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Cleft lip research may reduce childhood operations

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RESEARCH could help children born with a cleft lip and palate to avoid multiple operations as they grow up.

Around one in every 700 babies worldwide is born with a cleft lip or palate and reconstructive surgery is usually required during the early months.

As they grow and develop, some children may require additional surgery to improve facial appearance and function or the alignment of the jaw.

In a bid to reduce the need for multiple operations, computer scientists at Aberystwyth University are working with clinical experts to better forecast growth patterns in a baby’s mouth.

They are using 3D models and machine learning techniques to accurately predict what the outcomes of surgery will look like in five or ten years’ time.

Speaking during Cleft Lip and Palate Awareness Week 2025, lead investigator Professor Reyer Zwiggelaar from the Department of Computer Science at Aberystwyth University said:

“We want our research to lead to better outcome for patients born with a cleft lip or palate. Although corrective surgery for the majority of cleft lip or palate patients is successful, some require further intervention as they grow older. Using state-of-the-art deep learning technologies, we aim to provide surgeons with the tools they need to make precision-informed decisions before operating. We hope our work will help avoid the need for some children to go through additional operations.”

Cory Thomas, a research software engineer in the Department of Computer Science at Aberystwyth, said: “We are developing algorithms which will be able to identify six significant points in a baby’s mouth and these annotations can then be used to predict future growth. The software will help avoid what is referred to in clinical terms as “bad growth” which requires further surgical intervention, for example, to address a flattening of the face.”

The research at Aberystwyth is being informed by the expertise and experience of a clinical surgeon and an orthodontist who have been working with young cleft lip and palate patients for many years.

Bruce Richard, a retired plastic surgeon who specialised in cleft and palate surgeon at Birmingham Children’s Hospital for over 30 years, said:

“About 25% of children born with a complete cleft lip and palate end up with poor mid-face growth by the age of 16 and can choose to have a major bony operation to pull the mid face and the upper jaw teeth forward to correct the ‘caved in’ mid-face look.

“If we could predict which children are at the highest risk of experiencing this poor growth, then we could develop new strategies with dental appliances to try and reduce the issue before the child reaches 5-8 years of age. Success would mean fewer teenagers having to go through a major operation in young adulthood.”

Lars Enocson, lead Cleft Orthodontic Consultant at Birmingham Children’s Hospital, said: “The way the face grows in childhood depends on your genes and the world around you, like good food or pollution levels. If a child with a cleft lip and palate never has an operation to repair the cleft, then the face grows normally. Our study is looking at the shape of the baby’s upper jaw at birth to see if there is any particular 3-D shape that predicts those who get poor growth after surgery. Knowing this would allow choices about how we care for the child as they are growing.” 

The next stage of the research will focus on building 3D prediction models, and a series of clinical trials will be required before the technology can be used in a medical setting.

The research has received funding from the VTCT Foundation, a charity that funds research for people living with a visible difference, in addition to funding from Aberystwyth University.

Medical Imaging

The work on cleft lip or palate builds on years of medical imaging processing expertise in the Department of Computer Science at Aberystwyth University.

The technique allows for in-depth but non-invasive exploration of internal anatomy and has led to a significant number of healthcare developments, particularly for image analysis of breast and prostate cancer cases.

Other applications include using the software to examine Multiple Sclerosis lesions, stroke rehabilitation, and the diagnosis and management of endometriosis. 

 

Health

Health board targets rise in steroid and gym drug use across west Wales

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THE LOCAL health board has launched new targeted measures after recording a sharp rise in the use of steroids and other image-enhancing drugs across the region.

Hywel Dda University Health Board says needle exchange figures show significant growth over the past two years in people seeking support related to Image and Performance Enhancing Drugs (IPEDs), including anabolic steroids and so-called Selective Androgen Receptor Modulators (SARMs).

SARMs, while marketed online as safer alternatives to steroids, are illegal to sell in the UK and health professionals warn they carry serious and largely unknown risks.

The health board has now teamed up with Dyfed Drug and Alcohol Service (DDAS) and Choices, a young people’s substance use service, to tackle what officials describe as an “emerging public health challenge”.

Workshops and outreach

Two key initiatives have been introduced.

Educational workshops are being delivered to young people, focusing on the risks of using performance-enhancing substances during physical development and the potential long-term effects on hormones, mental health and fertility.

At the same time, enhanced support is being offered to people already involved in gym and fitness culture, with harm-reduction advice, health monitoring and confidential drop-in services.

Support includes testosterone testing, blood checks, cycle provision kits and discreet one-to-one consultations.

One service user described the programme as “quick, professional and non-judgemental”.

They said: “The drop-in clinic for my blood test was really convenient. I was seen quickly and given a full run-down of the services available. The staff made me feel comfortable the whole time and I got my results back faster than expected.”

Taking support into the community

The team has also worked directly with local gyms, leisure centres and sports venues, speaking to more than 100 people during five outreach sessions.

Twelve DDAS staff members have completed specialist IPED training delivered by Public Health Wales to strengthen expertise within the service.

Rachel Wilson, Resilient Families Manager at Choices, said the aim is to reduce stigma.

She said: “We’re proud to work alongside Hywel Dda to ensure people who use IPEDs are met with understanding, not judgement. These initiatives are helping us reach individuals who may not have previously considered accessing support.”

Craig Jones, Prevention and Population Health Improvement Manager, added: “This work is about meeting people where they are. By listening and responding with compassion and evidence-based care, we’re making a real difference.”

Dr Ardiana Gjini, Executive Director of Public Health, said the approach showed the board’s commitment to early intervention.

She said: “These initiatives reflect a proactive, collaborative response to emerging health challenges and demonstrate our dedication to protecting the health of our communities.”

Anyone seeking confidential advice or support can contact DDAS on 03303 639997 to book an appointment.

 

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Health

Nurses warn of pay and burnout crisis as new report exposes pressures in Wales

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A NEW national report has laid bare the growing pressures facing nurses and midwives in Wales, with concerns over pay, burnout and lack of professional development threatening the long-term future of the workforce.

The findings, published by the Nursing and Midwifery Council in its Spotlight on Nursing and Midwifery 2025 report, show that while many nurses remain deeply committed to their roles, large numbers feel undervalued, overstretched and reluctant to recommend the profession to others.

Responding to the report, Royal College of Nursing Wales said the data should act as a wake-up call for government and health boards.

Professor Sandy Harding, Associate Director of Nursing, Policy and Professional Development at RCN Wales, said:

“We welcome the determination and commitment shown by our existing nurses in Wales, with more than half surveyed saying they are satisfied with their day-to-day work and motivated by making a difference to people’s lives. However, the findings also present a stark reflection of the poor health of nursing in Wales.

“Too many nurses are not recommending the profession to others, are struggling and are facing abuse and discrimination in the workplace.”

Pay falling behind responsibility

One of the most pressing concerns raised in the report is pay.

Nursing leaders say salaries have failed to keep pace with the growing complexity of the job, heavier caseloads and the rising cost of living, leaving many staff feeling undervalued and financially squeezed.

For some, the pressure is forcing difficult decisions about staying in the profession or reducing hours.

RCN Wales argues that without meaningful improvements to pay, recruitment and retention will continue to suffer, placing further strain on already stretched hospital wards, community services and care settings.

Training and career progression gaps

The report also highlights inconsistent access to continuing professional development, with many nurses struggling to secure protected time or funding for further training.

According to the union, this not only limits career progression but risks undermining patient care in the long term.

Harding said: “Access to protected time and funding for continuing professional development remains inconsistent, undermining both career progression and the sustainability of the workforce.

“RCN Wales believes this is unacceptable and we will continue to support nurses and fight for fair pay, meaningful investment in professional development and better working conditions across Wales.”

Commitment remains strong

Despite the challenges, the report does note strong dedication among nursing staff.

More than half of those surveyed said they were satisfied with their day-to-day work and remained motivated by the difference they make to patients’ lives.

Health leaders say that commitment is a strength the NHS in Wales cannot afford to lose.

With around 35,000 members in Wales, the Royal College of Nursing says it will continue pressing ministers to address what it describes as a “workforce crisis” before it deepens further.

The union is calling for fairer pay settlements, safer staffing levels and guaranteed investment in training to ensure nursing remains an attractive and sustainable career.

 

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Health

Doctor struck off after sexual misconduct findings at Withybush Hospital

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Tribunal history reveals medic was removed in 2012 for dishonesty before being allowed back to practise

A DOCTOR accused of sexually harassing junior colleagues while working at Withybush Hospital had previously been struck off the medical register for lying about his qualifications, the Herald can reveal.

Dr Velmurugan Kuppuswamy is currently at the centre of fitness-to-practise proceedings after allegations he made sexually inappropriate comments and subjected two female doctors to unwanted physical contact during his time as a locum consultant in Haverfordwest.

But records show this is not the first time his conduct has come before regulators.

In 2012, an independent tribunal found he had been dishonest during an application and interview for a postgraduate cardiology training post at an NHS deanery in England.

The panel heard he falsely claimed to have submitted a Doctor of Medicine thesis, said he was a member of the Royal College of Physicians and stated he had passed a practical clinical skills assessment.

He initially admitted misleading information before later retracting parts of his account. The tribunal concluded he had “maintained his dishonest accounts” and had wrongly accused a witness of giving misleading evidence.

He was erased from the register and returned to India, where he later worked in a cardiac hospital.

In 2020, he applied to be restored to the UK medical register.

The General Medical Council investigated and opposed the application, arguing his expressions of remorse had come years late and raising concerns about a lack of independent evidence regarding his work overseas, as well as the absence of relevant ethics training.

However, an independent Medical Practitioners Tribunal at the Medical Practitioners Tribunal Service accepted his assurances that he had changed. His evidence was described as “compelling, heartfelt and genuine”, and the panel decided a well-informed member of the public would not be concerned about his return to practise.

His name was restored to the register.

Shortly afterwards, he began working shifts as a locum consultant at Withybush Hospital, which is run by Hywel Dda University Health Board.

Within months, fresh allegations emerged.

A tribunal has heard claims that between August and September 2021 he hugged junior colleagues without consent, touched their backs and waists, squeezed their wrists and arms and made sexually suggestive remarks at a staff social event.

On two occasions, he is alleged to have gripped one doctor so tightly it caused pain and ignored her requests to stop. He is also accused of staring at female colleagues, following groups of women around the venue, making comments about their bodies and placing a hand high on one doctor’s thigh.

Further allegations relate to behaviour at work, including sitting extremely close to a colleague, draping an arm behind her on a sofa and grabbing her arm while whispering comments.

According to the charges, his conduct created “an intimidating, hostile, degrading, humiliating or offensive environment” and amounted to a sexually motivated abuse of his senior position.

Dr Kuppuswamy denies wrongdoing.

Following the investigation, the case was referred to a tribunal by the General Medical Council. The decision on his fitness to practise was made independently by a Medical Practitioners Tribunal at the Medical Practitioners Tribunal Service.

The tribunal determined his behaviour amounted to serious professional misconduct and ordered that he be erased from the medical register.

Asked whether the doctor remains employed, the health board said it does not comment on individual staffing matters.

Medical director Mark Henwood said: “We have robust policies and procedures in place to ensure the safety of both staff and patients in our care and we take seriously our responsibility for their wellbeing. We are committed to providing a safe, supportive environment where patients and staff can be confident that best practice is being followed at all times.”

 

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