although the diet reduced fasting glucose levels, the body’s ability to efficiently metabolize carbohydrates from a meal diminished. Professor Gonzalez explained “by measuring proteins

in muscle samples taken from participants’ legs, we think this is probably an adaptive response to eating less carbohydrates day-to-day and reflects insulin resistance to storing carbohydrates in muscle. This insulin resistance is not necessarily a bad thing if people are following a ketogenic diet, but if these changes persist when people switch back to a higher carbohydrate diet it could increase the risk of developing type 2 diabetes in the long-term”. The sugar-restricted diet, on the other hand, had minimal impact on glucose tolerance, making it a potentially safer option for individuals concerned about glucose metabolism and insulin sensitivity.

Whilst it is worth noting that the participants in the study were metabolically healthy and are not necessarily reflective of a clinical population, healthcare providers should consider monitoring glucose tolerance and insulin sensitivity in patients who follow a ketogenic diet, especially those at risk for diabetes. Counselling on the potential implications of long-term carbohydrate restriction could help patients make informed decisions about their dietary choices.

4. Gut Microbiome: Keto Diet Alters

Gut Health

The ketogenic diet also had significant effects on the gut microbiome. Most notably, it decreased levels of Bifidobacterium, beneficial bacteria commonly found in

probiotic supplements, known for its role in producing vitamins, inhibiting harmful pathogens, and lowering cholesterol levels. In contrast, the sugar-restricted diet did not significantly alter the gut microbiome, preserving the diversity and balance of beneficial bacteria. These findings suggest that a ketogenic diet, while effective for fat loss, may have unintended consequences for gut health, potentially increasing the risk of digestive disorders such as irritable bowel disease or even weakening immune function.

Dr. Russell Davies, who led the microbiome research, explained the impact on gut health:

“Dietary fibre is essential for the survival of beneficial gut bacteria like Bifidobacteria. The ketogenic diet reduced fibre intake to around 15 grams per day, half the UK National Health Service (NHS) recommended intake. This reduction in Bifidobacteria might contribute to significant long-term health consequences such as an increased risk of digestive disorders like irritable bowel disease, increased risk of intestinal infection and a weakened immune function.”

With the knowledge that a ketogenic diet can reduce beneficial gut bacteria, healthcare providers can guide patients toward probiotic supplementation or dietary adjustments to support gut health, such as informing about the importance of fibre intake, particularly for those following lowcarbohydrate diets.

NEWS - Transforming Lung Cancer Care

Implications for Cardiometabolic Health

While both sugar-restricted and ketogenic diets led to reductions in fat mass, their broader metabolic effects differed substantially. The ketogenic diet’s impact on cholesterol levels, glucose tolerance, and the gut microbiome raises questions about its longterm cardiometabolic benefits for widespread use. Dr. Hengist noted that although the ketogenic diet is effective for fat loss, the increase in unfavorable cholesterol levels could have serious implications for heart health if sustained over time. Additionally, the transient reduction in glucose tolerance could become problematic for individuals who switch back to a higher carbohydrate diet, potentially increasing the risk of metabolic disorders such as type 2 diabetes. More work is needed to understand if different versions of the ketogenic diet could provide the beneficial effects of fat loss without the unfavourable effects on blood lipids in some people. In contrast, the sugar-restricted diet offered more favorable outcomes with respect to cholesterol and gut health, while still supporting fat loss. This makes it a potentially safer and more balanced option for individuals seeking to improve cardiometabolic health without the risk of negative side effects associated with a ketogenic diet.

As pharmacists continue to play a key role in patient education and health promotion, understanding the nuances of these dietary interventions will be essential in guiding patients toward informed, evidence-based decisions for their health and well-being.

A groundbreaking €4.9 million lung cancer research programme, funded by the Irish Cancer Society, has been launched, marking the largest single investment in lung cancer in Ireland's history.

Pictured are Anne Coyle, CEO, Beaumont Hospital; Dr Seamus Browne, Head of Strategic Research Initiatives and Industry Partnerships, RCSI; Professor Jarushka Naidoo, Professor of Medical Oncology and Consultant Medical Oncologist, Beaumont RCSI Cancer Centre; and Averil Power, CEO of the Irish Cancer Society

This pioneering initiative led by the Beaumont RCSI Cancer Centre aims to transform lung cancer care and research, bringing state-of-the-art cancer care to the community and enhancing access to Irish Cancer Society support services.

Lung cancer is the leading cause of cancer-related deaths in Ireland and worldwide, killing more people every year than breast, prostate and colorectal cancer combined. Early detection is crucial to improving survival

rates. Recognising this, the programme will introduce the Beaumont RCSI Irish Cancer Society Lung Health Check. This clinical trial, in collaboration with specific GP practices in North Dublin and the North East region, will invite high-risk individuals to attend community-based mobile scanning units for lung health checks.

The six-year Beaumont RCSI Irish Cancer Society Lung Outreach Programme, will advance cuttingedge cancer care, focusing on early detection, advanced diagnostics, and innovative treatments. The partnership strives for better outcomes for lung cancer patients and improvements in all key areas of the disease’s management, from the first GP appointment through diagnosis, treatment and survivorship.

Management of BRCA in Men

BRCA stands for BReast CAncer gene. BRCA1 and BRCA2 are tumour suppressor genes which means that they stop the cells in our body from growing and dividing out of control and becoming cancer. People who inherit harmful variants in one of these genes have increased risks of several cancers—most notably breast and ovarian cancer, but also several additional types of cancer. People who have inherited a harmful variant in BRCA1 and BRCA2 also tend to develop cancer at younger ages than people who do not have such a variant.

A lot of people still think that this is a ‘Female or Woman’s’ gene, but the truth is that a BRCA1 or BRCA2 alteration/fault can be inherited from a person’s mother or father. If you carry a genetic alteration, each of your children (male or female), and each of your siblings (male or female) have a 50% (1 in 2) risk of inheriting the same alteration.

Faulty BRCA1 and BRCA2 genes are rare. Around 1 in every 400 people have a faulty BRCA1 or BRCA2 gene. Men who have inherited a fault in their BRCA1 or BRCA2 gene also have a higher risk of developing certain types of cancers, including prostate, pancreatic, and even breast cancers.

While breast cancer is rare in men, it can happen. The average male has a 0.1 percent lifetime risk of developing breast cancer, but in men with BRCA alteration, the risk is much higher: 1 to 5 percent lifetime risk for men with BRCA1 alteration and 5 to 10

percent lifetime risk for men with BRCA2 alteration.

However, most men are probably more worried about prostate cancer than breast cancer, with good reason: the lifetime risk for prostate cancer for an average male is 14 percent. In Ireland, after non-melanoma skin cancer, prostate cancer is the most common cancer in men. It accounts for almost one-third of all invasive cancers in men. 1:9 Irish men will develop prostate cancer (to the age of 75) and 1:6 in their life time. An average of 3,980 men are diagnosed each year in Ireland with prostate cancer and 623 deaths occur due to prostate cancer. However, the 5 year survival rate for prostate cancer is increasing all the time and it is now up to 93%!

For men with BRCA1/2 alterations, the risk of developing prostate cancer is higher than for the general public and if prostate cancer does develop, it may be more aggressive. The risk is

Written by Bernie Carter, Assistant Director of Nursing, Marie Keating Foundation

higher for people born male with an alteration in the BRCA2 gene than in the BRCA1. Men who carry a BRCA2 alteration have a 27% risk of developing prostate cancer by the time they are 80 years old, more than double the rate compared to non-carriers and may be diagnosed at a younger age.

Men with BRCA alteration are also at increased risk for pancreatic

cancer: 2 to 3 percent lifetime risk for those with BRCA1 alteration and 3 to 5 percent lifetime risk for those with BRCA2 alteration, compared to just 1 percent lifetime risk in the general population.

BRCA2 alteration are also associated with a higher risk of melanoma in males. Patients should talk to their GP if they think they could have inherited any of these faulty genes or if they have a strong family history of cancer especially breast, ovarian and or prostate cancer. A strong family history of cancer means multiple close family members on the same side of the family who have the same cancer or related cancer types. Unfortunately, there's currently no reliable screening test for prostate cancer. Some research suggests that perhaps annual PSA tests for prostate cancer may benefit men who carry the faulty BRCA2 gene.

BRCA: The Breast Cancer Gene - BRCA Mutations & Risks (nationalbreastcancer.org)

Predictive genetic tests for cancer risk genes - NHS (www.nhs.uk)

BRCA Gene Mutations: Cancer Risk and Genetic Testing Fact Sheet - NCI

What Men Need to Know About BRCA and Other Gene Mutations | Breast Cancer Research Foundation (bcrf.org)

Nutrition and Cancer Survivorship

Introduction: In Ireland, there are more than 200,000 people who are living with or beyond cancer. This is equivalent to nearly 4% of the total population (Mullen & Hanan, 2019). In the next 25 years, the number of Irish cancer survivors is expected to double due to demographics, earlier detection, and improved treatment outcomes (Mullen et al., 2020). Cancer survivorship is now recognised as a distinct phase of the cancer journey with its own distinct health implications brought about by the cancer itself, the treatment received as well as a potentially impaired nutrition and physical status, these are discussed below.

National reviews and strategies

The National Cancer Registry of Ireland and the Irish Cancer Society recently published a review titled; ‘The Unmet Needs of Cancer Survivors in Ireland’ (O’ Connor et al., 2019). It highlights that the needs of cancer survivors have not been prioritised, with little support available for the management of treatment side-effects. A study included in this review, which focused on breast cancer survivors specifically, found a significant lack of nutritional information being made available during survivorship care (Power & Hegarty, 2010). A more recent survey of Irish cancer survivors found a lack of nutrition support being provided also (O’Sullivan et al., 2020).

Following the review, the Irish Cancer Society’s strategy for 2020-2025 includes ‘Living Well After Treatment’ as one of its five priorities, emphasising the importance of research in helping to improve the quality of life of cancer survivors by uncovering their unmet needs. Moreover, the HSE’s National Cancer Control Programme has placed significant importance on the wellbeing of survivors in its recent ‘National Cancer Survivorship Needs Assessment’ report (Hegarty et al., 2018). A cancer survivor’s quality of life can be profoundly impacted by the burden of symptoms including nutritional symptoms (Hegarty et al., 2018). One of the most common symptoms encountered by Irish healthcare professionals working with adult survivors in the acute sector were nutritional symptoms (Hegarty et al., 2018; Mullen & Hanan, 2019).

Written by Laura Keaver, Registered Dietitian, Lecturer in Human Nutrition and Dietetics and Programme Director, Department of Health and Nutritional Science, Atlantic Technological University Sligo

It is therefore important that healthcare professionals are aware of the nutritional issues faced by cancer survivors and are familiar with the current guidelines for nutrition for this group.

Nutrition-related issues

Survivors may become at risk of weight loss/gain, malnutrition, decreased intake of food and quality of life, should they not receive follow-up care long-term. Therefore, doctors, nurses and dietitians should regularly monitor and manage these symptoms into survivorship (Crowder et al., 2018).

Weight

Weight management in those with cancer has routinely been dominated by concerns about unintentional weight loss, however, many cancer survivors can be at increased risk for weight gain. As this can be associated with an increased risk of developing cancer, maintaining a healthy weight and body composition is important in survivorship (Reeves et al., 2014). This is reflected in the World Cancer Research Fund guidelines for cancer prevention (Table 1). This is further endorsed by European and American bodies where survivors are recommended to aim to achieve and maintain a healthy body weight and that weight loss should be modest (5-10% of total body weight) (El-Shami et al., 2015; Arends et al., 2017, WCRF/AICR 2018).

Residual impact symptoms

Cancer treatment can result in a variety of side effects. These side effects can, in turn, affect the food

intake, nutrition status and quality of life of the individual.

Recent Irish data (O’Callaghan et al., 2021) has shown that these impact symptoms can persist into survivorship. In this cohort of 169 Irish cancer survivors, who were at least six months post-treatment. Fatigue was still being experienced by the majority (76%). Other common impact symptoms were decreased energy levels (51.5%); pain (36.1%); constipation (33%); dry mouth (26%) and diarrhoea (16.6%). This is similar to findings in other countries where, fatigue, difficulty sleeping and pain are commonly reported in survivors (Strollo et al., 2020; Bower 2008).

Cardiovascular disease

After cancer recurrence, cardiovascular disease is the secondary cause of mortality in cancer survivors. This is a long-term complication of cancer therapies (Okwuosa et al., 2017). The risk of cardiovascular morbidity is actually higher than that of cancer recurrence (Schultz et al., 2003; Oeffinger et al., 2006). These morbidities include hypertension, dyslipidaemia, obesity and type 2 diabetes (Schultz et al., 2003; Oeffinger et al., 2006). Screening is important as is the promotion of lifestyle modifications such as increasing physical activity, consuming a healthy balanced diet and maintaining a healthy weight (Okwuosa et al., 2017). The WCRF recommendations in Table 1 should be promoted.

Nutrition related behaviours of survivors

While some studies have shown that cancer survivors are more likely to adopt healthy behaviours than those without a history of cancer (Park et al., 2015; Oh et al., 2013), there are many studies that have highlighted poor fruit and vegetable intakes (Kanera et al., 2016) as well as non-adherence to recommendations for alcohol intake (Iyer et al,2016; Underwood et al., 2009 Cortés-Ibáñez et al., 2020); and Body Mass Index (BMI) (Underwood et al., 2009; Cortes). Compared to those without cancer,

cancer survivors in the USA have a higher consumption of foods containing added sugars, solid fats and alcohol and lower intakes of fibre, calcium, vitamin D and vitamin E (Zhang et al., 2015).

Nutrition advice

Survivors have consistently indicated a desire for nutrition support (Hardcastle et al., 2017; Matsell et al., 2020.; Puller and Jackson 2012), particularly from healthcare professionals (Matsell et al.,2020). Survivors currently report receiving no or conflicting nutrition advice (Hardcastle et al., 2017; Matsell et al.; Puller and Jackson 2012). In the absence of advice from healthcare professionals, survivors source nutrition and physical activity advice from online sources (Keaver et al., 2020; Matsell et al., 2020), which are largely unregulated and often present conflicting or nonevidence-based advice (Keaver et al., 2019). Currently only 11%

of Irish cancer survivors report receiving nutrition advice from a dietitian (O’Callaghan et al., 2021).

Current guidelines and recommendations

A UK survey of specialist nurses, clinicians, surgeons and allied health professionals showed only half were aware of diet as part of lifestyle guidelines for those who had completed treatment (Murphy et al., 2021).

The World Cancer Research Fund recommends that in the absence of survivor specific evidence, cancer survivors should follow their

guidelines for cancer prevention. These have been outlined in Table 1 below. Similar guidelines have been promoted by the American Institute for Cancer Research.

Unfortunately, adherence to these recommendations is poor (Winkels 2016) and baseline knowledge of general or specific risk factors is low in some populations (Anderson, 2015)

Better adherence to these recommendations has been positively associated with global health status, most functioning scales and less fatigue among

Table 1: World Cancer Research Fund Guidelines for Cancer Prevention

Be a Healthy Weight

Be Physically Active

Eat a Diet Rich in Wholegrains, Vegetables, Fruits and Beans

Limit Consumption of ‘Fast Foods’ and Other Processed Foods High in Fat, Starches or Sugars

Limit Consumption of Red and Processed Meat

Limit Consumption of Sugar Sweetened Drinks

Limit Alcohol Consumption

Do Not Use Supplements for Cancer Prevention

For Mothers: Breastfeed Your Baby, If You Can

After A Cancer Diagnosis: Follow Our Recommendations, If You Can

1096 colorectal cancer survivors in the Netherlands (van Veen et al., 2019), with improvements in health-related quality of life also being observed in elderly female cancer survivors from the Iowa Women's Health Study (Inoue-Choi et al., 2013) and Chinese breast cancer survivors (Yei et al., 2018). Greater adherence has also been associated with improved survival in those with colorectal cancer (Song et al., 2021).

Results from a global survey of breast cancer survivors (Keaver et al., 2020) reported that fatigue (reported by 72.1% of respondents); followed by stress, depression or reduced mental function (69.5%); changes in taste preference during or after cancer treatment (48.6%); craving unhealthy food (42.5%); loss of appetite (31.4%); healthy food costing too much (30.5%); and lack of time to prepare healthy foods (34.3%) as the main barriers to healthy eating. Fatigue was also the main barrier to being physically active. To support positive behaviour changes we need to consider these barriers moving forward.

Future

There is a need for research into the nutrition specific needs

of cancer survivors as well as the impact of diet on longer term cancer recurrence and survival. This will help inform the development of more specific guidelines and practices for cancer survivors. There is also a need to determine how best to integrate nutrition into survivorship care. Survivors have a desire for individualised and specific advice relating to their nutritional problems (Matsell et al., 2020). Providing individualized nutritional advice could improve dietary intake and potentially prevent weight loss or weight gain, as well as vitamin and mineral deficiencies.

So, what can you do?

Monitoring weight and nutrition related impact symptoms and signposting to nutrition resources such as the WCRF guidelines or breakthrough cancer research cookbooks https:// breakthroughcancerresearch.ie/ cancer-diet/for specific impact symptoms and healthy eating and referring to a dietitian where appropriate could make a big impact to the health and health related quality of life of cancer survivors.

References available on request

Revolutionising Pharmacy Management: AI-Driven Pharmacy Software

In an era where technology is transforming industries at an unprecedented pace, retail pharmacy is now poised to experience its own digital revolution. The advent of Artificial Intelligence (AI) in healthcare is already changing the way hospitals and clinics operate and this is taking place globally.

To stay ahead of the curve and tackle the rising costs and operational challenges faced by pharmacies in Ireland, Taskgo Pharma are excited to announce the upcoming launch of an innovative AI-driven pharmacy software, currently undergoing a comprehensive feasibility study.

The Current Pharmacy Landscape

Pharmacies today are facing increasing pressure to deliver fast, accurate, and efficient services, while dealing with the complexities of rising administration, stringent regulatory requirements, all whilst dealing with lack of government funding. On top of this, the operational costs involved in staffing, prescription fulfilment, and growing a business can quickly add up, cutting into profits and limiting the capacity to offer a seamless patient experience.

AI technology, with its capacity to automate repetitive tasks, analyse massive data sets, and improve decision-making, offers a solution to these challenges. However, before fully committing to this transformative step, Taskgo

Pharma has been carrying out a thorough feasibility study to ensure that the implementation of AI will lead to substantial improvements in efficiency and cost-effectiveness for pharmacies. This has be led since 2022 and piloted within a chain of pharmacies in Ireland.

The Feasibility Study: Analysing Cost Savings Potential

The goal of our feasibility study is simple yet vital: to explore how Taskgo’s AI-powered pharmacy software can help pharmacies save money while improving overall service quality. To do this, Taskgo, led by pharmacists and business consultants are focusing on several key areas where AI can make a difference:

1. Compliance and Regulatory Adherence

Pharmacies must adhere to a wide range of regulations, and failing to do so can result in expensive consequences. Our AI software is equipped to track compliance metrics and flag potential issues, ensuring that pharmacies stay compliant without the need for costly audits or legal interventions.

Written by Adam Esa MBA MPSI MPHARM

LinkedIn: www.linkedin.com/in/ adam-esa-mba-mpsi-mpharm71105a3a

2. Data-Driven Decision Making

One of the most significant advantages of AI is its ability to process and analyse large amounts of data in real-time. By leveraging AI analytics, pharmacies can identify patterns in prescription ordering, understand their patient needs, and refine business marketing decisions, ultimately contributing to long-term profitability.

3. AI-Powered Customer Support

AI chatbots integration will handle routine inquiries from patients, such as checking prescription statuses or answering frequently asked questions. This reduces the load on staff, allowing them to focus on more complex customer interactions and clinical tasks. We expect this feature to cut administrative costs, while also improving customer satisfaction.

4. Optimised Claims Analysis

Claims Analysis can be a costly and time-consuming process. AI can flag patterns, break down large claims documents, and prevent pharmacies from making reoccurring errors. The software can pull together data from areas

of claims expertise and make

Call for Judges: OTC & Retail Pharmacy Product Awards 2025

As a judge for the OTC & Retail Pharmacy Product Awards 2025, you will play a crucial role in evaluating and selecting the most outstanding Over-the-Counter Pharmacy Products in Ireland. Your expertise and insights will help us identify products that have made significant contributions to the field, whether through technological advancements, patient care improvements, or other remarkable achievements.

Here are some key details about the judging process and requirements:

Judging Process:

• The judging process will be conducted remotely.

• Finalists’ Products will be posted to each judge giving you the opportunity to try, test and evaluate.

• Each judge will be assigned specific product categories.

• Judges will review product submissions, provide scores, and offer constructive feedback.

Requirements:

• Pharmacists, Buyers and Owners.

• A commitment to fairness, impartiality, and confidentiality.

• Availability to review and evaluate product submissions during the judging period.

If you are interested in becoming a judge for the OTC & Retail Pharmacy Product Awards 2025, please email with your name, contact information to robynmaginnis@ipn.ie

Management of Anaemia in Chronic Kidney Disease

Dr Niamh Corcoran1 Specialist Registrar in Nephrology

Professor Austin Stack1,2 Professor of Medicine, Consultant Nephrologist

¹Department of Nephrology, University Hospital Limerick, ²School of Medicine, University of Limerick

Dr Niamh Corcoran

Introduction

The development and progression of anaemia is an almost universal consequence of chronic kidney disease (CKD) and worsens with progressive loss of kidney function. Anaemia is considered both a risk marker and a risk amplifier in that it accelerates the risk of major events such as hospitalisations, stroke, myocardial infarction, and death in patients who have anaemia compared to those who do not. The mechanisms through which anaemia develops in CKD are diverse and complex. Studies over the past 20 years have elucidated mechanistic pathways and generated novel therapeutic interventions. Defective erythropoiesis, iron deficiency, and abnormal iron regulation coupled with a heightened inflammatory system have all conspired to drive the development of anaemia in CKD. The management of anaemia has been revolutionised with the wide availability of recombinant erythropoietin and increased utilisation of intravenous iron. More recently the discovery of a novel set of drugs, the hypoxia-inducible factor prolyl hydroxylase inhibitors (HIF-PHIs), has added to these treatment strategies. Optimisation of anaemia management is associated with improved quality of life, exercise tolerance, and lower risks of adverse clinical outcomes.

Evaluation of Anaemia in CKD

Anaemia is defined as a haemoglobin of <13g/dL in men and <12g/dL in non-pregnant women.1 The prevalence of anaemia increases with advancing

age and with worsening kidney function.2 A recent study by Clancy et al found that the prevalence of anaemia among patients in the Irish health system increased from 8.2% in individuals with GFR > 90 ml/min/1.73m2 to 64% for those with advanced kidney disease eGFR < 30 ml/ min/1.73m2, compared with an overall prevalence of 12% in the general population.3 Once anaemia is diagnosed, a detailed evaluation should seek to identify underlying causes.

The majority of patients with CKD will have a multifactorial anaemia with contributions from iron deficiency and anaemia of chronic disease.4 A focused clinical evaluation should evaluate for blood loss, the presence of comorbidity, and prescribed medications especially the use of antiplatelet agents and anticoagulants. With more advanced CKD, erythropoietin deficiency becomes a more significant contributory factor. The routine full blood count may reveal a microcytic (MCV <80 fL) picture if iron deficiency is a predominant contributor. First-line investigations should include a full blood count (including white cell differential, platelets), absolute reticulocyte count, transferrin saturation (TSAT), ferritin, B12 and folate concentrations, as well as a faecal occult blood test.5

Importance of Iron Deficiency in CKD

Iron deficiency is common contributor to the anaemia of CKD with approximately 60%

of patients affected at the start of dialysis. It can present either as functional iron deficiency –inadequate iron supply to meet demand despite normal iron stores – or absolute iron deficiency – a reduction in stored iron. In general, the detection of iron deficiency requires measurement of transferrin saturation ratio (TSAT), which is a measure of functional iron deficiency, and the plasma ferritin which measures iron storage. Absolute iron deficiency in CKD is generally defined as a TSAT <20% and serum ferritin <100ng/ mL (or <200ng/mL in patients on haemodialysis). This cut off is higher in CKD compared with the general population because plasma ferritin levels increase in states of inflammatory stress such as chronic kidney disease.6 In functional iron deficiency, the TSAT is generally <20% and plasma ferritin levels are elevated.

Management of Anaemia in CKD

The management of anaemia of CKD depends on many factors and requires a balanced approach to treatment. The approach will vary according to stage of CKD, the severity of anaemia, the copresence of iron deficiency, and may differ according to practice patterns within countries. In general, guidelines recommend correction of iron deficiency in the first instance. Treatment with erythropoietin may be indicated where there is persistent anaemia in the setting of advanced CKD and a rise in haemoglobin level is desired. Oral iron supplementation should be considered in the initial treatment of absolute iron deficiency. Oral iron is cheap and easy to administer, but is associated with gastrointestinal upset, non-adherence, and poor absorption. Intravenous iron may be the preferred option in symptomatic or severe iron deficiency (TSAT <12%), and for those who do not tolerate or fail to respond to oral iron. Intravenous iron fully corrects iron deficiency, bypasses need for GI absorption and is incorporated more rapidly into RBCs than oral iron, and delays or avoids the need for erythropoietin therapy.6

The goal of treatment is to correct iron deficiency and increase the haemoglobin concentration. For patients who are receiving dialysis,

the target haemoglobin levels are generally between 10-12 g/ dl. There are no evidence-based target haemoglobin concentrations for patients with CKD and not requiring dialysis, but in general levels should not exceed 13 g/ dl, due to an association between higher haemoglobin levels and adverse clinical outcomes.7

Erythropoietin stimulating agents (ESAs) are generally indicated for the correction of anaemia where patients have persistent anaemia, (Hb <10g/dl) despite adequate iron stores. These agents are administered subcutaneously for patients with non-dialysis dependent CKD or intravenously for those on dialysis. ESA are contraindicated in patients with active malignancy or prior stroke, where the risks may outweigh the benefits.8

A new class of agent, the hypoxia-inducible factor prolyl hydroxylase inhibitors (HIF PHIs) has emerged for the treatment of CKD-associated anaemia. Their novel mechanism of action mimics the natural response of the body to hypoxia and stimulates the transcription of the endogenous erythropoietin gene. Evidence from randomised clinical trials have shown them to increase haemoglobin levels, reduce blood transfusions, and improve iron homeostasis, though there are some concerns regarding the higher risk of thromboembolic events.9, 10

Conclusion

Anaemia in CKD is highly prevalent and confers substantial burden on both patients and the healthcare system. The aetiology is multifactorial, and thus therapeutic strategies must be individualised. Targeted screening of high-risk groups should be performed on a routine basis. Simple measures should be implemented to correct deficiencies wherever possible. Novel therapies such as ESAs and HIF PHIs are emerging as treatments where first line measures are insufficient. Clinicians must remain vigilant and endeavour to continuously improve the identification and treatment of patients with anaemia and CKD. References available on request

Professor Austin Stack

CRITICAL

NEW STUDY CONFIRMS IRISH INCIDENCE OF SUDDEN UNEXPECTED DEATH IN EPILEPSY (SUDEP)

New research has revealed the firstever national data on the incidence of Sudden Unexpected Death in Epilepsy (SUDEP) in Ireland. SUDEP is the sudden, unexpected death of someone with epilepsy, where no other cause of death can be found.

The study, led by Dr. Yvonne Langan of St. James’s Hospital Dublin & Trinity College Dublin, together with the HRB, examined data from all deaths referred to coroners in 2019, identifying those with a history of epilepsy. The research identified 33 cases of definite SUDEP in 2019, representing an incidence rate of 1:1400 per annum among people living with epilepsy. Of the 33 cases, 21 were men and 12 were women, with ages ranging from 9 to 81.

Speaking on the importance of identifying Irish specific data, lead investigator Dr. Yvonne Langan said the study will shape the treatment of epilepsy patients in future.

She said: “Ireland-specific data is vital in shaping effective healthcare policies. The findings will help raise awareness of SUDEP within both the patient and medical community and I hope will support tailored interventions to reduce risk for patients in the future.”

While the exact reasons for SUDEP occurring in some people with epilepsy is unknown, previous research has shown that having uncontrolled or untreated tonic-clonic seizures is the biggest risk factor. Epilepsy Ireland believes that with targeted action to improve access to specialist care, the incidence of SUDEP can be decreased.

Peter Murphy, CEO of Epilepsy Ireland, said not enough is known about SUDEP, even within the Irish epilepsy community.

He said: "This study is a significant step forward in our understanding of the extent of SUDEP in Ireland.

“SUDEP is the most devastating consequence of epilepsy and over the years, we have met with far too many bereaved families who were not aware of SUDEP until their loved one passed away.

“We know that at least some of these deaths can be prevented by ensuring that more people with epilepsy become seizure-free and remain that way. This can be achieved through faster access to diagnosis and treatment, improved dialogue between healthcare professionals and patients, and through enhanced efforts to improve education and selfmanagement about known SUDEP risk factors which are modifiable.

“To date, much of the action around SUDEP in Ireland has come from Epilepsy Ireland, supported by the fundraising efforts of bereaved families.

“The epilepsy community should not have to depend on the fundraising efforts of bereaved families to target this serious issue. This study tells us that a national, government-led strategy with input from clinicians and patients is urgently required and it is vital that these calls will be taken seriously by Government, the HSE and Department of Health.”

Continuing Research

While this study has established the incidence SUDEP in Ireland for the first time, ongoing research will focus on identifying the total number of epilepsy-related deaths, including causes such as status epilepticus (prolonged seizures) and seizure-related injuries. It is currently estimated that over 130 epilepsy-related deaths occur annually in Ireland (including those from SUDEP). This data is expected to be published in the coming months and according to Epilepsy Ireland, will further highlight the urgent need to develop a new strategy to reduce SUDEP and epilepsyrelated deaths.

The study’s findings have been released to coincide with SUDEP Action Day 2024 – a day in which awareness is raised of SUDEP and epilepsy risks internationally, as well as remembering those who have passed away.

Epilepsy Ireland is appealing to people with epilepsy and their families to visit www.epilepsy.ie to learn more about the risks of SUDEP and measures which can potentially be taken to reduce them

LIBTAYO® (CEMIPLIMAB) APPROVED FOR REIMBURSEMENT IN IRELAND FOR THE TREATMENT OF ADVANCED

CUTANEOUS SQUAMOUS CELL CARCINOMA

Regeneron Ireland DAC has announced that Libtayo® (cemiplimab) has been reimbursed by the Ireland Health Service Executive (HSE) for use as monotherapy treatment for adults with metastatic or locally advanced cutaneous squamous cell carcinoma (mCSCC or laCSCC) who are not candidates for curative surgery or curative radiation. Cemiplimab is a fully human monoclonal antibody targeting the immune checkpoint receptor PD-1 (programmed cell death protein-1) and is the first and only systemic treatment available on the HSE in Ireland to treat advanced CSCC.

When CSCC invades deeper layers of the skin or adjacent tissues, it is categorised as locally advanced. Once it spreads to other distant parts of the body, it is considered metastatic. Advanced disease is associated with a poor prognosis and can have a significant impact on quality of life. Currently, people with CSCC too advanced for surgery or radiation have a median survival of approximately one year. In Ireland, approximately 120 people each year will be impacted by advanced CSCC.

“CSCC is the second most common skin cancer, but compared to melanoma, treatment advances have been scarce,” said James Winterman, Regeneron UK and Ireland Country Manager, Oncology. “This acceptance of cemiplimab by the HSE marks the first targeted treatment for advanced CSCC in Ireland and a significant advance for people who until now have only had chemotherapy as an option. We are pleased to be able to bring this treatment to patients in Ireland.”

About Cemiplimab

Cemiplimab is a fully human monoclonal antibody targeting the immune checkpoint receptor PD-1 on T cells and was invented using Regeneron's proprietary VelocImmune® technology.10 By binding to PD-1, cemiplimab has been shown to block cancer cells from using the PD-1 pathway to suppress T-cell activation.10

Reimbursement approval is based on data from the pivotal, open-label, multi-centre, nonrandomised Phase 2 trial known as EMPOWER-CSCC 1 (Study 1540). Patients within the study (n=193) were assigned to three cohort groups (Groups 1, 2 and 3). The primary endpoint was confirmed objective response rate (ORR) by

independent review committee. With a median duration of followup of 18.5 months (Group 1, n=59), 15.5 months (Group 2, n=78) and 17 months (Group 3, n=56), the ORR was respectively 51% for metastatic CSCC patients (Group 1), 45% for locally advanced CSCC patients (Group 2) treated with weight-based dosing, and 46% for metastatic CSCC patients (Group 3) treated with the licensed dose of 350 mg every three weeks.

The safety of cemiplimab has been evaluated in 1,281 patients with advanced solid malignancies who received cemiplimab monotherapy in five clinical studies. Immune-mediated adverse reactions occurred in 21% of patients treated with cemiplimab and led to permanent discontinuation in 5% of patients. The most common immunemediated adverse reactions were hypothyroidism (7%), hyperthyroidism (3%), pneumonitis (3%), hepatitis (2%), colitis (2%) and skin adverse reactions (2%). Adverse reactions were serious in 32% of patients and led to permanent discontinuation in 9% of patients. Grade 3 or higher adverse reactions occurring in >1% of patients were anaemia (5%), hypertension (3%), fatigue (3%), urinary tract infection (2%), hepatitis (2%), musculoskeletal pain (2%), rash (2%), dyspnoea (1%) and pneumonitis (1%).

HEALTH CAMPAIGNERS URGE PUBLIC NOT TO DELAY STARTING CPR

The public has been urged not to be afraid of starting cardio pulmonary resuscitation (CPR) in cases of a cardiac arrest –after figures showed 240 people survived because someone started CPR or used a defibrillator.

The Irish Heart Foundation has said almost 70% of cardiac arrests happen at home, making it more

Peter Murphy, CEO of Epilepsy Ireland

Irish Heart Foundation's Resuscitation Manager, Brigid Sinnott

82 Clinical Profiles

likely that CPR will have to be performed on a family member instead of a stranger.

It highlighted the importance of CPR training to coincide with World Restart a Heart Day on Wednesday. (Oct16)

“By starting CPR and using an AED (defibrillator), you can double a person’s chance of survival,” said Brigid Sinnott, the charity’s Resuscitation Manager.

“For every minute without CPR or defibrillation, the chance of survival decreases by 10% per minute.

“What we want people to understand is that you can do no harm - it’s better to do CPR on someone who doesn’t need it than not to do CPR on someone who does.

“Ireland has a high bystander CPR rate (where someone who witnesses cardiac arrest steps in to provide CPR) at 85% but it is important to remember that it is more likely to be a family member’s life you could save.”

Bystander CPR in cases of outof-hospital cardiac arrest in this country increased from 60% to 85% between 2012 and 2023, according to the Out of Hospital Cardiac Arrest Register report 2023 from the HSE National Ambulance Service, published last week.

The Irish Heart Foundation aims to create a nation of lifesavers through its CPR courses, provided to the public through Affiliated Training Sites all around the country, and its free CPR 4 Schools programme.

The programme for post-primary schools trains students to perform the skill, respond in a cardiac emergency and use an AED.

A person who learns CPR even once in their life is ten times more likely to respond in an emergency than someone who has not.

“Our CPR 4 Schools programme has a reach of over 350,000 students in Ireland, thanks to the generosity of our supporters and the public - without their continued support, it just wouldn’t be possible,” said Ms Sinnott.

“The school programme means students will have learned CPR skills a number of times before they leave school, which will help to build a nation of lifesavers.

“Not everyone will survive a cardiac arrest but by performing CPR, you are giving people the best chance.

“I always equate it to riding a bike - you might be a bit rusty but with a small bit of practice, it’s easy to get back into it.”

To learn more about World Restart a Heart Day and to learn the crucial steps of CPR, visit: irishheart.ie

ILLUMINATING HEART HEALTH ON WORLD HEART DAY

Croí, the heart and stroke charity, was delighted to collaborate with some of the most iconic and historic buildings, organisations and landmarks throughout the west region to celebrate World Heart Day.

The illuminations are organised in support of the World Heart Federation’s (WHF) campaign urging all countries to have a ‘National Cardiovascular Action Plan’ to tackle heart disease, the world’s number one killer.

Marking this year’s World Heart Day with the launch of a global online petition, the WHF hopes the call to action will inspire a more robust and coordinated response to cardiovascular disease (CVD), which is responsible for more than 20.5 million deaths every year.

The staggering number of deaths from heart disease combined with scarce plans to tackle the disease, highlights the urgent need for countries to develop tailored strategies to address cardiovascular disease.

For over two decades, WHF has been leading the World Heart Day movement, which is celebrated every year on 29 September –raising awareness about CVD, calling for better healthcare policies and more funding for heart health research. To sign the global petition visit www.worldheartfederation.org

To mark their commitment in promoting the importance of Heart Heath, the following buildings and landmarks were illuminated red on World Heart Day:

ATU Mayo.

ATU Connemara.

ATU Donegal.

Ashford Castle.

The Mall Bridge, Westport.

Castlebar Garda Station.

Roscommon Town Garda Station.

Sligo Town Garda Station.

Garda North Western Regional Headquarters, Renmore, Galway.

Galway Hookers, Claddagh Basin.

PRECISIONBIOTICS LAUNCHES ‘WOMEN’S FLORA’ AND ‘GOOD BACTERIA’

The Portershed Galway.

Bon Secours Hospital Galway.

Kylemore Abbey.

The illumination campaign draws a close on the many events organised by Croí throughout September in recognition of World Heart Month. Details of events can be found on www.croi.ie

Croí not only encourages people to ensure their heart health is a priority, but also those around them, friends, family, and colleagues. Croí’s aim is to educate and empower individuals, families, and communities to take control of their heart health and to make and maintain the changes that can lead to a longer and healthier life. Croí would like to extend thanks to the public, the many healthcare professionals, organisations, and volunteers who worked to ensure World Heart Month was an outstanding success.

PrecisionBiotics has launched two new products in the Irish market. The products are ‘Women’s Flora,’ which supports a healthy vaginal microbiome and ‘Good Bacteria,’ a daily bacterial supplement. Both are now available in pharmacies around the country.

The latest products mark an expansion of the range of supplements the company sells in the Irish market. Current products include Alflorex and Zenflore.

PrecisionBiotics has its origins in UCC, Co Cork where more than 20 years ago scientists began researching thousands of bacterial cultures, together with experts from one of the world’s leading centres of microbiome research, the APC Microbiome Institute in UCC. Since then, they’ve discovered hundreds of different bacterial cultures and they’ve put each one through rigorous scientific tests. Amongst these hundreds are a handful of special bacteria that stand out because of the precise and significant impact they make to human gut health.

In 2020 Novozymes acquired the PrecisionBiotics Group, with an office located at the Cork Airport Business Park, and R&D labs based at the food hub in Teagasc, Fermoy. In January of this year, Novoymes merged with Chr. Hansen, a company established in 1984 to supply cultures and enzymes to the Irish dairy industry, to form Novonesis Ireland. With an emphasis on efficiency and sustainability, Novonesis creates scientifically researched and clinically tested biosolutions which include prebiotics, probiotics, enzymes, novel vitamins and proteins.

'Women’s Flora' is designed for women who are actively seeking to maintain a healthy vaginal balance. The product has been formulated with scientifically tested

bacterial strains prevalent in a healthy vaginal microbiome. Most women will experience vaginal bacterial or yeast imbalance in their lifetime, and over half will recur within 12 months. Common vaginal conditions and issues are often caused by an unbalanced microbiome. Symptoms include itching, discharge and odour, which can have a negative effect on both physical and mental health.

'Good Bacteria' was developed for those seeking a daily bacteria supplement, particularly during and after a course of antibiotics. Research has shown that over one in three people experience negative side effects while taking antibiotics, due to a disruption to the natural gut flora. These side effects commonly include diarrhoea.

The product aims to address the fact that diet and antibiotics can impact the delicate balance of gut microbiome. 'Good Bacteria'

combines scientifically tested bacterial strains and fibres.

Commenting on the new products, Marketing Manager Ireland with PrecisionBiotics Shirley O’Regan said: “We have pioneered the field of gut health research for decades now, creating unique solutions for the gut microbiome and gut / brain health, through products like Alflorex and Zenflore. We are extremely proud to now launch a product that promotes a healthy vaginal microbiome, which has its own universe of bacteria. It’s a largely unexplored area of women’s health and through rigorous trials and world class scientific research, we have created 'Women’s Flora,' which is a groundbreaking product. Similarly, 'Good Bacteria' addresses the very common but often ignored side effects of taking antibiotics. Our scientists have formulated a unique combination of bacterial strains to help balance tummy issues when people are on a course of antibiotics.”

'Women’s Flora' and 'Good Bacteria 'are available through pharmacies nationwide. For more information visit www.precisionbiotics.ie

HONOURS FOR DIABETES PATIENTS

On Wednesday, 02 October at a special awards ceremony in Croí, Diabetes Ireland honoured twelve people living with type 1 diabetes with special 50 and 65-year achievement medals in recognition of their courage and endurance in living with diabetes.

The Five women and seven men from across Galway, Mayo, Roscommon and Clare who attend Diabetes Outpatient Clinics in University Hospital Galway and Roscommon University Hospital, received either a 50-year or 65year achievement medal. (Two recipients of a 65-year medal and ten recipients of a 50-year medal).

Currently, there are approximately 308,000 people living with diabetes in Ireland. Professor Tim O Brien, Clinical Director of Saolta’s Medicine MCAN said, “I am delighted to be able to attend and share this time with these very special people. I have been working in diabetes care for 40 years and have witnessed the significant advances in care over that time but acknowledge the challenges that these patients have dealt with. It is a privilege for us in healthcare professions to be able to help in whatever way we can but the celebration tonight is an acknowledgment of the achievements of these incredible individuals who serve as role models to all of us.”

Speaking about this momentous occasion, Tomás Griffin, Consultant Physician/Diabetologist between University Hospital Galway, Roscommon University Hospital and Community Healthcare West said, “We are deeply honoured to celebrate this extraordinary group of individuals who have lived with diabetes for 50 years or more.

“Their resilience and determination inspires us all, showing that it is

not only possible but empowering to lead active, healthy, and fulfilling lives with diabetes. We also recognize the invaluable support of their families and caregivers – this milestone is a shared achievement, shaped by the dedication of many.

“It is a true privilege to stand alongside these individuals and their loved ones as we celebrate this remarkable journey. Over the past 50 years, people living with diabetes have witnessed incredible technological advancements, from the early days of urine testing and rigid insulin regimens to the introduction of continuous glucose monitors, insulin pumps, and now hybrid closed-loop systems. The progress has been nothing short of transformative.”

Kieran O’Leary, CEO, Diabetes Ireland said, ‘Our Living Well With Diabetes’ ceremony celebrates life with diabetes and it’s an honour and a privilege to present medals to people with diabetes who have lived over 50 years managing their condition and adapting to the many changes in treatment over the years.

“This group of recipients are among a special group of 289 people who have received a medal.”

Diabetes Ireland honouring twelve people living with type 1 diabetes with special 50 and 65-year achievement medals in recognition of their courage and endurance in living with diabetes

Optional glucose alarms6 every minute

14 Real-time glucose readings sent right to your patients’ smartphones4,5

Outstanding 14-day accuracy, even in the low glucose range7 Significant clinical outcomes for T1D8 and T2D2,9,10

CGM=continuous glucose monitoring; T1D=type 1 diabetes mellitus; T2D=type 2 diabetes mellitus. *FreeStyle Libre 2 flash glucose monitoring is continuous glucose monitoring system. 1. Campbell, F. Pediatr Diabetes (2018): https://doi.org/10.1111/pedi.12735. 2. Haak, T. Diabetes Therapy (2017): https://doi.org/10.1007/s13300-016-0223-6. 3. Data on file, Abbott Diabetes Care. Data based on the number of users worldwide for the FreeStyle Libre portfolio compared to the number of users for other leading personal use sensor-based glucose monitoring systems. 4. The FreeStyle LibreLink app is only compatible with certain mobile devices and operating systems. Please check the website for more information about device compatibility before using the app. Use of FreeStyle LibreLink may require registration with LibreView. 5. Glucose readings are automatically displayed in the app only when the smartphone and sensor are connected and in range. 6. Patients choose which device they want to receive alarms: FreeStyle Libre 2 reader or FreeStyle LibreLink app. They must start their FreeStyle Libre 2 sensor with that selected device. Once the patient scans their FreeStyle Libre 2 sensor with that device, they can receive alarms only on that device. Alarm notifications will only be received when alarms are turned on and the sensor is within 6 metres (20 ft) unobstructed of the reading device. 7. Alva S. et al, Journal of Diabetes Science and Technology, (September 2020). http://doi.org/10.1177/1932296820958754. 8. Leelarathna, L. N Engl J Med. (2022): DOI: 10.1056/NEJMoa2205650. 9. Kröger J, et al. Three European retrospective