Care Hub Resource for Pharmacy IPHA publish General Election Manifesto Revolutionising the Retail Experience FEATURE: Genitourinary Syndrome of Menopause Page 20
TRAINING: Emergency Contraception Page 26 PROFILE: Théa Pharma Celebrating Thirty Years in Business Page 36 CPD: Cough Page 41
Visit www.energia.ie/cash-for-kilowatts
Page 4: Best Managed Award for Meaghers
Page 6: New White Paper for Pharmacy
Page 8: IPHA published General Election Manifesto
Page 14: CarePlus continues expansion
Page 36: Celebrating Three Decades in Business
Foreword
A new White Paper, published by The Irish Pharmacy Union (IPU), has outlined a policy framework to transform pharmacy care in this country by turning pharmacies into key healthcare hubs, improving access to community care. The IPU says, that with the right strategy and resources pharmacies can play a greater role in improving access to community healthcare
Speaking on World Pharmacist Day, Tom Murray, President of the IPU, said, “With 78 million visits per year pharmacies are the most accessed part of our healthcare system. However, the absence of a national pharmaceutical care policy limits their potential.” The IPU White Paper – ‘Key Enablers for a Sustainable Pharmacy focusses on the areas of expanding pharmacy services, refocussing on patients and most importantly keeping pharmacies open by addressing under resourcing.
Page 64: How to grow your pharmacy profits
Page 66: Early diagnosis and therapeutic intervention for RA
Page 74: PHX Ireland Recognition Awards
PUBLISHER:
IPN Communications
Turn to page 6 for the full story.
In one of our other lead news stories this issue, we publish details of the newly published General Election Manifesto by IPHA. Central to this is an ask for the next Government to commit to a continuous and faster flow of new life-enhancing medicines, and vaccines, for patients in Ireland. The manifesto outlines innovative proposals on how this can be achieved.
Commenting on the launch of the IPHA General Election Manifesto, Mr. O’Connor said, “Next year, IPHA members expect to make applications for reimbursement for 36 medicines which, according to most recent estimates, would positively benefit as many as 3,700 patients in Ireland, alongside their families and carers. However, we need to ensure that patients in Ireland will have fast and fair access to these new life-enhancing medicines next year, and in subsequent years, through multi-annual funding and reform of the current reimbursement process.”
Turn to page 8 to read the full story.
This issue celebrates Women’s Health, with a number of contributed articles looking at conditions ranging from Menopause to Heart Health. On page 22, Dr Kirsty Hedding discusses the healthy component of movement through menopause and how it helps to prevent disease, whilst on page 75 Dr Rachel Byrne and Dr Niamh Phelan discuss current approaches to Polycystic Ovary Syndrome.
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.
Meanwhile, huge congratulations to Théa Pharma who is proudly celebrating 30 years in business, a significant milestone that speaks volumes about the company’s enduring commitment to excellence and innovation. Read our exclusive interview with Country Manager Diarmuid Gavin on page 36.
I hope you enjoy the issue.
Regulars
FEATURE: MOVEMENT THROUGH MENOPAUSE P22
CPD: MANAGEMENT OF COUGH P41
FEATURE: REFRACTIVE EYE SURGERY P34
FEATURE: PSORIASIS P56
FINANCE: ASSET MISALLOCATION P60
New Resource for Pharmacy
The Irish Institute of Pharmacy (IIOP) have collaborated with the National Cancer Control Programme (NCCP) to develop a Cancer Care Hub, which is intended to be a resource for all pharmacists, and one that is hoped will be especially useful to community pharmacists.
The pharmacist’s role, in particular the community pharmacist, is evolving due to increasing numbers of patients on systemic anti-cancer therapy (SACT) who receive their supportive care medicines from their community pharmacist, and also due to the increased use of oral anti-cancer medicines, which are largely dispensed in the community. 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.
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 6 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 3 categories:
Pharmacist information (immediate)
Pharmacist further education
Information for patients
The IIOP Cancer Care Hub can be found at this link: https://lnkd.in/ ekjmFznu
Best Managed Title for Meaghers
Meaghers Pharmacy Group have once again been named as a Deloitte Best Managed Company at the Deloitte Ireland Best Managed Awards held a the RDS on September 19th.
FIP
Handbook
On World Patient Safety Day held last month, the International Pharmaceutical Federation (FIP) launched a curriculum for addressing the risk of substandard and falsified (SF) medical products sold online. The curriculum is presented in a FIP handbook for educators.
Although SF medical products cause major problems in the healthcare system around the world, there is a lack of awareness and knowledge about them. Educating healthcare professionals including pharmacists, students, and the public is of great importance to avoid the use of SF medical products. There are several educational examples for this issue, one of which includes the FIP online course on substandard and falsified medical products for pharmacy students, which was developed in 2021 and is available on the FIPx platform.
“In recent years, patients and caregivers have increasingly used websites and social media to obtain medical products. Selfdiagnosis and self-prescription have increased the use of illegal online drug sellers where SF medical products are sold. Identifying SF medical products is difficult for patients and healthcare professionals.
This is the tenth consecutive year that Meaghers Pharmacy has been recognised by the judges at Deloitte and AIB for their business culture and commitment, their strategy, capability and innovation and governance and financials.
Managing Director Oonagh
O’Hagan commented, “It takes a small village to make this happen and I couldn’t be prouder of the Meaghers Pharmacy team for their passion and dedication.”
Oonagh O’Hagan, Managing Director, Meaghers Pharmacy Group with Financial Controller Paul Corrigan
“Similarly, identifying legal online pharmacies can be challenging for patients and healthcare professionals alike. Gaps in knowledge and skills in undergraduate students remain, as most courses may not cover the online sale of SF medical products,” said John Hertig, executive committee member of FIP’s Hospital Pharmacy Section, who led the development of the handbook.
It states, “In this handbook, you will learn how FIP developed a new module on SF medical products sold online. You will also learn about regulatory examples from various countries regarding the online sales of medical products. This handbook also provides advocacy points for pharmacists who have a crucial role in ensuring public safety globally.”
The new handbook provides teaching materials, resources and practical guidance to prepare pharmacy undergraduates for practice so that they can support public safety.
Patient Safety Act
Minster for Health Stephen Donnelly has marked World Patient Safety Day 2024 by announcing that the Patient Safety Act will be commenced in the coming days.
Minister Donnelly, said, “I am delighted to be commencing this landmark piece of patient safety legislation in recognition of World Patient Safety Day.
The Patient Safety (Notifiable Incidents and Open Disclosure) Act 2023 provides a legislative framework for several important patient safety issues, including the mandatory open disclosure of a list of specified serious patient safety incidents that must be disclosed to the patient and/or their family.
“The Act also provides for the mandatory external notification of those same events to the appropriate regulatory body. This is another great stride forward in patient safety and putting the patients’ needs at the heart of the health service”.
The Patient Safety (Notifiable Incidents and Open Disclosure) Act 2023 was signed into law by the President last year, and a number of preparatory steps required to enable commencement have now been completed.
These included the addition of a new module to the National Incident Management System (NIMS) to record notifications made under the Act, and the development of a new comprehensive training programme for all Health Service Executive (HSE) staff. The Act also makes a number of amendments to the Health Act 2007, including the provision for the expansion of HIQA’s remit into private hospital services.
The Minister made his announcement as a number of events take place this week under the World Health Organization (WHO) campaign and global action plan for patient safety. This includes a conference at Dublin Castle organised by the National Patient Safety Office (NPSO), in collaboration with the HSE and Patients for Patient Safety Ireland.
Business Impact Awards for Boots Ireland
Boots Ireland were thrilled to announce that they have been recognised at the Chambers Ireland Sustainable Business Impact Awards, taking home two incredible awards.
Pictured are the Boots Ireland team who scooped two Awards at the Chambers Ireland Sustainable Business Impact Awards
The Sustainable Business Impact Awards showcase best practice in sustainable development and social responsibility undertaken by companies across Ireland.
They were first warded the ‘Best Charity Partnership by a Multinational Company’ –
celebrating their cherished partnership with the Irish Cancer Society, where they support those affected by cancer and raise funds for the Irish Cancer Society Night Nursing Service.
The second award was the ‘Diversity, Equity & Inclusion
Health Literacy Report
Award in a Multinational Company’ award, recognising Boots Ireland ongoing commitment through policies, partnerships, and pioneering initiatives in creating an inclusive workplace where everyone feels they Belong at Boots.
The Sláintecare Healthy Communities Health Literacy Report was launched last month by Colm Burke, Minister of State with special responsibility for Public Health, Wellbeing and the National Drug Strategy in the Finglas Youth Resource Centre, Dublin 11.
The event marks the formal launch of the findings of a study conducted by Dublin City University in conjunction with Dublin City Council and Mayo County Council over the last 12 months. The Cabra/ Finglas area and designated areas of Mayo are part of the Sláintecare Healthy Communities Programme (SHCP) funded by the Department of Health.
With a growing focus and responsibility being given to Local Authorities for community well-being, Healthy Ireland Local Government plays an important role in encouraging local government to combine its effort at the local level leading to improved health and wellbeing outcomes.
Healthy Ireland Programmes within local government are funded by the Department of Health with two
main initiatives: Sláintecare Healthy Communities Programme where this research originated, and the Healthy Ireland Cities and Counties Programme. Healthy Ireland Local Government also operates the Healthy Cities & Counties of Ireland Network.
Key findings (based on research found in Ireland for this report):
• Around 40% of adults in Ireland have limited health literacy which impacts their ability to effectively manage personal health and interact with healthcare services.
• Individuals with lower health literacy levels are less likely to engage in preventive healthcare measures and more likely to require emergency medical interventions, resulting in higher
healthcare expenditures and poorer health outcomes.
• Improving health literacy helps individuals better access, understand, appraise and apply health information which can support healthier lifestyle choices and can improve ability to manage chronic conditions.
• Prevention of low levels of health literacy is advocated for through some established settings, but sustainable approaches are needed.
• Building health literacyresponsive systems that understand and reflect community needs and unique characteristics is essential, especially in underserved or vulnerable areas.
White Paper for Pharmacy
A new White Paper, published by The Irish Pharmacy Union (IPU), has outlined a policy framework to transform pharmacy care in this country by turning pharmacies into key healthcare hubs, improving access to community care. The IPU says, that with the right strategy and resources pharmacies can play a greater role in improving access to community healthcare.
Speaking on World Pharmacist Day, Tom Murray, President of the IPU, said, “With 78 million visits per year pharmacies are the most accessed part of our healthcare system. However, the absence of a national pharmaceutical care policy limits their potential.”
The IPU White Paper – ‘Key Enablers for a Sustainable Pharmacy focusses on the areas of expanding pharmacy services, refocussing on patients and most importantly keeping pharmacies open by addressing under resourcing.
Expanding Pharmacy Services
A central recommendation of the Expert Taskforce on the Future of Pharmacy Services, which we would hope to see implemented as soon as possible, is allowing pharmacists to prescribe medications for common conditions. With appropriate resourcing and an implementation plan this service will allow pharmacists to prescribe medication directly for patients and facilitate quicker access to care.
The IPU is also calling for:
• An expansion of the range of vaccines that can be administered in a pharmacy setting.
• The introduction of chronic disease management services to complement existing clinical care pathways.
• Oral Contraception to be available through consultation with a pharmacist.
“These are not new schemes or ideas; they are tried and tested and functioning well in other countries,”
Mr Murray said.
Keeping Pharmacies Open
“To enable this vision of pharmacy care will require the appropriate level of resourcing,” according to Mr Murray. “Many pharmacies, particularly those in rural areas, are facing financial difficulties due to outdated payment structures and rising costs.”
“The average pharmacy receives almost two-thirds of its income from the State for providing care through the community drug schemes. The fees provided for this care have been frozen since 2009, and pharmacies like every other business and individual, have experienced soaring operational costs.
The White Paper also outlines proposed reforms to address the shortages of pharmacy staff
highlighting that a comprehensive workforce planning strategy is required to address skill gaps, improve access to pharmacy education, and ensure adequate staffing levels are maintained.
Reducing Paperwork to Focus on Patients
Pharmacists spend up to 82% of their time on administrative task managing community drug schemes, leaving less time for patient care.
Mr Murray explained the impact of this red tape. “There is an overwhelming administrative workload that leaves little time for patient care. Worryingly, 27% of pharmacists are considering leaving the profession due to the administrative burdens associated with the complexity of managing existing drug schemes.”
“We are calling for the implementation of a modern ICT system and streamlined processes to automate routine tasks allowing pharmacists to dedicate more time to direct patient care.”
Chief Pharmaceutical Officer
Mr Murray called for the recruitment of a Chief Pharmaceutical Officer (CPO) to lead and represent the sector at a national level to be accelerated.
“The appointment of a CPO, as exists in many other countries and as recommended in the recent Expert Taskforce report, would provide strategic leadership, and ensure representation and involvement of the pharmacy profession at the highest level nationally.
In conclusion Mr Murray said, “There is so much exciting potential in pharmacy care. It is possible to revolutionise our pharmacy care services within a few short years, but it will require vision and, above all, the proper resourcing of our pharmacies to make this a reality.”
Geater Role for Pharmacy
Embrace pharmacists’ roles in healthcare delivery — slow transformation of the pharmacy profession comes at a significant cost to health systems, warns an article published in The Lancet Regional Health — Europe recently.
The article, co-written by officers at the WHO Regional Office for Europe and FIP, describes factors affecting the rate of progress and how good practices can be replicated and expanded.
“One obstacle is lack of awareness among policymakers about the potential of pharmacists. That’s why articles such as this, helping to raise awareness, are an important part of FIP’s advocacy work. We are proud to have collaborated with WHO Europe on this piece,” said co-author and FIP President Paul Sinclair.
The article states, “How can good practices be replicated and expanded? Through an inclusive policy dialogue, countries can identify the context-specific roles that pharmacists can play in healthcare delivery and adopt enabling policies outlining eligible conditions, the responsibilities of pharmacists and their operational protocols, requisite inputs, such as knowledge and skillsets, or the availability of infrastructure for pharmacy care delivery, supporting frameworks, such as integrated digital systems and patient pathways, financing mechanisms to ensure pharmacy care sustainability, monitoring service quality, and roadmaps for the integration of pharmacists’ services into the health-care ecosystem.”
The authors conclude, “By harnessing their full potential and skillset, pharmacists can play a central role in primary health care reform and moving towards Universal Health Coverage. Their contributions are invaluable, and their potential is vast. It is time we fully recognize this and utilize their capabilities in our journey towards better health for all.”
FIP and WHO Europe have also held a joint symposium in Copenhagen, Denmark, which will be attended by health ministers and policymakers, and ask what pharmacists can and should contribute to healthcare delivery.
Tom Murray, President, Irish Pharmacy Union
IPHA Publishes New Manifesto
The Board of the Irish Pharmaceutical Healthcare Association (IPHA), the representative body for the research-based biopharmaceutical industry in Ireland, is pleased to announce Shane Ryan as its new President.
“We believe that doctors should have the right medicine available for prescription for their patients at the right time and are therefore calling for a new voice for doctors in prioritising new medicines for patients”
Shane is the General Manager for Takeda in Ireland and has retained this role for over six years, carrying with him a track record of success through clarity of purpose and vision. Caitriona Duggan, Country President for Amgen in Ireland, becomes Vice-President. Mr Ryan takes over the role from Biogen’s Michael O’Connell after his two-year term.
Transparent partnerships and building trust with stakeholders across Government, the Department of Health and the Health Service Executive will play a key role in Shane’s presidency, which will focus on driving forward decisions that both value innovation and improve health outcomes for all.
Commenting on this, Shane Ryan, General Manager, Takeda Ireland shared, “I am honoured to serve IPHA members, representing a sector at the forefront of discovering, developing and
bringing life-changing medicines and innovation to patients, clinicians and the communities that support them. It is a pivotal time – the recent elections of the European Parliament and the upcoming Irish general election present exciting opportunities for us to work in collaboration with others to achieve our vision of creating an environment which helps patients and places Ireland as the investment destination for life sciences.”
Oliver O’Connor, Chief Executive of IPHA, welcomed the appointments.
“I am delighted to welcome Shane and Caitriona to their respective new roles. They bring experience and expertise at a critical time for the industry in Ireland and globally. As we continue to engage in the reform of the EU Pharmaceutical Legislation, plan ahead to work with the next Government in Ireland and prepare for a new
Shane Ryan, IPHA President
Framework Agreement, I look forward to supporting their goal in creating an innovative, competitive ecosystem which benefits all patients in Ireland”, said Mr O’Connor.
IPHA also publishes its General Election manifesto and central to this is an ask for the next Government to commit to a continuous and faster flow of new life-enhancing medicines, and vaccines, for patients in Ireland. The manifesto outlines innovative proposals on how this can be achieved.
Commenting on the launch of the IPHA General Election Manifesto, Mr. O’Connor said, “Next year, IPHA members expect to make applications for reimbursement for 36 medicines which, according to most recent estimates, would positively benefit as many as 3,700 patients in Ireland, alongside their families and carers. However, we need to ensure that patients in Ireland will have fast and fair access to these new life-enhancing medicines next year, and in subsequent years, through multi-annual funding and reform of the current reimbursement process. Over the next couple of months, in the lead up to the next General Election in Ireland, we look forward to presenting to candidates, and other stakeholders our proposals on how this can be achieved.
“We believe that doctors should have the right medicine available for prescription for their patients
at the right time and are therefore calling for a new voice for doctors in prioritising new medicines for patients. We would also like to see a levelling-up of care for patients with rare diseases through faster access to the medicines they need.
“To further these goals, industry is ready to play its part in speeding up the process and reaching a new Framework Agreement with the State in 2025. Since the last Agreement in 2021, IPHA member companies have actively delivered significant savings to the State well above what had been anticipated for the full fouryear period of the Agreement. As we start planning for the next Agreement, we remain ready and willing to collaborate to achieve certainty for clinicians and patients to bring newly-authorised medicines to the Irish healthcare system as quickly as possible.
“An innovative life-science sector is of strategic importance to Ireland and Europe. IPHA companies are key contributors to R&D and clinical trials which improve patient outcomes and quality of life here and around the world. However, currently in Ireland we need to do better in terms of the numbers of clinical trials being conducted. We want to give patients hope through faster access to research treatments. We welcome the recent establishment of a new National Clinical Trials Oversight Group by the Minister for Health to support innovation and patient outcomes and we look forward to seeing its outputs. In particular, we support the Minister’s goal of doubling the number of clinical trials in Ireland. We believe this can be achieved over the lifetime of the next Government with clear and sustained political support.”
“In order to achieve all this and remain at the forefront of innovation and efficiency, it is crucial that we continue to upskill, both through the development of the next generation of talent and the adoption of new technologies. To place our sector at the cutting edge of data, digital and technology we need to work with all partners to develop the next generation of pharmaceutical leaders. This will be fundamental to creating better experiences for patients, providers and payers while also driving investment and supporting the establishment of a globally competitive ecosystem”.
28 PACK NOW AVAILABLE
CCF: 26619 Date of preparation: (07-24)
ABBREVIATED PRESCRIBING INFORMATION
Product Name: Emazole Control 20 mg Gastro-Resistant Tablets
Composition: Each tablet contains 20 mg esomeprazole (as magnesium dihydrate).
Description: Light pink oval lm coated tablet.
Indication(s): Proton Pump Inhibitor (PPI): Short-term treatment of re ux symptoms (e.g. heartburn and acid regurgitation) in adults. Dosage: Swallow tablets whole with liquid, do not chew or crush. Disperse in half a glass of non-carbonated water if di culty in swallowing. Stir until tablets disintegrate, drink liquid with pellets immediately or within 15 min, or administer through a gastric tube. Do not chew or crush pellets. Adults: Recommended dose is 20 mg esomeprazole (one tablet) per day. It might be necessary to take the tablets for 2-3 consecutive days to achieve improvement of symptoms. Duration of treatment is up to 2 weeks. Once complete relief of symptoms has occurred, treatment should be discontinued. If no symptom relief is obtained within 2 weeks of continuous treatment, the patient should be instructed to consult a doctor. Elderly (≥ 65 years old): As per adults. Paediatric population (< 18 years): Not recommended. No relevant use in this group in the indication: “short-term treatment of re ux symptoms (e.g., heartburn and acid regurgitation)”. Severe impaired renal function: Caution. Severe liver impairment: 20 mg max daily dose. Contraindications: Hypersensitivity to esomeprazole, substituted benzimidazoles or any of the excipients. Not with nel navir. Warnings and Precautions for Use: On demand treatment: Contact a physician if symptoms change in character. In the presence of any alarm symptom (e.g. signi cant unintentional weight loss, recurrent vomiting, dysphagia, haematemesis or melaena) and when gastric ulcer is suspected or present, malignancy should be excluded, as treatment with esomeprazole may alleviate symptoms and delay diagnosis. Treatment with proton pump inhibitors (PPIs) may lead to a slightly increased risk of gastrointestinal infections such as Salmonella and Campylobacter and in hospitalised patients, also possibly Clostridium di cile. Patients should consult their doctor before taking this medicinal product if they are due to have an endoscopy or urea breath test. Absorption of vitamin B12 may be reduced due to hypo- or achlorhydria. Not recommended for long-term use as the following may also occur: Hypomagnesaemia; Risk of fracture. Consider stopping Emazole Control in cases of subacute cutaneous lupus erythematosus (SCLE) accompanied by arthralgia. Serious cutaneous adverse reactions (SCARs) such as erythema multiforme (EM), Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN) and drug reaction with eosinophilia and systemic symptoms (DRESS), which can be life-threatening, have been reported very rarely. Patients should be advised of the signs and symptoms of the severe skin reaction EM/SJS/TEN/DRESS. Discontinue and seek medical advice immediately when observing any indicative signs or symptoms. Do not re-challenge. Interference with laboratory tests: Increased Chromogranin A (CgA) level may interfere with investigations for neuroendocrine tumours. To avoid this interference, Emazole Control treatment should be stopped for at least 5 days before CgA measurements. If CgA and gastrin levels have not returned to reference range after initial measurement, measurements should be repeated 14 days after cessation of PPI treatment. Contains glucose and sucrose.
Interactions: E ect of esomeprazole on other drugs: Co-administration with atazanavir is not recommended. If the combination of atazanavir with a PPI is judged unavoidable, close clinical monitoring is recommended in combination with an increase in the dose of atazanavir to 400 mg with 100 mg of ritonavir; esomeprazole 20 mg should not be exceeded. Esomeprazole is a CYP2C19 inhibitor. When starting or ending treatment with esomeprazole, the potential for interactions with drugs metabolised through CYP2C19 should be considered. Serum levels of cilostazol, cisapride, tacrolimus, methotrexate may be increased. An interaction is observed between clopidogrel and esomeprazole, but the clinical relevance is uncertain. As a precaution, concomitant use of esomeprazole and clopidogrel should be discouraged. Gastric acid suppression by PPIs increase or decrease absorption of drugs with pH dependent absorption (decreased absorption of ketoconazole, itraconazole); esomeprazole inhibits CYP2C19 metabolising enzyme and could increase plasma concentrations of diazepam, citalopram, imipramine, clomipramine, phenytoin (monitor plasma levels of phenytoin), etc. resulting in need of a dose reduction; monitor INR when given with warfarin or similar. Caution as absorption of digoxin can increase. E ect of other drugs on esomeprazole: CYP2C19 and CYP3A4 inhibitors (clarithromycin, voriconazole) may increase the esomeprazole exposure. Dose adjustment not regularly required, except in severe hepatic impairment and long-term use. CYP2C19 and/or CYP3A4 inducers (rifampicin and St. John’s wort) may lead to decreased esomeprazole serum levels by increasing the esomeprazole metabolism.
Pregnancy and Lactation: Caution in pregnancy due to lack of clinical data. No studies in lactating women, therefore, not recommended during breast-feeding. Ability to Drive and Use
Machinery: Minor in uence on the ability to drive or use machines. Adverse reactions such as dizziness (uncommon) and blurred vision (rare) have been reported. If a ected, patients should not drive or use machines. Undesirable E ects: Common: Headache, abdominal pain, constipation, diarrhoea, atulence, nausea/vomiting, fundic gland polyps (benign). Uncommon: Peripheral oedema, insomnia, dizziness, paraesthesia, somnolence, vertigo, dry mouth, increased liver enzymes, dermatitis, pruritis, rash, urticaria, fracture of the hip, wrist or spine. For other side e ects refer to the SPC.
Marketing Authorisation Holder: Rowa Pharmaceuticals Ltd., Newtown, Bantry, Co. Cork. Marketing Authorisation Number: PA 0074/100/001. Further information and SPC are available from: Rowex Ltd, Bantry, Co. Cork. Freephone: 1800 304 400 Fax: 027 50417. E-mail rowex@rowa-pharma.ie
Legal Category: Not subject to medical prescription. Date of Preparation: July 2024 CCF for API: 26593
New Head of Pharmacy School
RCSI University of Medicine and Health Sciences has announced the appointment of Professor Helena Kelly as Head of its School of Pharmacy and Biomolecular Sciences.
Professor Kelly succeeds Professor Tracy Robson, who was recently appointed Deputy Vice-Chancellor for Academic Affairs at the university. She will lead the School of Pharmacy and Biomolecular Sciences in its ambition to be recognised internationally as a leading centre for pharmacy education, research and innovation.
A registered pharmacist, Professor Kelly undertook her PhD in the area of stimuli-responsive hydrogels and sustained drug delivery. She spent eight years in the pharmaceutical and biopharmaceutical industry before returning to academia in 2008.
In March, 2022 she was appointed as Deputy Head (Programmes Innovation) in the School of
Pharmacy and Biomolecular Sciences with responsibility for the implementation of two new programmes, an MSc in Technologies and Analytics in Precision Medicine and a BSc in Advanced Therapeutic Technologies.
Professor Kelly’s research focuses on the use of delivery platforms in translational research applications. She has been a principal investigator and deputy co-ordinator in two EU consortia, whereby she led on the formulation of hydrogel delivery platforms for minimally invasive delivery clinical applications. She is the inventor of ChemoGel, a novel patented thermoresponsive hydrogel platform for intratumoral drug delivery, the development
Professor Helena Kelly
of which has been funded through the Enterprise Ireland Commercialisation Fund. In 2023, this technology was spun out into a company, OncoLize, of which Professor Kelly is a co-founder and which is seeking to translate this technology platform to the clinic.
She has been closely involved in RCSI's growing collaboration with Soochow University in China and has been involved in Erasmus+ exchange programmes and Government of Ireland mobility programmes with Soochow University.
Accepting her role as Head of School, Professor Helena Kelly said: “My vision for the School of Pharmacy and Biomolecular Sciences is for it to evolve into a larger, more successful and more international school while maintaining the outstanding student experience and high quality of programme delivery for which we are known. In a very competitive environment, I will lead the school in identifying and attracting new student cohorts and in recruiting and retaining the highest calibre of staff”.
“I look forward working with my colleagues in the school to further enhance the impact of our research which spans across the translational spectrum from drug discovery and delivery, through to population health and healthcare education research, reflecting RCSI’s strategic goal of innovating for a healthier future, along with our commitment to the UN Sustainable Development Goals.”
Women in Leadership Event
The final Pharmaceutical Managers’ Institute Women in Leadership event of 2024 takes place on 16th October. The PMI are delighted to host Averil Power, CEO with the Irish Cancer Society as the guest speaker.
The WiL series is proudly supported by Uniphar Commercial.
World Alzheimer’s Month
Marking World Alzheimer’s month the HSE’s Dementia: Understand Together campaign is urging individuals, businesses and community organisations to learn more about dementia and help to create dementia inclusive communities that include people with dementia and help keep them and their families socially connected.
There are more than 64,000 people living with dementia in Ireland. With this number expected to more than double to over 150,000 by 2045, many more of us are going to be living with dementia, or supporting a loved one with the condition.
Research suggests that attitudes are changing, with 96% of people across the country feeling it is important to talk about dementia and 97% agreeing it is important to support people with dementia to stay active and socially connected in the community, when asked in the HSE’s Advertising Tracker* in March 2024.
Dr Seán O’Dowd, HSE National Dementia Services Clinical Lead and Consultant Neurologist at TUH, added: “A dementia diagnosis can be challenging for a person, and for their family and friends. By creating dementia inclusive communities, where people with dementia are welcomed and included, we hope that people will feel able to talk about their diagnosis, do the things they enjoy, maintain their independence and seek support.
“Social connection is important for all of us. It was confirmed as one of the 14 modifiable risk factors for dementia (The Lancet, July 2024**) with a recommendation globally to reduce social isolation by facilitating participation in activities and living with others. There is also some evidence that staying connected may slow cognitive decline, as well as improve health and wellbeing outcomes for people with dementia.”
Dementia is caused by different diseases of the brain. These diseases often affect the parts of the brain used for learning, memory and language.
RELIEF FAST FOR A MUCUS COUGH
Benylin Mucus Cough Honey & Lemon 100mg / 5ml Syrup. Composition: This product contains 20 mg guaifenesin in each ml. Syrup. Indications: For the symptomatic relief of productive cough in adults and adolescents of 12 years and above. Dosage: Adults and adolescents of 12 years and above: 10 ml (200 mg guaifenesin) 4 times a day. Maximum daily dose: 40 ml (800 mg guaifenesin). Paediatric population: The safety and efficacy of Benylin Mucus Cough Honey & Lemon 100mg / 5ml Syrup in children under 12 years has not yet been established. Elderly: As per adults. Hepatic/renal impairment: Caution should be exercised in severe hepatic and severe renal impairment. If cough persists for more than 7 days, tends to recur, or is accompanied by a fever, rash, or persistent headache, a physician should be consulted. Contraindications: Hypersensitivity to the active substance(s) or to any of the excipients. Special warnings and precautions for use: This product should not be used for persistent or chronic cough, such as occurs with asthma, or where cough is accompanied by excessive secretions, unless directed by a physician. A persistent cough may be a sign of a serious condition. If cough persists for more than one week, tends to recur, or is accompanied by a fever, rash, or persistent headache, a physician should be consulted. Caution should be exercised when using the product in the presence of severe renal or severe hepatic impairment. The concomitant use of cough suppressants is not recommended. Contains approximately 2 g of sucrose and 7 g of glucose in each 10 ml dose. This should be taken into account in patients with diabetes mellitus. Patients with rare hereditary problems of fructose intolerance, glucose galactose malabsorption or sucrase-isomaltase insufficiency should not take this medicine. Sucrose and glucose may be harmful to the teeth. This medicine contains 393 mg of alcohol (ethanol) in each 10 ml dose which is equivalent to 39.3 mg/ml. The amount in 10 ml of this medicine is equivalent to less than 10 ml beer or 4 ml wine. The small amount of alcohol in this medicine will not have any noticeable effects. This medicinal product contains 41.1 mg sodium per 10 ml, equivalent to 2.054% of the WHO recommended maximum daily intake of 2 g sodium for an adult. This medicinal product contains 20 mg of sodium benzoate in each 10 ml dose. This medicinal product contains 57.8 mg propylene glycol in each 10 ml dose. Undesirable effects: Immune System Disorders: Not Known - Hypersensitivity reactions including pruritus and uriticara, Rash, Anaphylactic reaction. Gastrointestinal Disorders: Not known – Abdominal pain upper, diarhoea, nausea, vomiting. Marketing Autorisation holder: JNTL Consumer Health I (Ireland) Ltd., Block 5, High Street, Tallaght, Dublin 24, Ireland. PA Number: PA23490/041/001. Date of revision of text: March 2024. Product not subject to medical prescription. Supply through pharmacy and non-pharmacy outlets. Further information available upon request.
Could you help a future pharmacist?
APPEL (Affiliation for Pharmacy Practice Experiential Learning) is now seeking expressions of interest from pharmacists in community and hospital pharmacy settings who would like to facilitate an experiential learning placement for a 2nd-year pharmacy student in 2025.
Experiential learning placements are a key part of the integrated pharmacy masters (M.Pharm). Students undertake placements throughout the course and the 2nd-year placement is the first of these placements. These placements take place in two different ways: a two-week block for UCC and TCD students (13th
– 24th January) and a longitudinal placement every Tuesday afternoon for RCSI students (7th January – 1st April).
Pharmacists who have previously facilitated APPEL placements have found the experience enjoyable and rewarding. In surveys, 83% of pharmacists said they
would recommend facilitating a placement to other pharmacists. The advantages of facilitating an APPEL placement include:
• Continuing Professional Development - APPEL Trainer Training can contribute to pharmacists CPD, as can the experience of facilitating a placement.
• Development of your talent pipeline - many students will look to start their career in the organisations or practice settings where they undertook their placements
Pharmax-ing Benefits for Pharmacy
Quicker
• Engagement - participating in the APPEL programme provides you with the opportunity to increase awareness of your pharmacy/ organisation. APPEL training and events provide fantastic networking opportunities.
Please register your interest in offering a placement (or placements) by filling in this short form: https://forms. gle/2haGCChzrzm8zvrz5
If you have any questions or want further information, please email ops@appel.ie.
and easier ordering of front of shop products within Pharmax.ie
United Drug, the leading pharmaceutical wholesaler in Ireland, is committed to empowering independent pharmacies with the best resources to thrive in a rapidly changing environment.
Pharmax, the compliance based and best-in-class buying group brought to market by United Drug, has been designed with one core goal in mind: to provide retail pharmacies with competitive pricing and enhanced purchasing power. The launch of Profitlines Plus has incorporated front of shop products in a quicker and easier method of ordering through the Pharmax platform.
What is Profitlines Plus?
Profitlines Plus simplifies the buying process by bringing together a range of Consumer and Wholesale products into one integrated system. With over 3000 products and a comprehensive range of category leading promotions, Profitlines Plus also rewards customers with an additional discount applicable as a rebate on statement.
This new solution not only simplifies front-of-shop ordering but also marks a significant step forward in aligning United Drug’s Consumer and Wholesale offerings, enabling a seamless experience for pharmacies across the board.
Pharmax Benefits
With a dedicated and specialised support team in Adrian O’Sullivan, Reggie Ismailov and Jo Moloney,
Pharmax members can experience excellent customer service and expert guidance, ensuring they maximize the benefits of the Pharmax platform to enhance their pharmacy operations.
Pharmax delivers best in class pricing for members. By leveraging the breadth of local purchasing options and the global scale of the PHOENIX group, United Drug ensures that pharmacies receive
top-tier pricing on high-volume medications. Pharmax members continue to experience the benefits of buying group membership including ordering as pack replacement, next day delivery and improved margin across the range of products available to them.
As pharmacies navigate the challenges of the modern retail landscape, innovation is key. Profitlines Plus is our commitment
to supporting pharmacies grow their business, bringing together the best of United Drug’s expertise in wholesale and consumer products to provide an enhanced and seamless ordering experience. Profitlines Plus is now live on the Pharmax platform, available exclusively to Pharmax members. For more information, visit www. pharmax.ie or contact your United Drug area manager.
Adrian O’Sullivan
pharmax@united-drug.com Ph: 01 5242425
Launching Profitlines Plus - United Drug’s new front of shop offering within the Pharmax ordering platform.
CarePlus welcome Remedi Pharmacy (IFSC) on board as franchise group continues to expand
CarePlus Pharmacy (part of Navi Group) have welcomed another new member to the franchise with the addition of Remedi Pharmacy IFSC, in Custom House Square, Dublin 1. CarePlus Pharmacy enables independent pharmacy owners to maintain their name and is flexible when adapting the existing pharmacy fitout, tailoring owner needs to accelerate business success.
Remedi Pharmacy has been in operation for over 20 years and is owned by Juan Del Alamo Iborra. Juan hails from Spain, having studied Pharmacy in the University of Navarra, Pamplona, before going on to complete his Master’s in Business Administration, Pharmaceutical Marketing and Management in the University of Barcelona. Juan started working in Remedi Pharmacy as a pharmacist in November 2003, before taking over as owner in May 2006.
When CarePlus and Juan first met to discuss the possibility of Remedi Pharmacy joining the franchise, they identified several challenges Juan was experiencing that CarePlus would be able to offer solutions for. These challenges ranged from managing stock front-of-shop, marketing for promotion cycles and a lack of available business intelligence data which would help to develop action plans in the dispensary, ensuring the pharmacy were maximising margin. This is where CarePlus came in, with operational efficiencies taking priority.
“Looking back, I realise how challenging it would have been to manage the planning, tendering, and shop fitting while coordinating stock and merchandising. The CarePlus Support Team made it all possible with their expertise,
delivering exceptional results inside and out.
Since joining CarePlus, sales have increased, and customer feedback has been great. Their team was highly organised and easy to work with.
The DispenSense dispensary software and TillSense EPOS installations went smoothly. The support from the DispenSense team has been outstanding— they’re quick and responsive to any queries. The system also makes monthly claims a breeze. I highly recommend DispenSense.”
Best-in-class pharmacy systems
The goal of CarePlus is to maximise turnover and margin return for your pharmacy. This is achieved by utilising an innovative suite of Navi Group’s products and services. The CarePlus Franchise provides independent pharmacies with best-in-class IT systems, designed by pharmacists, for pharmacists, as well as industry leading front-of-shop and dispensary buying.
Dispensary
• Axium is an established and comprehensive order management system for dispensary products that offers significant discounts to pharmacies
• DispenSense is a new and innovative cloud-based pharmacy dispensary system
• iGnite is a business intelligence solution to help drive the pharmacy business
Front-of-Shop
• TillSense is a new, cloud-based EPOS solution tailored for busy Irish pharmacies
• TouchPlus is an integrated Front-of-Shop order management system for franchise pharmacies, tightly integrated with Head Office systems
Business operations & development
CarePlus is designed to flexibly partner with independent pharmacies to enhance your business, in a manner tailored to your budget, needs and future plans. Members are supported in an innovative brand partnership, with nationwide recognition and awareness.
As part of the Navi franchise, your dedicated Business Development Manager will:
• Identify differences between expected and paid PCRS payments
• Review dispensary and front of shop sales
• Review margins, overheads and wages benchmarked against the industry and group
• Agree budgets and action plan for the upcoming year
Store promotion
Prescription ordering app
• The prescription ordering service via the CarePlus app is a convenient and complimentary platform for customers to order their prescriptions
• This service allows users to order one-off, repeat prescriptions or Healthmail prescriptions
Marketing support
• Access to a dedicated team of marketing personnel working to
enhance your business within your local community with bespoke marketing material
• Provision of a promotional pack to highlight offers and provide customer information
• Access to an editable point-ofsale system, where your team can create personalised POS
• Head Office create social media posts on health conditions and relevant seasonal health advice that can be automatically posted (by the in-house marketing team) to your pharmacy’s social media platforms, appearing as though they were created locally
Customer support
A dedicated Business Development Manager will visit your pharmacy regularly, helping to maximise dispensary and Front-of-Shop margins. The always-on Customer Service team of pharmacy technicians quickly respond to any queries by phone, interactive chat function or email.
CarePlus also offer support on HR, clinical governance, electronic services booking and eLearning via Our Academy.
CarePlus members’ feedback is at the forefront of the conversation when it comes to making improvements and directing how the brand develops, implementing feedback to make pharmacy easier.
Interested in joining CarePlus or looking to learn more? Call us on +353 1 4433884 or email info@navi.ie.
McLernons launch updated MPS Retail – which will revolutionise your retail experience!
When McLernons first launched their MPS Retail EPOS solution it was a game changer in the market place and we are happy to say that the latest version will have the same impact on your business.
Robin Hanna, Director, said, “We have listened to our customers, looked at leading solutions across the world and the ways in which retail is changing and we believe that the new MPS Retail will make your life easier and your operations more efficient.”
“The menu has been reworked to be more intuitive and we have changed some icons and grouped others together in a way that should make the way that you use the system faster and more efficient.”
Game-Changing Features for Your Business
• Intuitive Menu Design: Redesigned for a more intuitive navigation experience, making it easier than ever to find what you need quickly.
• Optimised Workflows: Improved processes reduce the number of keystrokes needed, speeding up transactions and daily tasks.
• Add to Sale from Price Enquiry: No need to exit the price enquiry screen to add items to a sale, simplifying your process.
• Single Daily Login: Log in once and stay connected throughout the day, saving time and reducing hassle.
• Unified Accounts Screen: Manage administration and functionality from one cohesive screen.
• Enhanced MPS Dispensing Integration: Seamlessly connect dispensing with retail operations for a unified workflow.
• FMD Product Decommissioning at Till: Easily decommission FMD products at the point of sale when handing medications to customers.
• Handheld Scanners for Live Stock Control: Enhance inventory management with realtime updates using handheld scanners.
• Direct Email Reporting: Send reports directly from the
software to your managed contact list, simplifying communication.
Robin added, “We recognised the need for more accessible and dynamic reports in our EPOS system. Our new design ensures that information is easier to read and act upon.”
“The improved workflow in MPS Retail means that the software is not only easier to use but also significantly reduces the time required to train new staff. Enhanced integration eliminates redundant data entry, substantially reducing errors.”
“The updates to MPS Retail are not just about aesthetics; they are about making the software more functional and user-friendly to truly make your life easier.”
Discover the all-new MPS Retail today and transform your retail operations. With our innovative updates, we promise a more efficient, user-friendly, and powerful software solution that will revolutionise the way you do business.
Find out more by contacting Robin or Tim on sales@mclernons.ie
Robin Hanna, Sales Director, McLernons
REVOLUTIONISE YOUR RETAIL EXPERIENCE WITH NEW LOOK MPS RETAIL
Our MPS Retail EPOS solution has been redesigned and updated to make your life easier and your retail operations more efficient.
We have added a host of new features to streamline your workflow with accessible and dynamic EPOS reports.
McLernons MPS Retail has a fresh, user-friendly interface, with improved integration for enhanced operational efficiency, increased ease of use for staff and a reduction in data entry thereby reducing errors.
GAME-CHANGING FEATURES
ADD TO SALE FROM PRICE ENQUIRY
No need to exit the price enquiry screen to add items to a sale.
SINGLE DAILY LOGIN
Log in once and stay connected through the day, saving time.
UNIFIED ACCOUNTS SCREEN
Manage administration and accounts from one screen.
ENHANCED MPS DISPENSING INTEGRATION
FMD PRODUCT DECOMMISSIONING AT THE TILL
Easily decommission FMD products at the point of sale when handing dispensed medicines to patients.
HANDHELD SCANNERS FOR LIVE STOCK CONTROL
Improve inventory management with real time updates using handheld scanners.
Unify the workflow by seamlessly connecting dispensing and retail operations.
DIRECT EMAIL REPORTING
Simplify communications with key staff by sending reports directly from the software to your contacts lists.
REPORT SCHEDULING
Free up time and ensure that selected contacts stay informed by scheduling reports to be sent at regular intervals.
Pharmacists Concerned at lack of Clarity on Funding
The Irish Pharmacy Union (IPU) has said that Budget 2025 has failed to provide the clarity that was expected on how the chronic underfunding of Ireland’s community pharmacy sector will be addressed.
Speaking following the announcement of the Budget, IPU President, Tom Murray, warned that the introduction of proposed new healthcare services in pharmacies will not be feasible if the funding shortfall is not addressed.
Mr Murray said, “The health system relies upon pharmacists’ professional services to ensure the safe supply of medicines through the community drugs schemes. This guarantees that medical card holders can access their medicines quickly and efficiently. The fees pharmacies receive for this service have been frozen for 16 years, since 2009, and are no longer viable.
The IPU, has been in negotiations with Department of Health Officials for over a year as part of a statutory review process which stipulates that the pharmacy fee structure must be reviewed every third year after 2020. To date no progress has been made, but the IPU expected that this Budget would contain measures to address the inequity and unfairness of the current fee structure.”
Mr Murray emphasised that while there has been potential progress made with the Department of Health on expanding pharmacy services there is a frustrating lack of clarity for pharmacies within this Budget about how core fees for essential professional services will
be addressed. Without this clarity, these promising proposals will not progress, he warned.
Concluding Mr. Murray said, “While Budget 2025 has delivered several meaningful supports to individuals and families to help with the increasing cost of living, regrettably the State continues to ignore the financial pressures pharmacies are facing. This is compounding the pressures already experienced by the sector, which if not addressed will have an impact on patient care.”
Record Breaking Budget
The Minister for Health Stephen Donnelly, Minister for Mental Health and Older People, Mary Butler and Minister for Public Health, Wellbeing and the National Drug Strategy, Colm Burke announced a record ¤25.8 billion health budget to support the continued delivery and expansion of quality, affordable healthcare services in 2025.
The funding represents an overall increase of ¤2.94 billion on the January 2024 allocation, recognising the challenges of inflation and the increased demand on services due to a growing and ageing population.
It will provide for more than 3,300 additional staff in our health and social care services, deliver 335 additional hospital beds, expand services, deliver increased
productivity and continue the reductions in waiting lists and trolley numbers.
Budget 2025 includes significant increases on 2024 in areas such as:
• Acute Hospitals (up 22% to ¤9.9 billion)
• Mental Health (up 10% to a record ¤1.48 billion)
• Older Persons Services (up ¤349 million to ¤3 billion)
• Palliative Care (up 13% to ¤179 million)
• National Ambulance Service (up 13% to ¤280 million)
The 2025 health Budget includes ¤1.2 billion allocated for existing level of service, ¤1.5 billion additional funding for 2024 pressures and ¤335 million in additional new measures.
Highlights include:
• ¤49.5 million to provide 335 more hospital beds
• ¤33 million to develop cancer services including full funding for the National Cancer Strategy
• ¤21.5 million additional funding to increase Home Support hours to 24 million in 2025
• investment of ¤30 million in new medicines through increased savings in the medicines budget
• ¤35 million women’s health package including provision of free Hormone Replacement Therapy (HRT) and expanded access to Assisted Human Reproduction (AHR) services
• ¤6 million to expand Injury Units
Budget 2025 also includes ¤0.9 billion of funding, initially introduced for one-off measures during the COVID-19 pandemic, that has now been made permanent. This will allow permanent funding to continue to reduce waiting lists. ¤420 million be allocated to the HSE and NTPF in 2025 for waiting list initiatives, a ¤60 million increase on 2024 funding.
The 2025 Health Budget will see spending on Mental Health rise to almost ¤1.5 billion. This marks the fifth consecutive year that an increase in funding has been provided to develop and support mental health services - an increase of 43.7% over the lifetime of this government.
Drugs initiatives will be boosted by ¤4.2 million funding, with a focus on expansion of community drug and alcohol treatment centre services to respond to increased demand. ¤1 million has been allocated for the national roll-out of integrated community alcohol treatment services, ensuring full geographic coverage across all health regions.
Genitourinary Syndrome of Menopause
Genitourinary syndrome of menopause (GSM), previously referred to as vulvovaginal atrophy (VVA) or atrophic vaginitis, is a common symptom of menopause. It may be present in perimenopause, but is more likely to become apparent as women progress through their menopause journey. Unlike vasomotor symptoms of menopause which will improve with time, genitourinary problems often persist and progress due to prolonged hypoestrogenism.
GSM is one of the most consistently identified predictors of sexual dysfunction in women, but is often underdiagnosed and undertreated. Many women do not voluntarily discuss these symptoms with their healthcare provider, and many healthcare professionals do not ask patients about it directly.
While the exact prevalence rates vary depending on the source it is estimated that between 36% and 84% of women in perimenopause and menopause will experience genitourinary symptoms.
GSM refers to a syndrome of defined signs and symptoms related to hypoestrogenic changes of the female genitourinary tract. The symptoms of GSM are directly related to the reduction in circulating estrogen levels after menopause. An abundance of estrogen receptors are present in the vagina, vulva, pelvic floor muscles, urethra, and bladder. As a result of the estrogen deficiency that occurs in menopause, both histological and anatomical changes occur in urogenital tissues. These changes lead to a thinning of the vaginal mucosa, reduced vaginal elasticity, increased vaginal pH leading to changes in the normal vaginal flora and decreased lubrication, all of which leave the tissues vulnerable to irritation, infection and trauma.
Symptoms include:
• Vaginal and vulval irritation, itching, burning or discomfort
• Urinary symptoms of urgency, frequency, nocturia and dysuria
• Recurrent urinary tract infections
• Lack of lubrication and pain during intercourse
• Light bleeding related to local trauma (for example insertion of a pessary)
Diagnosis is made based on the patient’s history and examination. As mentioned above, patients may not willingly disclose these symptoms and so healthcare providers should actively ask about them. An examination is important to rule out other causes of vaginal discomfort including Lichen Sclerosis, Lichen Planus, vulval dermatoses and malignant conditions. Signs of GSM include changes in tissue colour (ranging from pallor to inflammation), loss of elasticity, friable tissue that easily bleeds, petechiae and vaginal discharge.
For most women, further investigations are not necessary. If a vaginal discharge is present a high vaginal swab may be done to rule out candidiasis, bacterial vaginosis and sexually transmitted infections. Cervical smear tests should be kept up to date, although the smear taker should be mindful that the procedure may be traumatic to local tissues and extra lubrication may be required. Urinalysis may be required in patients presenting with urinary symptoms and a microscopy and culture should be considered for women experiencing recurrent urinary tract infections. Any abnormal vaginal bleeding should be investigated as appropriate.
Treatment of GSM is vital in order to restore normal function of the urogenital tissues as well as to alleviate these very bothersome symptoms and improve quality of
Written by Dr Genevieve Ferraris, Menopause Specialist at The Menopause Hub, Dublin
life. As the primary cause of these symptoms is a lack of estrogen, local estrogen therapy and/or systemic HRT would be considered the most logical first line therapy unless there is a contra-indication. It is important to note that local estrogen therapy is not considered to be HRT as it has little to no systemic absorption. The NICE Guidelines are quite clear that vaginal estrogen should be offered to women with GSM, even if on systemic HRT, and that it should be continued for as long as needed to relieve symptoms. It can and should be considered in women in whom systemic HRT is contraindicated, after seeking advice from a menopause specialist.
Local estrogen replacement can restore vaginal pH and helps to thicken and revascularise the vaginal epithelium. Vaginal estrogen use is also associated with a reduction in urinary symptoms and a decreased incidence of urinary tract infections. Vaginal estrogen can be absorbed from the vagina and surrounding area via a pessary, cream, gel or vaginal ring. There are two types of estrogen used – estradiol and estriol. Time to respond to therapy will depend on the degree of atrophic changes present when starting. Women with severe symptoms may only notice an improvement after several months. For many women, symptoms will return once the treatment is stopped, and so it is both safe and reasonable to continue vaginal estrogen therapy long-term.
Systemic HRT will very effectively treat genitourinary symptoms in women who have other menopausal symptoms and in whom HRT is not contra-indicated. Systemic HRT may also be used together with vaginal estrogen in those women who have persistent symptoms of GSM.
Non-hormonal treatments may be used alongside, or in place of,
hormone therapies. They do not restore normal vaginal physiology. They are a good treatment option for women with mild symptoms, or for those women that do not want to use hormonal treatment. Vaginal moisturisers, used on a regular basis, may offer relief from symptoms of vaginal dryness. They help to retain moisture in the mucosa and may balance the vaginal pH. They should be used regularly for maximum benefit. Vaginal lubricants are intended for use with any sexual or penetrative activity, including speculum exams. Care is needed in selecting preparations which are appropriate for the vaginal environment and free of potential irritants such as glycerol. There are a wide variety of over-the-counter products available and these may be water, oil, or silicon-based. Patients should be advised that oil-based lubricants may negatively affect condom integrity.
Vaginal laser therapy should not be offered to patients, as studies have shown no benefit over placebo.
Patients may require referral to a pelvic floor physiotherapist who can assist with treatment of vaginismus and hypertonicity, pelvic floor dysfunction, and the use of vaginal dilators if appropriate.
Other general recommendations for patients with GSM would be around minimising vaginal irritation. This can include wearing cotton underwear, avoiding very tight underwear and trousers, washing with warm water only and to avoid the use of soaps, bubble baths and feminine hygiene sprays.
In conclusion, genitourinary symptoms of menopause are common, bothersome and under-discussed by both patients and doctors. Healthcare providers should actively ask about symptoms, and should feel reassured that local estrogen therapy can be safely prescribed in almost all menopausal women with GSM. Systemic HRT may be offered to women who have other menopause symptoms and do not have contraindications to use. Vaginal moisturisers and lubricants can be helpful adjuncts to hormone therapy, or may be used alone in women with mild symptoms or who do not wish to use hormonal treatments.
AIM FOR CALM
INTRODUCING ZENFLORE® CALM, A NEW SUPPLEMENT FROM THE MAKERS OF ALFLOREX AND ZENFLORE. ZENFLORE® CALM, FORMULATED WITH 1714™ BACTERIAL CULTURE AND VITAMIN B6. BLENDED WITH SAFFRON EXTRACT TO HELP RELAX AND SUPPORT EMOTIONAL BALANCE.
Key Benefits:
• DAILY SUPPORT FOR A BUSY MIND** as you navigate through life’s daily challenges.
• RELAXATION SUPPORT blended with saffron extract to help relax and support emotional balance*.
Exercise has long been a fundamental component of being healthy. However, for women in particular, it has largely been seen as a tool to either ‘look a certain way’ or manage their weight. The idea that only certain exercises are beneficial has also contributed to this negative image.
Exercise or movement should instead be explored and celebrated as a means to improve our health and wellbeing. It is one of the most powerful tools we can use to remain healthy and prevent disease, but also challenge ourselves and feel great.
This is important for anyone as they age, but particularly for women as they transition through menopause. The menopause transition can be one of the most challenging periods in a woman’s life.1 This is due to the wide variety of symptoms they can experience at this time from physical to mental.1 These symptoms can vary in severity, duration and most importantly how they impact her daily life, and ultimately her future.1,2,3
While symptoms and management of menopause have gained more attention recently, there is still not enough awareness of the health consequences associated with being post-menopausal. Post-menopausal women are at higher risk for certain diseases, particularly cardiovascular disease and osteoporosis.1
• Did you know that 1 in 4 women die from heart disease and stroke?4
• Did you know that coronary heart disease (atherosclerotic heart disease) results in twice as many deaths in women as breast cancer?1
• Did you know that around 25% of women will have developed osteoporosis by the time they are 80 years old?1
• Did you know that 20% of women who sustain a hip fracture will die as a result? For those that survive, most will be left with some form of disability, requiring long-term care and possibly the inability to live independently.1
While hormone replacement therapy (HRT) can play an important role in both treating the symptoms and helping prevent diseases caused by the lack of oestrogen, our day-to-day lifestyle is as pivotal.1 Things like smoking, obesity and excessive alcohol consumption can all impact a woman’s risk of developing ischaemic heart disease, diabetes,
Written by Dr Kirsty Hedding, The Menopause Hub Menopause Society Certified Practitioner, MBChB (UCT), MPhil (EM) (UCT)
and a variety of cancers, most especially breast.1 Given that a lot of these factors are within our control, relying on HRT alone would be unwise, especially as not everyone is able to use it. So how can movement help women during the menopause transition?
1) Reducing severity of symptoms: although the studies done in this regard are small and limited, women who were more physically active during this period, reported less severe symptoms, particularly vasomotor symptoms (hot flushes/night sweats).3 It is thought that this may be attributable to the endorphins exercise creates and how that influences a woman’s physiology in a positive manner improving sensitivity to pain and hot flushes.3 However, the size of this effect may vary between individuals. Other evidence suggests that regular sustained aerobic exercise (like swimming) has the most benefit in reducing these symptoms.1
2) Improved sleep: regular moderate to vigorous exercise can help sleep by reducing the time it takes to fall asleep as well as improving the quality of sleep.3 Improved sleep results in less fatigue during the day, an improvement in mood and a greater chance of repeating regular exercise.1 Good sleep can also help women make better food choices during the day.
3) Reducing stress: movement reduces stress through enjoyment, time to oneself or through connection with a community.3,4 Also, depending on the type of exercise you participate in, it can bring you closer to nature which often has a calming effect.5
4) Improvement in mood symptoms: Irritability, low mood and mild depression is common during menopause.6 Exercise can be as effective as some medications at treating this. It additionally helps improve your self-esteem, which in turn improves overall well-being.3 How does exercise help prevent disease?
• Exercise stresses our bones by applying force to them, either through impact (like running) or through the muscles exerting a force on them through pulling. This in turn forces the bone to adapt and become stronger, reducing the likelihood of a fracture.
• Exercise can assist with increasing muscle mass which both enhances our metabolism, helping with weight maintenance.
• Movement assists with strengthening our balance, which will prevent a fall, and possible broken hip.1 Exercising with a focus on balance is particularly important for women over the age of 65 years.4
• Mobility and strong muscles enable us to remain active and independent for as long as possible.1
• It can strengthen the heart and cardiovascular system, allowing it to function at an optimal level.4
Gabby Logan
• Daily exercise can help lower blood pressure in women with high blood pressure, decreasing it by up to 5-7mmhg. This ultimately helps to decrease the risk of developing strokes or heart attacks.5
• Atherosclerosis, which results in cerebrovascular disease, is thought to be worsened by chronic inflammation, and exercise has been shown to play a role in decreasing inflammatory markers and preventing vascular endothelial dysfunction.7
• Obesity increases a person’s risk for chronic diseases, like diabetes as an example.1 The menopause transition is known to be associated with significant weight gain, although studies have attributed this to age and lifestyle, not specifically menopause. Although once again small, studies that
looked at women who did regular physical exercise during menopause, were found to gain the least amount of weight.8
Understanding the benefits of exercise in more detail can help motivate women to add movement to their lives both during the menopause transition and afterwards. Yet, it must be said that for many women, the very idea of ‘exercise’ can be completely overwhelming. This can be for many external reasons like shift work, long commutes or family responsibilities. Most importantly, the menopause itself contributes significantly to fatigue, lack of motivation and pain, all of which can prevent women from doing something. Encouraging movement isn’t to undermine the experience women go through during this time, but rather to help fuel their ‘why’ to do something worthwhile.
So where can you start?
1) Chat to your healthcare provider about what exercise is safe for you and/or would be of most benefit to you. This is particularly important if you have medical conditions or physical limitations that may make certain exercises risky.
2) Movement comes in a variety of shapes and sizes, so pick something that brings you joy. You get to choose what this looks like and it will be unique for every woman.
3) Start small and increase slowly. the recommended time by the World Health Organisation (WHO) for aerobic exercise is 150 minutes of moderate exercise per week.1 Breaking this into chunks of ten minutes at a time still provides the benefit, so don’t be intimidated by the overall amount.
even growth. Our health after all, is one of our most important assets to living a life we love.
References available on request
Topic Team Training – Emergency Contraception
Following on from the September issue Continuing Professional Development on the Pharmacy Role in Emergency Contraception, this 5-Minute Learning Module is designed to enhance the community pharmacy team understanding and ask further questions as to how you can support and advise patients.
After completing this module, you should recognise the different types of emergency contraceptives available, indications and suitability for patients that may present to the pharmacy and appropriate advice and counselling to be given for each.
A community pharmacy environment that fosters teamwork ensured high levels of consumer satisfaction. This series of articles is designed for you to use as guide to assist your team in focusing on meeting ongoing CPD targets and to identify any training needs in order to keep the knowledge and skills of you and your team up to date.
The below information, considerations and checklist provides support to enable you to run a team training session and identify opportunities for learning within the topic of Emergency Contraception.
Consider:
Incorrect use of contraceptives or contraceptive failure such as condom breakage, missed pills, incorrect timing of patch or vaginal ring application, contraceptive non-use, forced intercourse, and other circumstances, place women at risk of unintended pregnancy. There is a critical role for emergency contraception (EC) in preventing those pregnancies.
EC is indicated for women who do not want to conceive after unprotected sexual intercourse (UPSI) on any day of a natural menstrual cycle, or if their regular contraception use has been compromised. It is intended for occasional use, i.e. not to replace effective contraception.
Pregnancy is theoretically possible after UPSI on most days of the cycle, but is highest during the 6 days leading up to and including the day of ovulation. It can be difficult to accurately estimate the timing of ovulation using the
Reflect on the following in assessing your own knowledge and your team’s training:
Is your knowledge up-to-date on all methods of emergency contraception?
Are you aware of all cases where referral to GP or sexual health clinic are required? v Have you an up-to-date SOP implemented?
Do you know what advice should be given to all patients provided with emergency contraception?
Have you details of sources for further support that may be required, either for STIs or crisis situations?
Are you confident explaining the options for ongoing contraception?
usual cycle length and date of the last menstrual period. There is evidence to show that ovulation estimation in this way is imprecise when correlated with serum and ultrasound markers of ovulation. The resulting advice is to offer EC after UPSI on any day of the cycle, although choice of EC may be influenced by timing.
Copper intrauterine device (Cu-IUD): has multiple mechanisms of action: one is through its adverse effects on the motility and viability of the sperm, and the viability and transport of the egg.
Ulipristal acetate (UPA): This is a selective progesterone receptor modulator which delays ovulation for at least 5 days, i.e. until sperm from the UPSI are no longer viable.
Ulipristal acetate emergency contraception (UPA-EC) delays ovulation even after the luteinising hormone (LH) surge, whereas LNG-EC does not. However, UPAEC cannot inhibit ovulation at or after the LH peak.
Levonorgestrel (LNG): This inhibits ovulation, delaying follicular rupture and causing luteal dysfunction. If taken before the LH surge, ovulation is delayed for 5 days.
It is recommended that a pregnancy test is carried out
Key Points:
Ensure your team understands and is confident explaining the following:
All requests for Emergency Contraception must be referred to the pharmacist
The main aspects of the pharmacist consultation should be explained to the patient if requested
The difference between methods of emergency contraception available from the pharmacy
They have read the appropriate sections of the SOP
All requests for emergency contraception must be treated with utmost confidence
All patient conversations are conducted with discretion, sensitivity, and appropriate tone.
if menstruation is delayed by more than 7 days after EC. After UPA-EC, 75% of women had their next menstrual period at the expected time or within 7 days of the expected time. The majority of women also menstruate within 7 days of the expected time after LNG-EC.
Studies have demonstrated a higher pregnancy rate after EC amongst women who have further UPSI in the same cycle than amongst women who do not have further UPSI.
Pharmacists are equipped with the skills and knowledge about EC to advise women, and where necessary, to address potential barriers to emergency contraceptive use. It is important for pharmacists to have an awareness of these barriers described by women seeking EC, and that evidence based information is used to address specific individual needs to ensure appropriate advice about EC use. Some women may be uncomfortable discussing sensitive sexual health topics or hesitant to ask for more information on EC. It is essential that anyone seeking information in a pharmacy setting feels a level of trust and comfort in order to enable discussion about the safe and effective use of EC.
Actions:
Your checklist for Emergency Contraception training should include:
Your own knowledge is up-to-date on methods of EHC available from the pharmacy
Refresh your knowledge of contraindications and side-effects
Ensure you know the cases where one method should be provided over the other v The appropriate training has been provided to all team members, and assessed
You have an SOP implemented and followed by all relevant staff
You have a suitable method of carrying out patient consultations, either with a questionnaire or assessment form.
her morning af ter
PRODUCT INFORMATION ellaOne® 30 mg film-coated tablet (ulipristal acetate). Refer to the SmPC for further information. INDICATION: Emergency contraception (EC) within 120 hours (5 days) of unprotected sexual intercourse or contraceptive failure. DOSAGE: one 30mg tablet taken orally as soon as possible, but no later than 120 hours (5 days) after unprotected intercourse or contraceptive failure. Another tablet should be taken if vomiting occurs within 3 hours of intake. Can be taken at any time during the menstrual cycle. Not recommended for women with severe hepatic impairment. CONTRAINDICATIONS: Hypersensitivity to the active substance or excipients. SPECIAL WARNINGS AND PRECAUTIONS: Occasional use only. Use reliable barrier method after use until next menstrual period. If next menstrual period is delayed >7 days or is abnormal or suggestive symptoms occur then perform pregnancy test. Consider ectopic pregnancy. If pregnancy confirmed, woman should contact their doctor. Concomitant use with EC containing levonorgestrel not recommended. Does not contraindicate the continued use of regular hormonal contraception but reliable barrier method should be used until next menstrual period. Not recommended in severe asthma treated by oral corticosteroids. Concomitant use of CYP3A4 inducers [e.g. barbiturates (including primidone and phenobarbital), phenytoin, fosphenytoin, carbamazepine, oxcarbazepine, herbal medicines containing Hypericum perforatum (St. John’s wort), rifampicin, rifabutin, griseofulvin, efavirenz, nevirapine] not recommended (may decrease efficacy of ellaOne). Long term use of ritonavir not recommended. Not recommended for women who have used enzyme-inducing drugs in the past 4 weeks. Non-hormonal emergency contraception (i.e. a copper intrauterine device (Cu-IUD)) should be considered. Contains lactose. Patients with rare hereditary problems of galactose intolerance, total lactase deficiency or glucose-galactose malabsorption should not take this medicinal product. Contains
less than 1 mmol sodium (23 mg) per vial, essentially ‘sodium free’. FERTILITY, PREGNANCY AND LACTATION: Not intended for use during existing or suspected pregnancy. Limited human data does not suggest safety concern. Does not interrupt existing pregnancy. No teratogenic potential was observed; animal data insufficient with regard to reproduction toxicity. Marketing Authorisation Holder maintains a pregnancy registry (www.hra-pregnancy-registry.com) to monitor outcomes of pregnancy in women exposed to ellaOne®. Patients and health care providers are encouraged to report any exposure. Ulipristal acetate is excreted in human breast milk; breastfeeding is not recommended for one week after intake. Breast milk should be expressed and discarded. A rapid return of fertility is likely following ellaOne use; regular contraception should be continued or initiated as soon as possible; subsequent acts of intercourse should be protected by reliable barrier method until next menstrual period. UNDESIRABLE EFFECTS: Always consult the SmPC before prescribing. Only the most common side effects and those which are rare but may be serious are listed below. Most commonly reported adverse reactions: headache, nausea, abdominal pain and dysmenorrhea. Common (≥ 1/100 to <1/10): mood disorders, dizziness, vomiting, abdominal discomfort, myalgia, back pain, pelvic pain, breast tenderness and fatigue. Rare (≥1/10,000 to <1/1,000): ruptured ovarian cyst.
MARKETING AUTHORISATION HOLDER: Laboratoire HRA Pharma, 200 avenue de Paris 92320 Châtillon - France. MARKETED IN IRELAND BY: Chefaro Ireland DAC, The Sharp Building, 10-12 Hogan Place, Dublin 2, D02 TY74, Ireland MARKETING AUTHORISATION NUMBER(S): EU/1/09/522/003. LEGAL CATEGORY: Medicinal product not subject to medical prescription. Date of last revision of text: October 2023. Unique ID: IE/ELLA/0319.
REFERENCE: 1. Glasier A et al. Lancet 2010; 375 (9714): 555-62.
Her Heart Matters
Cardiovascular disease is the leading cause of death in women in Europe and worldwide with many women living with chronic cardiovascular disease. Similarly, in Ireland one in four women dies from heart disease or stroke every year, the same as men. Surprisingly very few women realise this or that their risk of dying of a heart attack or stroke is 6 times more likely than dying of breast cancer.
There are differences in the aetiology and sometimes the presentation of CVD in women leading to misdiagnoisis. For instance, younger women are more likely to present with myocardial infarction/ischaemia in the absence of obstructive coronary artery disease (MINOCA/INOCA), with coronary artery dissection (SCAD) or Takotsubo cardiomyopathy. Further more women are protected by their hormones until the menopause so may develop atherosclerotic disease a bit later than men. Together this has meant that historically the public feel that heart disease is a man’s disease. Research has shown that cardiovascular disease in women has been under recognised, under diagnosed and under treated in the past. This is only now starting to change, though there are still far fewer women enrolled in clinical trials. This lack of awareness has meant women delay seeking help, and their symptoms may not be recognised and diagnosed quickly by health professionals, all of which lead to delays in effective and often
life-saving treatment. The lack of women’s involvement in clinical trials has limited our knowledge of the efficacy, safety, and correct dose of many therapies in women compared to men which has led to the underutilisation of preventative treatments and interventions for CVD in women. It is therefore important to remove barriers for women entering clinical trials and encourage their participation so we can better understand their specific risk factors and response to treatment.
The Irish Heart Foundation’s campaign ‘Her Heart Matters’ is a very important campaign trying to address these misconceptions and raise awareness of the signs and symptoms of a heart attack as 50% of women are unaware of these signs and symptoms. Though the commonest symptom remains chest pain sometimes radiating to the arms, they can be more vague in women, who may also be breathless and dizzy. Women also tend to have more nausea and may underplay their symptoms.
Written by Dr Angie Brown, Consultant Cardiologist & Medical Director, Irish Heart Foundation
The traditional risk factors of hypertension, high cholesterol, a family history of premature IHD, a sedentary lifestyle and obesity, affect men and women equally.
However, diabetes in women increases the risk of developing cardiovascular disease more than men and may mean they are less likely to feel pain if they are having a heart attack.
Smoking increases the risk of cardiovascular disease in everyone but women who smoke have a much higher risk of heart disease than men, the risk increasing with the number of cigarettes smoked. The recent AMI audit confirmed smokers have a heart attack 9 years earlier than those who don’t smoke.
It’s also important to know there are sex specific risk factors. These include a premature menopause. The lack of oestrogen leads to stiffening of the coronary arteries and alters the lipid profile increasing cardiovascular risk.
Preeclampsia and gestational diabetes increase’s a women’s long term risk of developing CVD. Polycystic ovaries, inflammatory and autoimmune disorders may also increase the risk of heart disease. Psychosocial risk factors, socioeconomic depravation, poor health literacy and environmental risk factors also have a role in increasing risk.
The good news is 80% of premature cardiovascular disease is preventable.
In addition to managing the traditional risk factors by ensuring control of blood pressure, blood sugar and cholesterol, stopping smoking and modifying the diet, it is important to remember that physical activity is one of the greatest tools for prevention of cardiovascular disease, as well as improving mental health and menopause symptoms. A minimum of 150 minutes of moderate intensity activity a week divided into manageable and enjoyable sessions is recommended.
Stress is something else we all have in our lives but it’s important to manage it. For some it becomes negative, impacting on day to day lives. When we are stressed we are more likely to drink and smoke more and eat unhealthily.
This coupled with the release of cortisol, which raises blood glucose and adrenalin, raises the heart rate and blood pressure and can increase cardiovascular risk. Again, exercise has a role here as it releases tension and helps improve sleep. Staying connected to friends and family and your support network is important. Sometimes if things become overwhelming it’s worth talking to your GP and seeking professional help.
There has been a welcome focus around women’s health issues with the Governments Women’s Health Action Plan as phase 2 includes emphasis on improving cardiovascular health. Hopefully this will address some of these issues. We need to invest in research assessing women’s cardiovascular health, support more awareness raising activity and ensure educational activities for healthcare professionals to ensure they are better equipped to assess and treat specific risk factors and identify signs and symptoms of CVD in women.
Currently females are also under represented in the cardiology profession so we need to continue to increase the number of women working as cardiologists.
For more information see irishheart.ie
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Iron Deficiency in Third Trimester Prevalence
Four out of five pregnant women in Ireland are iron deficient by their third trimester, a University College Cork (UCC) study reveals. Researchers at the Irish Centre for Maternal and Child Health (INFANT) and School of Food and Nutritional Sciences in UCC have shown that over 80% of women are iron deficient by their third trimester.
The findings raise concerns as the participants in the study were a low-risk and generally healthy cohort. Iron deficiency during pregnancy is linked to increased risks of complications for both mother and child, including neurodevelopmental challenges for the baby.
This study is the largest of its kind globally and was conducted in collaboration with the University of Minnesota and the Masonic Institute of the Developing Brain. Led by UCC’s Dr Elaine McCarthy,
the study was published in the prestigious American Journal of Clinical Nutrition.
The study analysed data collected from 641 women in Ireland who were pregnant with their first baby and had a successful delivery. Blood samples were taken from the women throughout pregnancy, at 15, 20 and 33 weeks to determine iron status. “In Cork, which is a high-resource setting,” the authors found that “iron deficiency defined by a variety of markers was very common
during pregnancy, despite the mothers being generally healthy. Interestingly, despite these high rates of iron deficiency, none of the study participants were anemic in the first trimester. In particular, the authors noted that “our cohort had higher rates of deficiency in the third trimester than even some low-resource settings.”
In this study, almost threequarters of the participants took an iron-containing supplement that contained the Irish/European recommended daily iron allowance of 15-17mg. The authors did note that “iron-containing supplements (mainly multivitamins) taken pre/ early pregnancy were associated with a reduced risk of iron deficiency throughout pregnancy, including the third trimester.” The study did not have information on maternal diet, so it was not possible to investigate other dietary or lifestyle practices that were protective.
Lead researcher, Dr Elaine McCarthy from UCC’s INFANT Research Centre and the School of Food and Nutritional Sciences, explains the significance of the results, “Iron deficiency is the most common micronutrient deficiency
in the world, but it has often been thought of as mainly a problem in low-resource settings. Our research clearly illustrates that iron deficiency is extremely common amongst pregnant women, even in a generally healthy population, such as this cohort in Ireland, with greater than 80% of women iron deficient in their third trimester.”
A National Health Concern
Routine screening for iron deficiency during pregnancy is not common in Ireland or further afield and Dr McCarthy emphasises the need for a shift in healthcare practices:
“Our findings highlight the importance of screening to identify the women at the greatest risk of iron deficiency early in their pregnancy. In addition to this, we need to support and educate pregnant women around the importance of iron in their diets, something which we at UCC and colleagues in Cork University Maternity Hospital and the Ireland South Women and Infants Directorate are working on. We have a patient resource on iron during pregnancy launching in the coming months.”
Combat Menstrual Fatigue and Enhance Reproductive Health Management
Active Iron, the leading Irish iron supplement brand, is excited to announce a new partnership with Clue, a globally recognised menstrual and reproductive health app.
For a limited time, every purchase of Active Iron in pharmacies nationwide includes a complimentary annual subscription to Clue, valued at ¤39.99. This exclusive offer provides access to Clue’s advanced cycle tracking, symptom management tools, and personalised health insights.
“We are excited to offer our customers this unique opportunity to enhance their health and wellness,” said Claire Lynch, Head of Marketing at Active Iron. “By integrating Clue’s tracking capabilities with our iron supplements, we’re addressing menstrual fatigue - a significant and often overlooked symptom - helping women take control of their health.”
The campaign is supported in pharmacies with engaging pointof-sale materials and exciting offers, coinciding with Active Iron’s Perimenopause campaign for Menopause Awareness Month. This initiative aims to raise awareness about perimenopause and reduce the stigma around menstrual health.
Active Iron’s innovative supplements, combined with Clue’s health management tools, offer a comprehensive solution to the diverse needs of women. For more information and to redeem the free Clue subscription, visit activeiron.com/clue.
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Athlete’s Foot
Fungal nail and skin infections can present with various symptoms. Tines pedis, commonly known as ‘athlete’s foot', can present with red, sweaty, hot, and itchy feet. It is very common during the warmer months and can be accompanied by small red pustules on certain areas of the foot. It can be seen interdigitally and underneath the arch profile on the plantar aspect of the foot. The risk of leaving tinea pedis untreated is that small tears in the skin epidermis form, resulting in a portal for infection that can escalate to cellulitis. In warm weather, feet tend to sweat more, and such conditions as tinea pedis can be exacerbated.
Unfortunately, fungal toenails are notoriously common, and the patients coming in to see pharmacists are getting younger. Again, if possible, prevention is the best solution! This can include the use of sandals during warmer weather or around the house.
Giving the nails a break from nail varnish and letting air at the feet can be very effective.
Fungal nail infections can make the nail:
• thicker
• change colour
• brittle
• painful
Fungal nail infections sometimes start at the edges of the nail. The infection often spreads to the middle of the nail. The nail becomes yellow and can lift off. The nail may become brittle and pieces can break off. It sometimes causes pain and swelling around the nail.
Often the infection is just in one nail but several may be affected. It is usually painless. The most common symptoms are:
• Thickened nail.
• Discoloured nail (often a yellowish colour).
Commonly, this is all that occurs and fungal nail infections often cause no other symptoms. The main reason people see their doctor is because the appearance is unsightly.
Sometimes the infection becomes worse and additional symptoms occur. These include:
• The nail becoming soft and crumbling.
• White or yellow patches appearing where the nail has come away from the skin.
• The skin next to the nail becoming inflamed or scaly. Sometimes the whole nail comes away. If left untreated, the infection may eventually destroy
the nail and the nail bed, and may become painful. Walking may become uncomfortable if a toenail is affected.
Between 3 and 8 out of 100 people will develop a fungal nail infection (tinea unguium) at some stage of their lives. Toenails are more commonly affected than fingernails. It is more common in people aged over 60 and in younger people who share communal showers, such as swimmers or athletes.
Athletes Foot
Athlete’s foot is contagious via skin to skin contact and indirectly if one uses the same towel as a person with the condition. Athlete’s foot, a common fungal infection that usually develops between the toes, most commonly affects teenagers and young adults. The infection usually clears up within days or weeks with antifungal treatment. Customers can choose between fungicidal products that kill the fungus and fungistatic products, which slow down its growth until
it stops. A low-potency steroid cream may be recommended if the skin is very sore.
Athlete’s foot is highly infectious, as the fungi multiply quickly in warm and humid environments, such as swimming pools, showers and changing rooms. Good foot hygiene can help to reduce the spread of an infection and involves drying the feet thoroughly, particularly between the toes, wearing clean cotton socks, rotating footwear and avoiding walking barefoot in changing rooms.
Symptoms of Athlete’s foot include:
• An itchy, red rash, which often starts in between the 4th and 5th toes, before spreading to the other toes.
• Scaling or cracking of the skin may occur.
• Blisters can occur. If these burst, they can cause pain & swelling.
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Exploring the Latest Advancements in Refractive Eye Surgery
Written by Mr Nakul Mandal, MRCOphth, PhD, FEBO, PgDip CRS, Consultant Ophthalmic Surgeon, Blackrock Health Galway Clinic
Mr Frank Kinsella, MRCPI, FRCOphth, FWCRS, Consultant Ophthalmic Surgeon, Blackrock Health Galway Clinic
Introduction
Refractive surgery encompasses a range of procedures designed to correct or minimize refractive errors such as myopia (nearsightedness), hyperopia (farsightedness), astigmatism, and presbyopia. With continuous advancements in technology, the options for refractive surgery have become more diverse, offering patients further choices tailored to their specific needs.
Laser Refractive Surgery
Laser in Situ Keratomileusis (LASIK) is one of the most wellknown and commonly performed refractive surgeries. It involves creating a thin flap on the cornea using a femtosecond laser or microkeratome. The underlying corneal tissue is then reshaped with an excimer laser to correct the refractive error, and the flap is repositioned. Wavefront-Guided and Topography-Guided LASIK use detailed measurements of the eye's optical system, creating a customized treatment plan to improve visual quality. LASIK provides quick recovery and high success rates, making it a popular choice for patients with myopia, hyperopia, and astigmatism.1 Indeed, the US Patient-Reported Outcomes With Laser In Situ
Keratomileusis (PROWL) Studies showed that the vast majority of patients were satisfied with their treatment.2
Photorefractive Keratectomy (PRK) is a surface ablation technique where the corneal epithelium is removed, and the underlying corneal tissue is reshaped with an excimer laser. Unlike LASIK, PRK does not involve creating a corneal flap, making it a more suitable option for patients with thinner corneas. Though recovery time is longer compared to LASIK, the visual outcomes are similar.3
Small Incision Lenticule
Extraction (SMILE) is a minimally invasive procedure that uses a femtosecond laser to create a small lenticule (a thin disc of corneal tissue) within the cornea. This lenticule is then removed through a small incision, reshaping the cornea and correcting the refractive error. SMILE may offer certain benefits such as the reduction of dry eye symptoms.4
Intraocular Lenses
Refractive Lens Exchange (RLE) involves removing the natural lens and replacing it with an artificial intraocular lens (IOL). This procedure is similar to cataract surgery and is commonly used
to correct myopia, hyperopia, astigmatism, and presbyopia. Modern IOL options include toric lenses, which correct astigmatism, and multifocal lenses, which create multiple focal points to provide unaided vision at near, intermediate, and far distances. Extended Depth of Focus (EDOF) lenses are designed to provide a continuous range of focus, offering excellent unaided distance and intermediate vision, with reasonable near vision.5
Phakic Intraocular Lenses (PIOLs) are advanced vision correction devices implanted in the eye while preserving the natural lens. They are primarily used for patients with high refractive errors or those who are not suitable candidates for laser eye surgery. Given its success and the evolving landscape of refractive surgery, it is anticipated that the indications for PIOLs will broaden in the future, making them a more common option for a wider range of patients. PIOLs can be implanted in either the anterior chamber (between the cornea and iris) or the posterior chamber (behind the iris). The Visian ICL (STAAR Surgical), a popular posterior chamber PIOL, is particularly renowned for its excellent visual outcomes and safety profile.6
Safety and Patient Considerations
Refractive surgery has a high success rate, but it is crucial to consider patient-specific factors such as corneal thickness,
Mr Frank Kinsella
refractive error severity, and overall eye health. Preoperative evaluations, including corneal topography and wavefront analysis, are essential to determine the most suitable procedure for each patient.
Possible side effects of refractive surgery may include dry eye, glare, and halos. While most of these issues resolve over time, some patients may experience persistent symptoms. Serious complications, such as infection or ectasia (corneal weakening), are rare but can occur. It is important for patients to follow postoperative care instructions and attend all follow-up appointments to ensure optimal outcomes.
Future Directions
The field of refractive surgery continues to evolve with ongoing research and technological advancements. Future developments may include:
• Artificial Intelligence (AI) and Machine Learning: AI algorithms can enhance preoperative evaluations and improve patient selection, leading to better surgical outcomes.
• Stromal Lenticule Implantation: Lenticules removed during SMILE procedures can potentially be used to treat hyperopia or presbyopia, offering a novel approach to corneal reshaping.
Conclusion
Although refractive surgery, as discussed here, is an elective procedure, its impact on people’s lives is profound. For many, the decision to undergo refractive surgery goes beyond convenience, marking an important step toward greater independence and an enhanced quality of life. With modern, precise, and reliable techniques, refractive surgery is transformative, offering a newfound sense of freedom to individuals who have long been dependent on contact lenses or glasses.
References available on request
Mr Nakul Mandal
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Three Decades Strong: Théa Pharma’s Journey of Success and Growth
Théa Pharma is proudly celebrating 30 years in business, a significant milestone that speaks volumes about the company’s enduring commitment to excellence and innovation. Reaching three decades in operation is no small achievement, and it highlights the resilience, vision, and dedication that have driven Théa Pharma’s success.
This anniversary not only reflects the trust and loyalty of the customers and partners they have served but also underscores the impact they’ve had on the pharmaceutical industry. In a constantly evolving field, lasting 30 years truly signifies a business that has consistently adapted, grown, and made a meaningful difference in the lives of countless individuals.
Irish Pharmacy News recently sat down with Country Manager, Mr Diarmuid Gavin to explore the key strengths that have consistently positioned the company as a leader in its market sector. During the conversation, we also delved into the challenges the company has faced in recent times and how they continue to overcome them.
In celebration of the company’s 30-year milestone, Diarmuid highlighted their decades of innovation and progress.
“Celebrating our 30th anniversary is a moment of immense pride for everyone at Théa Pharma,” he notes.
“This milestone marks not only three decades of innovation but also a unique journey that has opened new doors and transformed the landscape of eye care in Ireland. Over the years, we’ve introduced a wide range of 100% preservative-free products into pharmacy, from solutions for dry and tired eyes to advanced care for blepharitis, lid hygiene, nutrition, Glaucoma, antiinflammatory’s and anti-infective’s.
“We are also present in hospitals with our surgical range where we offer a pre cataract surgery mydriatic and post intracameral cefuroxime. The growth within the eye care category has been remarkable over the past few years with the dry eye segment growing significantly. Théa is a company with 150 years of history dedicated to eyecare.
Mr Diarmuid Gavin, Country Manager, Théa Pharma
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Future Growth
“As we grow our global business and enter new markets, we remain focused on innovation and the development and introduction of new technologies and continue to grow our portfolio of preservative free products.
“At the pharmacy we remain focused on ensuring the eye care category gets the recognition it deserves by being placed in a prominent position at front of shop and being allocated shelf space based on its profitability and unit sales compared to other categories.”
Théa continue to invest heavily on education for all their customers, ensuring a well-informed decision at point of care for Irish patients.
Diarmuid adds, “We aim to evolve in this era of artificial intelligence and be ready to pioneer with agility and entrepreneurship and best serve you in delivering care for your customers. Our challenge, as always, lies in staying ahead of the curve in a competitive and ever-evolving market. Yet, with the dedication of our passionate team in Ireland, we’ve seen tremendous growth and impact this year. Each challenge we face is met with resilience and the understanding that through collaboration, there is always an opportunity to thrive.”
So, how has Théa Pharma managed to position themselves as a leading brand within the industry?
Diarmuid believes their success is built on strong foundations.
“Our Irishness is at the heart of everything we dowe know the importance of community and work together with our partners to bring the best eye care solutions to those who need it most”
Blephaclean is our daily eyelid cleanser, clinically proven to reduce symptoms of blepharitis. Nutrof Total is an eye care supplement, providing a premium comprehensive formula specially developed to help maintain healthy eyes and vision by ensuring the correct nutritional intake.
“Our dedication to creating tailored solutions means that we have products to enhance quality of life by promoting healthier eyes at every stage of life. Our brands are more than products—they are paths to a clearer, healthier vision, and we are proud to offer such an extensive range to meet the needs of our Irish community.”
In a highly competitive market, brand recognition is crucial for success. Thea Pharma has not only achieved this but has firmly established itself as a leader in the eyecare industry. Through consistent innovation, exceptional product quality, and a deep understanding of customer needs, they’ve built a brand that stands out.
“Our success in Ireland is built on the foundation of a strong, unified team that believes in the power of making a difference in people’s lives,” he says.
“We’ve established Théa as a leader by staying true to our values: trust, integrity, and a relentless commitment to patient care. Ireland, with its close-knit communities and respect for expertise, has been the perfect environment for us to flourish. We’ve cultivated genuine relationships with healthcare professionals across the country, providing them not only with products but with ongoing education, support, and a shared commitment to the well-being of their patients.
“Our Irishness is at the heart of everything we do—we know the importance of community and work together with our partners to bring the best eye care solutions to those who need it most.”
Category Commitment
As a leading OTC eyecare business, Thea Pharma is fully committed to this category.
Diarmuid continues, “We are 100% committed and dedicated to eyecare, and this dedication allows us to focus fully on the eyecare category. The team at Théa are dedicated and exceptionally well trained professionals across our marketing, sales, logistics, training and regulatory departments who deliver customer care and educational training and events to
a very high standard, this sets us apart. Théa’s 100% preservativefree approach is more than just a product feature—it’s a philosophy.
“Théa invented the first multidose bottle capable of dispensing preservative-free eye drops, the ABAK®, so initiating a whole series of preservative-free packaging forms. Thanks to Théa, ophthalmology has entered the preservative-free era, allowing patients to benefit from a whole range of eye care treatments which respect their visual potential. We have a deep respect for the science behind eye care, but we never lose sight of the human element. In Ireland, we’ve built a reputation not just for quality products, but for care that goes beyond the bottle. Our team in Ireland works tirelessly to ensure that every pharmacist, healthcare provider, and customer feels supported, valued, and informed. This is the difference we bring—a connection that’s as personal as it is professional.”
The Théa Pharma portfolio reflects the extensive and specific eye care needs across Ireland.
Diarmuid explains, “We offer a range of products, from advanced dry eye solutions to innovative surgical solutions, all backed by years of research and a commitment to preservativefree care. Thealoz Duo is clinically proven to treat dry eye symptoms. It offers a special fixed combination of 2 active ingredients that protect, hydrate, lubricate, and repair the eyes.
Diarmuid continues, “Maintaining brand recognition requires more than just visibility—it requires trust. We’ve invested in not just marketing but in fostering genuine relationships with healthcare professionals and patients across Ireland. Our team has a deep understanding of the local market, and this allows us to communicate Théa’s values in a way that resonates with our audience.
“We believe in being part of the conversation about eye care in Ireland, whether through educational initiatives, partnerships with local bodies, or simply being there for our pharmacists and optometrists when they need us. At the end of the day, we maintain recognition by staying true to our mission: providing preservativefree, world-class eye care solutions while always putting people first.”
What’s on the Horizon?
“2024 has been another year of innovation with the introduction of Blephaderm: a 5 in 1, 100% preservative free, clinically proven, repairing, soothing and hydrating eyelid and eye contour cream for sensitive, dry, irritated and atopyprone skin.
“8 out of 10 adults suffering from dry eye or eyelid disorders also suffer from skin disorders in the eye area. Blephaderm has arrived at the perfect time to offer soothing relief for the skin around the eye.
“As for the future? Without giving away too many secrets, I can say that Théa Pharma has exciting things in the pipeline for Ireland.
We’ve always been at the forefront of innovation in eye care, and this year is no exception. We’re working on solutions that not only address existing conditions but are also designed to anticipate future needs as we continue to evolve in a digital world. Our team is incredibly excited to bring these products to the Irish market because we know they have the potential to make a real difference in people’s lives.”
The importance of companies, such as Théa Pharma working closely with pharmacists, educational and representative bodies cannot be underestimated and this not something lost on Diarmiud. Such partnerships enhance knowledge and awareness, improve patient outcomes and foster trust and credibility.
He adds, “Education has been our core and strongest pillar for over 30 years. At Théa Pharma Ireland, we place a huge emphasis on collaboration with educational bodies and representative organisations. Working closely with institutions such as the Association of Optometrists Ireland, the Irish College of Ophthalmology, the Association of Ophthalmic Nurses Ireland and many patient support groups allows us to stay aligned with the highest standards of care and ensure that both pharmacists and healthcare professionals are well-equipped with the latest knowledge and tools.
“We regularly engage in educational programs, workshops, and hands-on training sessions that not only elevate the level of care provided but also create a sense of unity and shared purpose. This commitment ultimately benefits our customers by ensuring that they receive informed, attentive care from professionals who truly understand and believe in our products.
“Education is the key; we invest heavily in continued professional development of all our customers. We have developed educational programs for counter staff, pharmacy technicians and the pharmacists. Understanding the importance of preservative free care is fundamental, we believe that Théa Pharma is not just contributing to the present state of eye care in Ireland but shaping its future. Théa is a pioneer and remains the world leader in preservative-free eye care products.
“By championing preservativefree solutions, we’re setting a new
standard of care that prioritises long-term eye health over shortterm convenience. Théa has a continuous innovation process and unique expertise, 100% dedicated to ophthalmology. We continue to invest in research and development to stay at the forefront of innovation and be a pioneer delivering a new generation of products. We are committed globally to the construction of strong sustainable partnerships, signing licensing agreements with researchers, universities and pharmaceutical or biotechnology companies.
“We also support inventors in their process of recovery and help to protect their research by helping with patents and know how transfer. This ensures we are always at the cutting edge of innovation allowing Théa to deliver innovative preservative free products. But above all, our Irish team is leading the charge in making eye care more accessible, more personal, and easier to understand. We’re creating a future where every individual has access to the best possible eye care, delivered by professionals who care about their well-being.”
Pharmacists are at the frontline of healthcare and at Théa Pharma, Diarmuid and his team aim to provide the necessary education for pharmacy staff on the eye conditions that present in front of them daily.
“Preservative-free products are key in eyecare today, and we offer an extended and detailed interactive training regimen based on the 4 steps of eye care (Warm – Cleanse – Hydrate – Nourish) as well as providing a pioneering and innovative merchandising approach that demonstrates the importance of eye care category in the Irish Pharmacy, an approach that guarantees higher ROI as well as helping educate the consumers on the importance of eye health.
“We have designed a detailed Margin Calculator file that showcase the value for money offerings of each of our products ensuring Pharmacists high margins and profitability. We ensure that they have everything they need to confidently recommend our solutions, knowing that they are offering the best possible care to their customers. Whether through one-on-one consultations, group workshops, or ongoing
Théa has a continuous innovation process and a unique expertise, 100% dedicated to ophthalmology
professional development, we are committed to empowering pharmacists to deliver excellence every day. “We are encouraging pharmacists to release the potential of the eyecare category by ensuring it's placed in a prominent position at front of shop where customers can self-select or can be advised by a staff member.
“As our population grows and lives longer, now more than ever we need to provide preservative free high-quality products with education to ensure Irish people are well informed in the knowledge that they are doing their best for their long-term eye health.
“Let’s open our eyes.”
Mr
Diarmuid
Gavin,
Country Manager, Théa Pharma
News
World Sight Day 2024
World Sight Day 2024 is officially launched! The campaign is an opportunity for individuals and organisations worldwide to unite in support of eye health for all.
“The World Sight Day campaign has always been about building awareness of the importance of eye health. With the 2024 campaign, we are focusing our efforts on ensuring parents and carers understand the role eye care plays in a child’s development, learning attainment and social interactions. We also hope that through the support of our Love Your Eyes Global Partners and membership network we can inspire millions of young people everywhere to take care
of their eyes,” said Peter Holland, IAPB CEO.
To further build engagement and awareness, a mascot has been introduced to the campaign called Artie. Artie, as the face of the World Sight Day campaign, is the physical representation of the Love Your Eyes heart and brings a fun, youthful element to the campaign. In addition to Artie, a suite of eye health activities pages and learning materials designed for children of all ages are available.
Simon Darvill, Director of Communications, Campaigns and Events for IAPB said, “We introduced Artie and The Glasses of the Future Competition as fun ways to inspire children to look away from the screen and learn healthy habits that will protect their eyes for a long time. Our hope is that everyone with an interest in helping children see will adopt Artie in a way that supports their awareness and campaigning efforts. We would also love for businesses to invite the children
that come through their waiting rooms to enter the competition and create some cool glasses.”
People are reminded that as an important part of the Love Your Eyes campaign, World Sight Day is not a single day of observation but a series of opportunities for awareness from July and running through to 10 October. This extended campaign allows participants, in the eye health sector and beyond, to maximize engagement and promotion that best suit their organisation.
Date for the Diary - Pan Ireland Ophthalmic Conference 2024
Queen’s University Belfast is hosting two special events in October to celebrate World Sight Day 2024.
World Sight Day (Thursday, Oct 10th) and Pan-Ireland Ophthalmology Day (Friday, Oct 11th) is an annually run event, hosted by Queen’s University Belfast which aims to focus attention on the global issue of avoidable blindness and visual impairment.
Venue: Assembly Buildings, 2-10 Fisherwick Place, Belfast BT1 6DW THURSDAY 10TH OCTOBER 2024: WORLD SIGHT DAY CONFERENCE
Time: 9.30am - 4.00pm
World Sight Day is the most important advocacy and communications event on the eye health calendar. It is a great time to engage with the world at large and highlight the importance of eye-health around the world. Queens University Belfast has organised a special programme to mark this important annual milestone.
On Thursday 10th October 2024, an international line-up of speakers will share their insights, thoughts and expertise to celebrate this key event.
For more information on the event and details of the programme please contact sara.shields@qub.ac.uk
ScopeMovesforMore Campaign
As part of its ongoing commitment to raising awareness and supporting charities, Scope has launched its four-month-long #ScopeMovesforMore campaign. This initiative aims to encourage Scope employees to get moving in a variety of activities while raising funds for their Charities of Choice, including Vision Ireland, the Royal Society for Blind Children (RSBC) and Perkins School for the Blind.”
The campaign kicked off with a 7 km hike up Croagh Patrick in County Mayo, where a group of 14 Scopers took on the scenic yet challenging ascent. Led by Nature Therapy Ireland, this event raised over £4,300 in support of Vision Ireland, which provides vital services to children and adults with vision impairments across Ireland.
The second major event took place on 7th September, when eight Scopers completed the “10K Along the Thames” to raise further awareness and support for RSBC. The team followed a picturesque route through London’s iconic riverside landmarks, finishing their walk with a tour of RSBC’s Life Without Limits Centre.
To date, the #ScopeMovesforMore campaign has raised over £6,000, which will help fund critical services for children and families
living with sight loss. These donations will make a significant impact, empowering individuals to navigate life with greater independence and confidence. Scope’s employees are energised by the campaign and will continue to take on more challenges in the coming months, involving friends and family with the goal of raising even more for these worthy causes.
AUTHOR: Theresa Lowry Lehnen, RGN, PG. Dip. Coronary Care, RNP, BSc, MSc, PG. Dip. Ed (QTS), M. Ed, PhD
Clinical Nurse Specialist and Associate Lecturer South East Technological University
Management of Cough in Pharmacy CPD
60 Second Summary
For most people, coughs are selflimiting, however, some coughs can be ominous and indicate serious underlying disease. As there are no objective tools to measure or clinically quantify a cough, evaluation is initially a subjective and highly variable assessment.
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.
Through careful questioning and the identification of red flags and danger symptoms, the pharmacist can determine whether the patient needs to be referred to the GP or seek urgent medical attention.
Pharmacological management of coughs and upper respiratory tract infections in the community pharmacy consists primarily of symptomatic relief for the presenting symptoms. Choice of product should be based on patient preference, presenting symptoms, and clinical considerations such as contraindications and potential drug–drug interactions.
Over the counter cough and cold medicines can be considered for children aged 6-12 years, after the basic principles of best care have been tried, but treatment should be restricted to 5 days or less. Children should not be given more than one brand of cough or cold preparation at a time because different brands may contain the same active ingredients.
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
A cough is an innate reflex, and important defence mechanism of the lungs that acts as part of the body’s immune system to protect against the entry of foreign materials. Coughing helps expel inhaled particles, irritants, fluids, or microorganisms, and helps clear secretions from the lungs. 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.1, 2 For most people, coughs are selflimiting, however, some coughs can be ominous and indicate serious underlying disease. As there are no objective tools to measure or clinically quantify a cough, evaluation is initially a subjective and highly variable assessment. Given the vagueness of cough as a presenting symptom, along with the risk of insidious underlying aetiologies and lack of objective tools, a cough should be evaluated and treated as an important clinical symptom, until a benign source is confirmed. Globally, cough affects approximately 10% of the adult
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 HPN. Copies can be downloaded from www.irishpharmacytraining.ie
Disclaimer: All material published is copyright, no part of this can be used in any other publication without permission of the publishers and author.
broncho has no editorial oversight of the CPD programmes included in these modules
population, and is associated with impaired quality of life. Three Coughs are classified as acute, subacute or chronic. A cough is considered ‘acute’ if it is present for less than 3 weeks. A ‘subacute’cough, is one lasting 3 to 8 weeks, most often due to a recent respiratory infection. A cough of greater than 8 week duration is considered a ‘chronic’ cough.1. 2
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 (haemoptysis).2 There are many causes of cough, and most
have a high temperature, and do not feel well enough to do their normal activities.7 There is no valid evidence for or against the effectiveness of OTC medicines in acute cough. 8
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. Infections of the lower airways, including acute viral bronchitis, pertussis, and tuberculosis, are also potential causes of acute cough. Acute bronchitis is typically viral in aetiology, but bacterial infection is the source in approximately 10% of cases. Antibiotics are not usually prescribed for coughs, and
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42 CPD: Cough
embolism. An acute cough is also a main symptom of SARS-CoV-2 (Covid-19) infection, and this must always be considered when a patient presents with a cough, and investigated and treated appropriately.1, 4, 5
A class of blood pressure medication called ACE inhibitors can cause a persistent dry cough in some people. Examples include ramipril, perindopril, and Lisinopril. Approximately 10-15% of people who use this class of blood pressure medication experience a dry cough, and the incidence appears to be higher in women.9 If the cough is due to the patient taking angiotensin-converting enzyme inhibitor medication, this medicine should be discontinued by the GP, and an aldosteronereceptor blocking medicine started in its place.1 The 3 most common causes of chronic cough in nonsmokers who are not taking an ACE inhibitor are asthma, acid reflux, and postnasal drip.5
Through careful questioning and the identification of red flags and danger symptoms, the pharmacist can determine whether the patient needs to be referred to the GP or seek urgent medical attention. Individuals presenting to a pharmacy with a cough should be referred to the GP if they;
Are finding it difficult to breathe
Are short of breath or have a wheeze
Are coughing up blood (Haemoptysis)
Have a hacking cough or cannot stop coughing and it is getting worse
Have a recurrent nocturnal cough
Have hoarseness lasting more than 3 weeks
Have a weak immune system
Have chest pain
Have pain on inspiration
Have asthma or a chronic lung condition
Have a persistent cough for more than three weeks
Have green, yellow or rusty coloured phlegm
Have systemic symptoms e.g. fever, night sweats, unexplained weight loss
Have a suspected adverse drug reaction
Have excessive sputum production
Experience recurrent chest infections
Experience difficulty swallowing when eating or drinking
Have symptoms suggestive of whooping cough
Experience a change in the nature of a smoker’s cough2, 7, 8
Considerations and questions to ask the patient presenting to the pharmacy with a cough
Age of patient-child, adult or an elderly person?
APPEARANCE/CHARACTERISTIC OF SPUTUM
Rust-coloured sputum
Blood-stained sputum or haemoptysis
Pink, frothy sputum
Yellow or green sputum suggests infection
Onset (acute or gradual) and duration of cough
Describe the cough e.g. productive, dry, barking, tickly
Travel history e.g. recent travel to a TB prevalent area or a recent long-haul flight
Are there any other symptoms associated with the cough e.g. fever, runny/blocked nose, sneezing and/or sore throat indicates cold or flu
Are there any red flags/danger symptoms that require a referral to the GP or seek urgent medical attention
Smoking history including those who have recently quit smoking
Substance misuse—does the patient display any warning signs of substance misuse or addiction
Drug history e.g. ACE inhibitors, check for potential drug interactions
Nocturnal cough e.g. asthma
Occupational history—is the cough due to the patient’s occupation or an environmental factor?
Past medical history/comorbidities—is the cough due to an exacerbation of a pre-existing condition e.g. asthma or COPD
Colour of sputum
POSSIBLE CAUSES
Pneumococcal (lobar) pneumonia
Lung cancer, tuberculosis, pulmonary embolism
Pulmonary oedema
Bronchiectasis (foul-smelling sputum), pneumonia
Types of presenting cough and OTC pharmacy treatments.
Pharmacological management of coughs and upper respiratory tract infections in the community pharmacy consists primarily of symptomatic relief for the presenting symptoms. Choice of product should be based on patient preference, presenting symptoms, and clinical considerations such as contraindications and potential drug–drug interactions. Healthy adults usually do not experience side effects from OTC cough medicines, however, some OTC cough medicines can cause irritability, sleepiness, or dizziness. Side effects may be a concern for people who have health problems, older people, or those who use cough medicines for long periods of time.5
A cough can be described as either productive (chesty), where sputum is produced, or nonproductive (dry, tickly or irritating), where no sputum is produced.8 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.11 During a cold, a cough is often caused by a nasal drip irritating the back of the throat. Steam inhalations can be a useful home-treatment, particularly in productive (chesty) coughs. Hot drinks such as lemon and honey can also provide a soothing effect. Sugar-free versions of cough mixtures are also available for diabetics.9
In 2011, HPRA restricted the sale of certain cough and cold remedies in Ireland for children under six years of age. Coughs and colds in children are frequent and usually self-limiting, and there is no clear evidence to support the use of these products in children under six.9 Children under
Table 2: Characteristics of sputum and possible associated causes11
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. It is important to check with the pharmacist which cough remedies are suitable for children under 6 years of age, and if there are any contraindications or possible interactions to its use for each individual child.9
The best advice for coughs in the under sixes, is to rest and drink plenty of fluids. If the child is over 1 year of age, a warm drink of lemon and honey may be useful. However, honey should not be given to a child under 1 years of age. Most coughs and colds in children under six resolve quickly, however, if the cough is not improving, or there are signs of a bacterial infection, it is advisable to be seen by the GP as an antibiotic may be needed. Over 80% of coughs and colds however, are viral in nature, and antibiotics do not treat viral infections.9
OTC Cough Treatments8
respiratory depression or mask signs and symptoms of asthma flare-ups. Narcotic cough suppressants may be subject to abuse and misuse and this must be considered when supplying. In order to combat abuse and misuse, some formulations contain laxatives such as sorbitol to discourage consumption of supratherapeutic doses.5
expectorants are sometimes sold in combination products to provide a synergistic effect in aiding cough management. Similar to antitussives, quality evidence for the clinical efficacy of expectorants and mucolytics is limited.5
Cough Suppressants (Antitussives)8
Productive coughs present as a cough where mucus is expectorated when coughing. Medication licensed for the management of productive coughs fall into two categories:
Indicated for the symptomatic relief of non-productive (dry, tickly or irritating) coughs e.g. codeine, pholcodine, dextromethorphan
Over the counter cough and cold medicines can be considered for children aged 6-12 years, after the basic principles of best care have been tried, but treatment should be restricted to 5 days or less. Children should not be given more than one brand of cough or cold preparation at a time because different brands may contain the same active ingredients. Care should always be taken to give the correct dose.10 Steam inhalations, used safely under adult guidance can help loosen nasal and chest congestion and make it easier for a child to expel built-up mucus. A humidifier can be used to keep the air moist and clear, and products such as vapour rub or balms containing essential oils such as eucalyptus can also help loosen nasal and chest congestion.11
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. There is limited quality evidence for the benefit of these agents, however, consumer demand can be high. Caution should be taken with preparations that may cause drowsiness such as codeine and dihydrocodeine. Dextromethorphan has been implicated in serotonin toxicity and should not be given to patients taking other drugs known to contribute to serotonin toxicity. Patients presenting with a non-productive cough who are known to have asthma should not be given cough suppressants as these may contribute to
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HIRES.pdf
Codeine can cause sedation and constipation
Patients should be advised of the possibility of sedation occurring with pholcodine or dextromethorphan
Cough suppressants should be used with caution in asthmatics
Codeine-containing OTC liquid medicines should not be used for cough suppression in children and young people less than age 18 years of age
OTC cough and cold medicines containing dextromethorphan and pholcodine should not be used in children under 6 years of age
Pholcodeine is contraindicated in bronchiectasis- bronchiolitis in children; chronic bronchitisCOPD in adults; and in patients at risk of respiratory failure10
Expectorants8
Indicated for the symptomatic relief of productive coughs
e.g. guaifenesin, ammonium chloride, ipecacuanha, squill
There is little evidence on the effectiveness of expectorants. More likely they serve as a placebo effect, however, some report them as being useful in alleviating cough symptoms
Guaifenesin has no known clinically significant drug interactions
OTC cough and cold medicines containing guaifenesin and ipecacuanha should not be used in children under 6 years of age
Antihistamines 8
Antihistamines used in cough and cold preparations include first-generation antihistamines such as diphenhydramine, promethazine and triprolidine
Antihistamines dry up the nasal and bronchial secretions and are indicated for the relief of cough and/or nasal symptoms e.g. rhinorrhoea, and sneezing
Antihistamines can cause anticholinergic adverse effects such as dry mouth, constipation,
blurred vision, urinary retention, exacerbation and precipitation of acute angle-closure glaucoma and should not be recommended in patients with glaucoma or prostate enlargement
Antihistamines cause sedation and may be suitable to recommend where the cough is disturbing sleep
OTC cold/cough preparations containing brompheniramine, chlorpheniramine, diphenhydramine, doxylamine, promethazine, and triprolidine should not be used in children under 6 years of age
Demulcents8
Demulcents relieve irritation of the mucous membranes by forming a protective film. Demulcents such as simple syrup or honey are non-medicated alternative for cough syrups. These ingredients are included in many cough syrups and may increase salivation and the secretion of pulmonary mucus. These are safe to use in children and other populations where medicated syrups or lozenges are contraindicated.5
Demulcent cough preparations coat and soothe the back of the throat and they contain soothing ingredients such as glycerol, syrup and/or honey.
Examples include paediatric simple linctus, simple linctus, glycerine, lemon and honey linctus
Indicated for the symptomatic relief of cough
They are pharmacological inert, and used mainly for their placebo effect
Demulcent cough preparations are inexpensive, and are safe to recommend for the elderly, children and pregnant women
Traditional Herbal Remedies (THRs)
Herbal medicines are popular in the treatment of minor medical conditions, including coughs. Herbal medicinal products on the Irish market must be either
authorised or registered with the HPRA. Effective regulation of herbal medicines is considered necessary in order to ensure that safe products of appropriate quality continue to be available in pharmacies and other outlets. If an herbal medicinal product does not meet the criteria for registration as a traditional herbal medicinal product (THMP), it can still be granted a marketing authorisation (MA) in the same way as nonherbal medicines.11
Herbal medicines are those with active ingredients made from plant extracts such as leaves, roots and flowers. Like conventional medicines, herbal medicines have an effect on the body, and can be potentially harmful if not used correctly. While traditional herbal remedies are safe to use for most people, some herbal medicines may not be suitable for certain individuals including; those taking other medicines; people with serious health conditions, such as kidney or liver disease; people who are undergoing surgery; pregnant or breastfeeding women; some older people and children.12
There are a wide variety of herbal remedies available for coughs in pharmacies. Consumers should check for a traditional herbal registration (THR) marking on the product packaging, which means the medicine complies with quality standards relating to safety and manufacturing, and provides information about how and when to use it. It is always important to check with the pharmacist if traditional herbal remedy products for coughs or other illnesses are suitable, and if there are any contraindications or possible interactions with its use for the individual person.12
Consumers should also be made aware that THR products are intended for conditions that can be self-medicated and which do
Other Important OTC Cough Treatment Considerations8
Cough/cold preparations containing sodium: Check sodium content and assess whether the cough/cold preparation is suitable for the patient e.g. low sodium diet, renal impairment, cardiovascular disease
Cough/cold preparations containing alcohol: Check alcohol content and assess whether the cough/cold preparation is suitable for the patient. Is there a history of alcohol abuse? Is the patient taking an existing medicine that may interact with the alcohol present in the cough/cold preparation? Who is it for, e.g. child, pregnant or breastfeeding woman?
Recommend a sugar-free cough/cold preparation over one containing sugar in children or people with diabetes
Do not recommend a cough/ cold preparation containing illogical combinations such as an antitussive and expectorant
Check that the cough/cold preparation is age-appropriate Medical Devices for Coughs
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. Steam mist humidifiers release soothing vapour into the air to help provide temporary relief from cough and congestion. The warm mist helps reduce respiratory discomfort by increasing humidity levels to
Offering Outstanding Patient Support
The Irish Pharmacy Awards
Awards
In what was an extremely hotly contested Category, Jenny Percival from Ryan’s Pharmacy in Derrinturn won the Athlone Pharmaceuticals Counter Assistant of the Year Award 2024.
Jenny has had a huge impact on her pharmacy team and the community. It is very clear to everyone in her community that Jenny goes above and beyond time and time again on a daily basis. Nothing is too much of an ask or too far beyond Jenny’s reach.
Says a colleague, “To many customers, Jenny is a counsellor, a friend to listen, a source of valuable healthcare information, a “free” courier service, an out of hours point of contact, always someone to have a joke and a laugh with to brighten your day, a personal shopper, a trusted salesperson, a forward planner/ budgeter (ringing customers to tell
them something they might like has come in, noticing them that a sale is about to happen), a first aider, the main point of contact even for their dispensary related queries, a mother figure.”
All of the above is exceptionally noble and also assists the business and Jenny does it with such delicacy and care and a little smile on her face.
Counter assistants play a vital role in helping patients manage their medications effectively, particularly in community pharmacy settings. Their contributions are crucial for several reasons including acting as the first point of contact. As the first people patients often
interact with in a pharmacy, Jenny’s communication with her customers is essential in providing initial guidance.
She has also been trained to explain the proper use of medications, including dosage, potential side effects, and interactions. By ensuring patients have this foundational knowledge, they help prevent misuse and improve adherence to treatment.
More recently, Jenny was instrumental in organising a prescription collection service from the local GP surgery and has grown and maintained it to this day; many customers rely on this as their way of organising their medicines. Especially the elderly.
She has taken the time to ensure any language barriers are easily remedied to make sure customers know exactly what they are to take and when. She has been credited for coming into work during the beast from the east to keep the pharmacy service going, attends work hail, rain, storm or snow, an unmatched attendance record, And visiting a customer who had a stroke in a nursing home on a weekly basis in her own time. Her colleagues told us, “In her role of OTC assistant, Jenny's
Barry Doyle, Head of Athlone Pharmaceuticals with Jenny Percival
“It is neither Jenny's knowledge or work ethic that makes her the linchpin of Ryan's Pharmacy, but her good nature, cheery disposition, and most importantly, her sense of community”
knowledge of every inch of the shop, and every item therein, is astounding, she knows a treatment for every ailment and where it can be found. She can make obscure probiotics appear at a mere mention, and can source them if they aren't there.
“She has a wonderful instinct of when to refer, either to the pharmacist or the doctors, and can generally distinguish between minor illness and major disease effortlessly. She knows when all that is needed is bed rest and a electrolyte, and when a trip to the doctor is in order.
“Alongside manning the counter, Jenny finds time to answer the phone, hoover, organise her OTC colleagues, wash floors, and cart boxes up and down the stairs, as well as ordering and sourcing items for customers, calling them, and answering emails. On top of this she works constantly to beautify the shop. Working with the group's buyers and merchandising managers, Jenny seems to pull ideas for displays from thin air, whether for Easter, Valentines Day, or the recent Mother and Baby Event, to name just a few from the past three months.
“Jenny's capacity for work is nearly boundless, and she is first in every morning to open up.
“However, it is neither Jenny's knowledge or work ethic that makes her the linchpin of Ryan's Pharmacy, but her good nature, cheery disposition, and most importantly, her sense of community. A native of Derrinturn, Jenny is known to, and knows, nearly every single customer on a personal level, and always has time for chats about personal life, family, or local goings-on, whether with a crotchety octogenarian, or the first-time mother, and is as happy dispensing well-timed witty remarks as she is medical or personal advice. She has a wonderful way with children, to the point where many of the village's toddlers will come right up to her in the shop to engage her by name in conversation.
“She is unstinting with her time and effort and will go far beyond what is expected of her, to chase up prescriptions, drop medication into elderly patients after work, and up to, and including saving cardboard boxes for people when they request them. Patients recognise this generosity, compassion, and knowledge, and most look for Jenny when calling by phone or dropping into the shop. In fact, many customers trust her more than any of the pharmacists!”
Jenny told us after receiving her Award, “I am so humbled but also
Walking up: Jenny Percival, winner of the 2024 Athlone Pharmaceuticals Counter Assistant of the Year Award
delighted to receive this Award, which I have to say is also a reflection of my entire team and how well we work together.
“The recognition these Awards brings to the profession is unrivalled. I would say to anyone who is thinking of entering – just go for it. Our whole community got behind us, we were inundated with good wishes and messages, the entire process has been exciting and so uplifting for all of us.”
Barry Doyle, Head of Athlone Pharmaceuticals added, “At Athlone Pharmaceuticals, we are very proud to sponsor the ‘Counter Assistant of the Year’ Award. It is never an easy task to shortlist from a cohort which demonstrate such high standards of professionalism and caring on a daily basis. It is important to support and acknowledge the people at the front line of healthcare, who are there to offer help and advice to the public when they need it.
“All of the Finalists here tonight are so deserving of this recognition and we know what this means to them. This is our first time sponsoring with the Irish Pharmacy Awards and we hope it will be the first of many.”
Awards
Emily Ashmore is the Ashbourne Winner
The Irish Pharmacy
Awards 2024
Emily Ashmore of Adrian Dunne Pharmacy in Ashbourne won the Alliance Community Pharmacy Technician of the Year Award for 2024.
Emily is currently working as part of a busy and dynamic Dispensary team. She is a vital part of the pharmacy team and has recently taken up a more senior role.
She is eager to learn and is a keen student. Emily is at the end of her IPU Technician course and has excelled in every part of it. She is self-motivated and it is evident she enjoys learning about all aspects of a Pharmacy Technician’s role.
Her journey from a part-time employee to a lead technician underscores not just her commitment to her role but also her exceptional ability to grow, adapt, learn, and excel in the fast-paced environment of community pharmacy.
She is forward thinking, dynamic and innovative. Her exceptional IT skills have directly contributed to the innovation and improvements in efficiency within the pharmacy.
Established in 2003, Adrian Dunne Pharmacy Ashbourne is a relatively new pharmacy, still growing and thriving situated in the second largest town in Meath. Emily’s role in this pharmacy is so important. She creates a calm environment, is keen to implement new, more efficient systems and is a point of contact for any new technician or indeed Pharmacist who comes to work in the store.
Emily began working in Ashbourne in December 2015 as a young second-level student as part of her work-experience programme.
She proved to be a quick learner and a trusted member of staff. She was then offered a permanent part-time role. She began her time as part of our vital weekend team, progressing to running our busy Photo Laboratory. Emily showed such promise she then trained as a Heath Care Advisor. She showed a keen interest in learning about medicines and helping customers treat many common ailments. Once she had served her time on the medicines counter, Emily expressed an interest in working in the Dispensary. We did not hesitate to offer Emily a position and in 2019 she became part of the team. This is when Emily’s true abilities shone through. She has flourished since she made the transition. She has obtained distinctions in almost
all her IPU modules and continues to learn on the job every day showing interest and eagerness in her role.
One of her colleagues and nominee told us, “Emily is an important liaison for our multidisciplinary healthcare teams. Not many realise how important a strong and dependable pharmacy technician is. Emily fulfills this role to the max! She
Emily Ashmore pictured with Natalie Maginnis, Managing Director, IPN Communications
“Emily is an important liaison for our multidisciplinary healthcare teams. Not many realise how important a strong and dependable pharmacy technician is. Emily fulfils
this role to the max” and the most vulnerable of our community receive the best possible level of care.”
Affectionately known by her peers as the ‘IT Queen’ - She is very competent at resolving IT issues, integrating new IT systems and liasing with vendors.
liaises with doctors, nurses, wholesalers & nursing home staff, on a daily basis.
“The expertise required to deal with constant medicine shortages, specialised Nursing homes orders and prescription queries, has been mastered by Emily. Her ability to gain their trust is commendable. We can see how valuable she is as they ask for Emily again and again. She is also an important confidant to many of our treasured patients. Two special customers come to mind. These two young girls have very particular needs and challenges. Emily has a very special bond with them, and she is their first port of call. She organises their specially tailored meds, goes out to chat & catch up and most importantly supports them on their journey.
“Managing this responsibility requires not just a deep understanding of patient care but also a high degree of empathy, communication, and coordination skills. Emily has excelled in this capacity ensuring the elderly
Her nominator explains, “Her competence in this area became very evident during our challenging Covid-19 years. Healthmail was rolled out overnight into Pharmacies which proved challenging. This is when Emily’s knowledge and abilities came to the fore. She designed a system to deal with the influx of emailed prescriptions. She adapted the system weekly/monthly as needed.
More recently we have rolled-out a new queuing system.
“Once again Emily’s IT skills have directly contributed to the innovation and increased the efficiency of the system. This innovation has not only reduced waiting times but also created a more organised system for dispensing medications. This demonstrates Emily’s direct impact on improving patient care and satisfaction.”
Emily’s contribution and commitment to the pharmacy’s vaccination programme is outstanding. At one stage during 2021 the team had daily vaccination
clinics, vaccinating over 85 patients daily while continuing to operate a busy Dispensary.
“Emily’s support during these clinics was vital. She helped set up the online booking system, ensured patients were recorded on the HSE suite and ensured the service was seamless. Liasing with locum vaccinating pharmacist and training staff on both systems was invaluable. This was recognised in 2022 when we won the Training and Education award at the Meath Business & Tourism awards,” said a colleague.
At 24 years of age, Emily’s 9-year commitment to the Adrian Dunne Pharmacy group is impressive. Having started her career in pharmacy so young she has made a significant impact. Her hard work and commitment is acknowledged by her peers, colleagues and the wider pharmacy family. So much so, she was put forward for the Pharmacy technician course at a very young age. What she lacked in experience she made up for in her ability, determination, and commitment. Coming to the end of her course in which she has excelled, Emily is already leading a large Dispensary team that is innovative and highly motivated. Emily is key to its success helping the store significantly in 2022 when it went through a full pharmacy refit. This was challenging as the
pharmacy remained open during this time. Although the 3-week turnaround proved difficult, Emily’s support and composure ensured there was minimal disruption to customer service. We now enjoy a state-of-the-art pharmacy.
Emily said after accepting her Award, “This Award means everything to me. And I know what it is also going to mean to my team who are always behind me and we work so well together. Every day we show up, happy to be there and ready to get stuck in and so for me, this Award is all of that work for the entire team rewarded.
“I think many people perhaps don’t still understand the amount of work that goes on behind the scenes every day in their local pharmacy and it’s about much more than just dispensing your medication or offering OTC products. Of course it is so much more than that, it’s about looking after the individual and looking after people who have specific needs and making sure that they are happy when leaving the pharmacy.”
Emily Ashmore, winner of the Alliance Community Pharmacy Technician of the Year Award with MC Marty Whelan
Women’s Health - Maternal Medicine
Maternal Medicine; Where Teamwork Makes the Dream Work
Written by Dr. Siobhán Corcoran, Consultant Obstetrician & Gynaecologist, The National Maternity Hospital
We are all familiar with older generations saying “It wasn’t like that in my day!”. Indeed, when it comes to Obstetrics, never a truer word was said.
Women are now embarking on childbearing later in life due to a variety of socio-economic factors. The Irish CSO figures show that the average age at first childbirth in 1980 was 24.9 years. In 2018, this had risen to 31.1 years. The National Maternity Hospital’s Annual Report in 2022 demonstrated that 11.6% of all births in that year were to women aged over 40. Older mothers are more likely to have comorbidities than younger counterparts. Added to this, developments in medical and surgical therapies over the last 20-30 years have meant that more women with complex
medical and surgical conditions in early life are now surviving & reaching childbearing years. All of these facts, coupled with a frameshift in societal expectation of what is now possible, has led to the development of Maternal Medicine as a distinct subspecialty of Obstetrics.
There are two key questions which the Maternal Medicine team must consider when meeting a woman with a complex medical condition who is now pregnant. How does the disease affect the pregnancy? And how does the pregnancy affect the disease? For example, the woman with epilepsy will have an increased risk of seizures in pregnancy due to the physiological plasma expansion and lowered serum levels of antiepileptic drugs that occurs in pregnancy
The Maternal Medicine Team at The National Maternity Hospital. Left to Right: Professor Mary Higgins, Consultant Obstetrician & Gynaecologist; Dr. Siobhán Corcoran, Consultant Obstetrician & Gynaecologist; Maternal Medicine Pharmacist, Benedetta Soldati; SpR Dr. Rachel O’Keefe; Maternal Medicine Midwives, Ms Shauna O’Callaghan, and Ms Celine O’Brien
health care professionals working together on any given pregnancy. Obstetricians, Specialist Midwives and Advanced Nurse Practitioners, Maternal Medicine Pharmacists, Anaesthetics, Renal, Haematology, GI, Endocrinology and Neurology physicians among many others will frequent input to the care of any one women.
and also the effects of pregnancy hormones on lowering the seizure threshold. Nausea and vomiting in pregnancy can affect medication compliance and sleep deprivation in late pregnancy can be a trigger for seizure activity also. Medication safety will be of critical importance to these women. Understanding the risk/benefit profile of the various anti-epileptic drugs will help get the best outcome for mother and baby. A second example of this could be a woman with active Lupus and hypertension. She will have a significant risk of pre-eclampsia, fetal growth restriction and iatrogenic preterm delivery due to her disease and so a care plan will need to be devised to mitigate against and offer surveillance for this. In turn, should she develop severe pre-eclampsia this may cause her renal function to deteriorate in the long term also and so the pregnancy may impact on her disease trajectory. Medication safety and optimisation will be a critical focus of the team here too.
Maternal Medicine is a team sport! Owing to the highly complex nature of the care provided at the Maternal Medicine Clinic, it is necessary to have a wide range of
So, what makes a Maternal Medicine team effective? The most critical skill in Maternal Medicine is good communication. Pregnancy is dynamic and deteriorations or changes in a patient’s status can happen quickly. Added to this, the unpredictability of obstetrics means that timely and effective communication between members is essential. The MultiDisciplinary Team (MDT) meeting is the linchpin of the service where members are updated weekly and careplans are made. Shared decision making with the patient is an important part of any effective service and of course the Maternal Medicine team has a critical role in clinical teaching and improving the care of women with complex medical needs. Flexibility in delivery planning means that the Maternal Medicine team will often have developed 2 or 3 different delivery plans with one woman to account for the unpredictability of childbirth.
Increasingly, Preconceptual Counselling has come to the fore in recent years as an opportunity and a challenge in Maternal Medicine. Pregnancy outcomes in many conditions are improved following preconceptual planning. Medications can be optimised, potential risks & complications can be explored and a pregnancy care plan can be devised. In very rare situations, pregnancy may not be advised due to serious risks to the health of the mother and alternatives can be explored.
Maternal Medicine as a subspecialty is both challenging and incredibly rewarding due to the variety and the complexity each day brings. Seeing a mother and her baby safely through pregnancy and supporting them through any complications means that no two days are the same. Working in a diverse and highly effective team with this shared goal is hugely fulfilling. The future is bright here.
An Overview of BRCA – BReast CAncer Gene
What is BRCA? BRCA stands for BReast CAncer gene. Everyone has BRCA1 and BRCA2 genes. They are important genes that stop the cells in our body from growing and dividing out of control. By doing this, the genes help to protect us from getting cancer. They are often referred to as tumour suppressor genes. Everyone has two copies of each of the BRCA1 and BRCA2 genes—one copy inherited from each parent.
Both men and women can inherit a fault in their BRCA1 or BRCA2 genes. A fault in the BRCA1 or BRCA2 gene means that the cells can grow out of control and this can lead to cancer developing.2 If you have one of the faulty BRCA genes, there is a 50% (1 in 2) chance you will pass this on to any children you have and a 50% (1 in 2) chance that each of your siblings also has it.9
• Most cancers are not linked to inherited faulty genes. Between 5 and 10 in every 100 cancers (5 to 10%) diagnosed are linked to an inherited faulty gene.2
• A fault in the BRCA1 or the BRCA2 gene can lead to an increased risk for female and male breast cancer, ovarian cancer (including fallopian tube and primary peritoneal cancers), and to a lesser extent other cancers such as prostate cancer, pancreatic cancer, and melanoma.10
most useful way of carrying out genetic testing is to start with someone who had a diagnosis of breast or ovarian cancer. This is called a diagnostic genetic test and involves a blood test.
If a BRCA1 or BRCA2 alteration is found in the family, it may be possible to offer genetic testing to other family members including those unaffected by cancer, to check if they share this gene alteration. This is called a predictive genetic test.8
You will need a GP referral for public or private genetic testing in Ireland.
Written by Bernie Carter, Assistant Director of Nursing, Marie Keating Foundation
• Risks for developing breast cancer with an alteration in the BRCA1 or BRCA2 gene:
What is the risk for breast and ovarian cancer with BRCA1 or BRCA2?
o On average, between 11 – 14% of females without a genetic alteration will develop breast cancer in their life time. This risk increases for females with a BRCA1 or BRCA2 fault. Most resent research shows that:
The risks of developing breast and ovarian cancer are markedly increased in people who inherit a fault in their BRCA1 or BRCA2.2
o 65 - 79% of females who have inherited a faulty BRCA1 gene and
o 61 - 77% of females who have inherited a faulty BRCA2 gene will develop breast cancer by the age of 80 (5)
People who have inherited a harmful change in BRCA1 or BRCA2 also tend to develop cancer at a younger age than people who do not have such a variant.2
• Risks for developing breast cancer with an alteration in the BRCA1 or BRCA2 gene:
o A large prospective cohort study of 6036 BRCA1 and 3820 BRCA2 female carriers (5046 unaffected and 4810 with breast or ovarian cancer or both at baseline) showed that breast cancer incidences increased rapidly in early adulthood until ages 30 to 40 years for BRCA1 and until ages 40 to 50 years for BRCA2 carriers
Genetic test for BRCA
If you are worried about a pattern of cancer in your family, talk to your GP. If your GP thinks that there may be an inherited cause for cancer, based on your family history, they will refer you to a genetics clinic. The clinic will do a detailed review of your family history to find your level of risk and whether you and or your close blood relatives should be referred for genetic testing. The
o A large prospective cohort study of 6036 BRCA1 and 3820 BRCA2 female carriers (5046 unaffected and 4810 with breast or ovarian cancer or both at baseline) showed that breast cancer incidences increased rapidly in early adulthood until ages 30 to 40 years for BRCA1 and until ages 40 to 50 years for BRCA2 carriers
taking medication to reduce their breast cancer risk and riskreducing surgery (sometimes referred to as prophylactic or preventive surgery).7
• Enhanced screening: Individuals who are confirmed as having a BRCA1 or BRCA2 gene alteration are typically offered breast screening from the age of 308
o This study showed that the cumulative risk for developing breast cancer in the opposite breast (contralateral breast cancer) 20 years after breast cancer diagnosis is 35%-45% for BRCA1 and 20%-33% for BRCA2 (5)
• Risks for developing ovarian cancer with an alteration in the BRCA1 or BRCA2 gene:
o On average, between 11 –14% of females without a genetic alteration will develop breast cancer in their life time. This risk increases for females with a BRCA1 or BRCA2 fault. Most resent research shows that:
o This study showed that the cumulative risk for developing breast cancer in the opposite breast (contralateral breast cancer) 20 years after breast cancer diagnosis is 35%-45% for BRCA1 and 20%-33% for BRCA25
o Most women will be offered regular mammograms (X-rays of the breast) and a breast examination by a specialist clinician.
o 65 - 79% of females who have inherited a faulty BRCA1 gene and
o On average, between 1-2% of females without a genetic alteration will develop ovarian cancer in their life time. This risk increases for females with a BRCA1 or BRCA2 fault. Most resent research shows that:
Managing your cancer risk with a BRCA1 or BRCA2 Alteration:
o 36 - 53% of females who have inherited a faulty BRCA1 gene and
o 11 - 25% of females who have inherited a faulty BRCA2 gene will develop ovarian cancer by the age of 80 (5)
o 61 - 77% of females who have inherited a faulty BRCA2 gene will develop breast cancer by the age of 805
Individuals who have inherited a harmful change in BRCA1 or BRCA2 have several options for reducing their risk of cancer. These include enhanced screening,
o Sometimes the clinician will include ultrasound scans, or Magnetic Resonance Imaging (MRI) of the breast because breast screening with mammogram alone is difficult in younger women who tend to have denser breast tissue. Dense breast tissue (nonfatty tissue) looks solid and white on a mammogram. You cannot see through it. This makes the mammogram more difficult to read12
o There is no known effective ovarian cancer screening methods. You may be offered an internal (transvaginal) ultrasound scan every year and a blood test called CA125. This is the only method available at present, but these procedures are not proven to be reliable in picking up early ovarian cancer.
Risk of Breast and Ovarian Cancer in female carriers with a BRCA1 or BRCA2 alteration (Kuchenbaecker 2017) (5)
54 Women’s Health - BRCA Gene
• Risk-reducing medications (sometimes called chemoprevention)
o Chemoprevention describes drugs that are used to reduce the risk of cancer developing. This is different from chemotherapy which describes drugs that are used in the treatment of cancer
o Two drugs have been recommended by the National Institute for Health and Care Excellence (NICE) – Tamoxifen and Raloxifene. Both these drugs have antioestrogen properties
o Women with a BRCA2 gene alteration who are considering chemoprevention should have a discussion with their doctor regarding the potential benefits and side effects. Chemoprevention is not recommended for women with a BRCA1 gene alteration because most women with a BRCA1 gene alteration develop a breast tumour that is not oestrogen sensitive, and there is no evidence that Tamoxifen or Raloxifene would reduce their risk of breast cancer11
Risk-reducing surgeries (sometimes referred to as prophylactic or preventive surgery
• Risk-reducing, or prophylactic, surgery involves removing as much of the “at-risk” tissue— that is, the tissue where cancer may develop—as possible11
Managing your risk of breast cancer:
• Women may choose to have both breasts removed (bilateral risk-reducing mastectomy) to reduce their risk of breast cancer3
• Women who have risk-reducing mastectomies reduce their risk of developing breast cancer to less than 5% over their lifetime, which is less than the risk in the general population11
• Breast Reconstruction or Not: Breast reconstruction is surgery to make a new breast after removal of the breast, part of the breast or both breast (double mastectomy)
• The aim is to make a breast of similar size and shape to your original breast but they won't be identical
Women’s Health News
• It is a personal choice to have reconstruction or not and it may not be suitable for all women. Some people choose not to have breast reconstruction
• There are several types of breast reconstruction. Some techniques use implants. Others use tissue from your body (tissue from your belly (abdomen), back, or thigh) to recreate the breast
• Your surgeon and breast care nurse will talk to you about all your options. They will explain the advantages and disadvantages to help you make the right decision for you13
Managing your risk of ovarian cancer:
• Surgery to remove the ovaries and fallopian tubes is called bilateral risk-reducing salpingo-oophorectomy13
• This surgery is carried out to reduce the risk of developing ovarian or fallopian tube cancer and lowers the risk to less than 5%
• There are studies looking at whether it is possible to remove the fallopian tubes first, and delay removing the ovaries until a later date, to prevent ovarian cancer11
o One of those studies is called PROTECTOR study but it is not open to people in the Republic of Ireland. It includes 42 hospitals across England, Wales, Scotland and Northern Ireland and recruitment is due to close in December 202414
Be Breast Aware and know the signs and symptoms for Ovarian Cancer
After discussion with your doctor, you may decide that none of the above options are appropriate for you at this time. It may be that you are younger than the recommended age for surgery, or it may be that you wish to stay fertile as you have not completed your family. It is important to make the decision that is right for you, and this decision can be discussed with your doctor, nurse, or genetic counsellor at any time.11
It is important to be ‘Breast Aware’ as part of your surveillance and to know the signs and symptoms of ovarian cancer. Please visit the Marie Keating Foundation website www.mariekeating.ie for further information and to view a video on how to check your breasts for changes.
References available on request
Calls for Greater Support for Women’s Health
Vhi, Ireland’s leading healthcare provider, has released data that reveals that only 3 in 10 female professionals (30%) believe their employer provides workplace supports for women’s health issues such as menopause, perimenopause and fertility issues.
The research demonstrates a clear divide between the level of support provided by employers and the expectation of employees. 80% of female professionals state that workplace supports are crucial to managing women’s health issues. However, only 43% of women say their workplace has a culture where women are supported to talk about their health.
The Vhi Workplace Health Insights research based on a survey of 1,000 corporate employees was undertaken by Ipsos B&A in August 2023. The research provides key insights into changing attitudes and actions in the workplace around women’s health.
Released in advance of the Vhi Workplace Health Insights online
event which took place on 26th September, the research reveals that there are rising levels of awareness and understanding of women’s health issues in the workplace. 74% of female professionals highlight that women’s health issues are becoming easier to discuss. In addition, there has been an increase in the understanding of perimenopause by 8% since 2022 and a 9% increase in awareness of the range of menopausal symptoms.
Despite positive progress, findings reveal that there is an ongoing stigma around women’s health issues in the workplace. 61% of female participants in the workplace say it’s easier to
pretend to have a headache than explain they are experiencing a health issue such as menopause or menstruation. Although 78% of women experiencing menopause state that symptoms interfere with their work, only 19% have discussed the condition with their employer.
Enhancing understanding of women’s health issues and increasing supports can have a positive impact on productivity and engagement across organisations. 80% of women highlight that an improved understanding of women’s health issues would enable men to work better with female colleagues. Free sanitary products (38%) are the most frequently offered health
support for women by employers. This is followed by agreed time off for female health issues (20%) and healthcare webinars covering women’s health issues (18%).
Vhi provides an extensive range of women’s health services to support healthier and more productive workforces. Vhi’s Women's Health Clinic provides holistic care for women experiencing symptoms of perimenopause and menopause. Corporate programmes can be tailored to ensure the evolving needs of staff are met and includes access to women’s health awareness training, an employee assistance programme, mindfulness and meditation apps, and online dieticians.
The Role of the Microbiome-Gut Brain Axis in Women’s Health and Pain
While chronic pain affects approximately 20% of adults, women and girls are disproportionally affected. Despite this, traditionally most of the pain research in the pre-clinical setting has been conducted solely in male animals.
More recently, with the inclusion of females in animal research it has been revealed that sex differences exist in many of the fundamental mechanisms underlying pain. Human studies have also identified differences in the neural circuitry involved in pain processing between the sexes using neuroimaging (Osborne and Davis, 2022). The gut microbiome is defined as the ecosystem of commensal, symbiotic, and pathogenic microorganisms (Armet et al., 2022) and is different between the sexes (Caputi et al., 2022). This community of microorganisms has been associated with both health and disease states and through a series of pathways, referred to as the microbiome-gut-brain axis, can impact the central nervous system including pain processing.
The microbiome-gut-brain axis is composed of neuronal, immune, and endocrine signalling pathways allowing bi-directional interactions between the gastrointestinal tract and the central nervous system (Cryan et al., 2019). The microbiome is capable of producing neurotransmitters as well as microbial-derived neuroactive products such as short-chain fatty acids, which allow microbes to directly impact the nervous systems. The gut microbiome is also directly involved in the production and metabolism of female hormones such as oestrogen, progesterone and luteinizing hormone (Diviccaro et al., 2021). The physiological levels of these hormones vary across the menstrual cycle and menstruation itself has various biological, social and psychological aspects associated with it (Jain et al., 2023) with the period preceding menstruation being linked to several nervous system and peripheral symptoms including anxiety, fatigue, decreased concentration, and abdominal bloating (Jain et al., 2023). The gut microbiome has been noted to be altered in certain female-specific conditions linked with hormonal imbalance such as polycystic ovaries, endometriosis and menopause (Siddiqui et al., 2022) with a specific community
of gut bacteria, referred to as the estrobolome, being capable of metabolising oestrogens and preventing their excretion.
The association between the gut microbiome and visceral pain as noted in irritable bowel syndrome has been extensively studied and verified in many cases (Moloney et al., 2016). In more recent times the gut microbiome has been proposed as being used to predict somatic pain conditions such as post-operative pain (Masaud et al., 2024). Furthermore, certain microbes are associated with female-specific pain conditions and those that present more frequently in women such as post-operative pain, fibromyalgia and endometriosis. The interaction of the gut microbiome and female hormones as well as the potential links to pain syndromes in women provides potential therapeutic opportunities such as microbiome-modulating interventions such as diet changes particularly increasing fibre and prebiotic foods that enhance microbes associated with antiinflammatory properties and anti-nociceptive properties. Other potential interventions include synbiotics where both prebiotics and probiotics (health-promoting bacteria) are administered together to optimise colonisation and efficacy. While fecal microbiota transplantation has been used to define the role of the microbiome in pain (Lucarini et al., 2022) there is still a long road to develop it as a therapeutic for pain.
Given the potential of the microbiome in healthcare for women, there is a real need to conduct further research into sexspecific therapeutic interventions that alleviate painful conditions in women. This research will hopefully shape the future of women's health and improve outcomes for women's health and pain management.
References
• Osborne NR, Davis KD. Sex and gender differences in pain. Int Rev Neurobiol 2022:164:277-307.
Authors: Dr Siobhain O'Mahony and Dr Mariarosaria Cuozzo, Department of Anatomy and Neuroscience, APC Microbiome Ireland, University College Cork, Ireland
• Armet AM, Deehan EC, O'Sullivan AF, Mota JF, Field CJ, Prado CM, Lucey AJ, Walter J. Rethinking healthy eating in light of the gut microbiome. Cell Host Microbe. 2022 Jun 8;30(6):764-785.
• Caputi V, Bastiaanssen TFS, Peterson V, Sajjad J, Murphy A, Stanton C, McNamara B, Shorten GD, Cryan JF, O'Mahony SM. Sex, pain, and the microbiome: The relationship between baseline gut microbiota composition, gender and somatic pain in healthy individuals. Brain Behav Immun. 2022 Aug;104:191-204.
• Cryan JF, O’Riordan KJ, Cowan CSM, Sandhu KV, Bastiaanssen TFS, Boehme M, Codagnone MG, Cussotto S, Fulling C, Golubeva AV, et al. The Microbiota-Gut-Brain Axis. Physiol. Rev. 2019;99:1877–2013.
• Diviccaro S, Caputi V, Cioffi L, Giatti S, Lyte, Caruso D, O’Mahony SM, Cosimo Melcangi R. Exploring the Impact of the Microbiome on Neuroactive Steroid Levels in Germ-Free Animals. Int J Mol Sci. 2021 Nov; 22(22): 12551.
• Jain P, Chauhan AK, Singh K, Garg R, Jain N, Singh R. Correlation of perceived stress with monthly cyclical changes
in the female body. J Family Med Prim Care. 2023 Nov; 12(11): 2927–2933.
• Siddiqui R, Makhlouf Z, Alharbi AM, Alfahemi, Khan NA. The Gut Microbiome and Female Health. Biology (Basel). 2022 Nov; 11(11): 1683.
• Moloney RD, Johnson AC, O'Mahony SM, Dinan TG, Greenwood-Van Meerveld B, Cryan JF. Stress and the Microbiota-Gut-Brain Axis in Visceral Pain: Relevance to Irritable Bowel Syndrome. CNS Neurosci Ther. 2016 Feb;22(2):102-17.
• Masaud K, Collins JM, Rubio RC, Corrigan M, Cotter PD, O'Brien N, Bluett R, Jimenez CK, O'Mahony SM, Shorten GD. The gut microbiota in persistent post-operative pain following breast cancer surgery. Sci Rep. 2024 May 30;14(1):12401.
• Lucarini E, Di Pilato V, Parisio C, Micheli L, Toti A, Pacini A, Bartolucci G, Baldi S, Niccolai E, Amedei A, Rossolini GM, Nicoletti C, Cryan JF, O'Mahony SM, Ghelardini C, Di Cesare Mannelli L. Visceral sensitivity modulation by faecal microbiota transplantation: the active role of gut bacteria in pain persistence. Pain. 2022 May 1;163(5):861-877.
Psoriasis Updates in Psoriasis
World Psoriasis Day is celebrated annually on 29th October across the world. In the UK, Psoriasis Awareness Week, also runs at the end of October and incorporates World Psoriasis Day. Its aim is to raise awareness of psoriasis and psoriatic arthritis. The theme for 2024 is community.
What is psoriasis?
Psoriasis is an immune-mediated inflammatory disease (IMID) primarily affecting the skin but also commonly associated with psoriatic arthritis (PsA), which impacts the joints.
In the United Kingdom and Ireland, psoriasis affects approximately 2% to 3% of the population. This condition results from an accelerated skin cell replacement process.
Typically, skin cells are replaced every 21-28 days. However, in individuals with psoriasis, this cycle is significantly shortened to just a few days. As a result, there is an excessive accumulation of skin cells on the skin’s surface, forming psoriatic plaques.
How to identify psoriasis?
Dry, thick, and raised patches on the skin are the most common sign of psoriasis. These patches are known as ‘plaques’ and are often covered with a silvery-white or grey coating called scale.
The appearance of psoriatic plaques can differ based on skin tone. On darker skin, they
may appear as purple or brown patches with grey scales, while on lighter skin, they often present as pink or red patches with silverywhite scales. Plaques can vary significantly in shape and size, ranging from small spots to several centimetres wide.
Psoriasis can cause discomfort, with affected areas often feeling itchy and sore. It is important to note that psoriasis is not contagious—it cannot be transmitted between individuals or spread from psoriatic to nonpsoriatic skin.
Currently, there is no cure for psoriasis, but a range of treatments and lifestyle adjustments are available to help individuals manage the condition effectively and maintain a good quality of life.
Are there different types of psoriasis?
There are many different types of psoriasis, with plaque psoriasis being the most common, affecting around 80% of individuals.
It presents as silvery or grey plaques most commonly on elbows, knees, lower back and
Written by Tass Miah, The Psoriasis Association
scalp. Scalp psoriasis can make the scalp feel itchy and tight, and cause dandruff-like flakes.
Other types include guttate psoriasis, commonly affecting children and teenagers, often triggered by throat infections. Guttate psoriasis is characterised by small, scaly patches. Rare forms include generalised pustular psoriasis (GPP), which causes small blisters, and erythrodermic psoriasis, affecting skin condition and body temperature. If you suspect you have GPP or erythrodermic psoriasis, it is important to seek immediate medical attention as both types can be serious.
What causes psoriasis?
The precise role of genetics in psoriasis development, is complex, however, psoriasis can run in families.
Research shows the psoriasiscausing changes in the skin begin in the immune system when certain immune cells (T cells) are triggered and become overactive.
In most cases, psoriasis develops following a ‘trigger’. For example, an infection, injury to skin (Koebner’s Phenomenon) or hormonal changes may lead to psoriasis.
Other triggers such as stress, diet, medication, alcohol or smoking may also cause psoriasis. These triggers can contribute to psoriasis getting worse or flaring.
How can psoriasis be treated?
There are four main types of psoriasis treatment. Depending on the type of psoriasis you have, and how severe it is determines the treatment you will receive.
Topical treatments (applied directly to the skin) are often the first line of
treatment. Moisturisers, emollients, coal tar preparations and vitamin D based topicals may be prescribed by your doctor.
The following courses of action are recommended for psoriasis that doesn’t respond to these treatment types. Phototherapy (controlled exposure to UVB or UVA light in a phototherapy unit), systemics (taken orally and affect the entire body) or biologics (injections that target specific parts of the immune system). Holistic approaches such as making changes to diet or lifestyle may also improve symptoms of psoriasis.
When should someone contact their GP?
If you notice any changes to your skin or a new itchy, scaly rash it is advisable to contact your GP to book an appointment at your earliest convenience.
For those already diagnosed with psoriasis, if your current treatment is not working or your psoriasis is worsening, do get back in touch with your GP.
A GP can diagnose psoriasis by examining your skin or scalp. If your doctor is unsure or your condition is severe, they may refer you to a dermatologist (skin specialist).
Can I see a specialist?
If your psoriasis is not improving with treatment, covers more than 10% of your body, affects sensitive areas (e.g. your face or genital area), or is impacting your mental health or daily life, your GP can refer you to a dermatologist.
Dermatologists have access to a wider range of treatments in comparison to primary care.
Can community pharmacists support people with psoriasis?
There are many treatment options available over the counter (OTC) for psoriasis.
This includes moisturisers and emollients, as well as coal tar shampoo and salicylic acid treatments which can treat scalp psoriasis. Pharmacists can familiarise themselves with these OTC psoriasis treatments.
Pharmacists should encourage proper usage of these treatments and following dosage guidelines. This way, if patients return with
symptoms or symptoms worsen, they can advise patients to see their GP.
Pharmacists may also direct patients to The Psoriasis Association or provide them with relevant literature, such as leaflets and information sheets.
Are there any current issues or advancements surrounding psoriasis care?
Skin of Colour: Psoriasis in individuals with skin of colour can be underdiagnosed, requiring special treatment considerations, including addressing dyspigmentation and adjusting phototherapy.
Impact on Mental Health: Psoriasis is not just a skin condition; it also has significant psychosocial impacts, including anxiety and depression. Few patients seek help, however, early treatment, including therapy
and medication, is essential for managing these comorbidities
Access to Specialist Care: Historically, people with chronic conditions affecting the skin, like psoriasis, faced difficulties in reaccessing specialist dermatology services after being discharged to primary care. Often, this required a new referral and a long wait to see a specialist when the condition flared up. However, the NHS has introduced a "Patient-Initiated Follow-Up" (PIFU) system. Dr Julia Schofield, Psoriasis Association Chair, shares “PIFU provides a flexible way for patients to stay ‘on the books’ of the specialist service so that they can reaccess care in a timely fashion as and when necessary, without needing a new referral.” The PIFU system is especially beneficial for managing unpredictable flare-ups of psoriasis.
Advancements in Treatment: New biosimilar versions of Ustekinumab
for managing psoriasis and PsA are now available, following the expiration of Stelara's patent in July 2024. This milestone introduces new treatment options for those living with these conditions, potentially improving management and outcomes.
AI in Dermatology: Another significant development is the increasing use of artificial intelligence (AI) in dermatology, which is enhancing the diagnosis and monitoring of skin diseases like psoriasis. AI technologies are expected to play a crucial role in improving the accuracy and efficiency of psoriasis care in the future.
Additional Information
If you're seeking more information or support, visit the Psoriasis Association. The UK's leading national charity and membership organisation for people affected by psoriasis and psoriatic
conditions. The charity supports individuals through funding research, providing information and raising awareness. You can find more out about The Psoriasis Association and the work they do via their website at www.psoriasis-association.org. uk and @psoriasisuk across social media channels.
Donegal patient Francis Hegarty became the 50th patient to undergo the Renal Denervation (RDN) procedure at Galway University Hospitals; a minimally invasive procedure to help treat high blood pressure in patients who have not responded to medications and lifestyle changes.
Galway University Hospitals were the first hospital in the country to carry out the RDN procedure, and the first internationally to offer RDN as a day-case surgery. This means that patients arrive at the hospital in the morning, have their procedure, and then return home the same day.
Following a number of successful clinical trials at GUH, the RDN procedure went mainstream in 2021. And just recently, on 30 August, the European Society of Cardiology (ESC) updated its guidelines for the management of elevated blood pressure and hypertension incorporating recommendations for the first time on the use of renal denervation to treat various types of hypertension. These ESC guidelines state that RDN may be considered, after a shared decision with the patient about risks and benefits and only in hospitals like GUH that undertake medium to high volumes of this procedure, among patients with resistant hypertension (not responsive to 3 or more medications) or among
Francis Hegarty from Teelin in County Donegal and Prof Faisal Sharif, Consultant Interventional Cardiologist at GUH and University of Galway.
patients with very high risk of cardiovascular disease who have uncontrolled hypertension.
“Approximately 35% of the adult population in Ireland have high blood pressure and around one third of these patients are taking medication but their blood pressure is still uncontrolled. If we are able to control blood pressure adequately overtime than we can reduce the risk of end-organ damage. Even a small reduction in blood pressure can lead to a significant reduction of the risk of stroke or heart attack,” explains Prof Faisal Sharif, Consultant Interventional Cardiologist at GUH and University of Galway.
“Renal denervation is indicated for very high-risk patients with uncontrolled blood pressure or resistant hypertension. First line of treatment is lifestyle changes and adherence to blood pressure medications. If these measures are insufficient to control the blood pressure or patient has intolerance to blood pressure medications, then RDN may be considered. The treatment is optional and is offered to patients who fit the criteria.
“It’s a minimally invasive procedure involving catheterisation through the femoral artery in the thigh, to deliver radiofrequency or ultrasound waves to the nerves surrounding the renal arteries. This process disrupts the overactive sympathetic nerve activity, leading to a reduction in blood pressure. Following the procedure, patients are monitored with a 24-hour blood pressure monitor every three months for the first year, and then annually for the next five year.
“Providing this approach as day case procedure has significant benefits for patients in terms of reduced disruption to their lives, recovery at home and we are not dependent on the availability of
beds for an overnight stay which can be a challenge with the current demands on inpatient care, added Prof Sharif.
Prof Bill McEvoy, a Consultant Cardiologist at University Hospital Galway, Professor of Preventive Cardiology at University of Galway and co-Chair of the ESC guidelines for the management of elevated blood pressure and hypertension said, "The ESC guidelines include evidence-based recommendations that provide guidance for clinicians and their patients on the use of this important new technology. However, it must be stressed that this RDN procedure needs to be undertaken in a centre where there is expertise and experience.”
Educational – Urinary Tract Infections
A community pharmacy environment that fosters teamwork ensures high levels of consumer satisfaction. This series of articles is designed for you to use as guide to assist your team in focusing on meeting ongoing CPD targets and to identify any training needs in order to keep the knowledge and skills of you and your team up to date.
Children with UTIs may also:
• Have a high temperature
• Appear generally unwell
• Wet the bed or themselves
• Be sick
When to Refer:
• Someone who has symptoms of a UTI for the first time
• A child has symptoms of a UTI
• A man with symptoms of a UTI
• Pregnant women with symptoms of a UTI
The below information, considerations and checklist provides support to enable you to run a team training session and identify opportunities for learning within the topic of Urinary Tract Infections.
Urinary tract infections (UTIs) are among the most common infections affecting adult women. One-half of all women will experience at least one UTI in their lifetime. Recurrence of UTIs is common, with a reported rate of 25% within 6 months of the first occurrence.
Urinary tract infection (UTI) is the collective term used to describe infections involving any part of the urinary tract, which includes the kidneys, ureters, bladder and urethra. Infections of the bladder (cystitis) and urethra (urethritis) are known as lower UTIs and infections of the kidneys (pyelonephritis) or ureters are classed as upper UTIs.
Diagnosis of UTI is based primarily on signs and symptoms.
The incidence of UTIs in adult males under age 50 years is low. Up to 40% of women develop a UTI at some point in their life, compared to 12% in men. In men, cystitis is often associated with infection and inflammation of the prostate gland (prostatitis).
Consider:
Anatomically, the female urethra is shorter and located closer to the anus than in males, which makes it easier for bacteria to reach the female urethra and bladder.
Adult women are 30 times more likely than men to develop a UTI, with almost half of them experiencing at least one episode during their lifetime and one-inthree women experiencing their first episode by the age of 24 years. UTIs are most commonly seen in sexually-active young women.
UTIs can be classified as ‘uncomplicated’ (sometimes referred to as a ‘simple’ UTI) or ‘complicated.’ Uncomplicated infections present most frequently in women without any structural or functional abnormality of the urinary tract, any history of renal disease, or other comorbidity (e.g. immunocompromised patients or those with diabetes), which may contribute to more serious outcomes. Complicated UTIs are associated with a condition or underlying disease that interferes with the patient’s immune mechanisms and increases the risk of acquiring infection.
Recurrent UTIs, defined as at least two UTIs in 6 months or three UTIs in 1 year, are a significant burden for the patient and result
Is your knowledge up-to-date on UTI symptoms, causes and treatments?
Can you identify other conditions that result in the same symptoms?
Does the team follow WWHAM protocol at all times?
Can you identify cases where GP referral is necessary?
Are all staff confident and comfortable giving advice and treatment recommendations for patients presenting with symptoms of UTIs?
Do all members of staff know the patients who should avoid cranberry juice or capsules?
in high costs to the health system. The most commonly prescribed regimens are trimethoprimsulfamethoxazole (or trimethoprim alone), nitrofurantoin, cephalexin and the fluoroquinolones at a quarter of the usual daily dose for 6 months.
Symptoms may include:
• Pain or a burning sensation when passing urine
• Needing to urinate more often during the night
• Urine that looks cloudy
• Needing to urinate more urgently than usual
• Blood in the urine
Key Points:
Ensure your team understands and is confident explaining the following:
The symptoms of different UTIs
The appropriate OTC products and what symptoms they can help with
The additional measures than can ease symptoms
The potential side-effects of each product and for whom they are unsuitable
The steps that should be taken to prevent discomfort during infection and reduce risk of infection
WWHAM protocol and which patients must be referred to the pharmacist
All patient conversations are conducted with discretion, sensitivity, and appropriate tone.
• Symptoms of a UTI after surgery
• Symptoms get worse or do not improve within 2 days
Those suffering with UTIs can be advised to take paracetamol up to four times a day to help reduce pain and a temperature. Children can take liquid paracetamol. They should also be advised to rest and drink fluids so that they can pass urine more regularly during the day.
It may also help for sufferers to avoid sexual intercourse until symptoms have passed.
Cranberry juice and capsules
Drinking cranberry juice may help to prevent UTIs. For those with recurring UTIs, higher strength cranberry capsules are recommended.
However, advise customers that they should not consume cranberry juice or cranberry capsules if they are taking warfarin.
Actions:
Team Your own knowledge is up-to-date, on UTI symptoms, causes, treatments and referral guidelines
Refresh your knowledge of other conditions which may result in the same symptoms
The appropriate training has been provided to all team members, and assessed, for example through observation or role play
You have the appropriate range of products available
WWHAM Protocol forms the basis of all interactions at the OTC counter
Update your CPD record.
The Tragedy of Asset Misallocation
Military history is full of episodes that offer lasting lessons that can be applied in other fields. Take, for example, the unexpected fall of Singapore in World War II. Known as the Gibraltar of the East, Singapore’s defence seemed unbeatable, with massive guns pointing to the sea, awaiting a naval attack. However, the actual assault came through the Malayan jungle, where the guns couldn’t even aim. This strategic blunder resulted from putting resources in the wrong place and had severe consequences.
Just as Singapore fell due to a mistaken assumption about the threat’s direction, many modernday investors are being misled about the ultimate threat to their financial security.
Guns Facing the Wrong Direction
Investors have been bombarded by internet gurus telling them how to invest. It has led to many investors believing that a DIY approach is the optimal strategy. While we acknowledge that some investors have the ability and discipline to follow a DIY approach, we have seen too many examples of investors working in isolation, leading to suboptimal results.
We frequently see clients making poor asset allocation decisions: how much to allocate to equities, bonds, and cash. This complex decision must weigh the investor’s time frame, goals, attitude to investing risks, and emotional makeup.
Research shows that over 90% of a portfolio’s return can be attributed to this single decision. It should be taken seriously, yet we still encounter too many investors who have misunderstood the path to success.
Not focusing on asset allocation can significantly impact investment success. It’s time we face the guns in the right direction.
Written by Colm Moore,
a Certified Financial Planner™ with Moore Wealth Management and has been advising the pharmacy community for 20 years. www.mwm.ie
Our role as your lifetime financial partner is to reflect your decisions back to you, helping you make the right trade-offs for your unique circumstances. Where appropriate, we will push back and encourage you to follow the path of discipline that your future self will thank you for. Let’s face the guns in the right direction, the direction of the stock market.
Ultimately, without a proper understanding of the stock market, these investors are likely to remove themselves as stock market participants, and those who do invest are unlikely to behave in a disciplined manner when market volatility inevitably arrives. Both scenarios will severely damage their chance of becoming financially independent.
The Critical Link Between Asset Allocation and Investor Behaviour
A successful investment strategy starts with knowing how to allocate assets correctly. Our best ally in this war is a good understanding of market history.
While equities (the ownership of the great companies of the world) has been the primary driver of global markets, too many investors have shied away from this asset class for fear of the frequent but temporary declines they experience.
Many long-term investors who can withstand short-term losses have given up real wealth to avoid the emotional stress of unpredictable markets. Some investors willingly accept this trade-off, understanding what it means. But too many investors don’t realise what they’re giving up or what other options they have. This is the great tragedy of asset misallocation.
There are countless examples of clients who have prospered thanks to a simple change in mindset aided by a caring adviser. This is the real value of advice and one we’re excited about showing to more clients.
The Courage To Be Disciplined
In a time where lifespans are becoming longer and longer, too many investors are at risk of investing without intention. While no single portfolio is perfect for every client, all investors could benefit from stress testing their portfolio by asking: “Am I shortchanging my future self?”.
The stock market might be one of the most misunderstood concepts in the world. Given its central role in helping investors become financially independent, it’s crucial to understand what it is, what it isn’t, and how it functions.
Unfortunately, rather than playing the role of educator, the financial media have a vested interest in focusing on sensationalism, short-term events, and fear-driven stories. In this article, we’ll bring the important concepts back to basics. We’ll unpack the various stock market misconceptions and provide a clear framework for thinking about the stock market on your investing journey. We hope this will help you observe the world through a new lens and become a more mature and successful investor
The
Wrong Way to Think About the Stock Market
Many investors consider the stock market an abstract concept they cannot see or interact with. With this mindset, it’s easy to start thinking about stock ownership as a piece of paper. You hope that one day it will be worth more than it is today, but it’s not clear why that will happen. Investors with this understanding are essentially hoping for the best, and when results do not match their expectations, they will develop resentment towards the market as a whole.
Another group of investors have a cynical view of the market as nothing more than a casino in which the game is rigged in favour of “insiders”. They view wealth as something that can only come at the expense of others—a zerosum game, as it were. Long-term success is not likely for someone operating within this framework.
The Right Way to Think About the Stock Market
The first step towards correctly understanding the stock market is to become aware of the companies you interact with daily. From the moment you wake up, you consume goods and services produced by businesses. Many of these companies have their shares listed on public exchanges, making them available for purchase by any investor. While some investors buy these shares directly, the average investor becomes a stock owner when they invest money in large investment funds.
Through their management and boards, these companies are incentivised to increase the revenue and profits generated by their products and services. They use these profits to reinvest in attractive opportunities or distribute the money to shareholders as dividends.
And so, when you buy from a listed business, you indirectly send money back to its investors. You likely are one of them. As you will see in our illustration of walking down Oxford Street in London you interact with the stock market every day. A walk down any high street will see you coming into contact with dozens of listed companies. The stock market, therefore, is nothing more than a collection of these companies. It’s real companies selling real things to real people.
The aggregate stock market value quoted in the media is the best estimate of the market’s future value as arrived at by the millions of market participants, and it’s a marvel that we can participate in the economic potential of the capitalist society we live in.
Long Term Success Is Inevitable Success in the investment markets comes down to good investor behaviour, and good behaviour only comes from correctly understanding the fundamentals. Typically, investors carrying around misconceptions about the stock market make poor decisions that result in financial loss, while investors with a mature understanding invest for long periods with confidence.
Your best starting point for interacting with the stock market is to remember that you are the stock market. It’s all around you. You contribute to it, and you benefit from it. You own the great companies of the world;
While short-term sentiment will ebb and flow among professional investors, you can take comfort in the fact that over more extended periods, the market increases due to higher corporate earnings and dividends. If you have the fortitude to stay disciplined during the inevitable (but temporary) downturns, you will experience lasting success.
Recognising Heart Attack and Stroke
Only half of women say they recognise the symptoms of heart disease and stroke, while 28% have never had a heart health check, new research showed recently.
The national Ipsos survey also reveals 70% of the public believe females are more likely to contract breast cancer than both heart disease and stroke - despite statistics showing they are six times more likely to die from both conditions.
It was commissioned by the Irish Heart Foundation for its ‘Her Heart Matters’ campaign, running throughout September.
“The perception is quite different to the reality that one in four women dies from heart disease and stroke,” said Dr Angie Brown, Consultant Cardiologist and Medical Director with the Irish Heart Foundation.
“Women are six times more likely to die from heart disease and stroke than they are from breast cancer so a significant gap in awareness of the symptoms has opened up.” The campaign is being supported by broadcaster Maura Derrane.
The research, conducted among 1,056 respondents, shows that a third of people in Ireland (33%)
Broadcaster Maura Derrane pictured with Dr Angie Brown, Consultant Cardiologist and Medical Director with the Irish Heart Foundation
believe women are at lower risk of heart disease and stroke than men, 41% believe the risk is the same and 16% think women are more at risk.
And, when women only were asked, just 50% said they recognised the symptoms of heart disease and stroke, 23% did not and 27% neither agreed nor disagreed.
The 50% figure compares to 64% of women who said they recognise breast cancer symptoms. The Ipsos poll also showed that 41% of women have spoken to a healthcare professional about their heart health within the last year –but 28% have never done so.
“We are encouraging all women, but especially those in their mid50s and beyond, to have their heart health checked, particularly if they experience chest or back pain, difficulty breathing, dizziness or extreme fatigue – please don’t put it on the long finger,” said Dr Brown.
“Society as a whole needs to confront this embedded myth that
heart disease is a male disease; it is still not seen as a disease that affects women to the degree that it does.
“Women need to seek help earlier if they have any suspicion something might be wrong, advocate for themselves, recognise the signs and potentially save their own lives.”
eCommerce Award for McCabes Pharmacy
A huge congratulations to McCabes Pharmacy Online Team who took home the award for Beauty Health & Wellbeing Ecommerce Website Of The Year at the recent Irish Ecommerce Awards.
The Irish eCommerce Awards is the biggest celebration of the internet retail industry on the island of Ireland.
The Irish eCommerce Awards recognise and reward the organisations, teams and individuals who are helping shape the thriving internet retail industry across the island of Ireland.
Congratulations Sean Gleeson and the entire online team on this fantastic recognition.
Sean Gleeson and team from McCabes Pharmacy
Do you Know the Signs of Sepsis?
According to the HSE National Sepsis Report 2023, there were 15,722 cases of sepsis and septic shock diagnosed in hospitals last year. However, while there has been a rise in cases of sepsis, the mortality rate has decreased (19.3%) when compared with the previous year (21.8%).
Last month marked World Sepsis Day and the HSE has encouraged everybody to be aware of the signs and symptoms of sepsis. Sepsis 2023 Report Key Findings
• 64% of people who died from sepsis were aged 75 or over
• Over 27% of sepsis patients were admitted to critical care beds
• 260 cases of pregnancy-related sepsis (no deaths)
• 2,891 cases in children between 2020 – 2023 of whom 117 died
The outcomes of the national report are due to the quality improvement initiatives in hospitals, helping to reduce sepsis-associated deaths.
Speaking on World Sepsis Day, Dr Michael O’ Dwyer, Clinical Lead, HSE Sepsis Programme says, “We are encouraging everybody to make themselves familiar with the signs and symptoms of sepsis. We know that, as well as prevention measures, early detection and treatment saves lives. That is why
it is so important to be aware and know the signs.
“Sepsis can hide behind any infection and can lead to a rapid deterioration in health. Research has found that symptoms of sepsis are easy to dismiss, miss or mistake for something else. So if you suspect you or someone you know has sepsis, seek urgent medical care and always ask, ‘Could it be Sepsis?’”
Improving knowledge around the signs and symptoms of sepsis is a key priority of the HSE Sepsis Programme, through national public information campaigns, community activities and ongoing engagement and education with health and social care staff.
The Signs and symptoms of sepsis in adults (including maternity) are:
S Slurred speech, new confusion, too sick to communicate, drowsiness.
E Extreme shivering, muscle aches, fever.
P Has not passed urine in the last 12 hours and does not feel like passing urine.
S Shortness of breath, lips tinged with blue, feels like your heart is racing, dizzy when you sit or stand.
I I feel like I’m going to die.
S Skin mottled and discoloured, new rash that is still visible when pressed on with a clear glass (glass test).
The signs and symptoms of sepsis in children are:
• Very fast breathing
• Fits or convulsions
• Mottled skin (irregular colour) bluish or pale
• A rash that does not fade when you press it
• Unusually sleepy and difficult to wake
• Unusually cold when you touch them
• Has had no pee for more than 12 hours.
Chronic Kidney Disease
The HSE’s Opportunistic Case Finding (OCF) Programme report, released on 5th September 2024, highlights an urgent need to address the growing impact of Chronic Kidney Disease (CKD) in Ireland, said Colin White, National Advocacy & Projects Manager for the Irish Kidney Association.
Following the OCF Programme report stark findings, the Irish Kidney Association (IKA) is calling for funding to be put in place to include Chronic Kidney Disease (CKD) in the Chronic Disease Management Programme (CDMP) for GPs, to ensure that vulnerable patients receive the necessary care and treatment they need. In addition, the IKA is calling for the enrolment age for the Chronic Disease Management Programme to be lowered to 18+ years for people with advanced stage CKD (stage 4 - 5) and for the Prevention Programme for people with earlier stage CKD (stages 13). The enrolment age for the Chronic Disease Management Programme should also be set at 18+ for all CKD-related conditions.
The Irish Kidney Association asserts that based on domestic and international research, these measures will result in significant long-term benefits for the population’s health outcomes, reducing the burden on our healthcare system and savings to the exchequer.
Chronic Kidney Disease is closely linked to cardiovascular disease, hypertension, and diabetes, all three of which are already covered by the Chronic Disease Management Programme.
Earlier diagnosis and intervention are essential for not only stopping or slowing down the progression of kidney disease, but also to alleviate the increasing burden on the Irish health service and the economy. There is a significant legal and financial risk to the State if no action is taken to manage the progression of the disease, as patients have been identified as having CKD but follow up treatment pathways are not established.
How To Grow Your Pharmacy Profits by ¤600,000!
In today’s dynamic and competitive business landscape, pharmacy organisations continually seek ways to improve efficiency, enhance profitability, and stay ahead of the curve. One effective model that has proven to be successful in other industries is the use of a business consultant. Whilst being of an unheard of strategy for many pharmacies, business consultants bring a wealth of expertise, fresh perspectives, and targeted solutions that can drive significant improvements in a company’s operations and outcomes.
www.taskgo.ie has been researching into use the of technology and how it can be applied within the Irish market to optimise workflow, efficiencies and more importantly…profit.
But first, here are several reasons why you should consider bringing in a business consultant to help boost your profits.
1. Expertise and Specialized Knowledge
Business consultants typically have extensive experience and specialised knowledge in their respective fields. Whether it’s technology, marketing, finance, operations, or lean management, consultants offer insights that are grounded in years of practical experience and advanced study. This expertise allows them to quickly identify problems, propose actionable solutions, and implement best practices that might be outside the purview of in-house teams.
2. Objective Analysis and Fresh Perspectives
Internal teams often have a limited view shaped by their daily involvement in the business. Consultants provide an outsider’s perspective, enabling them to see
issues and opportunities that might be overlooked by employees. This objective analysis can uncover inefficiencies, highlight new market opportunities, and challenge the status quo, fostering innovation and improvement.
3. Cost-Effective Solutions
Hiring a full-time expert for every business function is often not feasible, especially for small and medium-sized enterprises (SMEs). Business consultants offer a cost-effective alternative, providing high-level expertise on a temporary basis. This approach allows businesses to benefit from specialized skills and knowledge without the long-term financial commitment of a full-time hire.
4. Enhanced Focus on Core Business Activities
When businesses face challenges or embark on new projects, existing staff may be stretched thin, leading to decreased productivity and morale. Engaging a consultant can relieve this pressure, allowing employees to focus on their core responsibilities. Consultants handle specific tasks or projects, ensuring that business operations continue smoothly and efficiently.
Consultants are adept at managing change and driving projects forward. They bring methodologies that facilitate quick and effective implementation of new strategies. Whether it’s adopting new technologies or restructuring the organization, consultants can streamline the process, reducing downtime and accelerating the achievement of business goals.
6. Access to a Broader Network
Consultants often have extensive networks, which can be a valuable resource for businesses. These connections can provide access to additional expertise, potential partners, and new opportunities. Leveraging a consultant’s network can open doors and create synergies that might not be possible otherwise.
7. Training and Development
Consultants don’t just solve problems; they also transfer knowledge to the in-house team. Through their work, they provide training and development opportunities, equipping employees with new skills and perspectives. This knowledge transfer ensures that the benefits
of consulting engagements continue long after the consultant has left.
8. Risk Mitigation
With their extensive experience and specialised knowledge, consultants are well-versed in identifying and mitigating risks. They help businesses navigate complex challenges and avoid common pitfalls, thereby safeguarding the company’s assets and reputation. This proactive approach to risk management can save businesses from costly mistakes and ensure smoother operations.
9. Increased Competitiveness
In a rapidly changing market, maintaining a competitive edge is crucial. Consultants help businesses stay ahead by providing insights into industry trends, competitor strategies, and emerging opportunities. This strategic guidance enables companies to adapt quickly and make informed decisions that enhance their market position.
So, How Is This Going To Grow My Pharmacies by ¤600,000?
Engaging a business consultant is a strategic investment that can yield substantial returns. From providing specialised expertise and objective analysis to facilitating change and mitigating risks, consultants bring a range of benefits that can significantly enhance a business’s performance and competitiveness. In an environment where agility and informed decision-making are paramount, the value of a skilled business consultant cannot be overstated. By leveraging their insights and experience, businesses can navigate challenges, seize opportunities, and achieve sustained growth. Strategies taken by consultants include looking at processes and seeing how processes can be digitalised. Over the following series of articles, we will be looking at how technology can be used for lean management and how your pharmacy can save thousands of euros with very little effort or expenditure.
Early Diagnosis and Therapeutic Intervention for RA
Currently there are no cures for rheumatoid arthritis (RA) which affects 40,000 people in Ireland. The disease costs an estimated €20,000 per patient, per year with an overall cost to the health system of €544 million. Only 1 in 4 patients achieve remission and a significant proportion of patients have suboptimal responses or no response at all to current available therapies. As it is impossible to predict who will develop severe, erosive disease and who will respond to treatment, a trial-and-error approach prevails leading to potential irreversible joint damage before the patient has received the correct treatment.
Now, a study by researchers in Trinity College Dublin and St Vincent’s University Hospital proposes a better understanding of the site of inflammation in RA which will allow for the development of new treatment strategies or predictive biomarkers which could support the potential for a ‘personalised medicine’ approach. The study is published in the journal Science Advances
This work was led by Professor Ursula Fearon and Dr Megan Hanlon from the Molecular Rheumatology Group in Trinity, and by Professor Douglas Veale, from St Vincent’s University Hospital.
The team performed an indepth investigation of a specific population of cells: ‘the macrophages’ that reside in the synovium of RA patients, ‘individuals-at-risk’ of RA and healthy controls. Researchers demonstrated for the first time, the presence of a dominant macrophage subtype (CD40expressing CD206+CD163+) in the inflamed RA synovium, which importantly was associated with disease-activity and treatment response.
The team identified that these cells are resident in the joint which, in health play a protective role, but in disease - for reasons we are unsure of - become pro-
inflammatory, and release proteins called cytokines that induce inflammation, and also have the ability to activate the invasive fibroblast cell type which leads to cartilage and bone destruction.
Researchers identified that the pro-inflammatory status of these macrophages is maintained by specific signalling and metabolic pathways within the joint, the targeting of which may induce resolution of inflammation. Importantly the team identified that these changes in the macrophage status occurred pre-disease onset.
Combined, these findings identify the presence of an early pathogenic macrophage cell/gene signature that shapes the RA joint inflammatory environment and represents a unique opportunity for early diagnosis and therapeutic intervention.
Key Findings
Researchers:
• Identified a novel macrophage subtype in the joint and showed that these are the dominant macrophages in patients with active RA.
• Found this macrophage subtype is highly pro-inflammatory and releases proteins called cytokines that cause further inflammation in the joint.
Ursula Fearon, Professor of Molecular Rheumatology, School of Medicine, Trinity College Dublin
“This is an important breakthrough in our understanding of what goes wrong at the initial stages of disease in RA, which also has an impact on patient’s progression and relapse”
• Importantly, the identification of a dominant macrophage subtype (CD40-expressing CD206+CD163+) suggests targeting of CD40 signalling could represent a new strategy for patients who currently don’t respond to treatment.
• Finally, and really importantly the team identified that these cells are present and become activated in individuals at risk of developing RA, thus prior to clinical signs and symptoms. Identification of the early cellular/gene patterns and cues that transform protective macrophage population into a dysfunctional pro-inflammatory macrophage may provide opportunities to target early and reinstate joint homeostasis in RA patients.
• Identified that these cells also have the ability to activate other cell types (the fibroblast) in the joint that specifically invade and breakdown adjacent cartilage and bone.
• Identified that the frequency of this cell type in the joint at baseline predicted patients’ response to treatment and subsequent disease flare.
Also:
• In parallel, the protective barrier macrophages (CX3CR1+) were depleted in established RA, showing a switch in the dominance of joint macrophages from protective macrophages to pro-inflammatory macrophages.
Ursula Fearon, Professor of Molecular Rheumatology, School of Medicine, Trinity College Dublin said, “This is an important breakthrough in our understanding of what goes wrong at the initial stages of disease in RA, which also has an impact on patient’s progression and relapse. We have identified a dominant macrophage subtype/gene signature associated with driving the pro-inflammatory responses early in disease and therefore reprogramming of macrophages towards resolution of inflammation has the potential to be therapeutically targeted.”
Dr Megan Hanlon, post-doctoral fellow in Molecular Rheumatology, School of Medicine (at the time of the study, and now based in Harvard University), added, “The presence of these macrophages in individuals at risk of developing RA, highlights the possibility of an early cellular biomarker of disease onset, resulting in early treatment intervention.”
READ: you can read the paper: Loss of synovial tissue macrophage homeostasis precedes rheumatoid arthritis clinical onset at the following link: https://www.science.org/doi/ epdf/10.1126/sciadv.adj1252
Pharmacy Training
McLernons investing in the next generation of pharmacists and technicians
Did you know that every graduate from every School of Pharmacy and Pharmacy Technician Course on the island of Ireland will have trained on the McLernons MPS dispensing system?
We are delighted that we have fostered links going back over 30 years to ensure that every pharmacy contractor taking on a student for a Summer job, offering a placement during the course of their degree or offering them a job after graduation can be confident that they can hit the ground running, having already familiarized themselves with MPS throughout their University degree.
From Coleraine in the North East to Cork, and in the cities of Belfast and Dublin, we have donated almost 200 dispensing
systems to train the next generation of pharmacists. In addition, we also supply the Institutes of Technology with MPS dispensing systems, training the next generation of pharmacy technicians in Letterkenny, Dublin, Carlow and Athlone.
Keith McLernon, MD, said, “We think it is vital that we support the award-winning work and teaching carried out in Coleraine, Queens, Trinity, Royal College of Surgeons and Cork. Allowing students to become familiar with the processes involved in dispensing
in a safe learning environment is so important for their learning and development.”
“Originally there were just two Schools of Pharmacy, in Queens and Trinity, training all the pharmacists graduating North and South of the Border.
In the early years of the 21st century three more Schools opened, and we were delighted to be asked to provide their dispensing systems.”
He added, “Our most recent partnership has been with RCSI, who recently decided to use only McLernons MPS to teach their students. The process was rigorous, in that
Pharmacy Degrees:
Ulster University at Coleraine
Queen’s University Belfast
Trinity College Dublin
Royal College of Surgeons
University College Cork
they carried out analysis of all the dispensing systems in Ireland and took on board feedback and opinion from students and pharmacy practitioners.”
“We support our customers in a number of ways – not just with our trainers, engineers and help desk – but by sponsoring awards and partnering with academic institutions. We look forward to continuing our relationships with Universities and colleges to train and empower pharmacy students and pharmacy technicians.”
See Next Page for a full overview of McLernons investment in training.
Pharmacy Technician Courses:
Technological University of Dublin
Technological University of the Shannon, Athlone
South East Technological University, Carlow
Atlantic Technological University, Letterkenny
Keith McLernon, McLernons MD
McLernons investing in the next generation of pharmacists and technicians
Ulster University At Coleraine
Ulster University has three campuses – in Derry, Belfast and Coleraine.
The School of Pharmacy, sited along the banks of the River Bann in Coleraine, opened its doors to an initial cohort of 35 students in 2009 and since then the School has grown steadily, attracting more staff and more students each year. Today around 120 future pharmacists start each year, coming from all parts of Northern Ireland and most counties in the Republic with some from GB and some from further afield.
Prof Paul McCarron, Head of the School of Pharmacy and Pharmaceutical Sciences, discussed the relationship between McLernons and the School. “The new accreditation standards require a greater level of clinical involvement and decision-making. Students begin the process of learning how to deliver health care in their first year, and gradually spend longer periods of time in community and hospital settings and in GP practices.”
“From second year our students spend considerable time in community pharmacies – using the dispensing systems and labelling systems – and are much more involved in health care delivery from a very early stage in their studies.”
“Using the McLernons systems here and then going out to the community pharmacy and using them 'in situ' provides a complementary experience and a reinforcement of the systems and processes needed. Our relationship with McLernons since the School’s inception has been incredibly beneficial and we are very grateful for their support.”
University College Cork
UCC School of Pharmacy opened in 2004, and McLernons MPS has been the in-house dispensing system used since then. The dispensing lab has 38 terminals where the next generation of Irish pharmacists turn their academic knowledge into practice in a safe, simulation setting.
Dr Aoife Fleming, MPharm Director, said, “We receive invaluable support from McLernons – both from Brian our engineer and from the Support Desk. Their ability to ‘dial on’ to our systems and trouble shoot any problems remotely has been a game changer.”
“Weekly use of the MPS system throughout their five years at Cork helps prepare our students for practice, and it gives them a massive advantage to be familiar with the system that is most commonly used in the community.”
“Week on week we see their confidence grow, and they are fully au fait with MPS within 3 or 4 weeks, which means that they can then concentrate on acquiring and applying the skills that they need to become competent pharmacists, learning how to work effectively and safely.”
We feel that UCC is a unique place to study pharmacy in Ireland as the cluster of companies working in the pharmaceutical industry sector here provides great opportunities for training and career development for our students. Dr Michelle O’Driscoll, current module co-ordinator for the dispensing labs added, “Pharmacy practice is constantly changing, and it is important that our student build upon their academic knowledge and develop the skills and experience gained from a familiarity with the practice of pharmacy dispensing. The support from McLernons is invaluable to our students in this regard”
Pharmacy Technicians train on MPS at:
Queen's University Belfast
Queen’s University Belfast (QUB) has offered a pharmacy degree since 1929, originally as a B.Sc. in Pharmaceutics, making it one of the oldest degree courses in Britain and Ireland. Each year around 150 students start their four-year MPharm degree programme and McLernons supply all the dispensing systems used in their ‘mock’ community pharmacy and the dispensing software in one of the teaching laboratories.
Prof Lezley-Anne Hanna said, “The new (2021) ‘Standards for the initial education and training of pharmacists’ mean that we are educating students to be pharmacist independent prescribers at the point of professional registration. Therefore, we have transformed our MPharm degree programme to encompass prescribing skills and attributes, and ensure students have greater opportunities for experiential learning in patient-facing practice and interprofessional learning. Given these changes, we use simulation-based learning and teaching much more than we did in the past and strive to make the learning environment reflective of real-world practice.”
“Using MPS means that our students can learn in a safe, authentic environment using the sector leading software. The McLernons' systems are also used as part of our pharmacy practice assessments. We deem this gives students an excellent grounding for their future practice.”
“We place a great value on our relationship with McLernons, their support is exemplary and they are a very reliable IT partner. We need a good relationship with our vendor so that any issues we may have can be resolved quickly without compromising the student experience and are delighted that team at McLernons constantly exceed our expectations.”
Trinity College Dublin
The School of Pharmacy at Trinity College Dublin has had many shapes and guises with the first intake to a dedicated pharmacy Degree happening in 1977 and it is the oldest School of Pharmacy in Ireland.
McLernons first donated pharmacy systems for use in the Pharmaceutics Lab in 2010 and the MPS dispensing systems are now used on over 50 systems used throughout the School, in the dispensing lab and model pharmacy as well as pharmaceutics.
Associate Professor Cicely Roche said, “At Trinity, we place an emphasis on the integration of science with pharmacy practice in order to best prepare students to derive professional judgement in practice from the concurrent evidence base.”
“Having MPS systems in the School provides a space for students to learn in an environment where they feel safe. We want to expose them to challenges and different scenarios in order to really embed their learning, giving them the opportunity to make mistakes and to learn from those mistakes”, said Associate Professor Sheila Ryder. “Students value the opportunity to come in to the lab and practice – they can they work in a community pharmacy with confidence and a familiarity with the MPS software.”
Cicely added, “We are very grateful for the many years of support that McLernons has given both to the School of Pharmacy and to the students who have passed through it.”
Royal College of Surgeons in Ireland
The RCSI was founded by Royal Charter in 1784 to set and support professional standards for surgical training and practice. It has been at its current home at 123 St Stephen’s Green since 1810 and the School of Pharmacy opened in 2002. The 5 year M.Pharm course is clinically focused from the outset, with second year students completing their community pharmacy placement over a 12-week period rather than in one full two-week block. This allows them to align their practical experiences each week with what they learn on campus.
In the Summer of 2024 the School made the decision to switch the dispensing software used in their training labs to McLernons MPS software. “At the RCSI we are solely focused on the health professions, with a very obvious ethos that everything that happens in the College is driven to achieve the best healthcare outcomes”, said Dr Shane Cullinan, Senior Lecturer. “We changed to MPS because we wanted to prepare our students for the work place – both in placements and post qualification.”
Louise Enright and Sheenagh McCarthy, Senior Pharmacy Technician Educators, explained why RCSI made the switch in Summer 2024 to McLernons dispensing software for their students. “We carried out extensive market research of the PMR systems available in Ireland, and agreed that McLernons would be best placed to meet our student’s needs, considering it is the predominant software used within the community pharmacy sector,” said Louise.
“It was a great experience working with the engineers in McLernons from start to finish!”
70 Kids Nutrition
Nutrition in Children
Vitamins, minerals and supplements (VMS) have always been an important category in the pharmacy with various benefits for not only adults but children of all ages from birth right up to the elderly.
Vitamins and minerals are important for healthy growth and development in children. Children who eat a well-balanced diet usually do not need a vitamin or mineral supplement. However, some children are at risk for deficiencies and may need a supplement.
Important Considerations
Parents should strive for a wellrounded diet to ensure their child meets the daily recommended vitamin and mineral intakes. A balanced diet includes dairy or dairy alternatives, fruits and vegetables, whole grains and protein foods such as poultry, fish, eggs, nuts and legumes including beans and lentils. While all vitamins and minerals are important for growth and development, some are especially critical for children. It is generally recommended that all children aged 6 months to 5 years are given vitamin supplements containing vitamins A, C and D every day. Babies who are having more than 500ml (about a pint) of infant formula a day should not be given vitamin supplements. This is because formula is fortified with vitamins A, C and D and other nutrients.
Vitamin D
Vitamin D, the sunshine vitamin, is a very powerful immune modulator which means it helps our immune system to work properly. While we’re all topped up over the
summer, these stores will only last for 30 to 60 days. Indeed, the World Health Organisation advice is to get 5 to 15 minutes of casual sun exposure to hands, face and arms two to three times a week during the summer months.
We are unable, however, to make Vitamin D effectively from November to March and as a result, it is important to eat Vitamin D rich foods, such as eggs, oily fish including salmon, mackerel and trout, and fortified foods.
The Food Safety Authority of Ireland recommends that food, including supplements needs to deliver 10ug (400IU) of Vitamin D per day for everyone over 5 years of age. 100g of salmon, for example, provides 8ug, one egg provides 2ug and a 200ml glass of fortified milk provides 4ug. If consumption of these foods is sporadic, it would be a good idea to supplement over the winter months with a vitamin D spray, drops or tablet.
Fish Oils
Omega-3s are fatty acids that are important to many aspects of health, including foetal development, brain function, heart health, and immunity.
They’re considered essential fatty acids because your body cannot produce them on its own and needs to obtain them from food. The three main types are alpha-linolenic acid (ALA),
eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA). ALA is present in a variety of plant foods, including nuts, such as walnuts, and seeds, such as ground flaxseed, chia seed and pumpkin seeds. Meanwhile, EPA and DHA occur naturally in fatty fish, such as salmon, mackerel, and tuna, and are widely available in supplements.
Studies have shown a possible link between Omega-3 fatty acids and reduced asthma risk in children, brain development and mood modulation. In addition, the anti-inflammatory effect of Omega 3 has been studied widely. Ensuring that children are eating oily fish at least twice per week ensures that they can benefit from this essential nutrient.
Probiotics
If you think about it, our digestive tract is effectively ‘the outside’, so our digestive system plays a very important role in keeping bacteria, yeasts and viruses, that we inadvertently consume, away from the rest of our body.
If the gut lining is the castle wall, our ‘good’ bacteria, along with our immune system, are the soldiers at the gate.
Not only do our ‘good bacteria’ help our digestive system to clear out the waste every day, they also ‘feed’ the cells in our gut, helping the gut lining stay healthy so that it can do its job and keep any pathogens out. They also crowd out any bad bacteria and create an acidic environment that is more favourable to their own growth. A virtuous cycle.
Fibre
Interestingly, a way to increase your ‘good’ bacteria is to give them the food that they particularly like; fibre. By including a range of different coloured fruit and vegetables in their diet, or even hidden in tomato sauces or smoothies, you can help to feed their good bacteria.
Start the academic year by printing off an ‘Eat a Rainbow’ chart and start ticking off all the different colour fruits and vegetables you eat per day, no matter how small a piece it is. Incorporating a variety into smoothies, or hidden vegetable sauces, is a great way to boost your ‘good’ bacteria. Fibre is also
found in beans, legumes, lentils, nuts, seeds and wholegrains.
Iron Deficiency
Recent studies found that half of Irish 2-year-olds have low levels of iron. Almost 1 in 10 suffer from anaemia because of this.
Anaemia is a condition in which the amount of red blood cells in the body is decreased below normal for a child's age. It can make the child appear pale in colour and feel cranky, tired, or weak. The most common causes of anaemia, such as iron deficiency are generally easy to treat, especially when it is detected early.
Because rapid growth is a potential cause of the condition, the first year of life and adolescence are two age groups where infants and children are especially prone to anaemia.
Below is a table illustrating how much daily iron a child should have each day.
Age group Recommended amount of iron a day
7-12 months 11mg
1-3 years 7mg
4-8 years 10mg 13 years 8mg
14-18 years 15mg (girls)
14 - 18 years 11mg (boys)
What are the common signs and symptoms of anaemia?
• Pale or sallow (yellow) skin
• Pale cheeks and lips
• Lining of the eyelids and the nail beds may look less pink than normal
• Irritability
• Mild weakness
• Tiring easily, napping more frequently
Red meat is the best source of iron. Children should be offered this 3 times a week. Beef, lamb, pork and poultry are good sources of iron. Iron supplements are also available, especially for those children who may be vegetarian, vegan, following a plant-based diet or when their iron is very low.
Iron for Kids.
Pharmacy Recommendations in Wake of Stoptober
Pharmacists have a crucial role to play in tobacco and nicotine use cessation in order to reduce the heavy burden of non-communicable diseases, FIP has said in a new statement of policy published last month.
The policy statement makes recommendations for pharmacists, pharmaceutical organisations, pharmacy educators, governments, policy makers, regulatory agencies and healthcare funders to facilitate and support roles for the pharmacy profession in supporting the cessation of tobacco and nicotine use. It updates the 2003 FIP policy statement and builds on a joint statement by FIP and the World Health Organization which was adopted in May 2024.
“Use of tobacco remains a significant public health issue. Recognising the preventable nature of the harms of tobacco and tobacco-related products, this statement highlights pharmacists’ roles and further potential in reducing diseases and premature deaths linked to their
use. Pharmacists are uniquely positioned to influence public health through patient education, personalised support and pharmacological interventions.
“They can enhance cessation success rates through identifying individuals who use tobacco and nicotine, assessing their readiness to quit, and providing structured cessation programmes,” said Lars-Åke Söderlund, FIP vice president and co-chair of the policy committee.
“FIP also makes several commitments in the statement, including to promote scientific research and education to advance effective tobacco cessation interventions, to continue advocating the utilisation of pharmacists in tobacco cessation strategies, and to
continue supporting the work of pharmacists and FIP member organisations though a range of resources,” Mr Söderlund added.
Meanwhile, it was announced that approval has been granted from Government to draft legislation introducing further restrictions on nicotine inhaling products or vapes. The General Scheme for a Nicotine Inhaling Products Bill proposes:
• A prohibition on point-of-sale display and advertising in shops other than those who only or primarily sell these products.
• Restrictions on colours and imagery on packaging and devices, as well as a ban on devices resembling or functioning as other products, such as toys or games.
• A prohibition on all flavour descriptors and language other than basic flavour names.
• A limit on flavours in nicotine inhaling products to tobacco, with provisions to amend the list of allowed flavours as new evidence presents.
• A prohibition on the import, manufacture and sale of singleuse or disposable vapes.
Minister for Health, Stephen Donnelly said, “As a Government we introduced a ban on the sale of nicotine inhaling products to under 18s. However we must go further and this legislation will tackle the rise in the use of ’vapes’ among children and young people by reducing their attractiveness and availability. Nicotine is addictive and the long-term effects of these products is not yet known, so it is important to act.
“I know that some adult smokers use nicotine inhaling products to quit smoking so these products, other than disposable vapes, will continue to remain available. The measures I am taking are to reduce use among the youth, so that our children can grow up without the risks associated with these products.”
Stoptober – now in its 13th year –aims to empower people to give up smoking during October, as evidence shows people are 5 times more likely to quit for good if they can make it to at least 28 days smoke free.
Research shows that selfconfidence is a major factor in successful attempts at quitting smoking. This year’s campaign will encourage people to take simple steps to help build their confidence and get the support they need from family and friends, as well as professional help, to stop smoking for good.
Tobacco use is the leading cause of preventable death in Ireland with almost 6,000 smokers dying each year from tobacco related diseases. Smoking related deaths are mainly due to cancers, chronic obstructive pulmonary diseases (COPD) and heart disease. Cigarettes contain over 4000 toxic chemicals, many of which are proven to cause cancer. Smoking harms nearly every organ of the body, causing many different illnesses and diseases.
Reference: 1. Nicorette® Lozenge SmPC.
Nicorette Cools 2 mg Lozenge. Composition: Each lozenge contains 2 mg nicotine (as nicotine resinate). Compressed lozenge (lozenge). Indications: to be used for the treatment of tobacco dependence by relief of nicotine withdrawal symptoms and cravings in smokers 18 years and above. Permanent cessation of tobacco use is the eventual objective. Nicorette Cools 2 mg Lozenges should preferably be used in conjunction with a behavioural support programme. Dosage: Selecting the strength of lozenge to be used will depend on the smoking habits of the individual. Adults: Nicorette Cools 2 mg Lozenges are suitable for smokers with low nicotine dependency e.g. those smoking their first cigarette of the day more than 30 minutes after waking up or those who smoke 20 cigarettes or less per day. Lozenges should not be used for more than 9 months. If users still feel the need for treatment, a healthcare professional should be consulted. Behavioural therapy advice and support will normally improve the success rate. Abrupt cessation of smoking: The patient should make every effort to stop smoking completely during treatment with Nicorette Cools Lozenges. The lozenges should be used whenever there is an urge to smoke. Sufficient lozenges should be used each day and most smokers usually require 8 to 12, not to exceed 15 lozenges. The duration of treatment is individual, but up to six weeks treatment is recommended to break the habit of smoking. The nicotine dose should then be gradually reduced, by decreasing the total number of lozenges used per day. The treatment should be stopped, when the daily consumption is down to 1-2 lozenges. Use a lozenge whenever there is an urge to smoke to maintain complete abstinence from smoking. In the event of sudden cravings any spare lozenges should be retained and used whenever there is a craving or an urge to smoke. Gradual cessation through progressive reduction in smoking: For smokers who are unwilling or unable to quit abruptly. Use a lozenge between smoking episodes to manage the urge to smoke, to prolong smoke-free intervals and with the intention to reduce smoking as much possible. The number of lozenges a day is variable and depends on the patients needs. Nonetheless it should not exceed 15 lozenges per day. If a reduction in number of cigarettes per day has not been achieved after 6 weeks, professional advice should be sought. Reduced tobacco consumption should lead to complete cessation of smoking. A quit attempt should be made as soon as the smoker feels ready, but not later than 6 months after start of treatment. When the number of cigarettes has been reduced to a level from which the user feels able to quit completely, then the schedule for “abrupt cessation” as given above should be started. If the attempt to stop smoking completely has not been started within 6 months after the beginning of treatment, it is recommended to consult a healthcare professional. Paediatric population: Nicorette Cools 2 mg Lozenges should only be used by adolescents (12-17 years inclusive) with advice from a healthcare professional. Nicorette Cools Lozenges are not to be used by children below the age of 12. The safety and efficacy of Nicorette Cools 2 mg Lozenges in children and adolescents has not been investigated. One lozenge should be placed in the mouth and allowed to dissolve. Periodically, the lozenge should be moved from one side of the mouth to the other, and repeated, until the lozenge is completely dissolved (approximately 16-19 minutes). The lozenge should not be chewed or swallowed whole. Users should not eat or drink while a lozenge is in the mouth. Contraindications: Hypersensitivity to nicotine or to any of the excipients. Children under the age of 12 years. Those who have never smoked. Special warnings and precautions for use: The benefits of quitting smoking usually outweigh any risk associated with correctly administered nicotine replacement therapy (NRT). A risk-benefit assessment should be made by an appropriate healthcare professional for patients with the following conditions: Cardiovascular disease: Dependent smokers with a recent myocardial infarction, unstable or worsening angina including Prinzmetal’s angina, severe cardiac arrhythmias, recent cerebrovascular accident and/or who suffer with uncontrolled hypertension should be encouraged to stop smoking with nonpharmacological interventions (such as counselling). If this fails, Nicorette Cools 2 mg Lozenge may be considered but as data on safety in this patient group are limited, initiation should only be under close medical supervision. Diabetes Mellitus. Patients with diabetes mellitus should be advised to monitor their blood sugar levels more closely than usual when smoking is stopped and NRT is initiated as reduction in nicotine induced catecholamine released can affect carbohydrate metabolism. Allergic reactions:
NICORETTE LOZENGE STARTS TO FIGHT CRAVINGS IN JUST 2 MINUTES 1
Susceptibility to angioedema and urticaria. Renal and hepatic impairment: Use with caution in patients with moderate to severe hepatic impairment and/or severe renal impairment as the clearance of nicotine or its metabolites may be decreased with the potential for increased adverse effects. Phaeochromocytoma and uncontrolled hyperthyroidism: Use with caution in patients with uncontrolled hyperthyroidism or phaeochromocytoma as nicotine causes release of catecholamines. Gastrointestinal Disease: Swallowed nicotine may exacerbate symptoms in patients suffering from oesophagitis, gastric or peptic ulcers and oral NRT preparations should be used with caution in these conditions. Seizures: Use with caution in subjects taking anti-convulsant therapy or with a history of epilepsy as cases of convulsions have been reported in association with nicotine. Lozenges can represent a choking hazard. Use with caution in individuals with aspiration and swallowing problems. Paediatric population: Danger in children: Doses of nicotine tolerated by smokers can produce severe toxicity in children that may be fatal. Products containing nicotine should not be left where they may be handled or ingested by children. Stopping Smoking: Polycyclic aromatic hydrocarbons in tobacco smoke induce the metabolism of drugs metabolized by CYP 1A2 (and possibly by CYP 1A1). When a smoker stops smoking, this may result in a slower metabolism and a consequent rise in blood levels of such drugs. This is of potential clinical importance for products with a narrow therapeutic window, e.g. theophylline, tacrine, clozapine and ropinirole. Transferred dependence: Transferred dependence is unusual and is both less harmful and easier to break than smoking dependence. Excipients: This medicine contains less than 1 mmol sodium (23 mg) per lozenge, that is to say essentially ‘sodiumfree’. Undesirable effects: Effects of smoking cessation: Regardless of the means used, a variety of symptoms are known to be associated with quitting habitual tobacco use. These include emotional or cognitive effects such as dysphoria or depressed mood; insomnia; irritability, frustration or anger; anxiety; difficulty concentrating, and restlessness or impatience. There may also be physical effects such as decreased heart rate; increased appetite or weight gain, dizziness or presyncopal symptoms, cough, constipation, gingival bleeding or aphthous ulceration, or nasopharyngitis. In addition, and of clinical significance, nicotine cravings may result in profound urges to smoke. The Nicorette Cools Lozenge may cause adverse reactions similar to those associated with nicotine given by other means. Most of the undesirable effects reported by the subjects occur during the early phase of treatment and are mainly dose dependent. Irritation in the mouth and throat may be experienced, however most subjects adapt to this with ongoing use. Allergic reactions (including symptoms of anaphylaxis) occur rarely during use of Nicorette Cools Lozenge. Immune System Disorders Common Hypersensitivity Not known Allergic reactions including angioedema and anaphylaxis Psychiatric disorders Uncommon Abnormal dream Nervous system disorders Very common Headache Common Dysgeusia, paraesthesia Unknown Seizure* Eye disorders Not known Blurred vision, lacrimation increased Cardiac Disorders Uncommon Palpitations, tachycardia, atrial fibrillation Vascular disorders Uncommon Flushing, hypertension Respiratory, thoracic and mediastinal disorders Very common Cough, hiccups, throat irritation Uncommon Bronchospasm, dysphonia, dyspnoea, nasal congestion, oropharyngeal pain, sneezing, throat tightness Gastrointestinal disorders Very common Nausea, mouth/throat and tongue irritation Common Abdominal pain, dry mouth, diarrhoea, dyspepsia, flatulence, salivary hypersecretion, stomatitis, vomiting, heartburn Uncommon Eructation, glossitis, oral mucosal blistering and exfoliation, paresthesia oral Rare Dysphagia, hypoaesthesia oral, retching Not known Dry throat, gastrointestinal discomfort, lip pain Skin and subcutaneous tissue disorders Uncommon Hyperhidrosis, pruritus, rash, urticaria Not known Erythema General disorders and administration site conditions Common Burning sensation, fatigue Uncommon Asthenia, chest discomfort and pain, malaise. * Cases of seizures have been reported in subjects taking anti-convulsant therapy or with a history of epilepsy. Marketing Autorisation Holder: JNTL Consumer Health I (Ireland) Ltd., Block 5, High Street, Tallaght, Dublin 24, Ireland. PA Number: PA23490/019/011. Date of revision of text: June 2024. Product not subject to medical prescription. Supply through pharmacy and non-pharmacy outlets. Further information available upon request.
PHX Ireland Recognition Awards
Celebrating colleague dedication, collaboration, and commitment to delivering health
PHX Ireland recently held their recognising people awards in the Mansion House, Dawson Street. The awards celebrated the positive impact, dedication, and unwavering commitment to the PHX Ireland mission of delivering health and showcased the heroes who make a difference every day.
Across all PHX Ireland companies, the shared belief is that “the way we work makes us who we are”. Therefore, the awards are built to reflect the shared company values, which were launched earlier this year: customer focused, quality driven, collaborative, ambitious, innovative, and inclusive. They reflect the vibrancy, and energy of the team working together to deliver the company’s mission to deliver health, support their customers, while making a difference to patients, communities, and each other.
Overall, there were four hundred and sixty-five nominations made across PHX Ireland by teammates in TCP Homecare, LloydsPharmacy Ireland and United Drug - before sixty-five finalists were selected.
Almost three hundred people attended the awards night which kicked off in style with guests greeted by whopping entertainment. After a welcome cocktail, guests were seated for the awards presentation, hosted by Darren Kennedy. Darren was joined on stage by CEO Paul Reilly who shared a few words of acknowledgement, commending all teammates on their hard work and dedication. The country board participated in recognising each finalist within their respective categories and congratulated each of the winners.
There were eight individual awards for colleagues nominated by their peers, including the Customer Focused Award, Quality Driven Award, Collaborative Award, Ambitious Award, Innovative Award, Inclusive Award, Team of the Year and Employee of the Year. A new award was presented on the night to recognise the fantastic work of the McCabe’s teammates, following the acquisition earlier this year. The ‘McCabe’s Way’ award sets to honour the achievements of teams and individuals who go above and beyond to serve and support patients of McCabe’s Pharmacy each and every day.
These were awarded to Anita Duff, from McCabes Dundrum and the McCabes Limerick Pharmacy Team.
The Team had the pleasure to welcome Dr. Christina Froboese, Director of Strategic Initiatives from PHOENIX group to introduce and present, for the first time, the ‘We Deliver Health’ Award, which was established in recognition of the company values. This award acknowledges a team or individual who exemplifies the mission statement through their actions This new award celebrates the spirit of excellence that drives the company forward, recognising those who live the core values and contribute to the company mission of “we deliver health”
The thirteen teammates and teams of the PHX Ireland Recognising People Awards were:
1. customer focused - Carmel O’Shea, LloydsPharmacy Nutgrove Shopping Centre
2. quality driven – Emmett O’Driscoll, LloydsPharmacy Northside Shopping Centre
3. collaborative – UDW Operations Manager Team, United Drug Wholesale
4. ambitious – Christine Flynn, United Drug Consumer
5. innovative – Sarah Kenny, LloydsPharmacy Operations
6. inclusive – Elizabeth Mahon, HR, PHX Ireland
7. employee of the year – Sheona Ryan, Finance, PHX Ireland
8. team of the year – TCP Oncology Team (TCP Homecare, Nursing/Pharmacy/ Logistics/PCB)
9. spirit of phx – Ester Lugemba, LloydsPharmacy Lucan
10. spirit of phx – One View of Customer Project Team, PHX Ireland, Procurement/Quality
11. we deliver health –Roxboro Pharmacy Team, LloydsPharmacy Roxboro Shopping Centre
12. the McCabes way – Anita Duff, McCabes Dundrum
13. the McCabes way – McCabes Limerick Pharmacy Team
Local recognition and celebrations of all finalists will continue with leadership and management teams and work is underway for the launch of the 2025 Awards nomination process, as the team at PHX Ireland build upon the success of this year.
The PHX Ireland Recognition Awards are an integral part of the ourpeople and the ourpeople - recognising you event has been positively received by all employees.
PHX Ireland Group Limited comprises United Drug, Ireland’s leading pharmaceutical wholesaler and distributor; LloydsPharmacy Ireland and McCabes Pharmacy - a major community pharmacy chain; and TCP Homecare, innovators in clinical home nursing services and direct to patient delivery solutions.
Polycystic Ovary Syndrome
Written by Dr Rachel Byrne and Dr Niamh Phelan. Department of Endocrinology, St James’s Hospital, Dublin
Introduction
Polycystic ovary syndrome (PCOS) is the most common endocrinological condition seen in women of reproductive age affecting 8-13% of women in this cohort. In Ireland it is reported to affect 128 in 100’000 women, but a higher incidence is seen in women of eastern European and Asian descent. It is a complex condition with endocrine, reproductive and metabolic health implications.
Pathogenesis
The cause of PCOS is not fully understood, but is thought to be a multifactorial relationship between genetic predispositions, lifestyle and environmental factors. A complex interplay between insulin resistance and androgen excess appears to be a key driver in the pathogenesis of PCOS. Abnormalities in gonadotrophin releasing hormone (GnRH) pulsation and gonadotrophin secretion with raised luteinising hormone (LH) compared to follicle stimulating hormone (FSH) leads to impaired folliculogenesis, ovulatory dysfunction and increased ovarian
androgen synthesis. This results in a vicious cycle as androgen excess further exacerbates abnormal GnRH pulsation. Insulin resistance enhances ovarian androgen production from theca cells and inhibits hepatic sex hormone binding globulins (SHBG) production thereby increasing circulating free androgens.
Clinical manifestations
PCOS can have a varied clinical presentation. It most often presents in the teenage years/early to mid20s but many women will not seek medical advice for many years so it is not unusual to diagnose in women in their 30’s. The most common symptoms are menstrual irregularity with oligomenorrhea/ amenorrhoea but some women have polymenorrhoea. Features of androgen excess including acne, hirsutism and androgenic alopecia are also common presenting complaints. For some women fertility issues may be the initial presentation. Women with PCOS may also have secondary metabolic effects of PCOS including obesity, diabetes, hyperlipidaemia or obstructive sleep apnoea. There
are also significant psychological impacts from PCOS, particularly around fertility, obesity and overall body image.
Diagnosis
There are a number of diagnostic criteria for PCOS, but the most widely accepted is the Rotterdam criteria. This criterion requires at least two of the three following features for diagnosis: 1. Biochemical or clinical features of hyperandrogenism 2. Ovulatory dysfunction 3. Polycystic ovaries on ultrasound with exclusion of other potential causes. The most important conditions to exclude
are late-onset (non-classic) congenital adrenal hyperplasia (CAH), androgen secreting tumours, Cushing’s syndrome, hyperprolactinaemia and thyroid disorders. A thorough history, clinical examination and initial laboratory investigations outlined in Table 1 will guide further investigations if needed.
Table 1: Recommended investigations for diagnosis of PCOS and for exclusion of alternate causes
Initial Laboratory investigations
• LH, FSH and oestradiol
• Androgens: Testosterone, Androstenedione, DHEAS
• Prolactin
• Thyroid function tests
• 17 hydroxyprogesterone (to outrule CAH)
Further tests if indicated
• Dexamethasone suppression test (to outrule Cushing’s)
The recent 2023 international consensus guidelines suggest the stepwise approach outlined in figure 2 for diagnosis. Ovulatory dysfunction is characterised by irregular menstruation with cycles <21 or >35 days apart or <8 menses a year in women who are at least 3 years post menarche. For adolescents between 1-3 years post menarche, cycles <21 or >45 days are considered irregular. It is important to note that pelvic ultrasound is not required for the majority of patients in order to make a diagnosis of PCOS.
Dr Rachel Byrne
Dr Niamh Phelan
Figure one: Pathogenesis of PCOS. Image source: Miyuki Harada. Pathophysiology of polycystic ovary syndrome revisited: Current understanding and perspectives regarding future research. 2022.
Polycystic ovarian morphology is defined as ≥20 follicles per ovary in either ovary and/or ≥10 cm3 ovarian volume based on transvaginal ultrasonography. However, 20-40% of normal healthy women may have polycystic ovarian morphology (PCOM) on ultrasound but do not have PCOS.
Management
Treatment is aimed at tackling the varying symptoms of PCOS and these may change throughout a patient’s lifetime. However, a particular continual focus should be to promote a heathy lifestyle to prevent weight gain and metabolic complications, improve fertility potential and reduce pregnancy complications.
Metabolic Health
Lifestyle factors should firstly be addressed with the promotion of healthy diet and exercise. Research has shown that a modest weight loss of up to 5% of body weight improves insulin sensitivity and reduces hirsutism. It can also lead to recovery of a normal menstrual cycle and restoration of fertility. Weight loss is therefore a key initial management of PCOS. This is best approached by linking with dieticians and exercise programs. Consideration can also be given to the addition of medications such as glucagon-like peptide-1 (GLP1) agonist to aid weight loss. Unfortunately, these medications must be self-funded in Ireland when used for obesity and ongoing supply issues pose a challenge. For women seeking fertility, GLP1 agonist must be stopped at least 8 weeks prior to conception as the safety of these agents in pregnancy is unknown. In more difficult cases, surgical options for weight loss can also be explored.
All women with PCOS should be considered as at increased risk for cardiovascular disease and should have assessment of cardiovascular risk factors including blood pressure, lipids and screening for diabetes regardless of age and BMI. Obstructive sleep apnoea is also more common in women with PCOS and again can occur in women with normal BMI.
Irregular menses
In women with PCOS who are not seeking fertility, it is important to manage amenorrhoea/ very infrequent menses due to the risk of endometrial hyperplasia. Women with PCOS are five times more likely to develop endometrial carcinoma because of endometrial hyperplasia which can occur due to chronic exposure to oestrogen which is unopposed by progesterone in women with infrequent menses. To reduce this risk, it is recommended to ensure women with PCOS have a menstrual bleed at least once every three months. Strategies to achieve this include weight loss, hormonal contraceptives, regular progesterone therapy or hormonal intrauterine device (IUD).
Hormonal contraceptives are generally considered first line for regulation of the menstrual cycle. Combined oral contraceptive pills (COCP) also help to manage symptoms of androgen excess in a number of ways. Firstly, the progesterone component inhibits LH and in turn reduces ovarian androgen production. The oestrogen component increases SHBG levels and therefore reduces free androgen concentrations. However, many women may not be suitable for COCP due to risk of thromboembolic events or be intolerant, so the other options include the progesterone only pill or insertion of a hormonal IUD. Hormonal IUDs contain progesterone which maintains a
thin endometrial lining and since they are an effective contraceptive, they can be used in conjunction with antiandrogens.
Androgenic features
Androgenic features of PCOS (acne, hirsutism and androgenic alopecia) respond to COCPs which are usually the first line agent of choice. However, another option in those not suitable for COCP, those intolerant or where they have proved ineffective is to add an anti-androgen such as spironolactone, provided effective contraception is in place. Others antiandrogens such as cyproterone acetate or finasteride could also be considered but have a more deleterious side effect profile. These inhibit the binding of testosterone to the androgen receptor, thus reducing the features of hirsutism and acne. The recommended starting regime is Spironolactone 25mg once a day increasing up to 100mg once a day.
There are a number of options for mechanical removal of troublesome hair growth. These include shaving, waxing and electrolysis. Laser therapy is another option and often proves superior due its long-term impact. Topical elfornithine 11.5% which targets the hair follicle and slows hair growth may also be beneficial particularly if used in conjunction with mechanical removal. Patients should also be warned this can result in irritation of the skin and can take up to 8 weeks before any benefits are noted.
Treatment for acne should not be forgotten nor delayed during the holistic approach to PCOS. Delay in treatment can lead to unduly emotional and psychological distress as well as increase the risk of long-term scarring. In addition to the standard approach to acne management, women with PCOS
Figure two: Diagnostic algorithm in PCOS. Image source: Recommendations From the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome
should be offered combined oral contraceptives and antiandrogens as targets for the underlying hyperandrogenism.
Metformin and inositol
The use of metformin in PCOS is controversial with many conflicting studies published around its long-term benefits. Metformin undoubtedly reduces insulin resistance and has been shown to reduce visceral fat and overall body weight, however these effects are only significant when used in conjunction with lifestyle modifications. Metformin is also reported to improve ovulatory function, thus aiding fertility, however when compared to ovulation induction with clomiphene/ letrozole or gonadotrophins, metformin alone is inferior. Overall, there seems to be some benefit in the addition of metformin but only in tandem with other targeted therapies and lifestyle optimisation. Inositol supplementation could also be considered in PCOS. Early evidence has shown it can help tackle the metabolic syndrome, however there is limited evidence to suggest it helps with fertility, hyperandrogenism or obesity. It is therefore not recommended ahead of metformin but may be considered in addition to or when metformin is poorly tolerated due to gastrointestinal side effects.
Fertility treatment
70-80% of women with PCOS are reported to experience some degree of infertility, while PCOS is responsible for 75-80% of all infertility cases relating to anovulation. It is therefore very important that clinicians do not delay in referral for fertility support for PCOS patients. Prior to commencing fertility treatment, it is imperative that other causes of subfertility are ruled out. This includes tubal patency testing and
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Nytol One-A-Night 50 mg Tablets contains diphenhydramine hydrochloride. A symptomatic aid to the relief of temporary sleep disturbance in adults. Adults: One tablet to be taken 20 minutes before going to bed, or as directed by a physician. Do not exceed the maximum dose of one tablet in 24 hours. Elderly patients or patients with liver or kidney problems should consult their doctor before taking this medicine. Children under 18 years: Not recommended. The product should not be taken for more than 7 days without consulting a doctor. Contraindications: hypersensitivity to the active substance or to any of the excipients, stenosing peptic ulcer, pyloroduodenal obstruction, phaeochromocytoma, known acquired or congenital QT interval prolongation, known risk factors for QT interval prolongation. Special warnings and precautions: pregnancy/lactation, renal and hepatic impairment, myasthenia gravis, epilepsy or seizure disorders, narrow-angle glaucoma, prostatic hypertrophy, urinary retention, asthma, bronchitis, COPD. Patients should be advised to promptly report any cardiac symptoms. Tolerance and / or dependence may develop with continuous use. Do not take for more than 7 consecutive nights without consulting a doctor. Should not be used in patients currently receiving MAO inhibitors (MAOI) or patients who have received treatment with MAOIs within the last two weeks. Use in the elderly should be avoided. Avoid concomitant use of alcohol or other antihistamine-containing preparations. Do not drive or operate machines. Cases of abuse and dependence were reported in adolescents or young adults for recreational use and/or in patients with psychiatric dis-orders and/or history of abuse disorders. Contains lactose. May suppress the cutaneous histamine response to allergen extracts and should be stopped several days before skin testing. Interactions: Alcohol, CNS depressants, MAO inhibitors, anticholinergic drugs (e.g. atropine, tricyclic antidepressants), metoprolol and venlafaxine, CYP2D6 inhibitors, Class Ia and Class III anti-arrhythmics. Side effects: dry mouth, fatigue, sedation, drowsiness, disturbance in attention, unsteadiness, dizziness, thrombocytopenia, hypersensitivity reactions, confusion, paradoxical excitation, convulsions, headache, paraesthesia, dyskinesias, blurred vision, tachycardia, palpitations, thickening of bronchial secretions, gastrointestinal disturbance, muscle twitching, urinary dif culty, urinary retention. Product not subject to medical prescription. PA1186/016/001. MAH: Chefaro Ireland DAC. The Sharp Building. Hogan Place. Dublin 2. Ireland. Date of preparation: Nov. 2023. SPC: https://www.medicines.ie/medicines/nytol-one-a-night-50-mg-tablets-34889/spc MAT-5204
Figure 3: infertility algorithm for PCOS. Image source: Recommendations From the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome
semen analysis. As mentioned previously lifestyle improvement is key to fertility optimisation. The cornerstone of this is weight management, ensuring smoking and alcohol cessation as well as commencing high dose 5mg folic acid daily prenatally in obesity. The 2023 international consensus guidelines outline an algorithm for approaching infertility in PCOS (Figure 3). First line medical management of infertility is Letrozole, which is recommended before clomiphene due to the lower risk of multiple pregnancy. Metformin can also be added to clomiphene and is shown to be more effective than clomiphene alone. Further approaches are based on the presence or absence of ovulation. If ovulation is not achieved, ovulation induction with gonadotrophins and follicular tracking is recommended. If ovulation is detected repeated cycles of these medications is recommended before moving to assisted reproductive technologies (ART) such as in vitro fertilisation (IVF) +/- intracytoplasmic sperm injections. Recent research has shown that although more people with PCOS are using fertility treatments (38%) compared to those without PCOS (13%), the birth rate is the same across both groups. Therefore, with careful management and optimisation of fertility treatments PCOS patients can go on to have healthy and successful pregnancies.
Conclusion
Polycystic ovary syndrome is a common and underdiagnosed condition amongst women, resulting in menstrual irregularities, androgenic features, subfertility, and long-term metabolic health
complications. Early consideration and workup are imperative for prompt diagnosis and initiation of treatment. PCOS patient’s care needs are very likely to vary and develop throughout their journey, therefore a holistic and flexible
management approach is key to ensure these needs are met across each juncture in their lives.
Key further reading: Recommendations From the 2023 International Evidence-based
Guideline for the Assessment and Management of Polycystic Ovary Syndrome. Eur J Endocrinol. 2023 Aug;189 (2):G43-G64. doi: 10.1093/ejendo/lvad096.
References available on request
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
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ASTELLAS INITIATES PHASE 3 CLINICAL STUDY OF FEZOLINETANT FOR VMS IN WOMEN WITH BREAST CANCER RECEIVING ADJUVANT ENDOCRINE THERAPY
Astellas Pharma has recently announced dosing of the first patient in the HIGHLIGHT 1™ Phase 3 pivotal study for fezolinetant, an investigational oral, nonhormonal compound being studied for the treatment of moderate to severe vasomotor symptoms (VMS) in women with breast cancer receiving adjuvant endocrine therapy.
Breast cancer is the most common cancer in women globally, with approximately 2.3 million new cases in 2022. Hot flashes and night sweats, also known as VMS, are recognized as the most prominent side effect of adjuvant endocrine therapies used in the treatment of breast cancer. Approximately 77% of breast cancers can be treated with adjuvant endocrine therapies, most commonly tamoxifen and aromatase inhibitors, and up to 97% of breast cancer patients experience hot flashes or night sweats.
Marci English, Vice President, Head of BioPharma Development, Astellas “VMS can adversely affect quality of life, as well as compliance with treatment, for patients with breast cancer taking adjuvant endocrine therapy. We are excited to get the HIGHLIGHT 1 study underway, as currently there are no approved treatments for moderate to severe VMS that can be used by these patients.”
NEED TO SUPPORT FUTURE TECHNOLOGIES IN SURGERY
A new report from the Royal College of Surgeons in Ireland (RCSI) has heard from surgeons across a range of specialties and training stages about how technology is changing surgery.
The study explores the current technology-enabled trends that are
enabling surgery and improving patients’ lives and also what is needed to ensure surgeons can use emerging and new technologies into the future.
The New Technologies for Future of Surgery in Ireland RCSI Working Group Report 2024 engaged with 30 surgeons, surgical trainees and researchers across a range of disciplines.
Their responses identified biomaterials, robotics and digital platforms for collaboration as the most important current technologies for surgery, followed by data analytics and 3D-reconstructive models for planning operations.
Looking forward, the study participants believe that artificial intelligence, wearables, virtual/ augmented-reality displays and genomic analysis will be of great importance for surgery over the next decade.
Based on the study, surgeons are generally excited by the opportunities for more personalised and less invasive surgeries and across the board their interest in new technologies is being driven by the desire to improve patient care and outcomes.
However, the study respondents also highlighted potential challenges such as the steep learning curve for surgeons, data security and overreliance on or inappropriate use of technology. They also conveyed general concern about the ability of surgeons and their units to make best use of new/ disruptive technologies.
The majority of study participants believe that such technologies in surgery require a clear national strategy involving all stakeholders including the public, shared procurement considerations and they were concerned at current levels of investment.
Professor Ronan Cahill, RCSI Council Member and Chair of the Committee on New Technologies in Surgery in Ireland, described the work in the report as a first step in engagement. “Like everywhere else in society, technology is embedded in surgery with increasing capability coming onstream,” said Professor Cahill.
“With advances in computing power alongside improved patient diagnostics, including imaging and genomic analysis, the role of technology in surgery is set to accelerate further into the 21st century,” he added. “Such capabilities require consideration of training, working, implementation and administration.”
The New Technologies for Future of Surgery in Ireland RCSI Working Group Report 2024 also features a series of invited perspectives on surgical training and education, environmental impact, integrating innovation, the need for surgeons to adapt throughout their career and the medtech industry.
RCSI President Professor Deborah McNamara welcomed the insights expressed by surgeons in Ireland on new technologies for surgical practice. “Technologies are rapidly changing the landscape of surgery and RCSI has a leading role to play to ensure that our surgeons can practise, innovate and improve patient outcomes and lives in this fast-changing environment,” she said.
Marketing Authorization for PADCEVTM (enfortumab vedotin, an antibody-drug conjugate [ADC]) in combination with KEYTRUDA® (pembrolizumab, a PD-1 inhibitor) for the first-line treatment of adult patients with unresectable or metastatic urothelial cancer, who are eligible for platinum-containing chemotherapy.
The approval is based on results from the Phase 3 EV302 clinical trial (also known as KEYNOTE-A39) which showed that enfortumab vedotin in combination with pembrolizumab nearly doubled median overall survival (OS) and signficantly extended progression-free survival (PFS) compared to platinum-containing chemotherapy.
Dr. Thomas Powles, Barts Cancer Institute Biomedical Research Centre, UK
“Having an effective new firstline treatment for advanced urothelial cancer is opening a long-awaited new chapter in the management of this usually fatal disease. The impressive effects of the treatment combination were clearly seen during the Phase 3 clinical trial program, with enfortumab vedotin in combination with pembrolizumab significantly extending overall survival and progression-free survival compared to platinum-containing chemotherapy. I look forward to seeing the treatment combination implemented as a first-line regimen in the clinical setting.”
Alex Filicevas, Executive Director, World Bladder Cancer Patient Coalition
L-R Ms Debbie Killeen, Professor Deborah McNamara, Mr Kieran Ryan, Professor Ronan Cahill, Mr Ashokkumar Singarelvu, Professor Laura Viani, Dr Alice Moynihan
“The findings and insights from this report will help RCSI to shape our training programmes, to ensure we meet the needs of our current and future surgeons.”
The report was commissioned by immediate past president of RCSI, Professor Laura Viani during her term of office. The initiative involved 30 participants who answered survey questions with 17 of these taking part in more indepth interviews.
EUROPEAN COMMISSION APPROVES ASTELLAS’ PADCEVTM (ENFORTUMAB VEDOTIN) IN COMBINATION WITH KEYTRUDA® (PEMBROLIZUMAB) FOR FIRST-LINE TREATMENT OF ADVANCED UROTHELIAL CANCER
Astellas Pharma recently announced that the European Commission has granted
“Despite Europe having the highest reported rates of new bladder cancer cases in the world, awareness remains low, resulting in many patients only being correctly diagnosed at the stage of advanced disease. New treatment options are desperately needed to improve disease outcomes for these patients and provide hope for a better future for the whole bladder cancer patient community.”
Ahsan Arozullah, MD, MPH, Senior Vice President and Head of Oncology Development, Astellas
“In line with the recent updates to European clinical guidelines, we are delighted that the European Commission has approved enfortumab vedotin in combination with pembrolizumab as first-line treatment for patients with unresectable or metastatic urothelial cancer. This approval is testament to our ongoing partnership with clinical trial investigators, study participants and their families, and the broader
82 Clinical Profiles
bladder cancer community. We look forward to patients across the European Union gaining benefit from this combination early in their treatment journey.”
Bladder cancer is the fifth most commonly diagnosed cancer across the European region. Every year, more than 165,000 people are diagnosed with the disease and it claims the lives of over 50,000 people in the European Union (EU). Diagnosis often comes late, with many patients presenting with advanced or metastatic disease where survival outcomes are particularly poor.
The Phase 3 EV-302 clinical trial explored the efficacy and safety of enfortumab vedotin in combination with pembrolizumab in patients with previously untreated unresectable locally advanced or metastatic urothelial cancer (la/ mUC). Results showed that the treatment combination resulted in a median OS of 31.5 months (95% CI: 25.4-NR) compared to 16.1 months (95% CI: 13.918.3) with platinum-containing chemotherapy, representing a 53% reduction in risk of death (Hazard Ratio [HR]=0.47; 95% Confidence Interval [CI]: 0.380.58; P<0.00001). The median PFS of 12.5 months (95% CI: 10.4-16.6) with the combination compared to 6.3 months (95% CI: 6.2-6.5) with chemotherapy represents a 55% reduction in the risk of cancer progression or death (HR=0.45; 95% CI: (0.380.54); P<0.00001). During the EV-302 trial, approximately 30% of patients completed treatment with chemotherapy and then went on to receive maintenance therapy with avelumab, a PD-L1 inhibitor, which is reflective of current real world clinical practice. Results were presented at the 2023 European Society for Medical Oncology (ESMO) Congress and published in the New England Journal of Medicine.
The European Marketing Authorization is valid in all 27 EU member states as well as Iceland, Liechtenstein, and Norway, and is aligned to recently updated clinical guidelines from the European Society for Medical Oncology and European Association of Urology which recommend enfortumab vedotin in combination with pembrolizumab as first-line treatment for locally advanced or metastatic urothelial cancer. Astellas is working closely with local regulatory authorities and health technology assessment bodies across the EU to ensure that patients who may gain benefit are able to access the treatment combination as soon as possible.
The approval follows the European Commission approval
of enfortumab vedotin as a monotherapy for the treatment of adult patients with la/mUC who have previously received a platinum-containing chemotherapy and a programmed death receptor-1 (PD-1) or programmed death-ligand 1 (PD-L1) inhibitor in April 2022.
Astellas has already reflected the impact from this result in its financial forecast for the current fiscal year ending March 31, 2025.
GROUNDBREAKING RESEARCH AT TYNDALL AIMS TO ELIMINATE SKIN COLOUR BIAS IN HEALTHCARE
IPIC, the SFI centre for Photonics based at Tyndall National Institute (a research flagship of University College Cork) is pleased to announce that Dr Sanathana Konugolu Venkata Sekar has been awarded a European Research Council (ERC) Starting Grant. The grant, worth ¤1.58m, will support Dr Konugolu Venkata Sekar’s groundbreaking research project NOBIAS: “Novel diffuse Optical method to combat skin colour bias in non-invasive optical biomarker sensing devices”.
Skin colour bias in optical healthcare devices affects 2.2 billion people of colour worldwide. Dr Konugolu’s project, NOBIAS, aims to develop a revolutionary Time Domain Diffuse Optical Spectroscopy (TDDOS) method to eliminate colour bias, motion artefacts and inaccuracies in optical biomarker devices such as pulse oximeters (used to measure oxygen levels in blood) and smartwatches.
This pioneering technology will address the critical need for more accurate and equitable medical
Dr Sanathana Konugolu Venkata Sekar has been awarded ¤1.58 million from the European Research Council for his research project which aims to combat skin colour bias in healthcare
diagnostics by focusing on the influence of skin pigmentation, variations in skin layer thickness, and composition across different ethnicities. The goal is to create a bias-free foundation for optical biomarker assessments that will enable a new era of accurate optical biomarker sensors for fitness and clinical bedside monitors.
The prestigious ERC Starting Grants, awarded by Europe’s leading research funding body, are designed to support emerging research leaders in building their independent teams and conducting pioneering research with the potential for significant global impact.
Speaking about his work, Dr Konugolu explains: “My goal with the NOBIAS project is to lay the foundation for the world’s first bias-free and accurate optical biomarker sensing device and our hope is that its legacy will be the gold standard for bias-free clinical and personal biomarkers sensing”.
Professor Paul Townsend, Head of Photonics, Tyndall and Director of IPIC, said: “Dr Konugolu has consistently impressed me with his passion and commitment to the generation of new ideas and knowledge, as well as his ability to commercialise those ideas to realise new medical technologies that will benefit society in the future. This significant award confirms his outstanding potential as a worldleading biophotonics researcher, and I am confident the project will lead to new innovations that will be very impactful for the field”.
Welcoming the news, Martin O’Connell, EU Programme Manager at IPIC said: “ERC grants are among the most prestigious of any funding body worldwide and the successful award is testament to the research excellence consistently on display on an ongoing basis in IPIC.”
¤40MILLION INNOVATIVE ARRANGEMENT TO SET A NEW STANDARD FOR PRIVATE MEDICAL CARE IN IRELAND
St. Vincent’s Private Hospital (SVPH), part of St. Vincent’s Healthcare Group, has formed a 10-year Value Partnership worth ¤40m with Siemens Healthineers, the first-of-its-kind in the Republic of Ireland, setting new standards for private medical care and diagnostics. The partnership includes advanced AI technology and ensures the provision, maintenance and replacement of over 50 key radiology and cardiology assets from multiple vendors through a phased equipment replacement cycle. With value-add elements including facility re-design as well as continuous service improvement and workforce development programmes, the partnership will enable operational efficiency and enhance delivery of patient care across Dublin.
The partnership will enable SVPH, Dublin’s largest acute private hospital, to care for patients with complex requirements in Ireland’s only integrated multihospital campus. Having a co-located public and private hospital on a single campus, SVPH shares resources, expertise and medical facilities with St. Vincent’s University Hospital, supporting care delivery for St. Vincent’s Healthcare Group which serves 470,000 patients annually. Dedicated management of the radiology and cardiology equipment, plus advanced AI technology, will further enhance cancer care at SVPH, one of the few Irish hospitals offering radiotherapy, immunotherapy, surgery, and chemotherapy in one location. The hospital has already integrated Deep Resolve AI image reconstruction technology from Siemens Healthineers, accelerating MRI scan times and improving image quality.
Facility redesign expertise from the International Design Solutions team at Siemens Healthineers will aid future expansion, enabling the hospital to adapt to changing population health needs. The team brings decades of experience and will work collaboratively with the SVPH Building Services Department to achieve greater operational efficiency and improve patient flow, while allowing for future growth. Support will include analysis of the current situation through the development, visualisation and simulation of potential solutions, ultimately aiding the delivery of a sustainable healing environment,
boosting patient experience and staff satisfaction.
The partnership will also include a bespoke workforce development programme designed to support recruitment, retention and development of staff following the challenging years of the COVID-19 pandemic. Covering both vendor-specific and vendorneutral learnings, the programme includes a range of training, education and hands-on learning experiences and is set to bolster the workforce and improve the patient journey. SVPH will also introduce a continuous service improvement programme focused on developing staff and optimising clinical workflows. The programme will ensure the hospital uses its technology in the most effective way while continuing to maximise sustainable, long-term efficiencies.
Brian Fitzgerald, CEO, St Vincent’s Private Hospital said “This ¤40 million investment programme in cardiology and radiology is an investment in the future health and wellbeing of our
Professor Ronan KilleenConsultant Radiologist at St. Vincent's Private Hospital, Andy Wilks - Head of Enterprise Services for Siemens Healthineers Great Britain and Ireland, Edel O’KeeffeDirector of Finance at St. Vincent's Private Hospital, Ghada Trotabas - Managing Director of Siemens Healthineers Great Britain and Ireland, Brian Fitzgerald - Chief Executive Officer of St. Vincent's Private Hospital with Grania Heal –Country Head for Ireland at Siemens Healthineers, and Rob Ruttledge - Director of Building Services at St. Vincent's Private Hospital
patients. Partnering with Siemens Healthineers in a first of its kind partnership in Ireland reflects our pioneering approach and our leadership at the forefront of new developments that enable us to deliver exceptional patient care. The potential for AI in healthcare is vast and we believe that this new investment programme will improve clinical outcomes for patients and sets new standards for the delivery of personalised treatment and care in Ireland”.
Professor Ronan Killeen, Consultant Radiologist at St. Vincent's Private Hospital said: "The provision of AI solutions from Siemens Healthineers, such as Deep Resolve AI technology, as part of the Value Partnership significantly impacts our ability to improve MRI access and experience for patients. Higher resolution MRI imaging improves our interpretation and enables us to deliver more timely, accurate patient care. For example, the time to acquire a Lumbar Spine MRI has been reduced by more than 50 per cent, which is quite amazing."
HEARTFEST 2024: THE CROÍ MOBILE HEALTH HUB IS COMING TO EYRE SQUARE, GALWAY
Get ready, Galway! Croí, the heart and stroke charity, is thrilled to announce that the Croí Mobile Health Hub will be arriving at Eyre Square for the much-anticipated Heartfest—a three-day festival dedicated to cardiovascular health and wellness. This event, now in its third year, will take place on the plaza at the top of Eyre Square from Wednesday 25th – Friday 27th September and is set to be a vibrant celebration of heart health.
The event runs from 10am to 4pm on the Wednesday and Thursday and 10am to 1pm on the Friday.
Heartfest is a free, holistic event designed to empower individuals and communities to take control of their cardiovascular health. Visitors can expect an array of interesting activities and resources, all aimed at making heart health accessible, engaging, and meaningful. Free blood pressure and pulse checks will be available, with cholesterol and stethoscope checks offered to those who meet specific criteria. The Croí Health Team will be on hand to answer questions and discuss heart health with the public at this special event.
The Croí Mobile Health Hub is a first-of-its-kind in Ireland—a custom-built, 13.6-metre-long, multi-purpose mobile health unit that stands as the largest mobile stroke and heart disease detection unit in the country. This innovative vehicle can be converted from a facility with six private assessment cubicles and two consultation rooms into an open-plan educational space capable of hosting up to forty visitors. Its primary mission is to bring stroke and heart disease prevention
into communities across Ireland through mobile early detection and risk assessment programmes. It is designed to serve as a mobile community education and training facility, visiting towns, villages, schools, universities, workplaces, and sports clubs.
The state-of-the-art Croí Mobile Health Hub is the latest addition to Croí’s expanding fleet of community vehicles. Funded by the Joe & Helen O'Toole Charitable Trust, this hub will serve as the festival's centrepiece, offering visitors a chance to learn from Croí’s multidisciplinary health team about the risk factors for heart disease and stroke, healthy eating, physical activity, and even CPR.
Over the three days, visitors can speak with Croí’s experts about the comprehensive support services and programmes available at Croí Heart and Stroke Centre, as well as the vital community resources offered by Croí’s mobile health units. Whether you are looking to check your blood pressure, get a stethoscope check, learn about bystander CPR or set new health goals, Heartfest is the place to be!
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- Suitable for vegans†
Talk to our sales partner Pamex to learn more! Email: ask@pamex.ie | Phone: 094 902400
5.5 billion CFU : ASTARTETM (L. crispatus LbV 88, L. rhamnosus LbV 96, L. gasseri LbV
Added Biotin which contributes to the maintenance of normal mucous membranes9
B7
Developed for women seeking vaginal microbiome balance
