The Norfolk and Waveney Knowledge Repository Service (NWKRS) contains research and organisational information generated by staff and departments from Norfolk and Norwich University Hospitals NHS Foundation Trust, The Queen Elizabeth Hospital King’s Lynn NHS Foundation Trust, Norfolk and Suffolk NHS Foundation Trust, and NHS Norfolk and Suffolk Integrated Care Board. The Repository contains a wide variety of resources including (but not exclusive to):
- Research
- Systematic Reviews
- Journal articles
- Case Reports
- Quality Improvement
- Books and Book chapters
- Audits
- Trials
- The repository does not contain Trust Policies, Protocols or Guidelines.
Submissions:
Please use this online form to provide us with the details of any item you wish to submit to the repository. Only one submission per form. The details will be checked and added to the NWKRS by library staff. Please provide as much detail as you can. All fields are required. Queries about the service can be submitted via the feedback form.
Recent Submissions
Item Assessment of Scoring Balloons in STEMI Patients Treated With DCB-Only Angioplasty: A Single Center Study(John Wiley and Sons, 2025)Background and aims: A randomized trial has previously demonstrated that neointimal modification with a scoring balloon improves the anti-restenotic effect of drug-coated balloon (DCB) in patients with drug-eluting stent restenosis. There are very limited data about the safety and efficacy of using scoring balloons as part of lesion preparation in patients with STEMI, especially in patients with de novo disease treated with DCB-only angioplasty. Methods: We undertook an analysis of the SPARTAN Norwich Registry to address this question. We compared the composite endpoint of cardiovascular mortality or unplanned target lesion revascularization in the DCB-only cohort stratified based on the use or not of scoring balloon as part of the lesion preparation. Furthermore, we undertook a propensity score-matched analysis of the DCB-only cohort. Results: A total of 452 consecutive patients were treated with DCB-only angioplasty and scoring balloon was used in 121 patients as part of the lesion preparation. Scoring balloon was not a significant predictor of the composite endpoint even after propensity score-matched analysis. Chronic obstructive pulmonary disease was the only significant predictor of the composite endpoint after propensity score-matched analysis. Conclusion: This is the first study demonstrating the safety and efficacy of scoring balloon as part of lesion preparation in patients with STEMI due to de novo disease treated with DCB-only angioplastyItem Comparative Analysis of Preoperative Templating in Total Hip Replacement Surgery: KingMark TM Dual-Marker System Versus Single-Marker Method(Cureus, 2025)Purpose of the study Total hip replacements (THRs) are a standard and effective surgical procedure that benefits from preoperative planning. Despite this, no consensus exists on the best preoperative templating tool for THRs. In this study, we compare the single marker to the KingMark™ double-templating system for predicting the size of implants used intraoperatively. Methods This retrospective study compares two cohorts of 50 consecutively selected patients who underwent primary THR under the care of two orthopaedic surgeons. All patients had preoperative anteroposterior (AP) pelvic radiographs to facilitate templating by one of the two methods. The first cohort had surgery with single-marker templated THRs from August to December 2021. The second cohort had THRs templated using the KingMark™ system and underwent surgery between January and April 2022. For both groups, the templated size of the acetabular and femoral implants was compared to the definitive acetabular and femoral implants, respectively. Any patients with a history of previous hip surgery, with developmental abnormality affecting hip anatomy, or requiring bespoke implants were excluded. Results Single-marker templating accurately predicted the femoral implant size in 32% of cases. KingMark™ correctly predicted femoral implant size in 54% of cases, a statistically significant improvement (p=0.04). The mean templated acetabular cup size for the single-marker cohort templated acetabular size was 52.5±4.1, and the definitive acetabular size was 53.6±3.5. The mean templated acetabular cup size for the KingMark™ cohort was 52.0±3.7, and the definitive acetabular cup size was 53.2±4.8. The absolute difference between templated and definitive acetabular implants was 2.3±2.4 and 2.2±2.6, respectively, which was not statistically significant (p=0.84). This is consistent with the rate of accurate acetabular implant prediction for both templating methods (32% for single marker and 30% for KingMark™) with no significant difference (p=0.83). Conclusion The KingMark™ system showed superior accuracy in predicting the femoral stem size in THR over the conventional single mark. However, it's important to note that there was no significant difference between the two methods in predicting the cup size, a key finding of our studyItem Adrenal insufficiency in giant cell arteritis(Oxford University Press, 2025)Objectives: To ascertain the frequency of adrenal insufficiency in patients with GCA treated using the Norwich prednisolone regimen. Methods: Consecutive patients diagnosed with GCA between 1 January 2012 and 31 May 2022 were included. All patients were treated with the Norwich prednisolone regimen, educated about the benefits and risks of long-term prednisolone use and followed up in dedicated vasculitis clinics. When patients contacted the advice line to report being unwell, tests for adrenal function were performed after ruling out relapsing vasculitis or polymyalgia rheumatica. A 9 a.m. serum cortisol was used, providing the daily dose of prednisolone was ≤5 mg, as a gateway to dynamic testing with full-form adrenocorticotrophic hormone (ACTH) stimulation. Results: A total of 353 consecutive patients with GCA were included. During the prescribed glucocorticoid tapering regimen, 76/353 had a 9 a.m. serum cortisol check after ruling out relapsing disease. Of these, 34/76 had a serum cortisol >350 nmol/l (our laboratory cut-off for adequacy of adrenal reserve); 7/76 had a serum cortisol <100 nmol/l, indicative of insufficient adrenal function and 35/76 had a cortisol level of 100-350 nmol/l. Of the 35 patients who went on to have a standard-dose ACTH stimulation test, 27/35 had an adequate result (i.e. >450 nmol/l at 30 min) and 8/35 had an inadequate result. A total of 15/353 patients required long-term steroids because of adrenal insufficiency and 11/15 patients with adrenal insufficiency were female. The median (IQR) cumulative prednisolone dose at the time of testing was 11.53 grams (7.74) and the median (IQR) duration of prednisolone was 121 weeks (97). Conclusion: This is the largest study studying the frequency of adrenal insufficiency in patients with GCA treated using the Norwich prednisolone regimen. Adrenal insufficiency requiring long-term steroid replacement therapy is uncommon. Sequential testing using 9 a.m. serum cortisol levels as a gateway to rationalizing the necessity for dynamic testing with standard-dose ACTH stimulation testing is an efficient strategy for this cohort of patientsItem Enhanced Level A Multidisciplinary Team (MDT) Providing Holistic Local Children's Cancer Care(2026)The financial burden of paediatric oncology treatment is significant; travel to appointments is cited as the highest cost families face1. The NHS Long Term Strategy is to provide care closer to home. NHS Service Specifications from November 2021 state that an Enhanced Level A Paediatric Oncology Shared Care Unit (POSCU) should provide full MDT support for patients at the designated POSCU3. At Norfolk and Norwich University Hospital (NNUH) there is provision for 1.0 FTE (Full Time Equivalent) Consultant, 1.85 FTE Clinical Nurse Specialist, 1.0 FTE Psychologist, 0.2 FTE Dietetics support, and uncommissioned Physiotherapy support; to provide a local holistic MDT clinic once weekly. Additionally, there is local access to investigations such as GFR measurement and echocardiography, as well as paediatric surgical presence allowing for central line removal.
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