Norfolk and Norwich University Hospital

Achondroplasia (ACH), the most common skeletal dysplasia, arises from gain-of-function variants in the fibroblast growth factor receptor 3 gene. Children with ACH experience lifelong medical, functional and psychosocial challenges requiring coordinated and anticipatory care. Although international guidance exists, the UK lacks national clinical care recommendations specific to its healthcare systems. To develop UK-specific, multidisciplinary clinical recommendations for the care of children and young people (CYP) with ACH. The UK Achondroplasia Network developed guidance in stages: stakeholder mapping of the care pathway, integration of contemporary literature with clinical expertise to draft age-specific guidance and Delphi statements, and a modified Delphi process with 25 multidisciplinary experts. The Delphi process involved two voting rounds and an in-person meeting, with consensus defined as ≥80% agreement. In the first Delphi round, all 20 statements achieved consensus; nine achieved 100% agreement. To strengthen consensus, after meeting in person, 17 statements were refined (four were divided into two statements), one created and one removed, resulting in 24 statements for Round 2; all achieved consensus, with 21 reaching 100% agreement. The guidance outlines age-specific monitoring and referral from infancy to adolescence. Recommendations address medical management of complications, psychosocial support, educational planning and transfer to adult care. These are the first UK-specific multidisciplinary recommendations for the care of CYP with ACH. Aligned with international best practices and tailored to UK healthcare systems, they support anticipatory care, promote independence and enhance health and psychosocial outcomes. The guidelines offer a foundation for service planning, standardisation and equitable care.

Abstract Background The British Rhinological Society Multidisciplinary Consensus on the Hospital Management of Epistaxis published in 2016 recommends the continuation of anticoagulants and antiplatelets in patients with uncomplicated epistaxis. The aim of this audit is to improve adherence to the current consensus guideline. Methods Patients who were admitted under the ear, nose and throat (ENT) department at the Norfolk and Norwich University Hospital (NNUH) with uncomplicated epistaxis from May to September 2024 (cycle one) and were on anticoagulants or antiplatelets were included in our audit. We calculated how many had their antiplatelets or anticoagulants suspended during their admission. We implemented teaching on the national consensus guideline at the December 2024 ENT departmental induction for new ENT doctors. We then recollected the data from December 2024 to February 2025 (second cycle). Results In the first cycle, 22 patients were identified. Anticoagulants or antiplatelets were suspended in 68% of these patients. In the second cycle, 25 patients were identified, and 44% had their anticoagulants or antiplatelets suspended. There was a decrease in the percentage of patients who had their anticoagulants or antiplatelets suspended between the first and second cycles (P < 0.1), leading to an improvement in the adherence to the national consensus guideline. Conclusions Teaching at the ENT department induction improved adherence to the current guideline recommendations to continue anticoagulation and antiplatelets in patients admitted with epistaxis. We aim to share the guideline with emergency department and medical colleagues, and to continue teaching on these guidelines at departmental induction for new ENT doctors.

Abstract Background Robotic surgery is increasingly adopted across general surgical units in the United Kingdom, yet training opportunities remain inconsistent. This study explored the experiences, attitudes, and perceived barriers to robotic training among General Surgery higher surgical trainees in the East of England (EoE) deanery, with the aim of identifying areas for improvement to enhance future training provision. Methods A cross-sectional mixed-methods electronic survey was distributed to all ST3–ST8 General Surgery trainees in the EoE deanery (May–August 2025). Eligible participants were in a clinically active general surgical rotation within an EoE hospital. The 27-item questionnaire examined professional background, exposure to robotic surgery, and perceptions of training. Results Of 81 eligible trainees, 48 responded (59%), with representation from all 16 hospitals, 13 of which performed robotic procedures. Almost all respondents (98%) believed that robotic surgery would become integral to general surgical practice, and 77% intended to undertake a fellowship in robotic surgery. Twenty-seven trainees were in firms performing robotic cases, with a median exposure of one operating session per week. Satisfaction with training was low (mean 3.8/10). Independent console operating was rare (7%), with limited access to simulation (23%), structured induction (17%), and robotic courses (52%). Conclusions Trainees view robotic surgery as a valuable skill, yet current training opportunities are inadequate, inequitable and show marked variation between hospitals. Priorities for improvement include national curriculum integration, equitable access to simulation and formal training courses, and expansion of dual console operating to support safe progression from bedside assistance to independent practice.

Rheumatic and musculoskeletal diseases (RMDs) are leading causes of physical disability, necessitating support with activities of daily living. This study describes social care received by patients with RMDs in two disparate regions of England: Salford (urban) and Norfolk (rural). A cross-sectional survey identified how many patients received care and who provided it as well as care type (formal/informal), frequency, and duration. Participants included (1) patients attending rheumatology outpatient facilities at Salford Royal Hospital and (2) participants with inflammatory polyarthritis enrolled in the Norfolk Arthritis Register (NOAR). Descriptive statistics compared the care received, and a logistic regression model investigated factors associated with receiving help. The Salford cohort was younger and had a wider range of RMDs compared with NOAR. A significant number of participants in the Salford (85%) and NOAR (38%) groups required help with daily activities. Of those needing help, 61% and 73% received care in Salford and NOAR, respectively, predominantly informally from family and friends. Local authorities delivered social care to just 0.5% of Salford and 1.4% of NOAR participants. Daily care was provided to 43% of Salford and 53% of NOAR participants. Weekly care duration varied: 21% of Salford and 31% of NOAR responders received ≤4 hours, and 19% of Salford and 10% of NOAR responders received >20 hours. Having multiple conditions increased the likelihood of receiving care: Salford odds ratio 1.93 (95% confidence interval [CI] 1.18-3.18) and NOAR odds ratio 3.30 (95% CI 1.45-7.60). The survey highlights a lack of formal care for patients with RMDs, who mostly rely on undocumented informal care. Patients with multiple conditions often require daily living assistance; rheumatology services should consider incorporating social care reviews as part of routine practice.

<h3>Introduction</h3> Respiratory and oropharyngeal secretions present significant challenges in motor neurone disease (MND). Symptoms such as choking and impaired cough compromise quality of life, place burdens on unpaid carers, and limit the effectiveness of interventions including non-invasive ventilation. Despite their prevalence, good symptom management is rare. <h3>Aims</h3> The session Aims to: Describe the complexity of secretion management in MND. Consider the Impact of cough, choking, and secretion difficulties on patients and carers. Present emerging evidence and co-produced interventions to improve practice. <h3>Methods</h3> Speakers will present perspectives informed by clinical research and co-production with people living with MND. Topics include healthcare professional challenges, development of assessment tools, co-designed clinical management plans for choking, and approaches to sialorrhea management in complex neurological disability. A person living with MND will provide a lived experience perspective. The 45-minute session will combine structured presentations with panel discussion and case studies. <h3>Results</h3> The session will highlight the multifactorial nature of secretion management, the need for individualised approaches to cough augmentation, and the importance of equipping clinicians with confidence to respond to choking episodes. Co-production with patients and carers will underpin practical guidance and assessment tools, ensuring interventions are clinically relevant and acceptable. Lessons from specialist neurological care will broaden understanding of transferable strategies for secretion management. <h3>Conclusion</h3> Effective management of cough and secretions in MND require integrated, patient-centred solutions. Collaborative approaches between clinicians, researchers, and people living with MND will generate interventions that address unmet needs in palliative care. <h3>Impact</h3> This work will strengthen professional knowledge and confidence, support equitable palliative care for non-cancer conditions, and demonstrate the value of co-production. It will provide a model for improving symptom management and quality of life in MND and related neurodegenerative diseases.

Lay Summary Alopecia areata (AA) is a long-term condition that can occur in both children and adults. AA can appear as patches of baldness on the scalp. Sometimes, nail growth is also affected. Hair on other parts of the body may also fall out, such as the beard, eyebrows and eyelashes. Alopecia totalis is the name for total loss of scalp hair. Alopecia universalis is complete loss of scalp, facial and body hair. This is the second version of the guideline. The British Association of Dermatologists gathered a group of experts in managing people of all ages with AA. The group consisted of eight consultant dermatologists, one dermatology specialist registrar, one general practitioner, one psychologist, two people with AA and a team with expertise in preparing guidelines. This group of experts reviewed relevant studies published until 11 July 2025. Using the evidence, the group produced recommendations using rigorous standards for guideline development. The guideline development group produced 56 recommendations for management of people with AA. They also made 9 recommendations for future research and suggested 11 audit points for hospitals. Based on the guideline, a patient information leaflet is also available on the British Association of Dermatologists’ website (https://www.skinhealthinfo.org.uk/condition/alopecia-areata).