1083 lines
No EOL
341 KiB
XML
1083 lines
No EOL
341 KiB
XML
<?xml version="1.0" encoding="utf-8"?>
|
||
<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd">
|
||
<html xmlns="http://www.w3.org/1999/xhtml" xml:lang="en" lang="en">
|
||
|
||
<head><meta http-equiv="Content-Type" content="text/html; charset=utf-8" />
|
||
<!-- AppResources meta begin -->
|
||
<meta name="paf-app-resources" content="" />
|
||
<script type="text/javascript">var ncbi_startTime = new Date();</script>
|
||
|
||
<!-- AppResources meta end -->
|
||
|
||
<!-- TemplateResources meta begin -->
|
||
<meta name="paf_template" content="" />
|
||
|
||
<!-- TemplateResources meta end -->
|
||
|
||
<!-- Logger begin -->
|
||
<meta name="ncbi_db" content="books" /><meta name="ncbi_pdid" content="book-toc" /><meta name="ncbi_acc" content="NBK577892" /><meta name="ncbi_domain" content="niceng132er3" /><meta name="ncbi_report" content="printable" /><meta name="ncbi_type" content="fulltext" /><meta name="ncbi_objectid" content="" /><meta name="ncbi_pcid" content="/NBK577892/?report=printable" /><meta name="ncbi_app" content="bookshelf" />
|
||
<!-- Logger end -->
|
||
|
||
<title>Evidence review for indications for surgery - NCBI Bookshelf</title>
|
||
|
||
<!-- AppResources external_resources begin -->
|
||
<link rel="stylesheet" href="/core/jig/1.15.2/css/jig.min.css" /><script type="text/javascript" src="/core/jig/1.15.2/js/jig.min.js"></script>
|
||
|
||
<!-- AppResources external_resources end -->
|
||
|
||
<!-- Page meta begin -->
|
||
<meta name="robots" content="INDEX,FOLLOW,NOARCHIVE,NOIMAGEINDEX" /><meta name="author" content="National Guideline Centre (UK)" /><meta name="citation_title" content="Evidence review for indications for surgery" /><meta name="citation_publisher" content="National Institute for Health and Care Excellence (NICE)" /><meta name="citation_date" content="2019/05" /><meta name="citation_author" content="National Guideline Centre (UK)" /><meta name="citation_pmid" content="35167216" /><meta name="citation_fulltext_html_url" content="https://www.ncbi.nlm.nih.gov/books/NBK577892/" /><link rel="schema.DC" href="http://purl.org/DC/elements/1.0/" /><meta name="DC.Title" content="Evidence review for indications for surgery" /><meta name="DC.Type" content="Text" /><meta name="DC.Publisher" content="National Institute for Health and Care Excellence (NICE)" /><meta name="DC.Contributor" content="National Guideline Centre (UK)" /><meta name="DC.Date" content="2019/05" /><meta name="DC.Identifier" content="https://www.ncbi.nlm.nih.gov/books/NBK577892/" /><meta name="og:title" content="Evidence review for indications for surgery" /><meta name="og:type" content="book" /><meta name="og:url" content="https://www.ncbi.nlm.nih.gov/books/NBK577892/" /><meta name="og:site_name" content="NCBI Bookshelf" /><meta name="og:image" content="https://www.ncbi.nlm.nih.gov/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-niceng132er3-lrg.png" /><meta name="twitter:card" content="summary" /><meta name="twitter:site" content="@ncbibooks" /><meta name="bk-non-canon-loc" content="/books/n/niceng132er3/toc/" /><link rel="canonical" href="https://www.ncbi.nlm.nih.gov/books/NBK577892/" /><link rel="stylesheet" href="/corehtml/pmc/css/figpopup.css" type="text/css" media="screen" /><link rel="stylesheet" href="/corehtml/pmc/css/bookshelf/2.26/css/books.min.css" type="text/css" /><link rel="stylesheet" href="/corehtml/pmc/css/bookshelf/2.26/css/books_print.min.css" type="text/css" /><style type="text/css">p a.figpopup{display:inline !important} .bk_tt {font-family: monospace} .first-line-outdent .bk_ref {display: inline} </style><script type="text/javascript" src="/corehtml/pmc/js/jquery.hoverIntent.min.js"> </script><script type="text/javascript" src="/corehtml/pmc/js/common.min.js?_=3.18"> </script><script type="text/javascript">window.name="mainwindow";</script><script type="text/javascript" src="/corehtml/pmc/js/bookshelf/2.26/books.min.js"> </script>
|
||
|
||
<!-- Page meta end -->
|
||
<link rel="shortcut icon" href="//www.ncbi.nlm.nih.gov/favicon.ico" /><meta name="ncbi_phid" content="CE8E822F7D73FEC100000000006C005C.m_5" />
|
||
<meta name='referrer' content='origin-when-cross-origin'/><link type="text/css" rel="stylesheet" href="//static.pubmed.gov/portal/portal3rc.fcgi/4216699/css/3852956/3985586/3808861/4121862/3974050/3917732/251717/4216701/14534/45193/4113719/3849091/3984811/3751656/4033350/3840896/3577051/3852958/3984801/12930/3964959.css" /><link type="text/css" rel="stylesheet" href="//static.pubmed.gov/portal/portal3rc.fcgi/4216699/css/3411343/3882866.css" media="print" /></head>
|
||
<body class="book-toc">
|
||
<div class="grid no_max_width">
|
||
<div class="col twelve_col nomargin shadow">
|
||
<!-- System messages like service outage or JS required; this is handled by the TemplateResources portlet -->
|
||
<div class="sysmessages">
|
||
<noscript>
|
||
<p class="nojs">
|
||
<strong>Warning:</strong>
|
||
The NCBI web site requires JavaScript to function.
|
||
<a href="/guide/browsers/#enablejs" title="Learn how to enable JavaScript" target="_blank">more...</a>
|
||
</p>
|
||
</noscript>
|
||
</div>
|
||
<!--/.sysmessage-->
|
||
<div class="wrap">
|
||
<div class="page">
|
||
<div class="top">
|
||
|
||
<div class="header">
|
||
|
||
|
||
</div>
|
||
|
||
|
||
|
||
<!--<component id="Page" label="headcontent"/>-->
|
||
|
||
</div>
|
||
<div class="content">
|
||
<!-- site messages -->
|
||
<div class="container content">
|
||
<div class="source">
|
||
<div class="pre-content"><div><div class="bk_prnt"><p class="small">NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.</p></div></div></div>
|
||
<div class="main-content lit-style" itemscope="itemscope" itemtype="http://schema.org/Book"><div class="meta-content fm-sec"><div class="iconblock whole_rhythm clearfix no_top_margin"><a href="https://www.nice.org.uk" title="National Institute for Health and Care Excellence (NICE)" class="img_link icnblk_img" ref="pagearea=logo&targetsite=external&targetcat=link&targettype=publisher"><img class="source-thumb" src="/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-niceng132er3-lrg.png" alt="Cover of Evidence review for indications for surgery" /></a><div class="icnblk_cntnt"><h1 id="_NBK577892_"><span itemprop="name">Evidence review for indications for surgery</span></h1><div class="subtitle">Hyperparathyroidism (primary): diagnosis, assessment and initial management</div><p><b>Evidence review C</b></p><p><i>NICE Guideline, No. 132</i></p><p class="contrib-group"><h4>Authors</h4><span itemprop="author">National Guideline Centre (UK)</span>.</p><div class="half_rhythm">London: <a href="https://www.nice.org.uk" ref="pagearea=meta&targetsite=external&targetcat=link&targettype=publisher"><span itemprop="publisher">National Institute for Health and Care Excellence (NICE)</span></a>; <span itemprop="datePublished">2019 May</span>.<div class="small">ISBN-13: <span itemprop="isbn">978-1-4731-3415-7</span></div></div><div><a href="/books/about/copyright/">Copyright</a> © NICE 2019.</div></div></div></div><div class="body-content whole_rhythm" itemprop="text"><div id="ch3.s1"><h2 id="_ch3_s1_">1. Indications for surgery</h2><div id="ch3.s1.1"><h3>1.1. Review question</h3><div id="ch3.s1.1.1"><h4>1.1.1. What is the clinical and cost effectiveness of surgery (parathyroidectomy) in people with primary hyperparathyroidism?</h4></div><div id="ch3.s1.1.2"><h4>1.1.2. What are the indications for surgery (parathyroidectomy) in people with primary hyperparathyroidism?</h4></div></div><div id="ch3.s1.2"><h3>1.2. Introduction</h3><p>There is considerable variation in who is considered for surgical treatment of primary hyperparathyroidism (PHPT). Indications for surgery for symptomatic disease include the presence of end organ damage such as renal stones or reduced bone mineral density. There is much debate over whether surgery should be considered for people who are asymptomatic. In the UK, most practice adheres to the National Institute for Health consensus guidelines. They recommend surgery for the following indications:
|
||
<ul id="ch3.l1"><li id="ch3.lt1" class="half_rhythm"><div>Serum calcium (>upper limit of normal): 1.0 mg/dL (0.25 mmol/L);</div></li><li id="ch3.lt2" class="half_rhythm"><div>BMD by DXA: T-score ≤2.5 at lumbar spine, total hip, femoral neck, or distal 1/3 radius;</div></li><li id="ch3.lt3" class="half_rhythm"><div>Vertebral fracture by x-ray, CT, MRI, or VFA;</div></li><li id="ch3.lt4" class="half_rhythm"><div>Creatinine clearance <60 cc/min; 24-h urine for calcium >400 mg/d (>10 mmol/d) and increased stone risk by biochemical stone risk analysis;</div></li><li id="ch3.lt5" class="half_rhythm"><div>Presence of nephrolithiasis or nephrocalcinosis by x-ray, ultrasound, or CT;</div></li><li id="ch3.lt6" class="half_rhythm"><div><50 years</div></li></ul></p><p>It is relevant to consider the evidence base underpinning these consensus-based US recommendations.</p></div><div id="ch3.s1.3"><h3>1.3. PICO table</h3><p>For full details see the review protocol in <a href="#ch3.appa">appendix A</a>.</p><p>The aim of this review was to investigate the effectiveness of surgery (parathyroidectomy) in people with different ‘severities’ of PHPT. As there is no one tool to define severity of disease in PHPT, subgroup populations were included in the review protocol in order to investigate the subpopulations in which surgery is effective and should be recommended. The committee defined the subgroup populations using the same criteria as set out in the 4<sup>th</sup> International Guidelines for the Management of Asymptomatic PHPT, in order to determine in whom (the presence of which individual indications) surgery is effective and should be recommended. Therefore, evidence from this review informed <a href="#ch3.s1.1.1">review questions 1.1.1</a> and <a href="#ch3.s1.1.2">1.1.2</a>.</p><p>The committee did not define people with symptomatic and asymptomatic PHPT as separate strata or subgroups in the protocol, due to the difficulty in defining who is truly asymptomatic. Also, an absence of symptoms may not necessarily indicate milder disease, as end-organ effects can be present without symptoms. For these reasons, the committee wanted to move away from classifying people as symptomatic and asymptomatic.</p><p>As non-surgical options are available in people who do not have surgery, the comparators listed in the protocols also included non-surgical pharmacological options, in addition to conservative management (monitoring only).</p></div><div id="ch3.s1.4"><h3>1.4. Clinical evidence</h3><div id="ch3.s1.4.1"><h4>1.4.1. Included studies</h4><p>Eleven papers (reporting eight primary studies) were included in the review;<a class="bk_pop" href="#ch3.ref7"><sup>7</sup></a><sup>,</sup>
|
||
<a class="bk_pop" href="#ch3.ref13"><sup>13</sup></a><sup>,</sup>
|
||
<a class="bk_pop" href="#ch3.ref27"><sup>27</sup></a><sup>,</sup>
|
||
<a class="bk_pop" href="#ch3.ref34"><sup>34</sup></a><sup>,</sup>
|
||
<a class="bk_pop" href="#ch3.ref50"><sup>50</sup></a><sup>,</sup>
|
||
<a class="bk_pop" href="#ch3.ref51"><sup>51</sup></a><sup>,</sup>
|
||
<a class="bk_pop" href="#ch3.ref64"><sup>64</sup></a><sup>,</sup>
|
||
<a class="bk_pop" href="#ch3.ref83"><sup>83</sup></a><sup>,</sup>
|
||
<a class="bk_pop" href="#ch3.ref87"><sup>87</sup></a><sup>,</sup>
|
||
<a class="bk_pop" href="#ch3.ref88"><sup>88</sup></a><sup>,</sup>
|
||
<a class="bk_pop" href="#ch3.ref90"><sup>90</sup></a> these are summarised in <a class="figpopup" href="/books/NBK577892/table/ch3.tab2/?report=objectonly" target="object" rid-figpopup="figch3tab2" rid-ob="figobch3tab2">Table 2</a> and <a class="figpopup" href="/books/NBK577892/table/ch3.tab3/?report=objectonly" target="object" rid-figpopup="figch3tab3" rid-ob="figobch3tab3">Table 3</a> below. Evidence from these studies is summarised in the clinical evidence summary tables below (<a class="figpopup" href="/books/NBK577892/table/ch3.tab4/?report=objectonly" target="object" rid-figpopup="figch3tab4" rid-ob="figobch3tab4">Table 4</a> and <a class="figpopup" href="/books/NBK577892/table/ch3.tab5/?report=objectonly" target="object" rid-figpopup="figch3tab5" rid-ob="figobch3tab5">Table 5</a>). See also the study selection flow chart in <a href="#ch3.appc">appendix C</a>, study evidence tables in <a href="#ch3.appd">appendix D</a>, forest plots in <a href="#ch3.appe">appendix E</a> and GRADE tables in <a href="#ch3.appf">appendix F</a>.</p><div id="ch3.s1.4.1.1"><h5>1.4.1.1. Included RCTs</h5><p>Seven papers (reporting five studies) were RCTs included in the review. All studies compared surgery with conservative management.</p><p>For the comparison of surgery versus conservative management, all the available studies described the population as asymptomatic. As stated above, the committee defined subgroups in order to determine in whom (the presence of which indications) surgery is effective, with the aim of investigating the effectiveness of surgery in people with asymptomatic and biochemically mild PHPT. There were an insufficient number of studies to perform subgroup analysis for any of the protocol outcomes (to determine the effectiveness of surgery in people with or without the individual indications). However, the majority of the evidence was in people who overall do not meet the current criteria for surgery with the exception of one study<a class="bk_pop" href="#ch3.ref34"><sup>34</sup></a> in which the protocol subgroup criteria were unclear except to say people were free of symptoms, and another study<a class="bk_pop" href="#ch3.ref7"><sup>7</sup></a> which included a small number of people with osteoporosis (as it was based on the criteria for surgery prior to 2002); had the criteria of the 2002 Workshop on Asymptomatic PHPT been adopted, 29 of the 50 participants would have met these criteria for surgery. No studies were available in people with symptomatic disease or in people with asymptomatic disease who would be eligible for surgery under the current international consensus guidelines.</p><p>No RCT evidence was identified on the clinical effectiveness of surgery in any of the population strata listed in the protocol (people with normocalcaemic PHPT, people with previous unsuccessful parathyroidectomy or pregnant women).</p><p>For the comparison of surgery versus conservative management, the critical outcome of mortality was reported by one RCT, and the critical outcome of quality of life was reported in 4 of the 6 studies for this comparison. However, data from 3 of the studies reporting quality of life could not be analysed in the meta-analysis as it was only reported as graphs or narrative statements in the studies. The final study did report quality of life in a format that could be analysed, but each domain of the SF-36 was reported separately and the overall physical and mental components were not reported. This study also reported the SF-36 scores as estimated annual changes from the gradient of the slope, and did not report baseline to end of study change scores, or end of study final values. As there was insufficient evidence from RCTs for the critical outcome of quality of life for the comparison of surgery versus conservative management, NRSs meeting the study protocol were included. The outcome cardiovascular events was reported by one RCT for the comparison surgery versus conservative management, however a definition for this outcome was not provided in the study.</p><p>No RCT evidence was identified for the comparators of bisphosphonates, calcimimetics or combination treatment (calcimimetics and bisphosphonates). Therefore, NRSs meeting the study protocol were investigated to see if they reported outcomes for these comparisons.</p></div><div id="ch3.s1.4.1.2"><h5>1.4.1.2. Included NRS</h5><p>Four papers (reporting 3 studies) were NRSs included in the review. All of these studies compared surgery with conservative management. No NRSs were identified comparing surgery with bisphosphonates or any of the other comparators listed in the protocol. Only NRSs that adjusted for confounding factors were included in the review, however none of the included studies adjusted for all the key confounders listed in our protocol.</p><p>For the comparison of surgery versus conservative management, the outcomes reported were fracture, mortality, kidney stones and cancer. No evidence was available for the critical outcome of QOL. Evidence for all of the reported outcomes was already available from RCT evidence, however the population represented by the NRSs is likely to be different to that represented by the RCTs. For the NRSs, details of the severity of PHPT or details to inform our protocol subgroups were not reported, but it is likely that these studies included a mixed population of people who would and would not be eligible for surgery according to the current guidelines (in contrast to the RCT evidence which was in people not currently eligible for surgery).</p><p>No evidence was identified for the outcome of persistent hypercalcaemia from either RCTs or NRSs.</p></div></div><div id="ch3.s1.4.2"><h4>1.4.2. Excluded studies</h4><p>See the excluded studies list in <a href="#ch3.appi">appendix I</a>.</p></div><div id="ch3.s1.4.3"><h4>1.4.3. Summary of clinical studies included in the evidence review</h4><p>See <a href="#ch3.appd">appendix D</a> for full evidence tables.</p></div><div id="ch3.s1.4.4"><h4>1.4.4. Clinical evidence</h4><p>See <a href="#ch3.appf">appendix F</a> for full GRADE tables.</p><p>Narrative results</p><p>A modest but significant beneficial effect on quality of life [bodily pain (p=0.001); general health (p=0.008); vitality (p=0.003); and mental health (p=0.017)] was observed in patients after surgery compared with those followed without surgery. No difference was found in the remaining SF-36 and SCL-90R domains (Ambrogini). In comparison with the patients who did not have surgery, a statistically significant beneficial effect of parathyroidectomy was seen in two of the nine domains (social function, group difference p=0.007; and emotional role function, group difference, p=0.012 (Sudhaker). Concerning the physical domains, a slightly, but significant, decrease was observed over the two-year period in the medical observation group (p<0.01), whereas no change was seen in the operation group. The difference over time was significantly different in favour of surgery (p<0.01). The operation group scored slightly higher at year one, compared with baseline in the mental health subdomain and mental component summary score (p<0.05 for both), but not after two years of observation. For the mental health subdomain, the observation group scored higher at two years, compared with baseline (p<0.05). Although no longitudinal differences were observed in any group in the other psychological domains, the differences over time for the domain role emotional were in favour of surgery for both one and two years of observation<a class="bk_pop" href="#ch3.ref13"><sup>13</sup></a>.</p></div></div><div id="ch3.s1.5"><h3>1.5. Economic evidence</h3><div id="ch3.s1.5.1"><h4>1.5.1. Included studies</h4><p>No relevant health economic studies were identified.</p></div><div id="ch3.s1.5.2"><h4>1.5.2. Excluded studies</h4><p>One health economic study was identified relevant to this question, but was excluded due to a combination of limited applicability and methodological limitations.<a class="bk_pop" href="#ch3.ref74"><sup>74</sup></a> This is listed in <a href="#ch3.appi">appendix I</a>, with reasons for exclusion given.</p><p>See also the health economic study selection flow chart in <a href="#ch3.appg">appendix G</a>.</p></div><div id="ch3.s1.5.3"><h4>1.5.3. Unit costs</h4><p>Below are unit costs of surgery for primary hyperparathyroidism, from NHS reference costs.</p></div></div><div id="ch3.s1.6"><h3>1.6. Resource costs</h3><p>The recommendations made by the committee based on this review may have a substantial impact on resources.</p><p>Additional costs could be incurred where the recommendations lead to a change in practice for NHS providers. At present, people who are mostly asymptomatic are not routinely recommended for surgical intervention. If the recommendation lead to a large increase in the number of surgeries performed for PHPT, there will potentially be a large increase in healthcare resource use. However, it is unclear how widely this will be implemented.</p></div><div id="ch3.s1.7"><h3>1.7. Evidence statements</h3><div id="ch3.s1.7.1"><h4>1.7.1. Clinical evidence statements</h4><div id="ch3.s1.7.1.1"><h5>1.7.1.1. Surgery versus conservative management (randomised studies)</h5><p>There was a clinically important benefit of surgery for QOL (SF-36 Social functioning subscale; SF-36 Emotional role functioning subscale) (1 study, n=53; follow-up 2 years; Very Low quality) vertebral fractures (3 studies, n=208; follow-up 1–5 years; Low quality); lumbar spine BMD % change from baseline (1 study, n=49; follow up 17 years; Very Low quality); distal radius BMD % change from baseline (1 study, n=49; follow-up 1 year; Low quality and cardiovascular events (1 study, n=145; follow-up 5 years; Very Low quality).</p><p>There was no difference between surgery and conservative management for QOL (SF-36 physical functioning subscale; SF-36 physical role functioning subscale; SF-36 mental health subscale; SF-36 vitality subscale; SF-36 bodily pain subscale; SF-36 general health subscale; SF-36 health transition) (1 study, n=53; follow-up 2 years; Very Low quality); mortality (1 study, n=191; follow-up 5 years; Very Low quality); renal dysfunction (2 studies, n=73; follow-up 2–17 years; Low quality); peripheral skeletal fractures (1 study, n=106; follow-up 5 years; Very Low quality); kidney stones (3 studies, n=208; follow-up 1–5 years; Very Low quality); lumbar spine BMD Z score final value (1 study, n=111; follow-up 5 years; Very Low quality); distal radius BMD (1 study, n=20; follow-up 17 years; Very Low quality); ultra-distal radius BMD (1 study, n=85; follow-up 5 years; Low quality); radius 33% BMD (1 study, n=86; follow-up 5 years; Very Low quality); adverse events (2 studies, n=102; follow-up 1–2 years; Very Low quality); and cancer (2 studies, n=194; follow-up 1–5 years; Very Low quality). No evidence was identified for the outcome of persistent hypercalcaemia.</p></div><div id="ch3.s1.7.1.2"><h5>1.7.1.2. Surgery versus conservative management (non-randomised studies)</h5><p>There was a clinically important benefit of surgery for mortality (2 studies, n=3774; follow-up 6.1 years; Very Low quality) and fractures (2 studies, n=3746; follow-up 6.1–7.4 years; Very Low quality). There was clinical harm of surgery for the outcome kidney stones (1 study, n=3213; follow-up 6.1 years; Very Low quality). There was no difference between surgery and conservative management for cancer (1 study, n=3213; follow-up 6.1 years; Very Low quality). No evidence was identified for the outcomes persistent hypercalcaemia and health related QOL.</p></div><div id="ch3.s1.7.1.3"><h5>1.7.1.3. Surgery versus bisphosphonates</h5><p>No evidence was identified.</p></div><div id="ch3.s1.7.1.4"><h5>1.7.1.4. Surgery versus calcimimetics</h5><p>No evidence was identified.</p></div><div id="ch3.s1.7.1.5"><h5>1.7.1.5. Surgery versus combination treatment (calcimimetics and bisphosphonates)</h5><p>No evidence was identified.</p></div></div><div id="ch3.s1.7.2"><h4>1.7.2. Health economic evidence statements</h4><p>No relevant economic evaluations were identified.</p></div></div><div id="ch3.s1.8"><h3>1.8. The committee’s discussion of the evidence</h3><div id="ch3.s1.8.1"><h4>1.8.1. Interpreting the evidence</h4><div id="ch3.s1.8.1.1"><h5>1.8.1.1. The outcomes that matter most</h5><p>The committee considered the outcomes of health-related quality of life, mortality and preservation of end organ function (bone mineral density, fractures, renal stones and renal function) as critical outcomes for decision making. Other important outcomes included adverse events, cancer incidence, cardiovascular events and persistent hypercalcaemia. The committee was interested in cardiovascular and cancer outcomes, as there is some observational prognostic evidence to suggest that the risk of these future events is higher in untreated primary hyperparathyroidism.</p><p>From the non-randomised studies (NRSs) no evidence was available for the critical outcome of quality of life. No evidence was identified for the outcome of persistent hypercalcaemia from either the randomised controlled trials (RCTs) or NRSs.</p></div><div id="ch3.s1.8.1.2"><h5>1.8.1.2. The quality of the evidence</h5><p>All the evidence in this review (both RCTs and NRSs) compared surgery with conservative management. No evidence was available for the comparison of surgery with bisphosphonates, calcimimetics or combination treatment from either RCTs or NRSs.</p><p>The majority of the studies did not provide any details on conservative management; out of the 8 studies, 6 studies did not provide any details; one study stated ‘non-operative conservative management’ but did not provide any further details; another study reported ‘no surgery’ and follow-up every 6 months for at least 24 months with no further details.</p><p>All the available RCTs described the population as asymptomatic. The majority of the RCT evidence was in people who overall do not meet the current National Institutes of Health (NIH) criteria for surgery (with the exception of one study<a class="bk_pop" href="#ch3.ref34"><sup>34</sup></a> in which the protocol subgroup criteria were unclear except to say people were free of symptoms). There was another study which included a small number of people with osteoporosis as it was based on the criteria for surgery prior to 2002 – had the criteria of the 2002 Workshop on Asymptomatic primary hyperparathyroidism been adopted, 29 of the 50 participants would have met these criteria for surgery. No studies were available in people with symptomatic disease or in people with asymptomatic disease who would be eligible for surgery under the NIH guidelines. The current NIH criteria<a class="bk_pop" href="#ch3.ref11"><sup>11</sup></a> for surgery in people with asymptomatic primary hyperparathyroidism are as follows: serum calcium (>upper limit of normal): 1.0 mg/dL (0.25 mmol/L); BMD by DXA: T-score ≤2.5 at lumbar spine, total hip, femoral neck, or distal 1/3 radius; vertebral fracture by X-ray, CT, MRI, or VFA; creatinine clearance < 60 cc/min; 24-hour urine for calcium >400 mg/d (>10 mmol/d) and increased stone risk by biochemical stone risk analysis; presence of nephrolithiasis or nephrocalcinosis by X-ray, ultrasound, or CT; <50 years old.</p><p>For the RCTs comparing surgery with conservative management, the majority of the evidence was of Low to Very Low quality due to risk of bias and imprecision. This decreases our confidence in the estimate of effect of surgery.</p><p>For NRSs, details of the severity of primary hyperparathyroidism or to inform our protocol subgroups were not reported, but it is likely that these studies included a mixed population of people who would and would not be eligible for surgery according to the current guidelines (in contrast to the RCT evidence which was in people not currently eligible for surgery).</p><p>For the NRSs evidence all outcomes were graded as Very Low quality due to high risk of bias and imprecision.</p></div><div id="ch3.s1.8.1.3"><h5>1.8.1.3. Benefits and harms</h5><p>As there is no one tool to define severity of disease in primary hyperparathyroidism, subgroup populations were included to investigate the populations in which surgery is effective and should be recommended. The guideline committee defined the subgroup populations using the same criteria as set out in the 4<sup>th</sup> International Guidelines for the Management of Asymptomatic Primary Hyperparathyroidism, in order to determine in whom (the presence of which individual indications) surgery is effective and should be recommended.</p><p>The subgroups were: people with end-organ effects versus absence of end-organ effects (end organ effects defined as renal stones, history of fragility fractures or osteoporosis [BMD T-score <-2.5 at any site]); serum adjusted calcium > 0.25 mmol/litre above the ULN (same as ≥2.85 mmol/litre and <2.85 mmol/litre); reduction in creatinine clearance to <60 mL/minute; and age under 50 years versus ≥50 years. However, there were an insufficient number of studies to perform subgroup analysis for any of the protocol outcomes.</p><p>The committee also planned to consider the following population strata: people with normocalcaemic primary hyperparathyroidism (serum adjusted calcium ≤2.6 mmol/litre and an elevated PTH that cannot be explained by abnormal renal function or low 25OHD); previous unsuccessful parathyroidectomy (reoperation); and pregnant women. No evidence was identified on the clinical effectiveness of surgery in any of the population strata listed above.</p><p>The RCT evidence for the comparison surgery versus conservative management suggested that there was a clinical benefit of surgery for the outcomes quality of life (for 2 domains), vertebral fractures, lumbar spine BMD (% change from baseline); distal radius BMD % change from baseline (1 study, n=49; follow-up 1 year; Low quality) and cardiovascular events. The RCT evidence suggested that there was no difference between the groups surgery and conservative management for the outcomes mortality, quality of life (for 7 domains), renal dysfunction, peripheral skeletal fractures, renal stones, lumbar spine BMD Z score (final value), distal radius (BMD g/cm<sup>2</sup>), ultra-distal radius (BMD, g/cm<sup>2</sup>), radius 33% (BMD, g/cm<sup>2</sup>), adverse events and cancer. The estimates were imprecise for all the above outcomes except for distal radius BMD g/cm<sup>2</sup><sup>,</sup> ultra-distal radius (BMD, g/cm<sup>2</sup>) and vertebral fractures.</p><p>The NRS evidence for the comparison surgery versus conservative management suggested that there was clinical benefit of surgery for the outcomes mortality and fractures. Although there was a clinical benefit for fractures it was noted that the estimate was imprecise. Evidence suggested that there was clinical harm of surgery for the outcome renal stones. Evidence suggested that there was no difference between the groups for the outcome cancer however the estimate was imprecise.</p><p>For the non-randomised studies, the committee noted the apparent raised risk of renal stones in people who had surgery but from their experience felt that this was likely to represent their higher risk, as once someone has had a renal stone they remain at higher risk of a recurrence. The non-randomised data on fracture was consistent with the randomised evidence. It was reassuring that there was a significantly lower mortality in the surgical arm but this was largely likely to be due to confounding factors (people selected for surgery tend to be fitter).</p><p>The committee discussed that surgery is the only definitive cure for primary hyperparathyroidism. They noted that surgery is likely to cure primary hyperparathyroidism and therefore cure hypercalcaemia and relieve patients of symptoms of hypercalcaemia such as thirst, polyuria and constipation. These are the classical symptoms of hypercalcaemia that will most robustly show improvement on resolution of primary hyperparathyroidism. The committee also discussed that surgery in this population could also prevent future events such as renal stones and fragility fractures from occurring. The committee considered that some primary hyperparathyroidism patients present with long standing non-specific/undifferentiated symptoms such as fatigue, depression, muscle weakness, abdominal pain, loss of concentration etc. However the committee considered that such symptoms occur in many other diseases and agreed not to make a recommendation for such non-specific symptoms as indications for surgery. The committee noted that primary hyperparathyroidism is associated with a decline in renal function but there is no evidence that parathyroidectomy leads to an improvement. They noted that specific thresholds for renal dysfunction (creatinine clearance, 24-hour urine calcium) have been used in other countries as indications for surgery, but there are no data available to suggest that these cut-offs in isolation would be an indication for parathyroidectomy. The committee noted that 24-hour calcium is a good predictor of renal stone formation in the future. They felt that renal function thresholds for deteriorating renal function can be considered as part of decision making.</p><p>The committee noted that there was no evidence to support a particular cut-off point for adjusted serum calcium requiring surgery but they felt that it was reasonable to define a threshold of 2.85 mmol/litre or above at which surgery would be recommended.</p><p>The committee considered that the evidence in favour of surgery in patients who do not already have indications for surgery in these trials provided indirect evidence of benefit in the population in whom surgery is currently performed for whom no randomised evidence was found. This is because the currently accepted indications are in people who are at higher risk of the adverse sequellae of primary hyperparathyroidism and therefore would in principle benefit more from the operation.</p><p>The committee considered that the absence of randomised evidence in the population that meet the NIH criteria reflects the broad international consensus that surgery is indicated in this group. For people with no symptoms or indications for surgery, the committee based their recommendation on limited evidence together with their clinical experience. The recommendation is for the person to be referred for surgery so that their specific risks and benefits can be discussed. Surgery would not be offered for all of these people. A proportion of these people would meet the current criteria for surgery in the future but the committee proposed to consider surgery earlier to avoid the potential consequences of primary hyperparathyroidism. The committee considered that the benefits of surgery shown in people with no symptoms or other indications for surgery would be magnified for people with more severe disease. The committee from clinical experience noted that primary hyperparathyroidism patients have lower bone density, increased fracture risk, osteoporosis; and surgery reduces the risk of fracture in such patients. The committee from their clinical experience also discussed that kidney stones are one of the end organ effects of primary hyperparathyroidism and the risk of developing renal stones decreases after surgery. The committee agreed that surgery should be considered in people who have risk factors which are predictors of end organ disease or progressive disease. Risk factors discussed included younger age with persistent hypercalcaemia but below the 2.85 mmol/litre threshold, and symptoms suggestive of renal stone disease without current stones but with elevated urinary calcium excretion.</p><p>The committee discussed that if surgery is to be offered, it is important that the risks and benefits of the procedure are fully explained so that the patient can make an informed choice.</p><p>The committee determined that whilst the current NIH criteria separates those who are below 50 and those who are over 50, it would not be appropriate to make this distinction in their recommendations to ensure equality of access to surgery regardless of age. The age of the person is a factor for the clinician to discuss with the person when considering whether surgery is a suitable option for them. The committee emphasised that the consideration is more about life expectancy than age, as performance status is not necessary correlated with age in a linear way.</p><p>The committee discussed the other management approaches compared to surgery including calcimimetics and bisphosphonates. The committee noted that cinacalcet (calcimimetics) should be an option in people who are unable to undergo surgery only and not as an alternative to surgery, as parathyroidectomy is the only definitive treatment option in people with primary hyperparathyroidism without surgical contraindication. The committee from their experience stated that cinacalcet does not directly stop bone loss or kidney problems due to primary hyperparathyroidism (for further discussion of this evidence please refer to Evidence review G). The committee also discussed that as bisphosphonates do not provide a cure for the underlying condition of primary hyperparathyroidism, they should not be considered as an alternative to curative measures such as surgery. However the committee agreed that bisphosphonates should be considered in people with primary hyperparathyroidism and bone end organ effects, to reduce fracture risk (for further discussion of this evidence please refer to Evidence review H).</p></div></div><div id="ch3.s1.8.2"><h4>1.8.2. Cost effectiveness and resource use</h4><p>No relevant economic evaluations were identified for this question.</p><p>Unit costs were presented to the committee for consideration. The average cost of an elective inpatient parathyroid procedure is around £3,050, with an average length of stay of 1.5 days. This was estimated using NHS reference costs (2015–16), and takes into account complexity of procedure with regard to complications and comorbidities.</p><p>This area was initially identified as being high priority for original economic analysis. However, following the clinical review it was judged that economic modelling for this question would not be possible due to the lack of clinical evidence regarding the effectiveness of parathyroidectomy for people with either symptomatic or asymptomatic disease. Consequently, cost effectiveness of parathyroidectomy could not be calculated and is therefore highly uncertain.</p><p>However, the committee discussed that surgery is the only definitive cure for primary hyperparathyroidism. They noted that surgery is likely to cure primary hyperparathyroidism (current national cure rate around 94%) and therefore cure hypercalcaemia and relieve patients of symptoms such as thirst, polyuria and constipation. Furthermore, the committee considered that surgery in this population could also prevent future events such as renal stones and fragility fractures from occurring which will incur both a high cost to the NHS as well as reducing quality of life for the person. Furthermore, surgery would be more cost effective as it requires a one-off high cost with sustained benefit due to cure, whereas for example calcimimetics requires continuous high cost to maintain a similar benefit without providing a definitive cure of the primary hyperparathyroidism.</p><p>The committee considered that those with the greatest potential for quality of life gains and cost savings, and hence those for which surgery is most likely to be cost effective, are those who have symptoms of hypercalcaemia, or end organ disease, or those with a serum calcium level of 2.85 mmol/litre or above. They therefore agreed to offer surgery to this population. Therefore as mentioned in the benefits and harms section above, the population for which the committee have recommended surgery should be offered reflect broad international consensus, and as a result this recommendation is in line with current practice and therefore will not have a substantial resource impact.</p><p>The committee expressed concern that in current practice, people with primary hyperparathyroidism who may potentially be cured by surgery are not currently being referred to have surgery due to not meeting current NIH criteria. It was estimated this might affect around 15–20% of patients. Therefore, the committee also considered the cost effectiveness of surgery for those who do not meet these criteria – an ‘asymptomatic’ population. The committee discussed that as these people are generally ‘asymptomatic’ the likely quality of life gains initially after surgery are likely to be smaller, however they still considered there could be some improvement due to the possible resolution of non-specific symptoms people with ‘asymptomatic’ primary hyperparathyroidism can experience such as fatigue, depression and muscle weakness to name a few. The committee also discussed that if surgery was not considered in this population they would be monitored, which also incurs a cost. Furthermore the committee recognised that people may become eligible according to the recommendations at a later date due to disease progression. The committee discussed that by this point their quality of life could have worsened due to the development of symptoms of hypercalcaemia or possible due to end organ damage. However, as there are no data available to suggest the rate or proportion of people that are likely to become eligible for surgery according to these criteria, as well as a lack of data available on the effectiveness of monitoring in detecting potential disease progression prior to end organ damage occurring, the cost effectiveness of surgery in this population is highly uncertain. However, the committee considered that because future decrements in quality of life and cost of events associated with end organ damage could be avoided, surgery should be considered in this group.</p><p>It is uncertain how many additional surgeries would be performed as a result of this recommendation, but the committee do not anticipate there will be a significant increase in the number of referrals to result in a significant resource impact..</p></div><div id="ch3.s1.8.3"><h4>1.8.3. Other factors the committee took into account</h4><p>The committee considered symptomatic primary hyperparathyroidism to include symptoms attributable to hypercalcaemia such as thirst, polyuria and constipation. They also recognised associations with non-specific symptoms such as fatigue, depression, muscle weakness, constipation, abdominal pain, loss of concentration, mild confusion etc. End organ disease refers particularly to disease of the kidney and bones as these are more commonly associated with primary hyperparathyroidism. The committee noted primary hyperparathyroidism was considered as a rare cause of pancreatitis, but there was no evidence to suggest that parathyroid surgery would improve the course of pancreatitis in such patients.</p><p>The committee noted that surgery is only offered if the benefits outweigh the risks. People may not be offered surgery if they have a very high operative risk, airway problems, distorted anatomy or short life expectancy.</p><p>The committee discussed the terminologies used for parathyroid surgery and stated that parathyroid surgery is surgery targeted at the parathyroid and parathyroidectomy is removal of parathyroid tissue. They noted that there may be failed parathyroidectomy (or unsuccessful) that is still parathyroid surgery.</p></div></div></div><div id="ch3.rl.r1"><h2 id="_ch3_rl_r1_">References</h2><dl class="temp-labeled-list"><dt>1.</dt><dd><div class="bk_ref" id="ch3.ref1">Adler
|
||
JT, Sippel
|
||
RS, Chen
|
||
H. The influence of surgical approach on quality of life after parathyroid surgery. Annals of Surgical Oncology. 2008; 15(6):1559–65 [<a href="https://pubmed.ncbi.nlm.nih.gov/18379849" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18379849</span></a>]</div></dd><dt>2.</dt><dd><div class="bk_ref" id="ch3.ref2">Agus
|
||
ZS. Conservative vs surgical treatment of hyperparathyroidism: which to choose, and when?
|
||
Cleveland Clinic Journal of Medicine. 1993; 60(3):191–2 [<a href="https://pubmed.ncbi.nlm.nih.gov/8513538" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8513538</span></a>]</div></dd><dt>3.</dt><dd><div class="bk_ref" id="ch3.ref3">Alhava
|
||
EM, Karjalainen
|
||
P, Paakkonen
|
||
M. Bone mineral density and surgical treatment of primary hyperparathyroidism. Acta Chirurgica Scandinavica. 1988; 154(5–6):345–7 [<a href="https://pubmed.ncbi.nlm.nih.gov/3420999" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 3420999</span></a>]</div></dd><dt>4.</dt><dd><div class="bk_ref" id="ch3.ref4">Almqvist
|
||
EG, Becker
|
||
C, Bondeson
|
||
AG, Bondeson
|
||
L, Svensson
|
||
J. Early parathyroidectomy increases bone mineral density in patients with mild primary hyperparathyroidism: a prospective and randomized study. Surgery. 2004; 136(6):1281–8 [<a href="https://pubmed.ncbi.nlm.nih.gov/15657588" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 15657588</span></a>]</div></dd><dt>5.</dt><dd><div class="bk_ref" id="ch3.ref5">Almqvist
|
||
EG, Bondeson
|
||
AG, Bondeson
|
||
L, Nissborg
|
||
A, Smedgård
|
||
P, Svensson
|
||
SE. Cardiac dysfunction in mild primary hyperparathyroidism assessed by radionuclide angiography and echocardiography before and after parathyroidectomy. Surgery. 2002; 132(6):1126–32; discussion 1132 [<a href="https://pubmed.ncbi.nlm.nih.gov/12490865" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12490865</span></a>]</div></dd><dt>6.</dt><dd><div class="bk_ref" id="ch3.ref6">Alvarez-Allende
|
||
CR, Pascual Marrero
|
||
AM, Castillo
|
||
CA, Mendez-Latalladi
|
||
W. Parathyroidectomy outcomes in normocalcemic primary hyperparathyroidism. Journal of the American College of Surgeons. 2014; 219:(4 Suppl):e12</div></dd><dt>7.</dt><dd><div class="bk_ref" id="ch3.ref7">Ambrogini
|
||
E, Cetani
|
||
F, Cianferotti
|
||
L, Vignali
|
||
E, Banti
|
||
C, Viccica
|
||
G
|
||
et al. Surgery or surveillance for mild asymptomatic primary hyperparathyroidism: a prospective, randomized clinical trial. Journal of Clinical Endocrinology and Metabolism. 2007; 92(8):3114–21 [<a href="https://pubmed.ncbi.nlm.nih.gov/17535997" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 17535997</span></a>]</div></dd><dt>8.</dt><dd><div class="bk_ref" id="ch3.ref8">Anonymous. Erratum: A 10-year prospective study of primary hyperparathyroidision with or without parathyroid surgery (New England Journal of Medicine (October 21, 1999) 341 (1249–1255)). New England Journal of Medicine. 2000; 342(2):144 [<a href="https://pubmed.ncbi.nlm.nih.gov/10528034" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 10528034</span></a>]</div></dd><dt>9.</dt><dd><div class="bk_ref" id="ch3.ref9">Anonymous. Surgery reduces risk of fracture in primary hyperparathyroidism. BMJ. 2000; 321(7261):C [<a href="/pmc/articles/PMC1118477/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC1118477</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/10977860" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 10977860</span></a>]</div></dd><dt>10.</dt><dd><div class="bk_ref" id="ch3.ref10">Barkun
|
||
J, Duh
|
||
QY, Wiseman
|
||
S, McKenzie
|
||
M. Canadian Association of General Surgeons and American College of Surgeons Evidence Based Reviews in Surgery. 16. Randomized trial of parathyroidectomy in mild asymptomatic primary hyperparathyroidism. Canadian Journal of Surgery. 2006; 49(1):59–61 [<a href="/pmc/articles/PMC3207513/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3207513</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/16524146" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 16524146</span></a>]</div></dd><dt>11.</dt><dd><div class="bk_ref" id="ch3.ref11">Bilezikian
|
||
JP, Brandi
|
||
ML, Eastell
|
||
R, Silverberg
|
||
SJ, Udelsman
|
||
R, Marcocci
|
||
C
|
||
et al. Guidelines for the management of asymptomatic primary hyperparathyroidism: summary statement from the Fourth International Workshop. Journal of Clinical Endocrinology and Metabolism. 2014; 99(10):3561–9 [<a href="/pmc/articles/PMC5393490/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5393490</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/25162665" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25162665</span></a>]</div></dd><dt>12.</dt><dd><div class="bk_ref" id="ch3.ref12">Blanchard
|
||
C, Mathonnet
|
||
M, Sebag
|
||
F, Caillard
|
||
C, Kubis
|
||
C, Drui
|
||
D
|
||
et al. Quality of life is modestly improved in older patients with mild primary hyperparathyroidism postoperatively: Results of a prospective multicenter study. Annals of Surgical Oncology. 2014; 21(11):3534–40 [<a href="https://pubmed.ncbi.nlm.nih.gov/24823444" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24823444</span></a>]</div></dd><dt>13.</dt><dd><div class="bk_ref" id="ch3.ref13">Bollerslev
|
||
J, Jansson
|
||
S, Mollerup
|
||
CL, Nordenström
|
||
J, Lundgren
|
||
E, Tørring
|
||
O
|
||
et al. Medical observation, compared with parathyroidectomy, for asymptomatic primary hyperparathyroidism: a prospective, randomized trial. Journal of Clinical Endocrinology and Metabolism. 2007; 92(5):1687–92 [<a href="https://pubmed.ncbi.nlm.nih.gov/17284629" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 17284629</span></a>]</div></dd><dt>14.</dt><dd><div class="bk_ref" id="ch3.ref14">Bollerslev
|
||
J, Rosen
|
||
T, Mollerup
|
||
CL, Nordenström
|
||
J, Baranowski
|
||
M, Franco
|
||
C
|
||
et al. Effect of surgery on cardiovascular risk factors in mild primary hyperparathyroidism. Journal of Clinical Endocrinology and Metabolism. 2009; 94(7):2255–61 [<a href="https://pubmed.ncbi.nlm.nih.gov/19351725" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19351725</span></a>]</div></dd><dt>15.</dt><dd><div class="bk_ref" id="ch3.ref15">Bonzelaar
|
||
LB, Salapatas
|
||
AM, Hwang
|
||
MS, Friedman
|
||
M. Parathyroidectomy for hyperparathyroidism: Morbidity and mortality. Otolaryngology - Head and Neck Surgery. 2016; 155(1):P57</div></dd><dt>16.</dt><dd><div class="bk_ref" id="ch3.ref16">Britton
|
||
DC, Thompson
|
||
MH, Johnston
|
||
ID, Fleming
|
||
LB. Renal function following parathyroid surgery in primary hyperparathyroidism. Lancet. 1971; 2(7715):74–75 [<a href="https://pubmed.ncbi.nlm.nih.gov/4103985" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 4103985</span></a>]</div></dd><dt>17.</dt><dd><div class="bk_ref" id="ch3.ref17">Brothers
|
||
TE, Thompson
|
||
NW. Surgical treatment of primary hyperparathyroidism in elderly patients. Acta Chirurgica Scandinavica. 1987; 153(3):175–8 [<a href="https://pubmed.ncbi.nlm.nih.gov/3604520" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 3604520</span></a>]</div></dd><dt>18.</dt><dd><div class="bk_ref" id="ch3.ref18">Broulik
|
||
PD, Broulikova
|
||
A, Adamek
|
||
S, Libansky
|
||
P, Tvrdon
|
||
J, Broulikova
|
||
K
|
||
et al. Improvement of hypertension after parathyroidectomy of patients suffering from primary hyperparathyroidism. International Journal of Endocrinology. 2011; 2011:309068 [<a href="/pmc/articles/PMC3043284/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3043284</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/21403888" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21403888</span></a>]</div></dd><dt>19.</dt><dd><div class="bk_ref" id="ch3.ref19">Bruining
|
||
HA, Van Houten
|
||
H, Juttmann
|
||
JR. Results of operative treatment of 615 patients with primary hyperparathyroidism. World Journal of Surgery. 1981; 5(1):85–90 [<a href="https://pubmed.ncbi.nlm.nih.gov/7233958" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 7233958</span></a>]</div></dd><dt>20.</dt><dd><div class="bk_ref" id="ch3.ref20">Burney
|
||
RE, Jones
|
||
KR, Coon
|
||
JW, Blewitt
|
||
DK, Herm
|
||
AM. Assessment of patient outcomes after operation for primary hyperparathyroidism. Surgery. 1996; 120(6):1013–9 [<a href="https://pubmed.ncbi.nlm.nih.gov/8957488" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8957488</span></a>]</div></dd><dt>21.</dt><dd><div class="bk_ref" id="ch3.ref21">Burney
|
||
RE, Jones
|
||
KR, Peterson
|
||
M, Christy
|
||
B, Thompson
|
||
NW, Cady
|
||
B
|
||
et al. Surgical correction of primary hyperparathyroidism improves quality of life. Surgery. 1998; 124(6):987–92 [<a href="https://pubmed.ncbi.nlm.nih.gov/9854573" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9854573</span></a>]</div></dd><dt>22.</dt><dd><div class="bk_ref" id="ch3.ref22">Calo
|
||
PG, Medas
|
||
F, Loi
|
||
G, Pisano
|
||
G, Sorrenti
|
||
S, Erdas
|
||
E
|
||
et al. Parathyroidectomy for primary hyperparathyroidism in the elderly: experience of a single endocrine surgery center. Aging Clinical and Experimental Research. 2016; 29(S1):15–21 [<a href="https://pubmed.ncbi.nlm.nih.gov/27837463" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27837463</span></a>]</div></dd><dt>23.</dt><dd><div class="bk_ref" id="ch3.ref23">Carneiro-Pla
|
||
DM, Irvin
|
||
GL, III, Chen
|
||
H. Consequences of parathyroidectomy in patients with “mild” sporadic primary hyperparathyroidism. Surgery. 2007; 142(6):795–9 [<a href="https://pubmed.ncbi.nlm.nih.gov/18063058" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18063058</span></a>]</div></dd><dt>24.</dt><dd><div class="bk_ref" id="ch3.ref24">Chen
|
||
H, Parkerson
|
||
S, Udelsman
|
||
R. Parathyroidectomy in the elderly: Do the benefits outweigh the risks?
|
||
World Journal of Surgery. 1998; 22(6):531–6 [<a href="https://pubmed.ncbi.nlm.nih.gov/9597924" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9597924</span></a>]</div></dd><dt>25.</dt><dd><div class="bk_ref" id="ch3.ref25">Cheng
|
||
SP, Lee
|
||
JJ, Liu
|
||
TP, Yang
|
||
PS, Liu
|
||
SC, Hsu
|
||
YC
|
||
et al. Quality of life after surgery or surveillance for asymptomatic primary hyperparathyroidism: A meta-analysis of randomized controlled trials. Medicine. 2015; 94(23):e931 [<a href="/pmc/articles/PMC4616470/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4616470</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/26061318" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26061318</span></a>]</div></dd><dt>26.</dt><dd><div class="bk_ref" id="ch3.ref26">Chigot
|
||
JP, Menegaux
|
||
F, Achrafi
|
||
H. Should primary hyperparathyroidism be treated surgically in elderly patients older than 75 years?
|
||
Surgery. 1995; 117(4):397–401 [<a href="https://pubmed.ncbi.nlm.nih.gov/7716721" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 7716721</span></a>]</div></dd><dt>27.</dt><dd><div class="bk_ref" id="ch3.ref27">Clifton-Bligh
|
||
PB, Nery
|
||
ML, Supramaniam
|
||
R, Reeve
|
||
TS, Delbridge
|
||
L, Stiel
|
||
JN
|
||
et al. Mortality associated with primary hyperparathyroidism. Bone. 2015; 74:121–4 [<a href="https://pubmed.ncbi.nlm.nih.gov/25637062" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25637062</span></a>]</div></dd><dt>28.</dt><dd><div class="bk_ref" id="ch3.ref28">Cowie
|
||
AGA. Morbidity in adult parathyroid surgery. Journal of the Royal Society of Medicine. 1982; 75(12):942–5 [<a href="/pmc/articles/PMC1438490/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC1438490</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/7175884" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 7175884</span></a>]</div></dd><dt>29.</dt><dd><div class="bk_ref" id="ch3.ref29">D’Andrea
|
||
V, Biancari
|
||
F, Catania
|
||
A, Chiarini
|
||
S, Lippolis
|
||
G, Falvo
|
||
L
|
||
et al. Surgical treatment for hyperparathyroidism. Italian Journal of Mineral and Electrolyte Metabolism. 1996; 10(1):39–43</div></dd><dt>30.</dt><dd><div class="bk_ref" id="ch3.ref30">Department of Health. NHS reference costs 2015–16. Available from: <a href="https://www.gov.uk/government/publications/nhs-reference-costs-2015-to-2016" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">https://www<wbr style="display:inline-block"></wbr>.gov.uk/government<wbr style="display:inline-block"></wbr>/publications<wbr style="display:inline-block"></wbr>/nhs-reference-costs-2015-to-2016</a> Last accessed: 17/01/2018.</div></dd><dt>31.</dt><dd><div class="bk_ref" id="ch3.ref31">Diaz-Guerra
|
||
GM, Guadalix
|
||
S, Garcia
|
||
F, Melon
|
||
N, Martinez-Pueyo
|
||
JI, Ferrero
|
||
E
|
||
et al. Parathyroidectomy in primary hyperparathyroidism (PHPT): Retrospective study of 272 patients. Endocrine Reviews. 2015; 36:(2 Suppl):SAT–266</div></dd><dt>32.</dt><dd><div class="bk_ref" id="ch3.ref32">Dy
|
||
BM, Grant
|
||
CS, Wermers
|
||
RA, Kearns
|
||
AE, Huebner
|
||
M, Harmsen
|
||
WS
|
||
et al. Changes in bone mineral density after surgical intervention for primary hyperparathyroidism. Surgery. 2012; 152(6):1051–8 [<a href="https://pubmed.ncbi.nlm.nih.gov/23040710" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23040710</span></a>]</div></dd><dt>33.</dt><dd><div class="bk_ref" id="ch3.ref33">Edwards
|
||
ME, Rotramel
|
||
A, Beyer
|
||
T, Gaffud
|
||
MJ, Djuricin
|
||
G, Loviscek
|
||
K
|
||
et al. Improvement in the health-related quality-of-life symptoms of hyperparathyroidism is durable on long-term follow-up. Surgery. 2006; 140(4):655–64 [<a href="https://pubmed.ncbi.nlm.nih.gov/17011914" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 17011914</span></a>]</div></dd><dt>34.</dt><dd><div class="bk_ref" id="ch3.ref34">Elvius
|
||
M, Lagrelius
|
||
A, Nygren
|
||
A, Alveryd
|
||
A, Christensson
|
||
TA, Nordenström
|
||
J. Seventeen year follow-up study of bone mass in patients with mild asymptomatic hyperparathyroidism some of whom were operated on. European Journal of Surgery. 1995; 161(12):863–9 [<a href="https://pubmed.ncbi.nlm.nih.gov/8775626" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8775626</span></a>]</div></dd><dt>35.</dt><dd><div class="bk_ref" id="ch3.ref35">Espiritu
|
||
RP, Kearns
|
||
AE, Vickers
|
||
KS, Grant
|
||
C, Ryu
|
||
E, Wermers
|
||
RA. Depression in primary hyperparathyroidism: Prevalence and benefit of surgery. Journal of Clinical Endocrinology and Metabolism. 2011; 96(11):E1737–E1745 [<a href="https://pubmed.ncbi.nlm.nih.gov/21917870" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21917870</span></a>]</div></dd><dt>36.</dt><dd><div class="bk_ref" id="ch3.ref36">Falkheden
|
||
T, Ohlsson
|
||
L, Sjogren
|
||
B. Renal function in primary hyperparathyroidism. A follow-up study two to eleven years after surgery comprising 139 patients. Scandinavian Journal of Urology and Nephrology. 1980; 14(2):167–75 [<a href="https://pubmed.ncbi.nlm.nih.gov/7209421" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 7209421</span></a>]</div></dd><dt>37.</dt><dd><div class="bk_ref" id="ch3.ref37">Fang
|
||
WL, Tseng
|
||
LM, Chen
|
||
JY, Chiou
|
||
SY, Chou
|
||
YH, Wu
|
||
CW
|
||
et al. The management of high-risk patients with primary hyperparathyroidism - Minimally invasive parathyroidectomy vs. medical treatment. Clinical Endocrinology. 2008; 68(4):520–8 [<a href="https://pubmed.ncbi.nlm.nih.gov/17973936" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 17973936</span></a>]</div></dd><dt>38.</dt><dd><div class="bk_ref" id="ch3.ref38">Farnebo
|
||
LO, Trigonis
|
||
C, Forsgren
|
||
L. Surgery for primary hyperparathyroidism. Experience with 400 patients during 10 years (1972–1981). Acta Chirurgica Scandinavica. 1984; 150(Suppl. 520):11–6 [<a href="https://pubmed.ncbi.nlm.nih.gov/6594866" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 6594866</span></a>]</div></dd><dt>39.</dt><dd><div class="bk_ref" id="ch3.ref39">Freaney
|
||
R, Casey
|
||
OM, Muldowney
|
||
FP. The long-term effect of parathyroidectomy on renal function. Irish Journal of Medical Science. 1978; 147(6):205–9 [<a href="https://pubmed.ncbi.nlm.nih.gov/669906" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 669906</span></a>]</div></dd><dt>40.</dt><dd><div class="bk_ref" id="ch3.ref40">Ghose
|
||
RR, Morgan
|
||
WD. Improvement in renal function in primary hyperparathyroidism following parathyroidectomy. Postgraduate Medical Journal. 1981; 57(663):28–30 [<a href="/pmc/articles/PMC2424763/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC2424763</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/7279819" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 7279819</span></a>]</div></dd><dt>41.</dt><dd><div class="bk_ref" id="ch3.ref41">Hagstrom
|
||
E, Lundgren
|
||
E, Mallmin
|
||
H, Rastad
|
||
J, Hellman
|
||
P. Positive effect of parathyroidectomy on bone mineral density in mild asymptomatic primary hyperparathyroidism. Journal of Internal Medicine. 2006; 259(2):191–8 [<a href="https://pubmed.ncbi.nlm.nih.gov/16420548" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 16420548</span></a>]</div></dd><dt>42.</dt><dd><div class="bk_ref" id="ch3.ref42">Hedback
|
||
G, Oden
|
||
A, Tisell
|
||
LE. The influence of surgery on the risk of death in patients with primary hyperparathyroidism. World Journal of Surgery. 1991; 15(3):399–407 [<a href="https://pubmed.ncbi.nlm.nih.gov/1853620" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 1853620</span></a>]</div></dd><dt>43.</dt><dd><div class="bk_ref" id="ch3.ref43">Hedback
|
||
G, Tisell
|
||
LE, Bengtsson
|
||
BA, Hedman
|
||
I, Oden
|
||
A. Premature death in patients operated on for primary hyperparathyroidism. World Journal of Surgery. 1990; 14(6):829–36 [<a href="https://pubmed.ncbi.nlm.nih.gov/2256355" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 2256355</span></a>]</div></dd><dt>44.</dt><dd><div class="bk_ref" id="ch3.ref44">Horiuchi
|
||
T, Onouchi
|
||
T, Inoue
|
||
J, Shionoiri
|
||
A, Hosoi
|
||
T, Orimo
|
||
H. A strategy for the management of elderly women with primary hyperparathyroidism: a comparison of etidronate therapy with parathyroidectomy. Gerontology. 2002; 48(2):103–8 [<a href="https://pubmed.ncbi.nlm.nih.gov/11867933" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11867933</span></a>]</div></dd><dt>45.</dt><dd><div class="bk_ref" id="ch3.ref45">Jansson
|
||
S, Mollerup
|
||
C, Nordenstrom
|
||
J, Varhaug
|
||
JE, Isaksen
|
||
G, Bollerslev
|
||
J. The SIPH study: surgery vs. medical observation in mild, asymptomatic phpt preliminary results from a prospective, randomized study. Langenbeck’s Archives of Surgery. 2006; 391(3):242</div></dd><dt>46.</dt><dd><div class="bk_ref" id="ch3.ref46">Khosla
|
||
S, Melton
|
||
LJ, III, Wermers
|
||
RA, Crowson
|
||
CS, O’Fallon
|
||
WM, Riggs
|
||
BL. Primary hyperparathyroidism and the risk of fracture: A population-based study. Journal of Bone and Mineral Research. 1999; 14(10):1700–7 [<a href="https://pubmed.ncbi.nlm.nih.gov/10491217" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 10491217</span></a>]</div></dd><dt>47.</dt><dd><div class="bk_ref" id="ch3.ref47">Lafferty
|
||
FW, Hubay
|
||
CA. Primary hyperparathyroidism. A review of the long-term surgical and nonsurgical morbidities as a basis for a rational approach to treatment. Archives of Internal Medicine. 1989; 149(4):789–96 [<a href="https://pubmed.ncbi.nlm.nih.gov/2705830" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 2705830</span></a>]</div></dd><dt>48.</dt><dd><div class="bk_ref" id="ch3.ref48">Larsson
|
||
K, Ljunghall
|
||
S, Krusemo
|
||
UB, Naessen
|
||
T, Lindh
|
||
E, Persson
|
||
I. The risk of hip fractures in patients with primary hyperparathyroidism: A population-based cohort study with a follow-up of 19 years. Journal of Internal Medicine. 1993; 234(6):585–93 [<a href="https://pubmed.ncbi.nlm.nih.gov/8258750" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8258750</span></a>]</div></dd><dt>49.</dt><dd><div class="bk_ref" id="ch3.ref49">Leong
|
||
KJ, Sam
|
||
RC, Garnham
|
||
AW. Health-related quality of life improvement following surgical treatment of primary hyperparathyroidism in a United Kingdom population. Surgeon. 2010; 8(1):5–8 [<a href="https://pubmed.ncbi.nlm.nih.gov/20222396" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 20222396</span></a>]</div></dd><dt>50.</dt><dd><div class="bk_ref" id="ch3.ref50">Lundstam
|
||
K, Heck
|
||
A, Godang
|
||
K, Mollerup
|
||
C, Baranowski
|
||
M, Pernow
|
||
Y
|
||
et al. Effect of surgery versus observation: Skeletal 5-year outcomes in a randomized trial of patients with primary HPT (the SIPH study). Journal of Bone and Mineral Research. 2017; 32(9):1907–14 [<a href="https://pubmed.ncbi.nlm.nih.gov/28543873" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28543873</span></a>]</div></dd><dt>51.</dt><dd><div class="bk_ref" id="ch3.ref51">Lundstam
|
||
K, Heck
|
||
A, Mollerup
|
||
C, Godang
|
||
K, Baranowski
|
||
M, Pernow
|
||
Y
|
||
et al. Effects of parathyroidectomy versus observation on the development of vertebral fractures in mild primary hyperparathyroidism. Journal of Clinical Endocrinology and Metabolism. 2015; 100(4):1359–67 [<a href="https://pubmed.ncbi.nlm.nih.gov/25636048" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25636048</span></a>]</div></dd><dt>52.</dt><dd><div class="bk_ref" id="ch3.ref52">McDow
|
||
AD, Sippel
|
||
RS. Should symptoms be considered an indication for parathyroidectomy in primary hyperparathyroidism?
|
||
Clinical Medicine Insights. 2018; 11:1179551418785135 [<a href="/pmc/articles/PMC6043916/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC6043916</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/30013413" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30013413</span></a>]</div></dd><dt>53.</dt><dd><div class="bk_ref" id="ch3.ref53">Melton
|
||
LJ, 3rd, Atkinson
|
||
EJ, O’Fallon
|
||
WM, Heath
|
||
H, III Risk of age-related fractures in patients with primary hyperparathyroidism. Archives of Internal Medicine. 1992; 152(11):2269–73 [<a href="https://pubmed.ncbi.nlm.nih.gov/1444687" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 1444687</span></a>]</div></dd><dt>54.</dt><dd><div class="bk_ref" id="ch3.ref54">Mole
|
||
PA, Walkinshaw
|
||
MH, Gunn
|
||
A, Paterson
|
||
CR. Bone mineral content in patients with primary hyperparathyroidism: A comparison of conservative management with surgical treatment. British Journal of Surgery. 1992; 79(3):263–5 [<a href="https://pubmed.ncbi.nlm.nih.gov/1555098" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 1555098</span></a>]</div></dd><dt>55.</dt><dd><div class="bk_ref" id="ch3.ref55">Morris
|
||
GS, Grubbs
|
||
EG, Hearon
|
||
CM, Gantela
|
||
S, Lee
|
||
JE, Evans
|
||
DB
|
||
et al. Parathyroidectomy improves functional capacity in “asymptomatic” older patients with primary hyperparathyroidism: a randomized control trial. Annals of Surgery. 2010; 251(5):832–7 [<a href="https://pubmed.ncbi.nlm.nih.gov/20395857" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 20395857</span></a>]</div></dd><dt>56.</dt><dd><div class="bk_ref" id="ch3.ref56">National Institute for Health and Care Excellence. Developing NICE guidelines: the manual. London. National Institute for Health and Care Excellence, 2014. Available from: <a href="http://www.nice.org.uk/article/PMG20/chapter/1%20Introduction%20and%20overview" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">http://www<wbr style="display:inline-block"></wbr>.nice.org.uk<wbr style="display:inline-block"></wbr>/article/PMG20/chapter<wbr style="display:inline-block"></wbr>/1%20Introduction%20and%20overview</a> [<a href="https://pubmed.ncbi.nlm.nih.gov/26677490" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26677490</span></a>]</div></dd><dt>57.</dt><dd><div class="bk_ref" id="ch3.ref57">Nomura
|
||
R, Sugimoto
|
||
T, Tsukamoto
|
||
T, Yamauchi
|
||
M, Sowa
|
||
H, Chen
|
||
Q
|
||
et al. Marked and sustained increase in bone mineral density after parathyroidectomy in patients with primary hyperparathyroidism; a six-year longitudinal study with or without parathyroidectomy in a Japanese population. Clinical Endocrinology. 2004; 60(3):335–42 [<a href="https://pubmed.ncbi.nlm.nih.gov/15008999" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 15008999</span></a>]</div></dd><dt>58.</dt><dd><div class="bk_ref" id="ch3.ref58">Nordenstrom
|
||
E, Westerdahl
|
||
J, Bergenfelz
|
||
A. Recovery of bone mineral density in 126 patients after surgery for primary hyperparathyroidism. World Journal of Surgery. 2004; 28(5):502–7 [<a href="https://pubmed.ncbi.nlm.nih.gov/15085393" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 15085393</span></a>]</div></dd><dt>59.</dt><dd><div class="bk_ref" id="ch3.ref59">Oucharek
|
||
JJ, O’Neill
|
||
CJ, Suliburk
|
||
JW, Sywak
|
||
MS, Delbridge
|
||
LW, Sidhu
|
||
SB. Durability of focused minimally invasive parathyroidectomy in young patients with sporadic primary hyperparathyroidism. Annals of Surgical Oncology. 2011; 18(5):1290–2 [<a href="https://pubmed.ncbi.nlm.nih.gov/21108046" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21108046</span></a>]</div></dd><dt>60.</dt><dd><div class="bk_ref" id="ch3.ref60">Paloyan
|
||
E, Lawrence
|
||
AM, Oslapas
|
||
R, Shah
|
||
KH, Ernst
|
||
K, Hofmann
|
||
C. Subtotal parathyroidectomy for primary hyperparathyroidism. Long-term results in 292 patients. Archives of Surgery. 1983; 118(4):425–31 [<a href="https://pubmed.ncbi.nlm.nih.gov/6338863" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 6338863</span></a>]</div></dd><dt>61.</dt><dd><div class="bk_ref" id="ch3.ref61">Perrier
|
||
ND, Balachandran
|
||
D, Wefel
|
||
JS, Jimenez
|
||
C, Busaidy
|
||
N, Morris
|
||
GS
|
||
et al. Prospective, randomized, controlled trial of parathyroidectomy versus observation in patients with “asymptomatic” primary hyperparathyroidism. Surgery. 2009; 146(6):1116–22 [<a href="https://pubmed.ncbi.nlm.nih.gov/19879613" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19879613</span></a>]</div></dd><dt>62.</dt><dd><div class="bk_ref" id="ch3.ref62">Persson
|
||
A, Bollerslev
|
||
J, Rosen
|
||
T, Mollerup
|
||
CL, Franco
|
||
C, Isaksen
|
||
GA
|
||
et al. Effect of surgery on cardiac structure and function in mild primary hyperparathyroidism. Clinical Endocrinology. 2011; 74(2):174–80 [<a href="https://pubmed.ncbi.nlm.nih.gov/21044114" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21044114</span></a>]</div></dd><dt>63.</dt><dd><div class="bk_ref" id="ch3.ref63">Posen
|
||
S, Clifton-Bligh
|
||
P, Reeve
|
||
TS. Is parathyroidectomy of benefit in primary hyperparathyroidism?
|
||
Quarterly Journal of Medicine. 1985; 54(215):241–51 [<a href="https://pubmed.ncbi.nlm.nih.gov/3991879" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 3991879</span></a>]</div></dd><dt>64.</dt><dd><div class="bk_ref" id="ch3.ref64">Rao
|
||
DS, Phillips
|
||
ER, Divine
|
||
GW, Talpos
|
||
GB. Randomized controlled clinical trial of surgery versus no surgery in patients with mild asymptomatic primary hyperparathyroidism. Journal of Clinical Endocrinology and Metabolism. 2004; 89(11):5415–22 [<a href="https://pubmed.ncbi.nlm.nih.gov/15531491" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 15531491</span></a>]</div></dd><dt>65.</dt><dd><div class="bk_ref" id="ch3.ref65">Rao
|
||
DS, Wallace
|
||
EA, Antonelli
|
||
RF, Talpos
|
||
GB, Ansari
|
||
MR, Jacobsen
|
||
G
|
||
et al. Forearm bone density in primary hyperparathyroidism: Long-term follow-up with and without parathyroidectomy. Clinical Endocrinology. 2003; 58(3):348–54 [<a href="https://pubmed.ncbi.nlm.nih.gov/12608941" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12608941</span></a>]</div></dd><dt>66.</dt><dd><div class="bk_ref" id="ch3.ref66">Richmond
|
||
BK, Eads
|
||
K, Flaherty
|
||
S, Belcher
|
||
M, Runyon
|
||
D. Complications of thyroidectomy and parathyroidectomy in the rural community hospital setting. American Surgeon. 2007; 73(4):332–6 [<a href="https://pubmed.ncbi.nlm.nih.gov/17439023" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 17439023</span></a>]</div></dd><dt>67.</dt><dd><div class="bk_ref" id="ch3.ref67">Rolighed
|
||
L, Vestergaard
|
||
P, Heickendorff
|
||
L, Sikjaer
|
||
T, Rejnmark
|
||
L, Mosekilde
|
||
L
|
||
et al. Bone mineral density improvements after operation for primary hyperparathyroidism. Langenbeck’s Archives of Surgery. 2012; 397 (5):845 [<a href="https://pubmed.ncbi.nlm.nih.gov/23132462" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23132462</span></a>]</div></dd><dt>68.</dt><dd><div class="bk_ref" id="ch3.ref68">Rubin
|
||
MR, Bilezikian
|
||
JP, McMahon
|
||
DJ, Jacobs
|
||
T, Shane
|
||
E, Siris
|
||
E
|
||
et al. The natural history of primary hyperparathyroidism with or without parathyroid surgery after 15 years. Journal of Clinical Endocrinology and Metabolism. 2008; 93(9):3462–70 [<a href="/pmc/articles/PMC2567863/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC2567863</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/18544625" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18544625</span></a>]</div></dd><dt>69.</dt><dd><div class="bk_ref" id="ch3.ref69">Sankaran
|
||
S, Gamble
|
||
G, Bolland
|
||
M, Reid
|
||
IR, Grey
|
||
A. Skeletal effects of interventions in mild primary hyperparathyroidism: A meta-analysis. Journal of Clinical Endocrinology and Metabolism. 2010; 95(4):1653–62 [<a href="https://pubmed.ncbi.nlm.nih.gov/20130069" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 20130069</span></a>]</div></dd><dt>70.</dt><dd><div class="bk_ref" id="ch3.ref70">Sanzenbacher
|
||
LJ, Pak
|
||
CY, Bartter
|
||
FC. Preoperative and postoperative evaluation of patients with normocalcemic primary hyperparathyroidism. Surgical Forum. 1970; 21(4):96–8 [<a href="https://pubmed.ncbi.nlm.nih.gov/5514632" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 5514632</span></a>]</div></dd><dt>71.</dt><dd><div class="bk_ref" id="ch3.ref71">Saponaro
|
||
F, Faggiano
|
||
A, Grimaldi
|
||
F, Borretta
|
||
G, Brandi
|
||
ML, Minisola
|
||
S
|
||
et al. Cinacalcet in the management of primary hyperparathyroidism: Post marketing experience of an Italian multicentre group. Clinical Endocrinology. 2013; 79(1):20–6 [<a href="https://pubmed.ncbi.nlm.nih.gov/23228121" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23228121</span></a>]</div></dd><dt>72.</dt><dd><div class="bk_ref" id="ch3.ref72">Schneider
|
||
DF, Mazeh
|
||
H, Chen
|
||
H, Sippel
|
||
RS. Predictors of recurrence in primary hyperparathyroidism: An analysis of 1386 cases. Annals of Surgery. 2014; 259(3):563–8 [<a href="/pmc/articles/PMC4250051/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4250051</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/24263316" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24263316</span></a>]</div></dd><dt>73.</dt><dd><div class="bk_ref" id="ch3.ref73">Scott
|
||
HW, Jr, Richie
|
||
RE, Crane
|
||
JM, Rosenfeld
|
||
L, Jacobs
|
||
JK, Ginn
|
||
E
|
||
et al. Surgical experience with hyperparathyroidism. American Surgeon. 1981; 47(2):54–62 [<a href="https://pubmed.ncbi.nlm.nih.gov/7469179" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 7469179</span></a>]</div></dd><dt>74.</dt><dd><div class="bk_ref" id="ch3.ref74">Sejean
|
||
K, Calmus
|
||
S, Durand-Zaleski
|
||
I, Bonnichon
|
||
P, Thomopoulos
|
||
P, Cormier
|
||
C
|
||
et al. Surgery versus medical follow-up in patients with asymptomatic primary hyperparathyroidism: a decision analysis
|
||
European Journal of Endocrinology. 2005; 153(6):915–27 [<a href="https://pubmed.ncbi.nlm.nih.gov/16322399" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 16322399</span></a>]</div></dd><dt>75.</dt><dd><div class="bk_ref" id="ch3.ref75">Silverberg
|
||
SJ, Gartenberg
|
||
F, Jacobs
|
||
TP, Shane
|
||
E, Siris
|
||
E, Staron
|
||
RB
|
||
et al. Increased bone mineral density after parathyroidectomy in primary hyperparathyroidism. Journal of Clinical Endocrinology and Metabolism. 1995; 80(3):729–34 [<a href="https://pubmed.ncbi.nlm.nih.gov/7883824" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 7883824</span></a>]</div></dd><dt>76.</dt><dd><div class="bk_ref" id="ch3.ref76">Silverberg
|
||
SJ, Shane
|
||
E, Jacobs
|
||
TP, Siris
|
||
E, Bilezikian
|
||
JP. A 10-year prospective study of primary hyperparathyroidism with or without parathyroid surgery. New England Journal of Medicine. 1999; 341(17):1249–55 [<a href="https://pubmed.ncbi.nlm.nih.gov/10528034" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 10528034</span></a>]</div></dd><dt>77.</dt><dd><div class="bk_ref" id="ch3.ref77">Singh Ospina
|
||
N, Maraka
|
||
S, Rodriguez-Gutierrez
|
||
R, Espinosa de Ycaza
|
||
AE, Jasim
|
||
S, Gionfriddo
|
||
M
|
||
et al. Comparative efficacy of parathyroidectomy and active surveillance in patients with mild primary hyperparathyroidism: a systematic review and meta-analysis. Osteoporosis International. 2016; 27(12):3395–407 [<a href="https://pubmed.ncbi.nlm.nih.gov/27562567" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27562567</span></a>]</div></dd><dt>78.</dt><dd><div class="bk_ref" id="ch3.ref78">Singh Ospina
|
||
NM, Rodriguez-Gutierrez
|
||
R, Maraka
|
||
S, Espinosa de Ycaza
|
||
AE, Jasim
|
||
S, Castaneda-Guarderas
|
||
A
|
||
et al. Outcomes of parathyroidectomy in patients with primary hyperparathyroidism: A systematic review and meta-analysis. World Journal of Surgery. 2016; 40(10):2359–77 [<a href="https://pubmed.ncbi.nlm.nih.gov/27094563" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27094563</span></a>]</div></dd><dt>79.</dt><dd><div class="bk_ref" id="ch3.ref79">Siperstein
|
||
AE, Shen
|
||
W, Chan
|
||
AK, Duh
|
||
QY, Clark
|
||
OH, Giuliano
|
||
AE
|
||
et al. Normocalcemic hyperparathyroidism: Biochemical and symptom profiles before and after surgery. Archives of Surgery. 1992; 127(10):1157–63 [<a href="https://pubmed.ncbi.nlm.nih.gov/1417479" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 1417479</span></a>]</div></dd><dt>80.</dt><dd><div class="bk_ref" id="ch3.ref80">Solorzano
|
||
CC, Mendez
|
||
W, Lew
|
||
JI, Rodgers
|
||
SE, Montano
|
||
R, Carneiro-Pla
|
||
DM
|
||
et al. Long-term outcome of patients with elevated parathyroid hormone levels after successful parathyroidectomy for sporadic primary hyperparathyroidism. Archives of Surgery. 2008; 143(7):659–63 [<a href="https://pubmed.ncbi.nlm.nih.gov/18645108" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18645108</span></a>]</div></dd><dt>81.</dt><dd><div class="bk_ref" id="ch3.ref81">Soreide
|
||
JA, Van Heerden
|
||
JA, Grant
|
||
CS, Lo
|
||
CY, Schleck
|
||
C, Ilstrup
|
||
DM. Survival after surgical treatment for primary hyperparathyroidism. Surgery. 1997; 122(6):1117–23 [<a href="https://pubmed.ncbi.nlm.nih.gov/9426427" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9426427</span></a>]</div></dd><dt>82.</dt><dd><div class="bk_ref" id="ch3.ref82">Strewler
|
||
GJ. Indications for surgery in patients with minimally symptomatic primary hyperparathyroidism. Surgical Clinics of North America. 1995; 75(3):439–47 [<a href="https://pubmed.ncbi.nlm.nih.gov/7747251" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 7747251</span></a>]</div></dd><dt>83.</dt><dd><div class="bk_ref" id="ch3.ref83">Talpos
|
||
GB, Bone
|
||
HG, Kleerekoper
|
||
M, Phillips
|
||
ER, Alam
|
||
M, Honasoge
|
||
M
|
||
et al. Randomized trial of parathyroidectomy in mild asymptomatic primary hyperparathyroidism: patient description and effects on the SF-36 health survey. Surgery. 2000; 128(6):1013–20;discussion 1020–1 [<a href="https://pubmed.ncbi.nlm.nih.gov/11114637" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11114637</span></a>]</div></dd><dt>84.</dt><dd><div class="bk_ref" id="ch3.ref84">Tay
|
||
YK, Khoo
|
||
J, Chandran
|
||
M. Surgery or no surgery: What works best for the kidneys in primary hyperparathyroidism? A study in a multi-ethnic Asian population. Indian Journal of Endocrinology and Metabolism. 2016; 20(1):55–61 [<a href="/pmc/articles/PMC4743385/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4743385</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/26904469" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26904469</span></a>]</div></dd><dt>85.</dt><dd><div class="bk_ref" id="ch3.ref85">Tisell
|
||
LE. Results of surgical and medical treatment in primary hyperparathyroidism. Annales Chirurgiae et Gynaecologiae. 1983; 72(3):129–34 [<a href="https://pubmed.ncbi.nlm.nih.gov/6625510" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 6625510</span></a>]</div></dd><dt>86.</dt><dd><div class="bk_ref" id="ch3.ref86">Trombetti
|
||
A, Christ
|
||
ER, Henzen
|
||
C, Gold
|
||
G, Brandle
|
||
M, Herrmann
|
||
FR
|
||
et al. Clinical presentation and management of patients with primary hyperparathyroidism of the Swiss Primary Hyperparathyroidism Cohort: A focus on neuro-behavioral and cognitive symptoms. Journal of Endocrinological Investigation. 2016; 39(5):567–76 [<a href="https://pubmed.ncbi.nlm.nih.gov/26742935" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26742935</span></a>]</div></dd><dt>87.</dt><dd><div class="bk_ref" id="ch3.ref87">VanderWalde
|
||
LH, Liu
|
||
IL, O’Connell
|
||
TX, Haigh
|
||
PI. The effect of parathyroidectomy on bone fracture risk in patients with primary hyperparathyroidism. Archives of Surgery. 2006; 141(9):885–9 [<a href="https://pubmed.ncbi.nlm.nih.gov/16983032" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 16983032</span></a>]</div></dd><dt>88.</dt><dd><div class="bk_ref" id="ch3.ref88">VanderWalde
|
||
LH, Liu
|
||
ILA, Haigh
|
||
PI. Effect of bone mineral density and parathyroidectomy on fracture risk in primary hyperparathyroidism. World Journal of Surgery. 2009; 33(3):406–11 [<a href="https://pubmed.ncbi.nlm.nih.gov/18763015" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18763015</span></a>]</div></dd><dt>89.</dt><dd><div class="bk_ref" id="ch3.ref89">Vera
|
||
L, Accornero
|
||
M, Dolcino
|
||
M, Oddo
|
||
S, Giusti
|
||
M. Five-year longitudinal evaluation of mild primary hyperparathyroidism - Medical treatment versus clinical observation. Endokrynologia Polska. 2014; 65(6):456–63 [<a href="https://pubmed.ncbi.nlm.nih.gov/25554613" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25554613</span></a>]</div></dd><dt>90.</dt><dd><div class="bk_ref" id="ch3.ref90">Vestergaard
|
||
P, Mosekilde
|
||
L. Cohort study on effects of parathyroid surgery on multiple outcomes in primary hyperparathyroidism. BMJ. 2003; 327(7414):530–3 [<a href="/pmc/articles/PMC192894/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC192894</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/12958111" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12958111</span></a>]</div></dd><dt>91.</dt><dd><div class="bk_ref" id="ch3.ref91">Vestergaard
|
||
P, Mosekilde
|
||
L. Fractures in patients with primary hyperparathyroidism: Nationwide follow-up study of 1201 patients. World Journal of Surgery. 2003; 27(3):343–9 [<a href="https://pubmed.ncbi.nlm.nih.gov/12607064" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12607064</span></a>]</div></dd><dt>92.</dt><dd><div class="bk_ref" id="ch3.ref92">Wagner
|
||
K, Miskulin
|
||
J. Effect of parathyroidectomy on osteoporosis and bone metabolism. Clinical Reviews in Bone and Mineral Metabolism. 2007; 5(2):115–21</div></dd><dt>93.</dt><dd><div class="bk_ref" id="ch3.ref93">Wermers
|
||
RA, Khosla
|
||
S, Atkinson
|
||
EJ, Grant
|
||
CS, Hodgson
|
||
SF, O’Fallon
|
||
WM
|
||
et al. Survival after the diagnosis of hyperparathyroidism: A population-based study. American Journal of Medicine. 1998; 104(2):115–22 [<a href="https://pubmed.ncbi.nlm.nih.gov/9528728" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9528728</span></a>]</div></dd><dt>94.</dt><dd><div class="bk_ref" id="ch3.ref94">Witteveen
|
||
JE, Kievit
|
||
J, Morreau
|
||
H, Romijn
|
||
JA, Hamdy
|
||
NAT. No recurrence of sporadic primary hyperparathyroidism when cure is established 6 months after parathyroidectomy. European Journal of Endocrinology. 2010; 162(2):399–406 [<a href="https://pubmed.ncbi.nlm.nih.gov/19884262" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19884262</span></a>]</div></dd><dt>95.</dt><dd><div class="bk_ref" id="ch3.ref95">Wu
|
||
B, Haigh
|
||
PI, Hwang
|
||
R, Ituarte
|
||
PHG, Liu
|
||
ILA, Hahn
|
||
TJ
|
||
et al. Underutilization of parathyroidectomy in elderly patients with primary hyperparathyroidism. Journal of Clinical Endocrinology and Metabolism. 2010; 95(9):4324–30 [<a href="/pmc/articles/PMC2936062/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC2936062</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/20610600" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 20610600</span></a>]</div></dd><dt>96.</dt><dd><div class="bk_ref" id="ch3.ref96">Yeh
|
||
MW, Zhou
|
||
H, Adams
|
||
AL, Ituarte
|
||
PHG, Li
|
||
N, Liu
|
||
ILA
|
||
et al. The relationship of parathyroidectomy and bisphosphonates with fracture risk in primary hyperparathyroidism: An observational study. Annals of Internal Medicine. 2016; 164(11):715–23 [<a href="https://pubmed.ncbi.nlm.nih.gov/27043778" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27043778</span></a>]</div></dd><dt>97.</dt><dd><div class="bk_ref" id="ch3.ref97">Yu
|
||
N, Donnan
|
||
PT, Flynn
|
||
RWV, Murphy
|
||
MJ, Smith
|
||
D, Rudman
|
||
A
|
||
et al. Increased mortality and morbidity in mild primary hyperparathyroid patients. the Parathyroid Epidemiology and Audit Research Study (PEARS). Clinical Endocrinology. 2010; 73(1):30–4 [<a href="https://pubmed.ncbi.nlm.nih.gov/20039887" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 20039887</span></a>]</div></dd><dt>98.</dt><dd><div class="bk_ref" id="ch3.ref98">Zhao
|
||
DW, Yen
|
||
TW, Doffek
|
||
K, Evans
|
||
DB, Wang
|
||
TS. Changes in bone mineral density after parathyroidectomy in elderly patients with primary hyperparathyroidism. Journal of Surgical Research. 2014; 186 (2):557</div></dd></dl></div><div id="appendixesappgroup3"><h2 id="_appendixesappgroup3_">Appendices</h2><div id="ch3.appa"><h3>Appendix A. Review protocols</h3><div id="ch3.appa.tab1" class="table"><h3><span class="label">Table 7</span><span class="title">Review protocol: Surgery</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577892/table/ch3.appa.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch3.appa.tab1_lrgtbl__"><table><thead><tr><th id="hd_h_ch3.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Field</th><th id="hd_h_ch3.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Content</th></tr></thead><tbody><tr><td headers="hd_h_ch3.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Review question</td><td headers="hd_h_ch3.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">What is the clinical and cost effectiveness of surgery (parathyroidectomy) in people with primary hyperparathyroidism?</td></tr><tr><td headers="hd_h_ch3.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Type of review question</td><td headers="hd_h_ch3.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Intervention</td></tr><tr><td headers="hd_h_ch3.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Objective of the review</td><td headers="hd_h_ch3.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">To determine the clinical and cost effectiveness of parathyroidectomy versus conservative management or pharmacological intervention. To determine whether surgery should be recommended in all people with PHPT, or only subgroups of people with certain indications and poorer prognosis.</td></tr><tr><td headers="hd_h_ch3.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Eligibility criteria - population</td><td headers="hd_h_ch3.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>Adults (18 years or over) with confirmed primary hyperparathyroidism</p>
|
||
<p>Strata (report the following groups separately):
|
||
<ul id="ch3.l20"><li id="ch3.lt79" class="half_rhythm"><div>People with normocalcaemic PHPT (serum adjusted calcium ≤2.6 mmol/L and an elevated PTH that cannot be explained by abnormal renal function or low 25OHD)</div></li><li id="ch3.lt80" class="half_rhythm"><div>Previous unsuccessful parathyroidectomy (reoperation)</div></li><li id="ch3.lt81" class="half_rhythm"><div>Pregnant women</div></li></ul></p>
|
||
<p>Exclude people:
|
||
<ul id="ch3.l21"><li id="ch3.lt82" class="half_rhythm"><div>with secondary and tertiary HPT</div></li><li id="ch3.lt83" class="half_rhythm"><div>with multiple endocrine neoplasia (MEN)</div></li><li id="ch3.lt84" class="half_rhythm"><div>with familial hyperparathyroidism</div></li><li id="ch3.lt85" class="half_rhythm"><div>with parathyroid carcinoma</div></li><li id="ch3.lt86" class="half_rhythm"><div>Taking medications interfering with calcium metabolism (for example, lithium).</div></li></ul></p>
|
||
<p>Studies including mixed populations of people with primary and secondary or tertiary hyperparathyroidism will be excluded unless subgroups reported separately by type of hyperparathyroidism.</p>
|
||
</td></tr><tr><td headers="hd_h_ch3.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Eligibility criteria - intervention(s)</td><td headers="hd_h_ch3.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Parathyroid surgery (all types of surgery grouped within class, to include minimally invasive surgeries or unilateral or bilateral exploratory surgery)</td></tr><tr><td headers="hd_h_ch3.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Eligibility criteria - comparator(s)</td><td headers="hd_h_ch3.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<ul id="ch3.l22"><li id="ch3.lt87" class="half_rhythm"><div>no surgery (surveillance/conservative management)</div></li><li id="ch3.lt88" class="half_rhythm"><div>calcimimetic treatment</div></li><li id="ch3.lt89" class="half_rhythm"><div>bisphosphonate treatment</div></li><li id="ch3.lt90" class="half_rhythm"><div>combination pharmacological treatment (calcimimetics and bisphosphonates)</div></li></ul>
|
||
The above comparators will not be pooled in the analysis</td></tr><tr><td headers="hd_h_ch3.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outcomes and prioritisation</td><td headers="hd_h_ch3.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p><b>Report all outcomes separately for <6 months and ≥6 months</b></p>
|
||
<p><b>Critical outcomes:</b></p>
|
||
<p>HRQOL (continuous outcome)</p>
|
||
<p>Mortality (dichotomous outcome)</p>
|
||
<p>Preservation of end organ function (bone mineral density, fractures, renal stones and renal function) (dichotomous for fractures, renal function, renal stones and continuous for BMD)</p>
|
||
<p><b>Important outcomes:</b></p>
|
||
<p>Adverse events (to include voice chanqe, hvpoparathvroidism; dichotomous outcome)</p>
|
||
<p>Cancer incidence (dichotomous outcome)</p>
|
||
<p>Cardiovascular events (dichotomous outcome)</p>
|
||
<p>Persistent hypercalcaemia (dichotomous outcome)</p></td></tr><tr><td headers="hd_h_ch3.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Eligibility criteria - study design</td><td headers="hd_h_ch3.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>RCTs and systematic reviews of RCTs</p>
|
||
<p>In the absence of RCT evidence for the critical outcomes, NRSs will be included (only if the following key confounders are matched for or adjusted for in the analysis)</p>
|
||
<p>Key confounders:
|
||
<ul id="ch3.l23"><li id="ch3.lt91" class="half_rhythm"><div>Age</div></li><li id="ch3.lt92" class="half_rhythm"><div>Absence/presence of end-organ effects</div></li><li id="ch3.lt93" class="half_rhythm"><div>Adjusted serum calcium level</div></li></ul></p></td></tr><tr><td headers="hd_h_ch3.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Other inclusion exclusion criteria</td><td headers="hd_h_ch3.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>Non-English language articles</p>
|
||
<p>Conference abstracts</p>
|
||
</td></tr><tr><td headers="hd_h_ch3.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Proposed sensitivity / subgroup analysis, or meta-regression</td><td headers="hd_h_ch3.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>Subgroups will be investigated in the following order if there is heterogeneity in the data:
|
||
<ul id="ch3.l24"><li id="ch3.lt94" class="half_rhythm"><div>People with end-organ effects vs absence of end-organ effects (end organ effects defined as kidney stones, history of fragility fractures or osteoporosis (BMD T-score <-2.5 at any site)</div></li><li id="ch3.lt95" class="half_rhythm"><div>serum adjusted calcium > 0.25 mmol/L above the ULN (same as S2.85 mmol/L and <2.85 mmol/L)</div></li><li id="ch3.lt96" class="half_rhythm"><div>reduction in creatinine clearance to < 60 mL/min</div></li><li id="ch3.lt97" class="half_rhythm"><div>age under 50 years vs ≥50 years</div></li></ul></p>
|
||
</td></tr><tr><td headers="hd_h_ch3.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Selection process-duplicate screening / selection / analysis</td><td headers="hd_h_ch3.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Studies are sifted by title and abstract. Potentially significant publications obtained in full text are then assessed against the inclusion criteria specified in this protocol.</td></tr><tr><td headers="hd_h_ch3.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Data management (software)</td><td headers="hd_h_ch3.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<ul id="ch3.l25"><li id="ch3.lt98" class="half_rhythm"><div>Pairwise meta-analyses were performed using Cochrane Review Manager (RevMan5)</div></li><li id="ch3.lt99" class="half_rhythm"><div>GRADEpro was used to assess the quality of evidence for each outcome.</div></li><li id="ch3.lt100" class="half_rhythm"><div>Endnote for bibliography, citations, sifting and reference management</div></li><li id="ch3.lt101" class="half_rhythm"><div>Data extractions performed using EviBase, a platform designed and maintained by the National Guideline Centre (NGC)</div></li></ul></td></tr><tr><td headers="hd_h_ch3.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Information sources-databases and dates</td><td headers="hd_h_ch3.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>Clinical search databases to be used: Medline, Embase, Cochrane Library, CINAHL, PsyclNFO</p>
|
||
<p>Date: all years</p>
|
||
<p>Health economics search databases to be used: Medline, Embase, NHSEED, HTA</p>
|
||
<p>Date: Medline, Embase from 2002</p>
|
||
<p>NHSEED, HTA - all years</p>
|
||
<p>Language: Restrict to English only</p>
|
||
<p>Supplementary search techniques: backward citation searching</p>
|
||
</td></tr><tr><td headers="hd_h_ch3.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Identify if an update</td><td headers="hd_h_ch3.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">N/A</td></tr><tr><td headers="hd_h_ch3.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Author contacts</td><td headers="hd_h_ch3.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<a href="https://www.nice.org.uk/guidance/indevelopment/gid-ng10051" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">https://www<wbr style="display:inline-block"></wbr>.nice.org<wbr style="display:inline-block"></wbr>.uk/guidance/indevelopment/gid-ng10051</a>
|
||
</td></tr><tr><td headers="hd_h_ch3.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Highlight if amendment to previous protocol</td><td headers="hd_h_ch3.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">N/A</td></tr><tr><td headers="hd_h_ch3.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Search strategy - for one database</td><td headers="hd_h_ch3.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">For details please see <a href="#ch3.appb">appendix B</a></td></tr><tr><td headers="hd_h_ch3.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Data collection process - forms / duplicate</td><td headers="hd_h_ch3.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">A standardised evidence table format will be used, and published as <a href="#ch3.appd">appendix D</a> of the evidence report.</td></tr><tr><td headers="hd_h_ch3.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Data items-define all variables to be collected</td><td headers="hd_h_ch3.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">For details please see evidence tables in <a href="#ch3.appd">Appendix D</a> (clinical evidence tables) or <a href="#ch3.apph">H</a> (health economic evidence tables).</td></tr><tr><td headers="hd_h_ch3.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Methods for assessing bias at outcome / study level</td><td headers="hd_h_ch3.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>Standard study checklists were used to critically appraise individual studies. For details please see section 6.2 of <a href="https://www.nice.org.uk/article/pmg20/chapter/6-Reviewing-research-evidence#assessing-the-quality-of-the-evidence" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Developing NICE guidelines: the manual</a>.</p>
|
||
<p>The risk of bias across all available evidence was evaluated for each outcome using an adaptation of the ‘Grading of Recommendations Assessment, Development and Evaluation (GRADE) toolbox’ developed by the international GRADE working group <a href="http://www.gradeworkinggroup.org/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">http://www<wbr style="display:inline-block"></wbr>.gradeworkinggroup.org/</a></p></td></tr><tr><td headers="hd_h_ch3.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Criteria for quantitative synthesis</td><td headers="hd_h_ch3.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">For details please see section 6.4 of <a href="https://www.nice.org.uk/article/pmg20/chapter/6-Reviewing-research-evidence#assessing-the-quality-of-the-evidence" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Developing NICE guidelines: the manual</a>.</td></tr><tr><td headers="hd_h_ch3.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Methods for quantitative analysis-combining studies and exploring (in)consistency</td><td headers="hd_h_ch3.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">For details please see the separate Methods report for this guideline.</td></tr><tr><td headers="hd_h_ch3.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Meta-bias assessment-publication bias, selective reporting bias</td><td headers="hd_h_ch3.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">For details please see section 6.2 of <a href="https://www.nice.org.uk/article/pmg20/chapter/6-Reviewing-research-evidence#assessing-the-quality-of-the-evidence" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Developing NICE guidelines: the manual</a>.</td></tr><tr><td headers="hd_h_ch3.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Confidence in cumulative evidence</td><td headers="hd_h_ch3.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">For details please see sections 6.4 and 9.1 of <a href="https://www.nice.org.uk/article/pmg20/chapter/1-Introduction-and-overview" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Developing NICE guidelines: the manual</a>.</td></tr><tr><td headers="hd_h_ch3.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Rationale / context - what is known</td><td headers="hd_h_ch3.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">For details please see the introduction to the evidence review.</td></tr><tr><td headers="hd_h_ch3.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Describe contributions of authors and guarantor</td><td headers="hd_h_ch3.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>A <a href="https://www.nice.org.uk/guidance/indevelopment/gid-ng10051" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">multidisciplinary committee</a> developed the evidence review. The committee was convened by the National Guideline Centre (NGC) and chaired by Jonathan Mant in line with section 3 of <a href="https://www.nice.org.uk/article/pmg20/chapter/1%20Introduction%20and%20overview" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Developing NICE guidelines: the manual</a>.</p>
|
||
<p>Staff from the NGC undertook systematic literature searches, appraised the evidence, conducted meta-analysis and cost-effectiveness analysis where appropriate, and drafted the evidence review in collaboration with the committee. For details please see <a href="https://www.nice.org.uk/article/pmg20/chapter/1-Introduction-and-overview" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Developing NICE guidelines: the manual</a>.</p>
|
||
</td></tr><tr><td headers="hd_h_ch3.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Sources of funding / support</td><td headers="hd_h_ch3.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">The NGC is funded by NICE and hosted by the Royal College of Physicians.</td></tr><tr><td headers="hd_h_ch3.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Name of sponsor</td><td headers="hd_h_ch3.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">The NGC is funded by NICE and hosted by the Royal College of Physicians.</td></tr><tr><td headers="hd_h_ch3.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Roles of sponsor</td><td headers="hd_h_ch3.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NICE funds the NGC to develop guidelines for those working in the NHS, public health and social care in England.</td></tr><tr><td headers="hd_h_ch3.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">PROSPERO registration number</td><td headers="hd_h_ch3.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not registered</td></tr></tbody></table></div></div><div id="ch3.appa.tab2" class="table"><h3><span class="label">Table 8</span><span class="title">Health economic review protocol</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577892/table/ch3.appa.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch3.appa.tab2_lrgtbl__"><table><thead><tr><th id="hd_h_ch3.appa.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Review question</th><th id="hd_h_ch3.appa.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">All questions - health economic evidence</th></tr></thead><tbody><tr><td headers="hd_h_ch3.appa.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<b>Objectives</b>
|
||
</td><td headers="hd_h_ch3.appa.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">To identify health economic studies relevant to any of the review questions.</td></tr><tr><td headers="hd_h_ch3.appa.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<b>Search criteria</b>
|
||
</td><td headers="hd_h_ch3.appa.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<ul id="ch3.l26"><li id="ch3.lt102" class="half_rhythm"><div>Populations, interventions and comparators must be as specified in the clinical review protocol above.</div></li><li id="ch3.lt103" class="half_rhythm"><div>Studies must be of a relevant health economic study design (cost-utility analysis, cost-effectiveness analysis, cost-benefit analysis, cost-consequences analysis, comparative cost analysis).</div></li><li id="ch3.lt104" class="half_rhythm"><div>Studies must not be a letter, editorial or commentary, or a review of health economic evaluations (recent reviews will be ordered although not reviewed. The bibliographies will be checked for relevant studies, which will then be ordered).</div></li><li id="ch3.lt105" class="half_rhythm"><div>Unpublished reports will not be considered unless submitted as part of a call for evidence.</div></li></ul>
|
||
Studies must be in English.</td></tr><tr><td headers="hd_h_ch3.appa.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<b>Search strategy</b>
|
||
</td><td headers="hd_h_ch3.appa.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">A health economic study search will be undertaken using population-specific terms and a health economic study filter - see <a href="#ch3.appb">appendix B</a> below.</td></tr><tr><td headers="hd_h_ch3.appa.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<b>Review strategy</b>
|
||
</td><td headers="hd_h_ch3.appa.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>Studies not meeting any of the search criteria above will be excluded. Studies published before 2002, abstract-only studies and studies from non-OECD countries or the USA will also be excluded.</p><p>Each remaining study will be assessed for applicability and methodological limitations using the NICE economic evaluation checklist which can be found in <a href="#ch3.apph">appendix H</a> of Developing NICE guidelines: the manual (2014).<a class="bk_pop" href="#ch3.ref56"><sup>56</sup></a></p>
|
||
<p><b>Inclusion and exclusion criteria</b>
|
||
<ul id="ch3.l27"><li id="ch3.lt106" class="half_rhythm"><div>If a study is rated as both ‘Directly applicable’ and with ‘Minor limitations’ then it will be included in the guideline. A health economic evidence table will be completed and it will be included in the health economic evidence profile.</div></li><li id="ch3.lt107" class="half_rhythm"><div>If a study is rated as either ‘Not applicable’ or with ‘Very serious limitations’ then it will usually be excluded from the guideline. If it is excluded then a health economic evidence table will not be completed and it will not be included in the health economic evidence profile.</div></li><li id="ch3.lt108" class="half_rhythm"><div>If a study is rated as ‘Partially applicable’, with ‘Potentially serious limitations’ or both then there is discretion over whether it should be included.</div></li></ul></p>
|
||
<p><b>Where there is discretion</b></p>
|
||
<p>The health economist will make a decision based on the relative applicability and quality of the available evidence for that question, in discussion with the guideline committee if required. The ultimate aim is to include health economic studies that are helpful for decision-making in the context of the guideline and the current NHS setting. If several studies are considered of sufficiently high applicability and methodological quality that they could all be included, then the health economist, in discussion with the committee if required, may decide to include only the most applicable studies and to selectively exclude the remaining studies. All studies excluded on the basis of applicability or methodological limitations will be listed with explanation in the excluded health economic studies appendix below.</p><p>The health economist will be guided by the following hierarchies.</p>
|
||
<p><i>Setting</i>
|
||
<ul id="ch3.l28"><li id="ch3.lt109" class="half_rhythm"><div>UK NHS (most applicable).</div></li><li id="ch3.lt110" class="half_rhythm"><div>OECD countries with predominantly public health insurance systems (for example, France, Germany, Sweden).</div></li><li id="ch3.lt111" class="half_rhythm"><div>OECD countries with predominantly private health insurance systems (for example, Switzerland).</div></li><li id="ch3.lt112" class="half_rhythm"><div>Studies set in non-OECD countries or in the USA will be excluded before being assessed for applicability and methodological limitations.</div></li></ul></p>
|
||
<p><i>Health economic study type:</i>
|
||
<ul id="ch3.l29"><li id="ch3.lt113" class="half_rhythm"><div>Cost-utility analysis (most applicable).</div></li><li id="ch3.lt114" class="half_rhythm"><div>Other type of full economic evaluation (cost-benefit analysis, cost-effectiveness analysis, cost-consequences analysis).</div></li><li id="ch3.lt115" class="half_rhythm"><div>Comparative cost analysis.</div></li><li id="ch3.lt116" class="half_rhythm"><div>Non-comparative cost analyses including cost-of-illness studies will be excluded before being assessed for applicability and methodological limitations.</div></li></ul></p>
|
||
<p><i>Year of analysis:</i>
|
||
<ul id="ch3.l30"><li id="ch3.lt117" class="half_rhythm"><div>The more recent the study, the more applicable it will be.</div></li><li id="ch3.lt118" class="half_rhythm"><div>Studies published in 2002 or later but that depend on unit costs and resource data entirely or predominantly from before 2002 will be rated as ‘Not applicable’.</div></li><li id="ch3.lt119" class="half_rhythm"><div>Studies published before 2002 will be excluded before being assessed for applicability and methodological limitations.</div></li></ul></p>
|
||
<p><i>Quality and relevance of effectiveness data used in the health economic analysis:</i>
|
||
<ul id="ch3.l31"><li id="ch3.lt120" class="half_rhythm"><div>The more closely the clinical effectiveness data used in the health economic analysis match with the outcomes of the studies included in the clinical review the more useful the analysis will be for decision-making in the guideline.</div></li></ul></p></td></tr></tbody></table></div></div></div><div id="ch3.appb"><h3>Appendix B. Literature search strategies</h3><p>The literature searches for this review are detailed below and complied with the methodology outlined in Developing NICE guidelines: the manual 2014, updated 2017 <a href="https://www.nice.org.uk/guidance/pmg20/resources/developing-nice-guidelines-the-manual-pdf-72286708700869" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">https://www.nice.org.uk/guidance/pmg20/resources/developing-nice-guidelines-the-manual-pdf-72286708700869</a></p><p><i>For more detailed information, please see the</i> Methodology <i>Review</i>.</p><div id="ch3.appb.s1"><h4>B.1. Clinical search literature search strategy</h4><p>Searches were constructed using a PICO framework where population (P) terms were combined with Intervention (I) and in some cases Comparison (C) terms. Outcomes (O) are rarely used in search strategies for interventions as these concepts may not be well described in title, abstract or indexes and therefore difficult to retrieve. Search filters were applied to the search where appropriate.</p><div id="ch3.appb.tab1" class="table"><h3><span class="label">Table 9</span><span class="title">Database date parameters and filters used</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577892/table/ch3.appb.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch3.appb.tab1_lrgtbl__"><table><thead><tr><th id="hd_h_ch3.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Database</th><th id="hd_h_ch3.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Dates searched</th><th id="hd_h_ch3.appb.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Search filter used</th></tr></thead><tbody><tr><td headers="hd_h_ch3.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Medline (OVID)</td><td headers="hd_h_ch3.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1946 – 06 August 2018</td><td headers="hd_h_ch3.appb.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Exclusions</td></tr><tr><td headers="hd_h_ch3.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Embase (OVID)</td><td headers="hd_h_ch3.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1974 – 06 August 2018</td><td headers="hd_h_ch3.appb.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Exclusions</td></tr><tr><td headers="hd_h_ch3.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">The Cochrane Library (Wiley)</td><td headers="hd_h_ch3.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>Cochrane Reviews to 2018 Issue 8 of 12</p>
|
||
<p>CENTRAL to 2018 Issue 7 of 12</p>
|
||
<p>DARE, and NHSEED to 2015 Issue 2 of 4</p>
|
||
<p>HTA to 2016 Issue 4 of 4</p>
|
||
</td><td headers="hd_h_ch3.appb.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">None</td></tr><tr><td headers="hd_h_ch3.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">CINAHL, Current Nursing and Allied Health Literature (EBSCO)</td><td headers="hd_h_ch3.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Inception – 06 August 2018</td><td headers="hd_h_ch3.appb.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Exclusions</td></tr><tr><td headers="hd_h_ch3.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">PsycINFO (ProQuest)</td><td headers="hd_h_ch3.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Inception – 06 August 2018</td><td headers="hd_h_ch3.appb.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Exclusions</td></tr></tbody></table></div></div><div id="ch3.appb.tab2" class="table"><h3><span class="title">Medline (Ovid) search terms</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577892/table/ch3.appb.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch3.appb.tab2_lrgtbl__"><table><tbody><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">l.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">hyperparathyroidism/ or hyperparathyroidism, primary/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((primary or asymptomatic or symptomatic or mild or familial or maternal) adj6 (HPT or hyperparathyroidis*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">PHPT.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Parathyroid Neoplasms/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">5.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(parathyroid* adj3 (adenoma* or carcinoma* or hyperplasia* or neoplas* or tumo?r* or cancer* or metasta* or hypercalc?emi*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">6.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/1–5</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">7.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">letter/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">8.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">editorial/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">news/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">10.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp historical article/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">11.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Anecdotes as Topic/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">12.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">comment/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">13.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">case report/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">14.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(letter or comment*).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">15.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/7–14</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">16.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomized controlled trial/ or random*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">17.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">15 not 16</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">18.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">animals/ not humans/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">19.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Animals, Laboratory/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">20.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Animal Experimentation/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">21.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Models, Animal/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">22.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Rodentia/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">23.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(rat or rats or mouse or mice).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">24.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/17–23</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">25.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">6 not 24</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">26.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">limit 25 to English language</td></tr></tbody></table></div></div><div id="ch3.appb.tab3" class="table"><h3><span class="title">Embase (Ovid) search terms</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577892/table/ch3.appb.tab3/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch3.appb.tab3_lrgtbl__"><table><tbody><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">hyperparathyroidism/ or primary hyperparathyroidism/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((primary or asymptomatic or symptomatic or mild or familial or maternal) adj6 (HPT or hyperparathyroidis*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">PHPT.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">parathyroid tumor/ or parathyroid adenoma/ or parathyroid carcinoma/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">5.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(parathyroid* adj3 (adenoma* or carcinoma* or hyperplasia* or neoplas* or tumo?r* or cancer* or metasta* or hypercalc?emi*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">6.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/1–5</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">7.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">letter.pt. or letter/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">8.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">note.pt.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">editorial.pt.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">10.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Case report/ or Case study/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">11.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(letter or comment*).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">12.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/7–11</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">13.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomized controlled trial/ or random*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">14.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">12 not 13</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">15.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">animal/ not human/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">16.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Nonhuman/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">17.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Animal Experiment/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">18.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Experimental animal/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">19.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Animal model/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">20.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Rodent/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">21.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(rat or rats or mouse or mice).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">22.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/14–21</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">23.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">6 not 22</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">24.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">limit 23 to English language</td></tr></tbody></table></div></div><div id="ch3.appb.tab4" class="table"><h3><span class="title">Cochrane Library (Wiley) search terms</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577892/table/ch3.appb.tab4/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch3.appb.tab4_lrgtbl__"><table><tbody><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#1.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Hyperparathyroidism] explode all trees</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#2.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Hyperparathyroidism, Primary] explode all trees</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#3.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((primary or asymptomatic or symptomatic or mild or familial or maternal) near/6 (HPT or hyperparathyroidis*)):ti,ab</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#4.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">PHPT:ti,ab</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#5.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Parathyroid Neoplasms] explode all trees</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#6.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(parathyroid* near/3 (adenoma* or carcinoma* or hyperplasia* or neoplas* or tumo?r* or cancer* or metasta* or hypercalc?emi*)):ti,ab</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#7.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(or#1-#6)</td></tr></tbody></table></div></div><div id="ch3.appb.tab5" class="table"><h3><span class="title">CINAHL (EBSCO) search terms</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577892/table/ch3.appb.tab5/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch3.appb.tab5_lrgtbl__"><table><tbody><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">SI.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(MH “Hyperparathyroidism”)</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">S2.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((primary or asymptomatic or symptomatic or mild or familial or maternal) n6 HPT) OR ((primary or asymptomatic or symptomatic or mild or familial or maternal) n6 hyperparathyroidis*)</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">S3.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">PHPT</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">S4.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(MH “Parathyroid Neoplasms”)</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">S5.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(parathyroid* n3 (adenoma* or carcinoma* or hyperplasia* or neoplas* or tumor* or tumour* or cancer* or metasta* or hypercalcemi* or hypercalcaemi*))</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">S6.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">S1 OR S2 OR S3 OR S4 OR S5</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">S7.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">PT anecdote or PT audiovisual or PT bibliography or PT biography or PT book or PT book review or PT brief item or PT cartoon or PT commentary or PT computer program or PT editorial or PT games or PT glossary or PT historical material or PT interview or PT letter or PT listservs or PT masters thesis or PT obituary or PT pamphlet or PT pamphlet chapter or PT pictorial or PT poetry or PT proceedings or PT “questions and answers” or PT response or PT software or PT teaching materials or PT website</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">S8.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">S6 NOT S7</td></tr></tbody></table></div></div><div id="ch3.appb.tab6" class="table"><h3><span class="title">PsycINFO (ProQuest) search terms</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577892/table/ch3.appb.tab6/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch3.appb.tab6_lrgtbl__"><table><tbody><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">su.Exact(“parathyroid neoplasms” OR “hyperparathyroidism” OR “hyperparathyroidism, primary”)</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">PHPT</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((primary or asymptomatic or symptomatic or mild or familial or maternal) Near/6 (HPT or hyperparathyroidis*))</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(parathyroid* near/3 (adenoma* or carcinoma* or hyperplasia* or neoplas* or tumor* or tumour* or cancer* or metasta* or hypercalcaemi* or hypercalcemi*))</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">5.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1 or 2 or 3 or 4</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">6.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(su.exact.explode(“rodents”) or su.exact.explode(“mice”) or (su.exact(“animals”) not (su.exact(“human males”) or su.exact(“human females”))) or ti(rat or rats or mouse or mice))</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">7.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(s1 or s2 or s3 or s4) NOT (su.exact.explode(”rodents“) or su.exact.explodefmice”) or (su.exact(“animals”) not (su.exact(“human males”) or su.exact(“human females”))) or ti(rat or rats or mouse or mice))</td></tr></tbody></table></div></div></div><div id="ch3.appb.s2"><h4>B.2. Health Economics literature search strategy</h4><p>Health economic evidence was identified by conducting a broad search relating to the primary hyperparathyroidism population in the NHS Economic Evaluation Database (NHS EED – this ceased to be updated after March 2015) and the Health Technology Assessment database (HTA) with no date restrictions. The NHS EED and HTA databases are hosted by the Centre for Research and Dissemination (CRD). Additional searches were run on Medline and Embase for health economics papers published since 2002.</p><div id="ch3.appb.tab7" class="table"><h3><span class="label">Table 10</span><span class="title">Database date parameters and filters used</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577892/table/ch3.appb.tab7/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch3.appb.tab7_lrgtbl__"><table><thead><tr><th id="hd_h_ch3.appb.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Database</th><th id="hd_h_ch3.appb.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Dates searched</th><th id="hd_h_ch3.appb.tab7_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Search filter used</th></tr></thead><tbody><tr><td headers="hd_h_ch3.appb.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Medline</td><td headers="hd_h_ch3.appb.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2002–06 August 2018</td><td headers="hd_h_ch3.appb.tab7_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>Exclusions</p>
|
||
<p>Health economics studies</p>
|
||
</td></tr><tr><td headers="hd_h_ch3.appb.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Embase</td><td headers="hd_h_ch3.appb.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2002–06 August 2018</td><td headers="hd_h_ch3.appb.tab7_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>Exclusions</p>
|
||
<p>Health economics studies</p>
|
||
</td></tr><tr><td headers="hd_h_ch3.appb.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Centre for Research and Dissemination (CRD)</td><td headers="hd_h_ch3.appb.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>HTA - Inception - 06 August 2018</p>
|
||
<p>NHSEED - Inception to March 2015</p>
|
||
</td><td headers="hd_h_ch3.appb.tab7_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">None</td></tr></tbody></table></div></div><div id="ch3.appb.tab8" class="table"><h3><span class="title">Medline (Ovid) search terms</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577892/table/ch3.appb.tab8/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch3.appb.tab8_lrgtbl__"><table><tbody><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">hyperparathyroidism/ or hyperparathyroidism, primary/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((primary or asymptomatic or symptomatic or mild or familial or maternal) adj6 (HPT or hyperparathyroidis*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">PHPT.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Parathyroid Neoplasms/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">5.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(parathyroid* adj3 (adenoma* or carcinoma* or hyperplasia* or neoplas* or tumo?r* or cancer* or metasta* or hypercalc?emi*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">6.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/1–5</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">7.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">letter/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">8.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">editorial/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">news/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">10.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp historical article/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">11.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Anecdotes as Topic/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">12.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">comment/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">13.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">case report/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">14.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(letter or comment*).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">15.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/7–14</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">16.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomized controlled trial/ or random*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">17.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">15 not 16</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">18.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">animals/ not humans/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">19.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Animals, Laboratory/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">20.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Animal Experimentation/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">21.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Models, Animal/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">22.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Rodentia/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">23.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(rat or rats or mouse or mice).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">24.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/17–23</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">25.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">6 not 24</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">26.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">limit 25 to English language</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">27.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Economics/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">28.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Value of life/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">29.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp “Costs and Cost Analysis”/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">30.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Economics, Hospital/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">31.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Economics, Medical/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">32.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Economics, Nursing/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">33.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Economics, Pharmaceutical/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">34.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp “Fees and Charges”/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">35.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Budgets/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">36.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">budget*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">37.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">cost*.ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">38.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(economic* or pharmaco?economic*).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">39.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(price* or pricing*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">40.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(cost* adj2 (effective* or utilit* or benefit* or minimi* or unit* or estimat* or variable*)).ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">41.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(financ* or fee or fees).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">42.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(value adj2 (money or monetary)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">43.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/27–42</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">44.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">26 and 43</td></tr></tbody></table></div></div><div id="ch3.appb.tab9" class="table"><h3><span class="title">Embase (Ovid) search terms</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577892/table/ch3.appb.tab9/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch3.appb.tab9_lrgtbl__"><table><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">hyperparathyroidism/ or primary hyperparathyroidism/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((primary or asymptomatic or symptomatic or mild or familial or maternal) adj6 (HPT or hyperparathyroidis*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">PHPT.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">parathyroid tumor/ or parathyroid adenoma/ or parathyroid carcinoma/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">5.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(parathyroid* adj3 (adenoma* or carcinoma* or hyperplasia* or neoplas* or tumo?r* or cancer* or metasta* or hypercalc?emi*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">6.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/1–5</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">7.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">letter.pt. or letter/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">8.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">note.pt.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">editorial.pt.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">10.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Case report/ or Case study/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">11.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(letter or comment*).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">12.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/7–11</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">13.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomized controlled trial/ or random*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">14.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">12 not 13</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">15.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">animal/ not human/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">16.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Nonhuman/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">17.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Animal Experiment/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">18.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Experimental animal/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">19.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Animal model/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">20.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Rodent/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">21.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(rat or rats or mouse or mice).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">22.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/14–21</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">23.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">6 not 22</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">24.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">limit 23 to English language</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">25.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">health economics/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">26.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp economic evaluation/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">27.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp health care cost/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">28.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp fee/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">29.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">budget/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">30.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">funding/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">31.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">budget*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">32.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">cost*.ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">33.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(economic* or pharmaco?economic*).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">34.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(price* or pricing*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">35.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(cost* adj2 (effective* or utilit* or benefit* or minimi* or unit* or estimat* or variable*)).ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">36.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(financ* or fee or fees).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">37.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(value adj2 (money or monetary)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">38.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/25–37</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">39.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">24 and 38</td></tr></table></div></div><div id="ch3.appb.tab10" class="table"><h3><span class="title">NHS EED and HTA (CRD) search terms</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577892/table/ch3.appb.tab10/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch3.appb.tab10_lrgtbl__"><table><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#1.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH DESCRIPTOR Hyperparathyroidism EXPLODE ALL TREES</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#2.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH DESCRIPTOR Hyperparathyroidism, Primary EXPLODE ALL TREES</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#3.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(((primary or asymptomatic or symptomatic or mild or familial or maternal) adj6 (HPT or hyperparathyroidis*)))</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#4.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(PHPT)</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#5.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH DESCRIPTOR Parathyroid Neoplasms EXPLODE ALL TREES</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#6.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((parathyroid* adj3 (adenoma* or carcinoma* or hyperplasia* or neoplas* or tumo?r* or cancer* or metasta* or hypercalc?emi*)))</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#7.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#1 OR #2 OR #3 OR #4 OR #5 OR #6</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#8.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">* IN NHSEED</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#9.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">* IN HTA</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#10.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#7 AND #8</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#11.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#7 AND #9</td></tr></table></div></div></div></div><div id="ch3.appc"><h3>Appendix C. Clinical evidence selection</h3><div id="ch3.appc.fig1" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%201.%20Flow%20chart%20of%20clinical%20study%20selection%20for%20the%20review%20of%20surgery.&p=BOOKS&id=577892_ch3appcf1.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK577892/bin/ch3appcf1.jpg" alt="Figure 1. Flow chart of clinical study selection for the review of surgery." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 1</span><span class="title">Flow chart of clinical study selection for the review of surgery</span></h3></div></div><div id="ch3.appd"><h3>Appendix D. Clinical evidence tables</h3><p id="ch3.appd.et1"><a href="/books/NBK577892/bin/ch3-appd-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (333K)</span></p></div><div id="ch3.appe"><h3>Appendix E. Forest plots</h3><div id="ch3.appe.s1"><h4>E.1. Surgery versus conservative management</h4><div id="ch3.appe.fig1" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%202.%20QOL%20(SF-36%20Physical%20role%20functioning%20subscale).&p=BOOKS&id=577892_ch3appef1.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK577892/bin/ch3appef1.jpg" alt="Figure 2. QOL (SF-36 Physical role functioning subscale)." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 2</span><span class="title">QOL (SF-36 Physical role functioning subscale)</span></h3></div><div id="ch3.appe.fig2" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%203.%20QOL%20(Emotional%20role%20functioning%20subscale).&p=BOOKS&id=577892_ch3appef2.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK577892/bin/ch3appef2.jpg" alt="Figure 3. QOL (Emotional role functioning subscale)." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 3</span><span class="title">QOL (Emotional role functioning subscale)</span></h3></div><div id="ch3.appe.fig3" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%204.%20QOL%20(SF-36%20mental%20health%20subscale).&p=BOOKS&id=577892_ch3appef3.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK577892/bin/ch3appef3.jpg" alt="Figure 4. QOL (SF-36 mental health subscale)." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 4</span><span class="title">QOL (SF-36 mental health subscale)</span></h3></div><div id="ch3.appe.fig4" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%205.%20QOL%20(SF-36%20vitality%20subscale).&p=BOOKS&id=577892_ch3appef4.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK577892/bin/ch3appef4.jpg" alt="Figure 5. QOL (SF-36 vitality subscale)." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 5</span><span class="title">QOL (SF-36 vitality subscale)</span></h3></div><div id="ch3.appe.fig5" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%206.%20QOL%20(SF-36%20Bodily%20pain%20subscale).&p=BOOKS&id=577892_ch3appef5.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK577892/bin/ch3appef5.jpg" alt="Figure 6. QOL (SF-36 Bodily pain subscale)." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 6</span><span class="title">QOL (SF-36 Bodily pain subscale)</span></h3></div><div id="ch3.appe.fig6" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%207.%20QOL%20(SF-36%20General%20health%20subscale).&p=BOOKS&id=577892_ch3appef6.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK577892/bin/ch3appef6.jpg" alt="Figure 7. QOL (SF-36 General health subscale)." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 7</span><span class="title">QOL (SF-36 General health subscale)</span></h3></div><div id="ch3.appe.fig7" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%208.%20QOL%20(SF-36%20Health%20transition%20subscale).&p=BOOKS&id=577892_ch3appef7.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK577892/bin/ch3appef7.jpg" alt="Figure 8. QOL (SF-36 Health transition subscale)." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 8</span><span class="title">QOL (SF-36 Health transition subscale)</span></h3></div><div id="ch3.appe.fig8" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%209.%20Mortality.&p=BOOKS&id=577892_ch3appef8.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK577892/bin/ch3appef8.jpg" alt="Figure 9. Mortality." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 9</span><span class="title">Mortality</span></h3></div><div id="ch3.appe.fig9" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%2010.%20Renal%20dysfunction.&p=BOOKS&id=577892_ch3appef9.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK577892/bin/ch3appef9.jpg" alt="Figure 10. Renal dysfunction." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 10</span><span class="title">Renal dysfunction</span></h3></div><div id="ch3.appe.fig10" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%2011.%20Vertebral%20fractures.&p=BOOKS&id=577892_ch3appef10.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK577892/bin/ch3appef10.jpg" alt="Figure 11. Vertebral fractures." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 11</span><span class="title">Vertebral fractures</span></h3></div><div id="ch3.appe.fig11" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%2012.%20Peripheral%20skeletal%20fractures.&p=BOOKS&id=577892_ch3appef11.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK577892/bin/ch3appef11.jpg" alt="Figure 12. Peripheral skeletal fractures." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 12</span><span class="title">Peripheral skeletal fractures</span></h3></div><div id="ch3.appe.fig12" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%2013.%20Kidney%20stones.&p=BOOKS&id=577892_ch3appef12.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK577892/bin/ch3appef12.jpg" alt="Figure 13. Kidney stones." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 13</span><span class="title">Kidney stones</span></h3></div><div id="ch3.appe.fig13" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%2014.%20Lumbar%20spine%20BMD%20(Z%20score).&p=BOOKS&id=577892_ch3appef13.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK577892/bin/ch3appef13.jpg" alt="Figure 14. Lumbar spine BMD (Z score)." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 14</span><span class="title">Lumbar spine BMD (Z score)</span></h3></div><div id="ch3.appe.fig14" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%2015.%20Lumbar%20spine%20BMD%20(%25%20change%20from%20baseline).&p=BOOKS&id=577892_ch3appef14.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK577892/bin/ch3appef14.jpg" alt="Figure 15. Lumbar spine BMD (% change from baseline)." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 15</span><span class="title">Lumbar spine BMD (% change from baseline)</span></h3></div><div id="ch3.appe.fig15" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%2016.%20Distal%20radius%20BMD%20(g%2Fcm2).&p=BOOKS&id=577892_ch3appef15.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK577892/bin/ch3appef15.jpg" alt="Figure 16. Distal radius BMD (g/cm2)." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 16</span><span class="title">Distal radius BMD (g/cm<sup>2</sup>)</span></h3></div><div id="ch3.appe.fig16" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%2017.%20Distal%20radius%20BMD%20(%25%20change%20from%20baseline).&p=BOOKS&id=577892_ch3appef16.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK577892/bin/ch3appef16.jpg" alt="Figure 17. Distal radius BMD (% change from baseline)." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 17</span><span class="title">Distal radius BMD (% change from baseline)</span></h3></div><div id="ch3.appe.fig17" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%2018.%20Radius%2033%25%20(BMD%2C%20g%2Fcm2)%20(5%20years).&p=BOOKS&id=577892_ch3appef17.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK577892/bin/ch3appef17.jpg" alt="Figure 18. Radius 33% (BMD, g/cm2) (5 years)." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 18</span><span class="title">Radius 33% (BMD, g/cm<sup>2</sup>) (5 years)</span></h3></div><div id="ch3.appe.fig18" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%2019.%20Ultradistal%20radius%20(BMD%2C%20g%2Fcm2)%20(5%20years).&p=BOOKS&id=577892_ch3appef18.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK577892/bin/ch3appef18.jpg" alt="Figure 19. Ultradistal radius (BMD, g/cm2) (5 years)." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 19</span><span class="title">Ultradistal radius (BMD, g/cm<sup>2</sup>) (5 years)</span></h3></div><div id="ch3.appe.fig19" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%2020.%20Cardiovascular%20events.&p=BOOKS&id=577892_ch3appef19.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK577892/bin/ch3appef19.jpg" alt="Figure 20. Cardiovascular events." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 20</span><span class="title">Cardiovascular events</span></h3></div><div id="ch3.appe.fig20" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%2021.%20Adverse%20events.&p=BOOKS&id=577892_ch3appef20.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK577892/bin/ch3appef20.jpg" alt="Figure 21. Adverse events." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 21</span><span class="title">Adverse events</span></h3></div><div id="ch3.appe.fig21" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%2022.%20Cancer.&p=BOOKS&id=577892_ch3appef21.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK577892/bin/ch3appef21.jpg" alt="Figure 22. Cancer." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 22</span><span class="title">Cancer</span></h3></div></div><div id="ch3.appe.s2"><h4>E.2. Surgery versus conservative treatment (non-randomised)</h4><div id="ch3.appe.fig22" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%2023.%20Mortality%20(median%20follow-up%206.1%20years).&p=BOOKS&id=577892_ch3appef22.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK577892/bin/ch3appef22.jpg" alt="Figure 23. Mortality (median follow-up 6.1 years)." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 23</span><span class="title">Mortality (median follow-up 6.1 years)</span></h3></div><div id="ch3.appe.fig23" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%2024.%20Fractures%20(median%20follow%20up%20from%20diagnosis%206.1%20to%207.4%20years).&p=BOOKS&id=577892_ch3appef23.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK577892/bin/ch3appef23.jpg" alt="Figure 24. Fractures (median follow up from diagnosis 6.1 to 7.4 years)." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 24</span><span class="title">Fractures (median follow up from diagnosis 6.1 to 7.4 years)</span></h3></div><div id="ch3.appe.fig24" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%2025.%20Cancer%20(median%20follow%20up%20from%20diagnosis%206.1%20years).&p=BOOKS&id=577892_ch3appef24.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK577892/bin/ch3appef24.jpg" alt="Figure 25. Cancer (median follow up from diagnosis 6.1 years)." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 25</span><span class="title">Cancer (median follow up from diagnosis 6.1 years)</span></h3></div><div id="ch3.appe.fig25" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%2026.%20Kidney%20stones%20(median%20follow%20up%20from%20diagnosis%206.1%20years).&p=BOOKS&id=577892_ch3appef25.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK577892/bin/ch3appef25.jpg" alt="Figure 26. Kidney stones (median follow up from diagnosis 6.1 years)." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 26</span><span class="title">Kidney stones (median follow up from diagnosis 6.1 years)</span></h3></div></div></div><div id="ch3.appf"><h3>Appendix F. GRADE tables</h3><div id="ch3.appf.tab1" class="table"><h3><span class="label">Table 11</span><span class="title">Clinical evidence profile: Surgery versus conservative management</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577892/table/ch3.appf.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch3.appf.tab1_lrgtbl__"><table class="no_bottom_margin"><tbody><tr><th id="hd_b_ch3.appf.tab1_1_1_1_1" colspan="7" rowspan="1" style="text-align:center;vertical-align:middle;">Quality assessment</th><th id="hd_b_ch3.appf.tab1_1_1_1_2" colspan="2" rowspan="1" style="text-align:center;vertical-align:middle;">No of patients</th><th id="hd_b_ch3.appf.tab1_1_1_1_3" colspan="2" rowspan="1" style="text-align:center;vertical-align:middle;">Effect</th><th id="hd_b_ch3.appf.tab1_1_1_1_4" rowspan="2" colspan="1" headers="hd_b_ch3.appf.tab1_1_1_1_4" style="text-align:center;vertical-align:middle;">Quality</th><th id="hd_b_ch3.appf.tab1_1_1_1_5" rowspan="2" colspan="1" headers="hd_b_ch3.appf.tab1_1_1_1_5" style="text-align:center;vertical-align:middle;">Importance</th></tr><tr><th headers="hd_b_ch3.appf.tab1_1_1_1_1" id="hd_b_ch3.appf.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">No of studies</th><th headers="hd_b_ch3.appf.tab1_1_1_1_1" id="hd_b_ch3.appf.tab1_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Design</th><th headers="hd_b_ch3.appf.tab1_1_1_1_1" id="hd_b_ch3.appf.tab1_1_1_2_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Risk of bias</th><th headers="hd_b_ch3.appf.tab1_1_1_1_1" id="hd_b_ch3.appf.tab1_1_1_2_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Inconsistency</th><th headers="hd_b_ch3.appf.tab1_1_1_1_1" id="hd_b_ch3.appf.tab1_1_1_2_5" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Indirectness</th><th headers="hd_b_ch3.appf.tab1_1_1_1_1" id="hd_b_ch3.appf.tab1_1_1_2_6" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Imprecision</th><th headers="hd_b_ch3.appf.tab1_1_1_1_1" id="hd_b_ch3.appf.tab1_1_1_2_7" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Other considerations</th><th headers="hd_b_ch3.appf.tab1_1_1_1_2" id="hd_b_ch3.appf.tab1_1_1_2_8" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Surgery</th><th headers="hd_b_ch3.appf.tab1_1_1_1_2" id="hd_b_ch3.appf.tab1_1_1_2_9" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">No surgery (in mild PHPT)</th><th headers="hd_b_ch3.appf.tab1_1_1_1_3" id="hd_b_ch3.appf.tab1_1_1_2_10" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Relative (95% Cl)</th><th headers="hd_b_ch3.appf.tab1_1_1_1_3" id="hd_b_ch3.appf.tab1_1_1_2_11" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Absolute</th></tr><tr><th headers="hd_b_ch3.appf.tab1_1_1_1_1 hd_b_ch3.appf.tab1_1_1_2_1 hd_b_ch3.appf.tab1_1_1_2_2 hd_b_ch3.appf.tab1_1_1_2_3 hd_b_ch3.appf.tab1_1_1_2_4 hd_b_ch3.appf.tab1_1_1_2_5 hd_b_ch3.appf.tab1_1_1_2_6 hd_b_ch3.appf.tab1_1_1_2_7 hd_b_ch3.appf.tab1_1_1_1_2 hd_b_ch3.appf.tab1_1_1_2_8 hd_b_ch3.appf.tab1_1_1_2_9 hd_b_ch3.appf.tab1_1_1_1_3 hd_b_ch3.appf.tab1_1_1_2_10 hd_b_ch3.appf.tab1_1_1_2_11 hd_b_ch3.appf.tab1_1_1_1_4 hd_b_ch3.appf.tab1_1_1_1_5" id="hd_b_ch3.appf.tab1_1_1_3_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:middle;">Quality of life (SF-36 Physical functioning subscale) (follow-up 2 years; measured with: annual change estimate; range of scores: 0–100; Better indicated by higher values)</th></tr><tr><td headers="hd_b_ch3.appf.tab1_1_1_1_1 hd_b_ch3.appf.tab1_1_1_2_1 hd_b_ch3.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_b_ch3.appf.tab1_1_1_1_1 hd_b_ch3.appf.tab1_1_1_2_2 hd_b_ch3.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomised trials</td><td headers="hd_b_ch3.appf.tab1_1_1_1_1 hd_b_ch3.appf.tab1_1_1_2_3 hd_b_ch3.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">very serious<sup><a class="bk_pop" href="#ch3.appf.tab1_1">a</a></sup></td><td headers="hd_b_ch3.appf.tab1_1_1_1_1 hd_b_ch3.appf.tab1_1_1_2_4 hd_b_ch3.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_b_ch3.appf.tab1_1_1_1_1 hd_b_ch3.appf.tab1_1_1_2_5 hd_b_ch3.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious indirectness</td><td headers="hd_b_ch3.appf.tab1_1_1_1_1 hd_b_ch3.appf.tab1_1_1_2_6 hd_b_ch3.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup><a class="bk_pop" href="#ch3.appf.tab1_2">b</a></sup></td><td headers="hd_b_ch3.appf.tab1_1_1_1_1 hd_b_ch3.appf.tab1_1_1_2_7 hd_b_ch3.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">none</td><td headers="hd_b_ch3.appf.tab1_1_1_1_2 hd_b_ch3.appf.tab1_1_1_2_8 hd_b_ch3.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">25</td><td headers="hd_b_ch3.appf.tab1_1_1_1_2 hd_b_ch3.appf.tab1_1_1_2_9 hd_b_ch3.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">28</td><td headers="hd_b_ch3.appf.tab1_1_1_1_3 hd_b_ch3.appf.tab1_1_1_2_10 hd_b_ch3.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">-</td><td headers="hd_b_ch3.appf.tab1_1_1_1_3 hd_b_ch3.appf.tab1_1_1_2_11 hd_b_ch3.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">MD2.1 lower (5.43 lower to 1.23 higher)</td><td headers="hd_b_ch3.appf.tab1_1_1_1_4 hd_b_ch3.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">VERY LOW</td><td headers="hd_b_ch3.appf.tab1_1_1_1_5 hd_b_ch3.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">CRITICAL</td></tr><tr><th id="hd_b_ch3.appf.tab1_1_1_5_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:middle;">Quality of life (SF-36 Social functioning subscale) (follow-up 2 years; measured with: annual change estimate; range of scores: 0–100; Better indicated by higher values)</th></tr><tr><td headers="hd_b_ch3.appf.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_b_ch3.appf.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomised trials</td><td headers="hd_b_ch3.appf.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">very serious<sup><a class="bk_pop" href="#ch3.appf.tab1_1">a</a></sup></td><td headers="hd_b_ch3.appf.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_b_ch3.appf.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious indirectness</td><td headers="hd_b_ch3.appf.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup><a class="bk_pop" href="#ch3.appf.tab1_2">b</a></sup></td><td headers="hd_b_ch3.appf.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">none</td><td headers="hd_b_ch3.appf.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">25</td><td headers="hd_b_ch3.appf.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">28</td><td headers="hd_b_ch3.appf.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">-</td><td headers="hd_b_ch3.appf.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">MD 3.92 higher (1.19 to 6.64 higher)</td><td headers="hd_b_ch3.appf.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">VERY LOW</td><td headers="hd_b_ch3.appf.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">CRITICAL</td></tr><tr><th id="hd_b_ch3.appf.tab1_1_1_7_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:middle;">Quality of life (SF-36 Physical role functioning subscale) (follow-up 2 years; measured with: annual change estimate; range of scores: 0–100; Better indicated by higher values)</th></tr><tr><td headers="hd_b_ch3.appf.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_b_ch3.appf.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomised trials</td><td headers="hd_b_ch3.appf.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">very serious<sup><a class="bk_pop" href="#ch3.appf.tab1_1">a</a></sup></td><td headers="hd_b_ch3.appf.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_b_ch3.appf.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious indirectness</td><td headers="hd_b_ch3.appf.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">very serious<sup><a class="bk_pop" href="#ch3.appf.tab1_2">b</a></sup></td><td headers="hd_b_ch3.appf.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">none</td><td headers="hd_b_ch3.appf.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">25</td><td headers="hd_b_ch3.appf.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">28</td><td headers="hd_b_ch3.appf.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">-</td><td headers="hd_b_ch3.appf.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">MD 0.39 higher (5.82 lower to 6.61 higher)</td><td headers="hd_b_ch3.appf.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">VERY LOW</td><td headers="hd_b_ch3.appf.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">CRITICAL</td></tr><tr><th id="hd_b_ch3.appf.tab1_1_1_9_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:middle;">Quality of life (SF-36 Emotional role functioning subscale) (follow-up 2 years; measured with: annual change estimate; range of scores: 0–100; Better indicated by higher values)</th></tr><tr><td headers="hd_b_ch3.appf.tab1_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_b_ch3.appf.tab1_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomised trials</td><td headers="hd_b_ch3.appf.tab1_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">very serious<sup><a class="bk_pop" href="#ch3.appf.tab1_1">a</a></sup></td><td headers="hd_b_ch3.appf.tab1_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_b_ch3.appf.tab1_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">to serious indirectness</td><td headers="hd_b_ch3.appf.tab1_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup><a class="bk_pop" href="#ch3.appf.tab1_2">b</a></sup></td><td headers="hd_b_ch3.appf.tab1_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">none</td><td headers="hd_b_ch3.appf.tab1_1_1_9_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">25</td><td headers="hd_b_ch3.appf.tab1_1_1_9_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">28</td><td headers="hd_b_ch3.appf.tab1_1_1_9_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">-</td><td headers="hd_b_ch3.appf.tab1_1_1_9_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">MD 5.96 higher (1.47 to 10.44 higher)</td><td headers="hd_b_ch3.appf.tab1_1_1_9_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">VERY LOW</td><td headers="hd_b_ch3.appf.tab1_1_1_9_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">CRITICAL</td></tr><tr><th id="hd_b_ch3.appf.tab1_1_1_11_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:middle;">Quality of life (SF-36 mental health subscale) (follow-up 2 years; measured with: annual change estimate; range of scores: 0–100; Better indicated by higher values)</th></tr><tr><td headers="hd_b_ch3.appf.tab1_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_b_ch3.appf.tab1_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomised trials</td><td headers="hd_b_ch3.appf.tab1_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">very serious<sup><a class="bk_pop" href="#ch3.appf.tab1_1">a</a></sup></td><td headers="hd_b_ch3.appf.tab1_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_b_ch3.appf.tab1_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">to serious indirectness</td><td headers="hd_b_ch3.appf.tab1_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">to serious mprecision</td><td headers="hd_b_ch3.appf.tab1_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">none</td><td headers="hd_b_ch3.appf.tab1_1_1_11_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">25</td><td headers="hd_b_ch3.appf.tab1_1_1_11_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">25</td><td headers="hd_b_ch3.appf.tab1_1_1_11_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">-</td><td headers="hd_b_ch3.appf.tab1_1_1_11_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">MD 0.23 higher (1.58 lower to 2.03 higher)</td><td headers="hd_b_ch3.appf.tab1_1_1_11_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">LOW</td><td headers="hd_b_ch3.appf.tab1_1_1_11_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">CRITICAL</td></tr><tr><th id="hd_b_ch3.appf.tab1_1_1_13_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:middle;">Quality of life (SF-36 vitality subscale) (follow-up 2 years; measured with: annual change estimate; range of scores: 0–100; Better indicated by higher values)</th></tr><tr><td headers="hd_b_ch3.appf.tab1_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_b_ch3.appf.tab1_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomised trials</td><td headers="hd_b_ch3.appf.tab1_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">very serious<sup><a class="bk_pop" href="#ch3.appf.tab1_1">a</a></sup></td><td headers="hd_b_ch3.appf.tab1_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_b_ch3.appf.tab1_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious indirectness</td><td headers="hd_b_ch3.appf.tab1_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup><a class="bk_pop" href="#ch3.appf.tab1_2">b</a></sup></td><td headers="hd_b_ch3.appf.tab1_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">none</td><td headers="hd_b_ch3.appf.tab1_1_1_13_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">25</td><td headers="hd_b_ch3.appf.tab1_1_1_13_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">28</td><td headers="hd_b_ch3.appf.tab1_1_1_13_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">-</td><td headers="hd_b_ch3.appf.tab1_1_1_13_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">MD 0.97 higher (1.19 lower to 3.13 higher)</td><td headers="hd_b_ch3.appf.tab1_1_1_13_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">VERY LOW</td><td headers="hd_b_ch3.appf.tab1_1_1_13_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">CRITICAL</td></tr><tr><th id="hd_b_ch3.appf.tab1_1_1_15_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:middle;">Quality of life (SF-36 Bodily pain subscale) (follow-up 2 years; measured with: annual change estimate; range of scores: 0–100; Better indicated by higher values)</th></tr><tr><td headers="hd_b_ch3.appf.tab1_1_1_15_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_b_ch3.appf.tab1_1_1_15_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomised trials</td><td headers="hd_b_ch3.appf.tab1_1_1_15_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">very serious<sup><a class="bk_pop" href="#ch3.appf.tab1_1">a</a></sup></td><td headers="hd_b_ch3.appf.tab1_1_1_15_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_b_ch3.appf.tab1_1_1_15_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious indirectness</td><td headers="hd_b_ch3.appf.tab1_1_1_15_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup><a class="bk_pop" href="#ch3.appf.tab1_2">b</a></sup></td><td headers="hd_b_ch3.appf.tab1_1_1_15_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">none</td><td headers="hd_b_ch3.appf.tab1_1_1_15_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">25</td><td headers="hd_b_ch3.appf.tab1_1_1_15_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">28</td><td headers="hd_b_ch3.appf.tab1_1_1_15_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">-</td><td headers="hd_b_ch3.appf.tab1_1_1_15_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">MD 0.65 higher (2.55 lower to 3.84 higher)</td><td headers="hd_b_ch3.appf.tab1_1_1_15_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">VERY LOW</td><td headers="hd_b_ch3.appf.tab1_1_1_15_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">CRITICAL</td></tr><tr><th id="hd_b_ch3.appf.tab1_1_1_17_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:middle;">Quality of life (SF-36 General health subscale) (follow-up 2 years; measured with: annual change estimate; range of scores: 0–100; Better indicated by higher values)</th></tr><tr><td headers="hd_b_ch3.appf.tab1_1_1_17_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_b_ch3.appf.tab1_1_1_17_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomised trials</td><td headers="hd_b_ch3.appf.tab1_1_1_17_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">very serious<sup><a class="bk_pop" href="#ch3.appf.tab1_1">a</a></sup></td><td headers="hd_b_ch3.appf.tab1_1_1_17_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_b_ch3.appf.tab1_1_1_17_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious indirectness</td><td headers="hd_b_ch3.appf.tab1_1_1_17_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup><a class="bk_pop" href="#ch3.appf.tab1_2">b</a></sup></td><td headers="hd_b_ch3.appf.tab1_1_1_17_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">none</td><td headers="hd_b_ch3.appf.tab1_1_1_17_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">25</td><td headers="hd_b_ch3.appf.tab1_1_1_17_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">28</td><td headers="hd_b_ch3.appf.tab1_1_1_17_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">-</td><td headers="hd_b_ch3.appf.tab1_1_1_17_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">MD1.81 higher (0.38 lower to 4.01 higher)</td><td headers="hd_b_ch3.appf.tab1_1_1_17_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">VERY LOW</td><td headers="hd_b_ch3.appf.tab1_1_1_17_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">CRITICAL</td></tr><tr><th id="hd_b_ch3.appf.tab1_1_1_19_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:middle;">Quality of life (SF-36 Health transition) (follow-up 2 years; measured with: annual change estimate; range of scores: 0–100; Better indicated by higher values)</th></tr><tr><td headers="hd_b_ch3.appf.tab1_1_1_19_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_b_ch3.appf.tab1_1_1_19_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomised trials</td><td headers="hd_b_ch3.appf.tab1_1_1_19_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">very serious<sup><a class="bk_pop" href="#ch3.appf.tab1_1">a</a></sup></td><td headers="hd_b_ch3.appf.tab1_1_1_19_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_b_ch3.appf.tab1_1_1_19_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">to serious indirectness</td><td headers="hd_b_ch3.appf.tab1_1_1_19_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">very serious<sup><a class="bk_pop" href="#ch3.appf.tab1_2">b</a></sup><sup>,</sup><sup><a class="bk_pop" href="#ch3.appf.tab1_3">c</a></sup></td><td headers="hd_b_ch3.appf.tab1_1_1_19_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">none</td><td headers="hd_b_ch3.appf.tab1_1_1_19_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">25</td><td headers="hd_b_ch3.appf.tab1_1_1_19_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">28</td><td headers="hd_b_ch3.appf.tab1_1_1_19_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">-</td><td headers="hd_b_ch3.appf.tab1_1_1_19_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">MD 0.12 higher (3.1 lower to 3.33 higher)</td><td headers="hd_b_ch3.appf.tab1_1_1_19_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">VERY LOW</td><td headers="hd_b_ch3.appf.tab1_1_1_19_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">CRITICAL</td></tr><tr><th id="hd_b_ch3.appf.tab1_1_1_21_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:middle;">Mortality (follow-up 5 years)</th></tr><tr><td headers="hd_b_ch3.appf.tab1_1_1_21_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_b_ch3.appf.tab1_1_1_21_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomised trials</td><td headers="hd_b_ch3.appf.tab1_1_1_21_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">very serious<sup><a class="bk_pop" href="#ch3.appf.tab1_1">a</a></sup></td><td headers="hd_b_ch3.appf.tab1_1_1_21_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_b_ch3.appf.tab1_1_1_21_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">to serious indirectness</td><td headers="hd_b_ch3.appf.tab1_1_1_21_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">very serious<sup><a class="bk_pop" href="#ch3.appf.tab1_2">b</a></sup></td><td headers="hd_b_ch3.appf.tab1_1_1_21_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">none</td><td headers="hd_b_ch3.appf.tab1_1_1_21_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
||
<p>2/96</p>
|
||
<p>(2.1%)</p>
|
||
</td><td headers="hd_b_ch3.appf.tab1_1_1_21_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">1.1%</td><td headers="hd_b_ch3.appf.tab1_1_1_21_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">RR 1.98 (0.18 to 21.46)</td><td headers="hd_b_ch3.appf.tab1_1_1_21_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">11 more per 1000 (from 9 fewer to 225 more)</td><td headers="hd_b_ch3.appf.tab1_1_1_21_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">VERY LOW</td><td headers="hd_b_ch3.appf.tab1_1_1_21_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">CRITICAL</td></tr><tr><th id="hd_b_ch3.appf.tab1_1_1_23_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:middle;">Renal Dysfunction (follow-up 2–17 years)</th></tr><tr><td headers="hd_b_ch3.appf.tab1_1_1_23_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2</td><td headers="hd_b_ch3.appf.tab1_1_1_23_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomised trials</td><td headers="hd_b_ch3.appf.tab1_1_1_23_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup><a class="bk_pop" href="#ch3.appf.tab1_1">a</a></sup></td><td headers="hd_b_ch3.appf.tab1_1_1_23_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_b_ch3.appf.tab1_1_1_23_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">to serious indirectness</td><td headers="hd_b_ch3.appf.tab1_1_1_23_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious mprecision<sup><a class="bk_pop" href="#ch3.appf.tab1_6">f</a></sup></td><td headers="hd_b_ch3.appf.tab1_1_1_23_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">none</td><td headers="hd_b_ch3.appf.tab1_1_1_23_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
||
<p>0/37</p>
|
||
<p>(0%)</p>
|
||
</td><td headers="hd_b_ch3.appf.tab1_1_1_23_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">0%</td><td headers="hd_b_ch3.appf.tab1_1_1_23_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">-</td><td headers="hd_b_ch3.appf.tab1_1_1_23_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">0 more per 1000 (from 180 fewer to 180 more)<sup><a class="bk_pop" href="#ch3.appf.tab1_4">d</a></sup></td><td headers="hd_b_ch3.appf.tab1_1_1_23_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">LOW</td><td headers="hd_b_ch3.appf.tab1_1_1_23_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">CRITICAL</td></tr><tr><th id="hd_b_ch3.appf.tab1_1_1_25_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:middle;">Vertebral fractures (follow-up 1–5 years)</th></tr><tr><td headers="hd_b_ch3.appf.tab1_1_1_25_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3</td><td headers="hd_b_ch3.appf.tab1_1_1_25_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomised trials</td><td headers="hd_b_ch3.appf.tab1_1_1_25_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">very serious<sup><a class="bk_pop" href="#ch3.appf.tab1_1">a</a></sup></td><td headers="hd_b_ch3.appf.tab1_1_1_25_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_b_ch3.appf.tab1_1_1_25_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">to serious indirectness</td><td headers="hd_b_ch3.appf.tab1_1_1_25_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">to serious mprecision</td><td headers="hd_b_ch3.appf.tab1_1_1_25_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">none</td><td headers="hd_b_ch3.appf.tab1_1_1_25_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
||
<p>0/100</p>
|
||
<p>(0%)</p>
|
||
</td><td headers="hd_b_ch3.appf.tab1_1_1_25_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">4%</td><td headers="hd_b_ch3.appf.tab1_1_1_25_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">OR 0.14 (0.03 to 0.69)</td><td headers="hd_b_ch3.appf.tab1_1_1_25_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">60 fewer per 1000 (from 110 fewer to 0 more)<sup><a class="bk_pop" href="#ch3.appf.tab1_4">d</a></sup></td><td headers="hd_b_ch3.appf.tab1_1_1_25_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">LOW</td><td headers="hd_b_ch3.appf.tab1_1_1_25_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">CRITICAL</td></tr><tr><th id="hd_b_ch3.appf.tab1_1_1_27_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:middle;">Peripheral skeletal fractures (follow-up 5 years)</th></tr><tr><td headers="hd_b_ch3.appf.tab1_1_1_27_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_b_ch3.appf.tab1_1_1_27_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomised trials</td><td headers="hd_b_ch3.appf.tab1_1_1_27_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">very serious<sup><a class="bk_pop" href="#ch3.appf.tab1_1">a</a></sup></td><td headers="hd_b_ch3.appf.tab1_1_1_27_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_b_ch3.appf.tab1_1_1_27_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious indirectness</td><td headers="hd_b_ch3.appf.tab1_1_1_27_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">very serious<sup><a class="bk_pop" href="#ch3.appf.tab1_2">b</a></sup></td><td headers="hd_b_ch3.appf.tab1_1_1_27_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">none</td><td headers="hd_b_ch3.appf.tab1_1_1_27_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
||
<p>3/51</p>
|
||
<p>(5.9%)</p>
|
||
</td><td headers="hd_b_ch3.appf.tab1_1_1_27_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">7.3%</td><td headers="hd_b_ch3.appf.tab1_1_1_27_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">RR 0.81 (0.19 to 3.44)</td><td headers="hd_b_ch3.appf.tab1_1_1_27_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">14 fewer per 1000 (from 59 fewer to 178 more)</td><td headers="hd_b_ch3.appf.tab1_1_1_27_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">VERY LOW</td><td headers="hd_b_ch3.appf.tab1_1_1_27_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">CRITICAL</td></tr><tr><th id="hd_b_ch3.appf.tab1_1_1_29_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:middle;">Kidney Stones (follow-up 1–5 years)</th></tr><tr><td headers="hd_b_ch3.appf.tab1_1_1_29_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3</td><td headers="hd_b_ch3.appf.tab1_1_1_29_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomised trials</td><td headers="hd_b_ch3.appf.tab1_1_1_29_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very serious<sup><a class="bk_pop" href="#ch3.appf.tab1_1">a</a></sup></td><td headers="hd_b_ch3.appf.tab1_1_1_29_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_b_ch3.appf.tab1_1_1_29_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious indirectness</td><td headers="hd_b_ch3.appf.tab1_1_1_29_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup><a class="bk_pop" href="#ch3.appf.tab1_2">b</a></sup></td><td headers="hd_b_ch3.appf.tab1_1_1_29_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">none</td><td headers="hd_b_ch3.appf.tab1_1_1_29_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
||
<p>1/100</p>
|
||
<p>(1%)</p>
|
||
</td><td headers="hd_b_ch3.appf.tab1_1_1_29_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">3.6%</td><td headers="hd_b_ch3.appf.tab1_1_1_29_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Peto OR 0.39 (0.06 to 2.82)</td><td headers="hd_b_ch3.appf.tab1_1_1_29_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">20 fewer per 1000 (from 60 fewer to 30 more)</td><td headers="hd_b_ch3.appf.tab1_1_1_29_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">VERY LOW</td><td headers="hd_b_ch3.appf.tab1_1_1_29_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">CRITICAL</td></tr><tr><th id="hd_b_ch3.appf.tab1_1_1_31_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:middle;">Lumbar spine BMD (follow-up 5 years; measured with: Z score (final value); Better indicated by higher values)</th></tr><tr><td headers="hd_b_ch3.appf.tab1_1_1_31_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_b_ch3.appf.tab1_1_1_31_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomised trials</td><td headers="hd_b_ch3.appf.tab1_1_1_31_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">very serious<sup><a class="bk_pop" href="#ch3.appf.tab1_1">a</a></sup></td><td headers="hd_b_ch3.appf.tab1_1_1_31_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_b_ch3.appf.tab1_1_1_31_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious indirectness</td><td headers="hd_b_ch3.appf.tab1_1_1_31_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup><a class="bk_pop" href="#ch3.appf.tab1_2">b</a></sup></td><td headers="hd_b_ch3.appf.tab1_1_1_31_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">none</td><td headers="hd_b_ch3.appf.tab1_1_1_31_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">58</td><td headers="hd_b_ch3.appf.tab1_1_1_31_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">53</td><td headers="hd_b_ch3.appf.tab1_1_1_31_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">-</td><td headers="hd_b_ch3.appf.tab1_1_1_31_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">MD 0.48 higher (0.03 lower to 0.99 higher)</td><td headers="hd_b_ch3.appf.tab1_1_1_31_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">VERY LOW</td><td headers="hd_b_ch3.appf.tab1_1_1_31_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">CRITICAL</td></tr><tr><th id="hd_b_ch3.appf.tab1_1_1_33_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:middle;">Lumbar spine BMD (follow-up 1 years; measured with: % change from baseline; Better indicated by higher values)</th></tr><tr><td headers="hd_b_ch3.appf.tab1_1_1_33_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_b_ch3.appf.tab1_1_1_33_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomised trials</td><td headers="hd_b_ch3.appf.tab1_1_1_33_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup><a class="bk_pop" href="#ch3.appf.tab1_1">a</a></sup></td><td headers="hd_b_ch3.appf.tab1_1_1_33_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_b_ch3.appf.tab1_1_1_33_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">to serious indirectness</td><td headers="hd_b_ch3.appf.tab1_1_1_33_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">very serious<sup><a class="bk_pop" href="#ch3.appf.tab1_2">b</a></sup></td><td headers="hd_b_ch3.appf.tab1_1_1_33_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">none</td><td headers="hd_b_ch3.appf.tab1_1_1_33_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">24</td><td headers="hd_b_ch3.appf.tab1_1_1_33_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">25</td><td headers="hd_b_ch3.appf.tab1_1_1_33_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">-</td><td headers="hd_b_ch3.appf.tab1_1_1_33_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">MD 5.28 higher (4.76 to 5.8 higher)</td><td headers="hd_b_ch3.appf.tab1_1_1_33_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">VERY LOW</td><td headers="hd_b_ch3.appf.tab1_1_1_33_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">CRITICAL</td></tr><tr><th id="hd_b_ch3.appf.tab1_1_1_35_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:middle;">Distal radius BMD (follow-up 17 years; measured with: g/cm<sup>2</sup>; Better indicated by higher values)</th></tr><tr><td headers="hd_b_ch3.appf.tab1_1_1_35_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_b_ch3.appf.tab1_1_1_35_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomised trials</td><td headers="hd_b_ch3.appf.tab1_1_1_35_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">very serious<sup><a class="bk_pop" href="#ch3.appf.tab1_1">a</a></sup></td><td headers="hd_b_ch3.appf.tab1_1_1_35_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_b_ch3.appf.tab1_1_1_35_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">to serious indirectness</td><td headers="hd_b_ch3.appf.tab1_1_1_35_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">very serious<sup><a class="bk_pop" href="#ch3.appf.tab1_2">b</a></sup></td><td headers="hd_b_ch3.appf.tab1_1_1_35_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">none</td><td headers="hd_b_ch3.appf.tab1_1_1_35_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">12</td><td headers="hd_b_ch3.appf.tab1_1_1_35_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">18</td><td headers="hd_b_ch3.appf.tab1_1_1_35_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">-</td><td headers="hd_b_ch3.appf.tab1_1_1_35_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">MD 0.05 lower (0.22 lower to 0.12 higher)</td><td headers="hd_b_ch3.appf.tab1_1_1_35_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">VERY LOW</td><td headers="hd_b_ch3.appf.tab1_1_1_35_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">CRITICAL</td></tr><tr><th id="hd_b_ch3.appf.tab1_1_1_37_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:middle;">Distal radius BMD (follow-up 1 years; measured with: % change from baseline; Better indicated by higher values)</th></tr><tr><td headers="hd_b_ch3.appf.tab1_1_1_37_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_b_ch3.appf.tab1_1_1_37_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomised trials</td><td headers="hd_b_ch3.appf.tab1_1_1_37_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup><a class="bk_pop" href="#ch3.appf.tab1_1">a</a></sup></td><td headers="hd_b_ch3.appf.tab1_1_1_37_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_b_ch3.appf.tab1_1_1_37_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">to serious indirectness</td><td headers="hd_b_ch3.appf.tab1_1_1_37_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup><a class="bk_pop" href="#ch3.appf.tab1_2">b</a></sup></td><td headers="hd_b_ch3.appf.tab1_1_1_37_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">none</td><td headers="hd_b_ch3.appf.tab1_1_1_37_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">24</td><td headers="hd_b_ch3.appf.tab1_1_1_37_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">25</td><td headers="hd_b_ch3.appf.tab1_1_1_37_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">-</td><td headers="hd_b_ch3.appf.tab1_1_1_37_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">MD0.21 higher (0.1 lower to 0.52 higher)</td><td headers="hd_b_ch3.appf.tab1_1_1_37_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">LOW</td><td headers="hd_b_ch3.appf.tab1_1_1_37_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">CRITICAL</td></tr><tr><th id="hd_b_ch3.appf.tab1_1_1_39_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:middle;">Radius 33% (BMD, g/cm<sup>2</sup>) (follow-up 5 years; Better indicated by higher values)</th></tr><tr><td headers="hd_b_ch3.appf.tab1_1_1_39_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_b_ch3.appf.tab1_1_1_39_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomised trials</td><td headers="hd_b_ch3.appf.tab1_1_1_39_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">very serious<sup><a class="bk_pop" href="#ch3.appf.tab1_1">a</a></sup></td><td headers="hd_b_ch3.appf.tab1_1_1_39_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_b_ch3.appf.tab1_1_1_39_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">to serious indirectness</td><td headers="hd_b_ch3.appf.tab1_1_1_39_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup><a class="bk_pop" href="#ch3.appf.tab1_2">b</a></sup></td><td headers="hd_b_ch3.appf.tab1_1_1_39_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">none</td><td headers="hd_b_ch3.appf.tab1_1_1_39_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">40</td><td headers="hd_b_ch3.appf.tab1_1_1_39_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">46</td><td headers="hd_b_ch3.appf.tab1_1_1_39_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">-</td><td headers="hd_b_ch3.appf.tab1_1_1_39_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">MD 0.03 higher (0.02 lower to 0.08 higher)</td><td headers="hd_b_ch3.appf.tab1_1_1_39_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">VERY LOW</td><td headers="hd_b_ch3.appf.tab1_1_1_39_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">CRITICAL</td></tr><tr><th id="hd_b_ch3.appf.tab1_1_1_41_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:middle;">Ultradistal radius (BMD, g/cm<sup>2</sup>) (follow-up 5 years; Better indicated by higher values)</th></tr><tr><td headers="hd_b_ch3.appf.tab1_1_1_41_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_b_ch3.appf.tab1_1_1_41_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomised trials</td><td headers="hd_b_ch3.appf.tab1_1_1_41_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup><a class="bk_pop" href="#ch3.appf.tab1_1">a</a></sup></td><td headers="hd_b_ch3.appf.tab1_1_1_41_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_b_ch3.appf.tab1_1_1_41_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious indirectness</td><td headers="hd_b_ch3.appf.tab1_1_1_41_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">very serious<sup><a class="bk_pop" href="#ch3.appf.tab1_2">b</a></sup></td><td headers="hd_b_ch3.appf.tab1_1_1_41_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">none</td><td headers="hd_b_ch3.appf.tab1_1_1_41_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">39</td><td headers="hd_b_ch3.appf.tab1_1_1_41_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">46</td><td headers="hd_b_ch3.appf.tab1_1_1_41_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">-</td><td headers="hd_b_ch3.appf.tab1_1_1_41_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">MD0.01 higher (0.03 lower to 0.04 higher)</td><td headers="hd_b_ch3.appf.tab1_1_1_41_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">LOW</td><td headers="hd_b_ch3.appf.tab1_1_1_41_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">CRITICAL</td></tr><tr><th id="hd_b_ch3.appf.tab1_1_1_43_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:middle;">Cardiovascular events (follow-up 5 years)</th></tr><tr><td headers="hd_b_ch3.appf.tab1_1_1_43_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_b_ch3.appf.tab1_1_1_43_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomised trials</td><td headers="hd_b_ch3.appf.tab1_1_1_43_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">very serious<sup><a class="bk_pop" href="#ch3.appf.tab1_1">a</a></sup></td><td headers="hd_b_ch3.appf.tab1_1_1_43_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_b_ch3.appf.tab1_1_1_43_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious indirectness</td><td headers="hd_b_ch3.appf.tab1_1_1_43_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">very serious<sup><a class="bk_pop" href="#ch3.appf.tab1_2">b</a></sup></td><td headers="hd_b_ch3.appf.tab1_1_1_43_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">none</td><td headers="hd_b_ch3.appf.tab1_1_1_43_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
||
<p>5/72</p>
|
||
<p>(6.9%)</p>
|
||
</td><td headers="hd_b_ch3.appf.tab1_1_1_43_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">11%</td><td headers="hd_b_ch3.appf.tab1_1_1_43_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">RR 0.63 (0.22 to 1.85)</td><td headers="hd_b_ch3.appf.tab1_1_1_43_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">41 fewer per 1000 (from 86 fewer to 94 more)</td><td headers="hd_b_ch3.appf.tab1_1_1_43_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">VERY LOW</td><td headers="hd_b_ch3.appf.tab1_1_1_43_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">IMPORTANT</td></tr><tr><th id="hd_b_ch3.appf.tab1_1_1_45_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:middle;">Adverse events (follow-up 1–2 years)</th></tr><tr><td headers="hd_b_ch3.appf.tab1_1_1_45_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2</td><td headers="hd_b_ch3.appf.tab1_1_1_45_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomised trials</td><td headers="hd_b_ch3.appf.tab1_1_1_45_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup><a class="bk_pop" href="#ch3.appf.tab1_1">a</a></sup></td><td headers="hd_b_ch3.appf.tab1_1_1_45_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_b_ch3.appf.tab1_1_1_45_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious indirectness</td><td headers="hd_b_ch3.appf.tab1_1_1_45_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">very serious<sup><a class="bk_pop" href="#ch3.appf.tab1_2">b</a></sup></td><td headers="hd_b_ch3.appf.tab1_1_1_45_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">none</td><td headers="hd_b_ch3.appf.tab1_1_1_45_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
||
<p>2/49</p>
|
||
<p>(4.1%)</p>
|
||
</td><td headers="hd_b_ch3.appf.tab1_1_1_45_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">5.4%</td><td headers="hd_b_ch3.appf.tab1_1_1_45_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">RR 0.75 (0.14 to 4.11)</td><td headers="hd_b_ch3.appf.tab1_1_1_45_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">14 fewer per 1000 (from 46 fewer to 168 more)</td><td headers="hd_b_ch3.appf.tab1_1_1_45_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">VERY LOW</td><td headers="hd_b_ch3.appf.tab1_1_1_45_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">IMPORTANT</td></tr><tr><th id="hd_b_ch3.appf.tab1_1_1_47_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:middle;">Cancer (follow-up 1–5 years)</th></tr><tr><td headers="hd_b_ch3.appf.tab1_1_1_47_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2</td><td headers="hd_b_ch3.appf.tab1_1_1_47_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomised trials</td><td headers="hd_b_ch3.appf.tab1_1_1_47_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<a class="bk_pop" href="#ch3.ref1"><sup>1</sup></a></td><td headers="hd_b_ch3.appf.tab1_1_1_47_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No serious inconsistency<sup><a class="bk_pop" href="#ch3.appf.tab1_5">e</a></sup></td><td headers="hd_b_ch3.appf.tab1_1_1_47_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">to serious indirectness</td><td headers="hd_b_ch3.appf.tab1_1_1_47_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">very serious<sup><a class="bk_pop" href="#ch3.appf.tab1_2">b</a></sup></td><td headers="hd_b_ch3.appf.tab1_1_1_47_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">none</td><td headers="hd_b_ch3.appf.tab1_1_1_47_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
||
<p>3/96</p>
|
||
<p>(3.1%)</p>
|
||
</td><td headers="hd_b_ch3.appf.tab1_1_1_47_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">2.7%</td><td headers="hd_b_ch3.appf.tab1_1_1_47_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Peto OR 1.53 (0.26 to 8.97)</td><td headers="hd_b_ch3.appf.tab1_1_1_47_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">10 more per 1000 (from 40 fewer to 60 more)</td><td headers="hd_b_ch3.appf.tab1_1_1_47_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">VERY LOW</td><td headers="hd_b_ch3.appf.tab1_1_1_47_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">IMPORTANT</td></tr></tbody></table></div><div><div><dl class="temp-labeled-list small"><dt>a</dt><dd><div id="ch3.appf.tab1_1"><p class="no_margin">Downgraded by 1 increment if the majority of the evidence was at high risk of bias, and downgraded by 2 increments if the majority of the evidence was at very high risk of bias</p></div></dd><dt>b</dt><dd><div id="ch3.appf.tab1_2"><p class="no_margin">Downgraded by 1 increment if the confidence interval crossed 1 MID, and downgraded by 2 increments if the confidence interval crossed both MIDs.</p></div></dd><dt>c</dt><dd><div id="ch3.appf.tab1_3"><p class="no_margin">stablished MID not available for this domain of the SF-36, therefore default MID used</p></div></dd><dt>d</dt><dd><div id="ch3.appf.tab1_4"><p class="no_margin">Manual calculation of absolute risk difference</p></div></dd><dt>e</dt><dd><div id="ch3.appf.tab1_5"><p class="no_margin">Inconsistency is not applicable due to zero events in one arm of one study</p></div></dd><dt>f</dt><dd><div id="ch3.appf.tab1_6"><p class="no_margin">Downgraded by 1 increment as both studies had 0 events in both arms and sample size was >70<350</p></div></dd></dl></div></div></div><div id="ch3.appf.tab2" class="table"><h3><span class="label">Table 12</span><span class="title">Clinical evidence profile: Surgery versus conservative treatment (non-randomised)</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577892/table/ch3.appf.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch3.appf.tab2_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_ch3.appf.tab2_1_1_1_1" colspan="7" rowspan="1" style="text-align:center;vertical-align:middle;">Quality assessment</th><th id="hd_h_ch3.appf.tab2_1_1_1_2" colspan="2" rowspan="1" style="text-align:center;vertical-align:middle;">No of patients</th><th id="hd_h_ch3.appf.tab2_1_1_1_3" colspan="2" rowspan="1" style="text-align:center;vertical-align:middle;">Effect</th><th id="hd_h_ch3.appf.tab2_1_1_1_4" rowspan="2" colspan="1" headers="hd_h_ch3.appf.tab2_1_1_1_4" style="text-align:center;vertical-align:middle;">Quality</th><th id="hd_h_ch3.appf.tab2_1_1_1_5" rowspan="2" colspan="1" headers="hd_h_ch3.appf.tab2_1_1_1_5" style="text-align:center;vertical-align:middle;">Importance</th></tr><tr><th headers="hd_h_ch3.appf.tab2_1_1_1_1" id="hd_h_ch3.appf.tab2_1_1_2_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">No of studies</th><th headers="hd_h_ch3.appf.tab2_1_1_1_1" id="hd_h_ch3.appf.tab2_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Design</th><th headers="hd_h_ch3.appf.tab2_1_1_1_1" id="hd_h_ch3.appf.tab2_1_1_2_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Risk of bias</th><th headers="hd_h_ch3.appf.tab2_1_1_1_1" id="hd_h_ch3.appf.tab2_1_1_2_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Inconsistency</th><th headers="hd_h_ch3.appf.tab2_1_1_1_1" id="hd_h_ch3.appf.tab2_1_1_2_5" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Indirectness</th><th headers="hd_h_ch3.appf.tab2_1_1_1_1" id="hd_h_ch3.appf.tab2_1_1_2_6" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Imprecision</th><th headers="hd_h_ch3.appf.tab2_1_1_1_1" id="hd_h_ch3.appf.tab2_1_1_2_7" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Other considerations</th><th headers="hd_h_ch3.appf.tab2_1_1_1_2" id="hd_h_ch3.appf.tab2_1_1_2_8" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Surgery</th><th headers="hd_h_ch3.appf.tab2_1_1_1_2" id="hd_h_ch3.appf.tab2_1_1_2_9" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Conservative treatment (NRS)</th><th headers="hd_h_ch3.appf.tab2_1_1_1_3" id="hd_h_ch3.appf.tab2_1_1_2_10" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Relative (95% CI)</th><th headers="hd_h_ch3.appf.tab2_1_1_1_3" id="hd_h_ch3.appf.tab2_1_1_2_11" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Absolute</th></tr></thead><tbody><tr><th headers="hd_h_ch3.appf.tab2_1_1_1_1 hd_h_ch3.appf.tab2_1_1_2_1 hd_h_ch3.appf.tab2_1_1_2_2 hd_h_ch3.appf.tab2_1_1_2_3 hd_h_ch3.appf.tab2_1_1_2_4 hd_h_ch3.appf.tab2_1_1_2_5 hd_h_ch3.appf.tab2_1_1_2_6 hd_h_ch3.appf.tab2_1_1_2_7 hd_h_ch3.appf.tab2_1_1_1_2 hd_h_ch3.appf.tab2_1_1_2_8 hd_h_ch3.appf.tab2_1_1_2_9 hd_h_ch3.appf.tab2_1_1_1_3 hd_h_ch3.appf.tab2_1_1_2_10 hd_h_ch3.appf.tab2_1_1_2_11 hd_h_ch3.appf.tab2_1_1_1_4 hd_h_ch3.appf.tab2_1_1_1_5" id="hd_b_ch3.appf.tab2_1_1_1_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:middle;">Mortality</th></tr><tr><td headers="hd_h_ch3.appf.tab2_1_1_1_1 hd_h_ch3.appf.tab2_1_1_2_1 hd_b_ch3.appf.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2</td><td headers="hd_h_ch3.appf.tab2_1_1_1_1 hd_h_ch3.appf.tab2_1_1_2_2 hd_b_ch3.appf.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">observational studies</td><td headers="hd_h_ch3.appf.tab2_1_1_1_1 hd_h_ch3.appf.tab2_1_1_2_3 hd_b_ch3.appf.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">very serious<sup><a class="bk_pop" href="#ch3.appf.tab2_1">a</a></sup></td><td headers="hd_h_ch3.appf.tab2_1_1_1_1 hd_h_ch3.appf.tab2_1_1_2_4 hd_b_ch3.appf.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_h_ch3.appf.tab2_1_1_1_1 hd_h_ch3.appf.tab2_1_1_2_5 hd_b_ch3.appf.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious indirectness</td><td headers="hd_h_ch3.appf.tab2_1_1_1_1 hd_h_ch3.appf.tab2_1_1_2_6 hd_b_ch3.appf.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious imprecision</td><td headers="hd_h_ch3.appf.tab2_1_1_1_1 hd_h_ch3.appf.tab2_1_1_2_7 hd_b_ch3.appf.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">none</td><td headers="hd_h_ch3.appf.tab2_1_1_1_2 hd_h_ch3.appf.tab2_1_1_2_8 hd_b_ch3.appf.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">-</td><td headers="hd_h_ch3.appf.tab2_1_1_1_2 hd_h_ch3.appf.tab2_1_1_2_9 hd_b_ch3.appf.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">-<sup><a class="bk_pop" href="#ch3.appf.tab2_3">c</a></sup></td><td headers="hd_h_ch3.appf.tab2_1_1_1_3 hd_h_ch3.appf.tab2_1_1_2_10 hd_b_ch3.appf.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">HR 0.65 (0.57 to 0.74)</td><td headers="hd_h_ch3.appf.tab2_1_1_1_3 hd_h_ch3.appf.tab2_1_1_2_11 hd_b_ch3.appf.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">-<a class="bk_pop" href="#ch3.ref3"><sup>3</sup></a></td><td headers="hd_h_ch3.appf.tab2_1_1_1_4 hd_b_ch3.appf.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">VERY LOW</td><td headers="hd_h_ch3.appf.tab2_1_1_1_5 hd_b_ch3.appf.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">CRITICAL</td></tr><tr><th headers="hd_h_ch3.appf.tab2_1_1_1_1 hd_h_ch3.appf.tab2_1_1_2_1 hd_h_ch3.appf.tab2_1_1_2_2 hd_h_ch3.appf.tab2_1_1_2_3 hd_h_ch3.appf.tab2_1_1_2_4 hd_h_ch3.appf.tab2_1_1_2_5 hd_h_ch3.appf.tab2_1_1_2_6 hd_h_ch3.appf.tab2_1_1_2_7 hd_h_ch3.appf.tab2_1_1_1_2 hd_h_ch3.appf.tab2_1_1_2_8 hd_h_ch3.appf.tab2_1_1_2_9 hd_h_ch3.appf.tab2_1_1_1_3 hd_h_ch3.appf.tab2_1_1_2_10 hd_h_ch3.appf.tab2_1_1_2_11 hd_h_ch3.appf.tab2_1_1_1_4 hd_h_ch3.appf.tab2_1_1_1_5" id="hd_b_ch3.appf.tab2_1_1_3_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:middle;">Fractures</th></tr><tr><td headers="hd_h_ch3.appf.tab2_1_1_1_1 hd_h_ch3.appf.tab2_1_1_2_1 hd_b_ch3.appf.tab2_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2</td><td headers="hd_h_ch3.appf.tab2_1_1_1_1 hd_h_ch3.appf.tab2_1_1_2_2 hd_b_ch3.appf.tab2_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">observational studies</td><td headers="hd_h_ch3.appf.tab2_1_1_1_1 hd_h_ch3.appf.tab2_1_1_2_3 hd_b_ch3.appf.tab2_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">very serious<sup><a class="bk_pop" href="#ch3.appf.tab2_1">a</a></sup></td><td headers="hd_h_ch3.appf.tab2_1_1_1_1 hd_h_ch3.appf.tab2_1_1_2_4 hd_b_ch3.appf.tab2_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_h_ch3.appf.tab2_1_1_1_1 hd_h_ch3.appf.tab2_1_1_2_5 hd_b_ch3.appf.tab2_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious indirectness</td><td headers="hd_h_ch3.appf.tab2_1_1_1_1 hd_h_ch3.appf.tab2_1_1_2_6 hd_b_ch3.appf.tab2_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup><a class="bk_pop" href="#ch3.appf.tab2_2">b</a></sup></td><td headers="hd_h_ch3.appf.tab2_1_1_1_1 hd_h_ch3.appf.tab2_1_1_2_7 hd_b_ch3.appf.tab2_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">none</td><td headers="hd_h_ch3.appf.tab2_1_1_1_2 hd_h_ch3.appf.tab2_1_1_2_8 hd_b_ch3.appf.tab2_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">-</td><td headers="hd_h_ch3.appf.tab2_1_1_1_2 hd_h_ch3.appf.tab2_1_1_2_9 hd_b_ch3.appf.tab2_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">-<sup><a class="bk_pop" href="#ch3.appf.tab2_1">c</a></sup></td><td headers="hd_h_ch3.appf.tab2_1_1_1_3 hd_h_ch3.appf.tab2_1_1_2_10 hd_b_ch3.appf.tab2_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">HR 0.67 (0.55 to 0.82)</td><td headers="hd_h_ch3.appf.tab2_1_1_1_3 hd_h_ch3.appf.tab2_1_1_2_11 hd_b_ch3.appf.tab2_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">-<a class="bk_pop" href="#ch3.ref3"><sup>3</sup></a></td><td headers="hd_h_ch3.appf.tab2_1_1_1_4 hd_b_ch3.appf.tab2_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">VERY LOW</td><td headers="hd_h_ch3.appf.tab2_1_1_1_5 hd_b_ch3.appf.tab2_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">CRITICAL</td></tr><tr><th headers="hd_h_ch3.appf.tab2_1_1_1_1 hd_h_ch3.appf.tab2_1_1_2_1 hd_h_ch3.appf.tab2_1_1_2_2 hd_h_ch3.appf.tab2_1_1_2_3 hd_h_ch3.appf.tab2_1_1_2_4 hd_h_ch3.appf.tab2_1_1_2_5 hd_h_ch3.appf.tab2_1_1_2_6 hd_h_ch3.appf.tab2_1_1_2_7 hd_h_ch3.appf.tab2_1_1_1_2 hd_h_ch3.appf.tab2_1_1_2_8 hd_h_ch3.appf.tab2_1_1_2_9 hd_h_ch3.appf.tab2_1_1_1_3 hd_h_ch3.appf.tab2_1_1_2_10 hd_h_ch3.appf.tab2_1_1_2_11 hd_h_ch3.appf.tab2_1_1_1_4 hd_h_ch3.appf.tab2_1_1_1_5" id="hd_b_ch3.appf.tab2_1_1_5_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:middle;">Cancer</th></tr><tr><td headers="hd_h_ch3.appf.tab2_1_1_1_1 hd_h_ch3.appf.tab2_1_1_2_1 hd_b_ch3.appf.tab2_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_h_ch3.appf.tab2_1_1_1_1 hd_h_ch3.appf.tab2_1_1_2_2 hd_b_ch3.appf.tab2_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">observational studies</td><td headers="hd_h_ch3.appf.tab2_1_1_1_1 hd_h_ch3.appf.tab2_1_1_2_3 hd_b_ch3.appf.tab2_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">very serious<sup><a class="bk_pop" href="#ch3.appf.tab2_1">a</a></sup></td><td headers="hd_h_ch3.appf.tab2_1_1_1_1 hd_h_ch3.appf.tab2_1_1_2_4 hd_b_ch3.appf.tab2_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_h_ch3.appf.tab2_1_1_1_1 hd_h_ch3.appf.tab2_1_1_2_5 hd_b_ch3.appf.tab2_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious indirectness</td><td headers="hd_h_ch3.appf.tab2_1_1_1_1 hd_h_ch3.appf.tab2_1_1_2_6 hd_b_ch3.appf.tab2_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup><a class="bk_pop" href="#ch3.appf.tab2_1">b</a></sup></td><td headers="hd_h_ch3.appf.tab2_1_1_1_1 hd_h_ch3.appf.tab2_1_1_2_7 hd_b_ch3.appf.tab2_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">None</td><td headers="hd_h_ch3.appf.tab2_1_1_1_2 hd_h_ch3.appf.tab2_1_1_2_8 hd_b_ch3.appf.tab2_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
||
<p>135/1934</p>
|
||
<p>(7%)</p>
|
||
</td><td headers="hd_h_ch3.appf.tab2_1_1_1_2 hd_h_ch3.appf.tab2_1_1_2_9 hd_b_ch3.appf.tab2_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
||
<p>119/1279</p>
|
||
<p>(9.3%)</p>
|
||
</td><td headers="hd_h_ch3.appf.tab2_1_1_1_3 hd_h_ch3.appf.tab2_1_1_2_10 hd_b_ch3.appf.tab2_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">HR1.11 (0.9 to 1.37)</td><td headers="hd_h_ch3.appf.tab2_1_1_1_3 hd_h_ch3.appf.tab2_1_1_2_11 hd_b_ch3.appf.tab2_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">10 more per 1000 (from 9 fewer to 32 more)</td><td headers="hd_h_ch3.appf.tab2_1_1_1_4 hd_b_ch3.appf.tab2_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">VERY LOW</td><td headers="hd_h_ch3.appf.tab2_1_1_1_5 hd_b_ch3.appf.tab2_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">IMPORTANT</td></tr><tr><th headers="hd_h_ch3.appf.tab2_1_1_1_1 hd_h_ch3.appf.tab2_1_1_2_1 hd_h_ch3.appf.tab2_1_1_2_2 hd_h_ch3.appf.tab2_1_1_2_3 hd_h_ch3.appf.tab2_1_1_2_4 hd_h_ch3.appf.tab2_1_1_2_5 hd_h_ch3.appf.tab2_1_1_2_6 hd_h_ch3.appf.tab2_1_1_2_7 hd_h_ch3.appf.tab2_1_1_1_2 hd_h_ch3.appf.tab2_1_1_2_8 hd_h_ch3.appf.tab2_1_1_2_9 hd_h_ch3.appf.tab2_1_1_1_3 hd_h_ch3.appf.tab2_1_1_2_10 hd_h_ch3.appf.tab2_1_1_2_11 hd_h_ch3.appf.tab2_1_1_1_4 hd_h_ch3.appf.tab2_1_1_1_5" id="hd_b_ch3.appf.tab2_1_1_7_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:middle;">Kidney stones</th></tr><tr><td headers="hd_h_ch3.appf.tab2_1_1_1_1 hd_h_ch3.appf.tab2_1_1_2_1 hd_b_ch3.appf.tab2_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_h_ch3.appf.tab2_1_1_1_1 hd_h_ch3.appf.tab2_1_1_2_2 hd_b_ch3.appf.tab2_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">observational studies</td><td headers="hd_h_ch3.appf.tab2_1_1_1_1 hd_h_ch3.appf.tab2_1_1_2_3 hd_b_ch3.appf.tab2_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">very serious<sup><a class="bk_pop" href="#ch3.appf.tab2_1">a</a></sup></td><td headers="hd_h_ch3.appf.tab2_1_1_1_1 hd_h_ch3.appf.tab2_1_1_2_4 hd_b_ch3.appf.tab2_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_h_ch3.appf.tab2_1_1_1_1 hd_h_ch3.appf.tab2_1_1_2_5 hd_b_ch3.appf.tab2_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious indirectness</td><td headers="hd_h_ch3.appf.tab2_1_1_1_1 hd_h_ch3.appf.tab2_1_1_2_6 hd_b_ch3.appf.tab2_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious imprecision</td><td headers="hd_h_ch3.appf.tab2_1_1_1_1 hd_h_ch3.appf.tab2_1_1_2_7 hd_b_ch3.appf.tab2_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">None</td><td headers="hd_h_ch3.appf.tab2_1_1_1_2 hd_h_ch3.appf.tab2_1_1_2_8 hd_b_ch3.appf.tab2_1_1_7_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
||
<p>297/1934</p>
|
||
<p>(15.4%)</p>
|
||
</td><td headers="hd_h_ch3.appf.tab2_1_1_1_2 hd_h_ch3.appf.tab2_1_1_2_9 hd_b_ch3.appf.tab2_1_1_7_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
||
<p>83/1279</p>
|
||
<p>(6.5%)</p>
|
||
</td><td headers="hd_h_ch3.appf.tab2_1_1_1_3 hd_h_ch3.appf.tab2_1_1_2_10 hd_b_ch3.appf.tab2_1_1_7_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">HR 1.87 (1.3 to 2.69)</td><td headers="hd_h_ch3.appf.tab2_1_1_1_3 hd_h_ch3.appf.tab2_1_1_2_11 hd_b_ch3.appf.tab2_1_1_7_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">53 more per 1000 (from 19 more to 100 more)</td><td headers="hd_h_ch3.appf.tab2_1_1_1_4 hd_b_ch3.appf.tab2_1_1_7_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">VERY LOW</td><td headers="hd_h_ch3.appf.tab2_1_1_1_5 hd_b_ch3.appf.tab2_1_1_7_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">CRITICAL</td></tr></tbody></table></div><div><div><dl class="temp-labeled-list small"><dt>a</dt><dd><div id="ch3.appf.tab2_1"><p class="no_margin">Downgraded by 1 increment if the majority of studies were at high risk of bias, and downgraded by 2 increments if the majority of studies were at very high risk of bias</p></div></dd><dt>b</dt><dd><div id="ch3.appf.tab2_2"><p class="no_margin">Downgraded by 1 increment if the confidence interval crossed 1 MID, and downgraded by 2 increments if the confidence interval crossed both MIDs</p></div></dd><dt>c</dt><dd><div id="ch3.appf.tab2_3"><p class="no_margin">Control group rate not reported</p></div></dd></dl></div></div></div></div><div id="ch3.appg"><h3>Appendix G. Health economic evidence selection</h3><div id="ch3.appg.fig1" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%2027.%20Flow%20chart%20of%20health%20economic%20study%20selection%20for%20the%20guideline.&p=BOOKS&id=577892_ch3appgf1.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK577892/bin/ch3appgf1.jpg" alt="Figure 27. Flow chart of health economic study selection for the guideline." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 27</span><span class="title">Flow chart of health economic study selection for the guideline</span></h3><div class="caption"><p>* Non-relevant population, intervention, comparison, design or setting; non-English language</p></div></div></div><div id="ch3.apph"><h3>Appendix H. Health economic evidence tables</h3><p>None.</p></div><div id="ch3.appi"><h3>Appendix I. Excluded studies</h3><div id="ch3.appi.s1"><h4>I.1. Excluded clinical studies</h4><div id="ch3.appi.tab1" class="table"><h3><span class="label">Table 13</span><span class="title">Studies excluded from the clinical review</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577892/table/ch3.appi.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch3.appi.tab1_lrgtbl__"><table><thead><tr><th id="hd_h_ch3.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study</th><th id="hd_h_ch3.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Exclusion reason</th></tr></thead><tbody><tr><td headers="hd_h_ch3.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Adler 2008<a class="bk_pop" href="#ch3.ref1"><sup>1</sup></a></td><td headers="hd_h_ch3.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Inappropriate comparison – study compares different types of surgery</td></tr><tr><td headers="hd_h_ch3.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Agus 1993<a class="bk_pop" href="#ch3.ref2"><sup>2</sup></a></td><td headers="hd_h_ch3.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">An opinion piece</td></tr><tr><td headers="hd_h_ch3.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Alhava 1988<a class="bk_pop" href="#ch3.ref3"><sup>3</sup></a></td><td headers="hd_h_ch3.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Non-comparative before and after study</td></tr><tr><td headers="hd_h_ch3.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Almqvist 2002<a class="bk_pop" href="#ch3.ref5"><sup>5</sup></a></td><td headers="hd_h_ch3.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No relevant outcomes</td></tr><tr><td headers="hd_h_ch3.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Almqvist 2004<a class="bk_pop" href="#ch3.ref4"><sup>4</sup></a></td><td headers="hd_h_ch3.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Inappropriate comparison. Incorrect interventions. Comparison of different timings of surgery.</td></tr><tr><td headers="hd_h_ch3.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Alvarez-Allende 2014<a class="bk_pop" href="#ch3.ref6"><sup>6</sup></a></td><td headers="hd_h_ch3.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Conference abstract</td></tr><tr><td headers="hd_h_ch3.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Anonymous 2000<a class="bk_pop" href="#ch3.ref9"><sup>9</sup></a></td><td headers="hd_h_ch3.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not a primary study – article</td></tr><tr><td headers="hd_h_ch3.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Anonymous 2000<a class="bk_pop" href="#ch3.ref8"><sup>8</sup></a></td><td headers="hd_h_ch3.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not a primary study – article</td></tr><tr><td headers="hd_h_ch3.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Barkun 2006<a class="bk_pop" href="#ch3.ref10"><sup>10</sup></a></td><td headers="hd_h_ch3.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Commentary of an included RCT</td></tr><tr><td headers="hd_h_ch3.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Blanchard 2014<a class="bk_pop" href="#ch3.ref12"><sup>12</sup></a></td><td headers="hd_h_ch3.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Non-comparative before and after study</td></tr><tr><td headers="hd_h_ch3.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Bollerslev 2009<a class="bk_pop" href="#ch3.ref14"><sup>14</sup></a></td><td headers="hd_h_ch3.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No relevant outcomes</td></tr><tr><td headers="hd_h_ch3.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Bonzelaar 2016<a class="bk_pop" href="#ch3.ref15"><sup>15</sup></a></td><td headers="hd_h_ch3.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Conference abstract</td></tr><tr><td headers="hd_h_ch3.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Britton 1971<a class="bk_pop" href="#ch3.ref16"><sup>16</sup></a></td><td headers="hd_h_ch3.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Non-comparative study</td></tr><tr><td headers="hd_h_ch3.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Brothers 1987<a class="bk_pop" href="#ch3.ref17"><sup>17</sup></a></td><td headers="hd_h_ch3.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Non-comparative study</td></tr><tr><td headers="hd_h_ch3.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Broulik 2011<a class="bk_pop" href="#ch3.ref18"><sup>18</sup></a></td><td headers="hd_h_ch3.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Non-comparative before and after study</td></tr><tr><td headers="hd_h_ch3.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Bruining 1981<a class="bk_pop" href="#ch3.ref19"><sup>19</sup></a></td><td headers="hd_h_ch3.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Non-comparative study</td></tr><tr><td headers="hd_h_ch3.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Burney 1996<a class="bk_pop" href="#ch3.ref20"><sup>20</sup></a></td><td headers="hd_h_ch3.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Non-comparative study</td></tr><tr><td headers="hd_h_ch3.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Burney 1998<a class="bk_pop" href="#ch3.ref21"><sup>21</sup></a></td><td headers="hd_h_ch3.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Non-comparative study</td></tr><tr><td headers="hd_h_ch3.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Calo 2016<a class="bk_pop" href="#ch3.ref22"><sup>22</sup></a></td><td headers="hd_h_ch3.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Inappropriate comparison</td></tr><tr><td headers="hd_h_ch3.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Carneiro-pla 2007<a class="bk_pop" href="#ch3.ref23"><sup>23</sup></a></td><td headers="hd_h_ch3.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Non-comparative study (all patients underwent surgery)</td></tr><tr><td headers="hd_h_ch3.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Chen 1998<a class="bk_pop" href="#ch3.ref24"><sup>24</sup></a></td><td headers="hd_h_ch3.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Non-comparative study</td></tr><tr><td headers="hd_h_ch3.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cheng 2015<a class="bk_pop" href="#ch3.ref25"><sup>25</sup></a></td><td headers="hd_h_ch3.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Systematic review. Screened for relevant references.</td></tr><tr><td headers="hd_h_ch3.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Chigot 1995<a class="bk_pop" href="#ch3.ref26"><sup>26</sup></a></td><td headers="hd_h_ch3.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Non-comparative study (all patients underwent surgery)</td></tr><tr><td headers="hd_h_ch3.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cowie 1982<a class="bk_pop" href="#ch3.ref28"><sup>28</sup></a></td><td headers="hd_h_ch3.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Incorrect study design – case series</td></tr><tr><td headers="hd_h_ch3.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">D’Andrea 1996<a class="bk_pop" href="#ch3.ref29"><sup>29</sup></a></td><td headers="hd_h_ch3.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Non-comparative study (all patients underwent surgery)</td></tr><tr><td headers="hd_h_ch3.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Diaz-Guerra 2015<a class="bk_pop" href="#ch3.ref31"><sup>31</sup></a></td><td headers="hd_h_ch3.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Conference abstract</td></tr><tr><td headers="hd_h_ch3.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Dy 2012<a class="bk_pop" href="#ch3.ref32"><sup>32</sup></a></td><td headers="hd_h_ch3.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Non-comparative study (all patients underwent surgery)</td></tr><tr><td headers="hd_h_ch3.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Edwards 2006<a class="bk_pop" href="#ch3.ref33"><sup>33</sup></a></td><td headers="hd_h_ch3.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Non-comparative study (all patients underwent surgery)</td></tr><tr><td headers="hd_h_ch3.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Espiritu 2011<a class="bk_pop" href="#ch3.ref35"><sup>35</sup></a></td><td headers="hd_h_ch3.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No relevant outcomes reported</td></tr><tr><td headers="hd_h_ch3.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Falkheden 1980<a class="bk_pop" href="#ch3.ref36"><sup>36</sup></a></td><td headers="hd_h_ch3.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Non-comparative study (all patients underwent surgery)</td></tr><tr><td headers="hd_h_ch3.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Fang 2008<a class="bk_pop" href="#ch3.ref37"><sup>37</sup></a></td><td headers="hd_h_ch3.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NRS – no multivariate analysis or adjustment for confounders</td></tr><tr><td headers="hd_h_ch3.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Farnebo 1984<a class="bk_pop" href="#ch3.ref38"><sup>38</sup></a></td><td headers="hd_h_ch3.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Non-comparative study (all patients underwent surgery)</td></tr><tr><td headers="hd_h_ch3.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Freaney 1978<a class="bk_pop" href="#ch3.ref39"><sup>39</sup></a></td><td headers="hd_h_ch3.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Non-comparative study (all patients underwent surgery)</td></tr><tr><td headers="hd_h_ch3.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Ghose 1981<a class="bk_pop" href="#ch3.ref40"><sup>40</sup></a></td><td headers="hd_h_ch3.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Non-comparative before and after study</td></tr><tr><td headers="hd_h_ch3.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Hagstrom 2006<a class="bk_pop" href="#ch3.ref41"><sup>41</sup></a></td><td headers="hd_h_ch3.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Non-comparative before and after study</td></tr><tr><td headers="hd_h_ch3.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Hedback 1990<a class="bk_pop" href="#ch3.ref43"><sup>43</sup></a></td><td headers="hd_h_ch3.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Non-comparative retrospective study</td></tr><tr><td headers="hd_h_ch3.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Hedback 1991<a class="bk_pop" href="#ch3.ref42"><sup>42</sup></a></td><td headers="hd_h_ch3.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Non-comparative retrospective study</td></tr><tr><td headers="hd_h_ch3.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Horiuchi 2002<a class="bk_pop" href="#ch3.ref44"><sup>44</sup></a></td><td headers="hd_h_ch3.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Inappropriate intervention – 2-week administration only of oral etidronate. This bisphosphonate is no longer used.</td></tr><tr><td headers="hd_h_ch3.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Jansson 2006<a class="bk_pop" href="#ch3.ref45"><sup>45</sup></a></td><td headers="hd_h_ch3.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Conference abstract</td></tr><tr><td headers="hd_h_ch3.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Khosla 1999<a class="bk_pop" href="#ch3.ref46"><sup>46</sup></a></td><td headers="hd_h_ch3.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NRS – only reports the effect of surgery on fracture risk from a univariate model and not the adjusted HR for this factor from the MV model.</td></tr><tr><td headers="hd_h_ch3.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Lafferty 1989<a class="bk_pop" href="#ch3.ref47"><sup>47</sup></a></td><td headers="hd_h_ch3.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Non-comparative study (all patients underwent surgery)</td></tr><tr><td headers="hd_h_ch3.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Larsson 1993<a class="bk_pop" href="#ch3.ref48"><sup>48</sup></a></td><td headers="hd_h_ch3.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NRS with no adjustment for confounders</td></tr><tr><td headers="hd_h_ch3.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Leong 2010<a class="bk_pop" href="#ch3.ref49"><sup>49</sup></a></td><td headers="hd_h_ch3.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Non-comparative study (all patients underwent surgery)</td></tr><tr><td headers="hd_h_ch3.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">McDow, 2018<a class="bk_pop" href="#ch3.ref52"><sup>52</sup></a></td><td headers="hd_h_ch3.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Review. Screened for relevant references.</td></tr><tr><td headers="hd_h_ch3.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Melton 1992<a class="bk_pop" href="#ch3.ref53"><sup>53</sup></a></td><td headers="hd_h_ch3.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NRS – surgery effect on fracture risk only reported from a univariate model (risk adjusted for confounders not reported).</td></tr><tr><td headers="hd_h_ch3.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Mole 1992<a class="bk_pop" href="#ch3.ref54"><sup>54</sup></a></td><td headers="hd_h_ch3.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NRS with no adjustment for confounders. Study also provides an analysis of 8 people who underwent surgery compared with 8 age-matched conservatively managed people (but other key confounders not matched).</td></tr><tr><td headers="hd_h_ch3.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Morris 2010<a class="bk_pop" href="#ch3.ref55"><sup>55</sup></a></td><td headers="hd_h_ch3.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No relevant outcomes reported – for some outcomes results are only reported for the intervention group. Paper includes a statement that there was no morbidity or mortality but it is unclear if this refers to both the intervention and control group or just the control group.</td></tr><tr><td headers="hd_h_ch3.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Nomura 2004<a class="bk_pop" href="#ch3.ref57"><sup>57</sup></a></td><td headers="hd_h_ch3.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NRS with no adjustment for confounders</td></tr><tr><td headers="hd_h_ch3.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Nordenstrom 2004<a class="bk_pop" href="#ch3.ref58"><sup>58</sup></a></td><td headers="hd_h_ch3.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Non-comparative before and after study</td></tr><tr><td headers="hd_h_ch3.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Oucharek 2011<a class="bk_pop" href="#ch3.ref59"><sup>59</sup></a></td><td headers="hd_h_ch3.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Non-comparative study (all patients underwent surgery)</td></tr><tr><td headers="hd_h_ch3.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Paloyan 1983<a class="bk_pop" href="#ch3.ref60"><sup>60</sup></a></td><td headers="hd_h_ch3.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Non-comparative study (all patients underwent surgery)</td></tr><tr><td headers="hd_h_ch3.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Perrier 2009<a class="bk_pop" href="#ch3.ref61"><sup>61</sup></a></td><td headers="hd_h_ch3.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No relevant outcomes</td></tr><tr><td headers="hd_h_ch3.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Persson 2011<a class="bk_pop" href="#ch3.ref62"><sup>62</sup></a></td><td headers="hd_h_ch3.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Follow-up study of an included RCT but with no relevant outcomes</td></tr><tr><td headers="hd_h_ch3.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Posen 1985<a class="bk_pop" href="#ch3.ref63"><sup>63</sup></a></td><td headers="hd_h_ch3.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NRS with no adjustment for confounders</td></tr><tr><td headers="hd_h_ch3.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Rao 2003<a class="bk_pop" href="#ch3.ref65"><sup>65</sup></a></td><td headers="hd_h_ch3.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NRS with no adjustment for confounders</td></tr><tr><td headers="hd_h_ch3.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Richmond 2007<a class="bk_pop" href="#ch3.ref66"><sup>66</sup></a></td><td headers="hd_h_ch3.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Non-comparative study</td></tr><tr><td headers="hd_h_ch3.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Rolighed 2012<a class="bk_pop" href="#ch3.ref67"><sup>67</sup></a></td><td headers="hd_h_ch3.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Conference abstract</td></tr><tr><td headers="hd_h_ch3.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Rubin 2008<a class="bk_pop" href="#ch3.ref68"><sup>68</sup></a></td><td headers="hd_h_ch3.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NRS with no adjustment for confounders</td></tr><tr><td headers="hd_h_ch3.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Sankaran 2010<a class="bk_pop" href="#ch3.ref69"><sup>69</sup></a></td><td headers="hd_h_ch3.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">A literature review not specified as systematic review and without quality assessment of the studies included</td></tr><tr><td headers="hd_h_ch3.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Sanzenbacher 1970<a class="bk_pop" href="#ch3.ref70"><sup>70</sup></a></td><td headers="hd_h_ch3.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Inappropriate study design</td></tr><tr><td headers="hd_h_ch3.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Saponaro 2013<a class="bk_pop" href="#ch3.ref71"><sup>71</sup></a></td><td headers="hd_h_ch3.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Incorrect interventions</td></tr><tr><td headers="hd_h_ch3.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Schneider 2014<a class="bk_pop" href="#ch3.ref72"><sup>72</sup></a></td><td headers="hd_h_ch3.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Inappropriate comparison. Incorrect interventions.</td></tr><tr><td headers="hd_h_ch3.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Scott Jr 1981<a class="bk_pop" href="#ch3.ref73"><sup>73</sup></a></td><td headers="hd_h_ch3.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Inappropriate study design</td></tr><tr><td headers="hd_h_ch3.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Sejean 2005<a class="bk_pop" href="#ch3.ref74"><sup>74</sup></a></td><td headers="hd_h_ch3.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Incorrect study design – decision analysis</td></tr><tr><td headers="hd_h_ch3.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Silverberg 1995<a class="bk_pop" href="#ch3.ref75"><sup>75</sup></a></td><td headers="hd_h_ch3.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Non-comparative study (all patients underwent surgery)</td></tr><tr><td headers="hd_h_ch3.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Silverberg 1999<a class="bk_pop" href="#ch3.ref76"><sup>76</sup></a></td><td headers="hd_h_ch3.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NRS – study performed a multivariate analysis but factors included are unclear and no adjusted risk given for the effect of surgery on the outcome</td></tr><tr><td headers="hd_h_ch3.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Singh Ospina 2016<a class="bk_pop" href="#ch3.ref77"><sup>77</sup></a></td><td headers="hd_h_ch3.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Systematic review screened for references</td></tr><tr><td headers="hd_h_ch3.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Singh Ospina 2016<a class="bk_pop" href="#ch3.ref78"><sup>78</sup></a></td><td headers="hd_h_ch3.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Systematic review screened for relevant references</td></tr><tr><td headers="hd_h_ch3.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Siperstein 1992<a class="bk_pop" href="#ch3.ref79"><sup>79</sup></a></td><td headers="hd_h_ch3.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Non-comparative study (all patients underwent surgery)</td></tr><tr><td headers="hd_h_ch3.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Solorzano 2008<a class="bk_pop" href="#ch3.ref80"><sup>80</sup></a></td><td headers="hd_h_ch3.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Non-comparative retrospective case series</td></tr><tr><td headers="hd_h_ch3.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Soreide 1997<a class="bk_pop" href="#ch3.ref81"><sup>81</sup></a></td><td headers="hd_h_ch3.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Non-comparative study (all patients underwent surgery)</td></tr><tr><td headers="hd_h_ch3.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Strewler 1995<a class="bk_pop" href="#ch3.ref82"><sup>82</sup></a></td><td headers="hd_h_ch3.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Literature review with commentary and opinion</td></tr><tr><td headers="hd_h_ch3.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Tay 2016<a class="bk_pop" href="#ch3.ref84"><sup>84</sup></a></td><td headers="hd_h_ch3.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NRS with multivariate analysis but no relevant outcomes</td></tr><tr><td headers="hd_h_ch3.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Tisell 1983<a class="bk_pop" href="#ch3.ref85"><sup>85</sup></a></td><td headers="hd_h_ch3.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Inappropriate comparison. Inappropriate study design.</td></tr><tr><td headers="hd_h_ch3.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Trombetti 2016<a class="bk_pop" href="#ch3.ref86"><sup>86</sup></a></td><td headers="hd_h_ch3.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NRS with no adjustment for confounders</td></tr><tr><td headers="hd_h_ch3.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Vera 2014<a class="bk_pop" href="#ch3.ref89"><sup>89</sup></a></td><td headers="hd_h_ch3.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NRS with no adjustment for confounders</td></tr><tr><td headers="hd_h_ch3.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Vestergaard 2003<a class="bk_pop" href="#ch3.ref91"><sup>91</sup></a></td><td headers="hd_h_ch3.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Overlap in recruitment of participants with an already included study (Vestergaard 2003) – larger study included in this review</td></tr><tr><td headers="hd_h_ch3.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Wagner 2007<a class="bk_pop" href="#ch3.ref92"><sup>92</sup></a></td><td headers="hd_h_ch3.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Review</td></tr><tr><td headers="hd_h_ch3.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Wermers 1998<a class="bk_pop" href="#ch3.ref93"><sup>93</sup></a></td><td headers="hd_h_ch3.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NRS with mulitvariate analysis but the effect of surgery on risk of death is not reported from the univariate or multivariate analysis</td></tr><tr><td headers="hd_h_ch3.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Witteveen 2010<a class="bk_pop" href="#ch3.ref94"><sup>94</sup></a></td><td headers="hd_h_ch3.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Non-comparative study (all patients underwent surgery)</td></tr><tr><td headers="hd_h_ch3.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Wu 2010<a class="bk_pop" href="#ch3.ref95"><sup>95</sup></a></td><td headers="hd_h_ch3.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Inappropriate comparison</td></tr><tr><td headers="hd_h_ch3.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Yeh 2016<a class="bk_pop" href="#ch3.ref96"><sup>96</sup></a></td><td headers="hd_h_ch3.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NRS – adjusted relative risk for the effect of surgery on fracture risk not reported</td></tr><tr><td headers="hd_h_ch3.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Yu 2010<a class="bk_pop" href="#ch3.ref97"><sup>97</sup></a></td><td headers="hd_h_ch3.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Inappropriate comparison</td></tr><tr><td headers="hd_h_ch3.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Zhao 2014<a class="bk_pop" href="#ch3.ref98"><sup>98</sup></a></td><td headers="hd_h_ch3.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Conference abstract</td></tr></tbody></table></div></div></div><div id="ch3.appi.s2"><h4>I.2. Excluded health economic studies</h4><div id="ch3.appi.tab2" class="table"><h3><span class="label">Table 14</span><span class="title">Studies excluded from the health economic review</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577892/table/ch3.appi.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch3.appi.tab2_lrgtbl__"><table><thead><tr><th id="hd_h_ch3.appi.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reference</th><th id="hd_h_ch3.appi.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reason for exclusion</th></tr></thead><tbody><tr><td headers="hd_h_ch3.appi.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Sejean 2005 <a class="bk_pop" href="#ch3.ref74"><sup>74</sup></a></td><td headers="hd_h_ch3.appi.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">This study was assessed as partially applicable with very serious limitations. The study took a non-UK perspective, and quality of life was not reported directly from patients. Furthermore, the analysis was based on multiple clinical studies (mostly cohort or case-series studies) that have been excluded from this review. In addition, it was considered that there were some assumptions that were likely to be biasing the results, namely that there is no resource use impact from progression, only that some people would then have surgery. Therefore this study was selectively excluded.</td></tr></tbody></table></div></div></div></div></div><div class="bk_prnt_sctn"><h2>Tables</h2><div class="whole_rhythm bk_prnt_obj bk_first_prnt_obj"><div id="ch3.tab1" class="table"><h3><span class="label">Table 1</span><span class="title">PICO characteristics of review question</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577892/table/ch3.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch3.tab1_lrgtbl__"><table><tbody><tr><th id="hd_b_ch3.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population</th><td headers="hd_b_ch3.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>Adults (18 years or over) with confirmed primary hyperparathyroidism</p>
|
||
<p>Strata:
|
||
<ul id="ch3.l2"><li id="ch3.lt7" class="half_rhythm"><div>People with normocalcaemic PHPT</div></li><li id="ch3.lt8" class="half_rhythm"><div>Previous unsuccessful parathyroidectomy (reoperation)</div></li><li id="ch3.lt9" class="half_rhythm"><div>Pregnant women</div></li></ul></p>
|
||
</td></tr><tr><th id="hd_b_ch3.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Intervention</th><td headers="hd_b_ch3.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Parathyroid surgery</td></tr><tr><th id="hd_b_ch3.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comparisons</th><td headers="hd_b_ch3.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<ul id="ch3.l3"><li id="ch3.lt10" class="half_rhythm"><div>No surgery (surveillance/conservative management)</div></li><li id="ch3.lt11" class="half_rhythm"><div>Calcimimetic treatment</div></li><li id="ch3.lt12" class="half_rhythm"><div>Bisphosphonate treatment</div></li><li id="ch3.lt13" class="half_rhythm"><div>Combination pharmacological treatment (calcimimetics and bisphosphonates)</div></li></ul></td></tr><tr><th id="hd_b_ch3.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outcomes</th><td headers="hd_b_ch3.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Health-related quality of life (HRQOL); mortality; preservation of end organ function [deterioration in renal function; fractures (vertebral or long bone); occurrence of kidney stones; BMD of the distal radius or the lumbar spine]; persistent hypercalcaemia (dichotomous outcome); cardiovascular events; adverse events; cancer.</td></tr><tr><th id="hd_b_ch3.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design</th><td headers="hd_b_ch3.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>RCT and systematic review of RCTs</p>
|
||
<p>NRS to be included in the absence of RCT evidence for the critical outcomes.</p>
|
||
<p>NRS must be adjusted for the key confounders.</p>
|
||
</td></tr></tbody></table></div></div></div><div class="whole_rhythm bk_prnt_obj"><div id="ch3.tab2" class="table"><h3><span class="label">Table 2</span><span class="title">Summary of RCTs included in the evidence review</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577892/table/ch3.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch3.tab2_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_ch3.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Study</th><th id="hd_h_ch3.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Intervention and comparison</th><th id="hd_h_ch3.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Population</th><th id="hd_h_ch3.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_ch3.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Comments</th></tr></thead><tbody><tr><td headers="hd_h_ch3.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Ambrogini 2007<a class="bk_pop" href="#ch3.ref7"><sup>7</sup></a></td><td headers="hd_h_ch3.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>Parathyroidectomy vs Conservative management</p>
|
||
<p>Follow-up: 12 months</p>
|
||
</td><td headers="hd_h_ch3.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>n=50</p>
|
||
<p>Patients with mild PHPT who did not meet any of the NIH criteria for surgery (based on guidelines prior to 2002<sup><a class="bk_pop" href="#ch3.tab2_1">(a)</a></sup> so does not exclude people with osteoporosis based on the T score but does exclude people with low BMD Z score <-2).</p>
|
||
<p>Protocol subgroups:
|
||
<ol id="ch3.l4"><li id="ch3.lt14" class="half_rhythm"><div>Adjusted serum calcium: <2.85 mmol/L</div></li><li id="ch3.lt15" class="half_rhythm"><div>Age: ≥50 years old</div></li><li id="ch3.lt16" class="half_rhythm"><div>Creatinine clearance: ≥ 60 mL/min (study reports as not less than 30% age-matched value).</div></li><li id="ch3.lt17" class="half_rhythm"><div>End-organ effects: mixed (people with kidney stones and fractures excluded, some people had osteoporosis but subgroups analysis done within study)</div></li></ol></p>
|
||
</td><td headers="hd_h_ch3.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<ul id="ch3.l5"><li id="ch3.lt18" class="half_rhythm"><div>QOL: SF-36 and SCL-90R (unable to analyse in meta-analysis)</div></li><li id="ch3.lt19" class="half_rhythm"><div>Fractures (clinical vertebral fragility fracture)</div></li><li id="ch3.lt20" class="half_rhythm"><div>Kidney stones</div></li><li id="ch3.lt21" class="half_rhythm"><div>Lumbar spine BMD (% change from baseline)</div></li><li id="ch3.lt22" class="half_rhythm"><div>Distal radius BMD (% change from baseline)</div></li><li id="ch3.lt23" class="half_rhythm"><div>Adverse events (study outcome surgical complications, such as laryngeal nerve dysfunction)</div></li><li id="ch3.lt24" class="half_rhythm"><div>Cancer</div></li></ul></td><td headers="hd_h_ch3.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">The QOL outcomes were not reported in a format able to put into meta-analysis – only reported as graphs or narrative statements about whether there were any significant differences between the two groups</td></tr><tr><td headers="hd_h_ch3.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Elvius 1995<a class="bk_pop" href="#ch3.ref34"><sup>34</sup></a></td><td headers="hd_h_ch3.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>Parathyroidectomy vs Conservative management</p>
|
||
<p>Follow-up: 17 years</p>
|
||
</td><td headers="hd_h_ch3.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>n=48</p>
|
||
<p>Females with hyperparathyroidism (no detail given on diagnosis, except for females with raised serum calcium concentrations who were free of symptoms of the disease).</p>
|
||
<p>Protocol subgroups:
|
||
<ol id="ch3.l6"><li id="ch3.lt25" class="half_rhythm"><div>Adjusted serum calcium: not stated</div></li><li id="ch3.lt26" class="half_rhythm"><div>Age: not stated</div></li><li id="ch3.lt27" class="half_rhythm"><div>Creatinine clearance: not stated</div></li><li id="ch3.lt28" class="half_rhythm"><div>End-organ effects: not stated</div></li></ol></p>
|
||
</td><td headers="hd_h_ch3.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<ul id="ch3.l7"><li id="ch3.lt29" class="half_rhythm"><div>Distal radius BMD (study outcome: bone mineral content [g/cm<sup>2</sup>])</div></li><li id="ch3.lt30" class="half_rhythm"><div>Kidney function</div></li></ul></td><td headers="hd_h_ch3.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_ch3.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Rao 2004<a class="bk_pop" href="#ch3.ref64"><sup>64</sup></a></td><td headers="hd_h_ch3.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>Parathyroidectomy vs Conservative management</p>
|
||
<p>Follow-up: 24 months</p>
|
||
</td><td headers="hd_h_ch3.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>n=53</p>
|
||
<p>Patients with mild asymptomatic PHPT</p>
|
||
<p>Protocol subgroups:
|
||
<ol id="ch3.l8"><li id="ch3.lt31" class="half_rhythm"><div>Adjusted serum calcium: <2.85 mmol/L</div></li><li id="ch3.lt32" class="half_rhythm"><div>Age: ≥50 years old</div></li><li id="ch3.lt33" class="half_rhythm"><div>Creatinine clearance: ≥ 60 mL/min (study states serum creatinine <1.5 mg/dL (<133 umol/L)</div></li><li id="ch3.lt34" class="half_rhythm"><div>End-organ effects: absent (excluded people with non-traumatic vertebral or hip fractures and nephrolithiasis. Forearm bone mineral density within 2 S.D. adjusted for age, sex and race [Z-scores])</div></li></ol></p>
|
||
</td><td headers="hd_h_ch3.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<ul id="ch3.l9"><li id="ch3.lt35" class="half_rhythm"><div>QOL: SF-36 (unable to analyse in meta-analysis)</div></li><li id="ch3.lt36" class="half_rhythm"><div>Renal dysfunction</div></li><li id="ch3.lt37" class="half_rhythm"><div>Fractures (skeletal fractures: X-ray performed to assess vertebral fractures)</div></li><li id="ch3.lt38" class="half_rhythm"><div>Kidney stones</div></li><li id="ch3.lt39" class="half_rhythm"><div>Lumbar spine BMD (unable to analyse in meta-analysis)</div></li><li id="ch3.lt40" class="half_rhythm"><div>Distal radius BMD (unable to analyse in meta-analysis)</div></li><li id="ch3.lt41" class="half_rhythm"><div>Adverse events</div></li></ul></td><td headers="hd_h_ch3.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>The QOL outcomes were not reported in a format able to put into meta-analysis – only reported as graphs or narrative statements</p>
|
||
<p>The BMD outcomes were given as means in each group but without any measure of variance, therefore unable to analyse in meta-analysis.</p>
|
||
</td></tr><tr><td headers="hd_h_ch3.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Scandinavian Investigation on Primary Hyperparat hyroidism (SIPH) trial: Bollerslev 2007<a class="bk_pop" href="#ch3.ref13"><sup>13</sup></a> (Lundstam 2015<a class="bk_pop" href="#ch3.ref50"><sup>50</sup></a><sup>,</sup><a class="bk_pop" href="#ch3.ref51"><sup>51</sup></a>)</td><td headers="hd_h_ch3.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>Parathyroidectomy vs Conservative management<sup><a class="bk_pop" href="#ch3.tab2_2">(b)</a></sup></p>
|
||
<p>Follow-up: 1, 2 and 5 years</p>
|
||
</td><td headers="hd_h_ch3.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>n=191</p>
|
||
<p>Adults with mild asymptomatic PHPT.</p>
|
||
<p>Protocol subgroups:
|
||
<ol id="ch3.l10"><li id="ch3.lt42" class="half_rhythm"><div>Adjusted serum calcium: <2.85 mmol/L</div></li><li id="ch3.lt43" class="half_rhythm"><div>Age: ≥50 years old</div></li><li id="ch3.lt44" class="half_rhythm"><div>Creatinine clearance: unclear (excluded impaired kidney function [creatinine level > 130 umol/l]).</div></li><li id="ch3.lt45" class="half_rhythm"><div>End-organ effects: absent (excluded people with kidney stones and hyperparathyroid bone disease)</div></li></ol></p>
|
||
</td><td headers="hd_h_ch3.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<ul id="ch3.l11"><li id="ch3.lt46" class="half_rhythm"><div>QOL: SF-36 (unable to analyse in meta-analysis; 1 & 2 years)</div></li><li id="ch3.lt47" class="half_rhythm"><div>Mortality (5 years)</div></li><li id="ch3.lt48" class="half_rhythm"><div>Fractures (vertebral fractures on radiograph; 5 years)</div></li><li id="ch3.lt49" class="half_rhythm"><div>Fractures (minor traumatic skeletal fractures; 5 years)</div></li><li id="ch3.lt50" class="half_rhythm"><div>Kidney stones (5 years)</div></li><li id="ch3.lt51" class="half_rhythm"><div>Lumbar spine BMD (Z score; 5 years)</div></li><li id="ch3.lt52" class="half_rhythm"><div>Radius 33% (BMD, g/cm<sup>2</sup> at 5 years)</div></li><li id="ch3.lt53" class="half_rhythm"><div>Ultra-distal radius (BMD, g/cm<sup>2</sup> at 5 years)</div></li><li id="ch3.lt54" class="half_rhythm"><div>CV events (5 years)</div></li><li id="ch3.lt55" class="half_rhythm"><div>Cancer (study outcome: development of malignancies; 5 years)</div></li></ul></td><td headers="hd_h_ch3.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">The QOL outcomes were not reported in a format able to put into meta-analysis – only reported as graphs or narrative statements</td></tr><tr><td headers="hd_h_ch3.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Talpos 2000<a class="bk_pop" href="#ch3.ref83"><sup>83</sup></a></td><td headers="hd_h_ch3.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>Parathyroidectomy vs Conservative management</p>
|
||
<p>Follow-up: 2 years</p>
|
||
</td><td headers="hd_h_ch3.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>n=53</p>
|
||
<p>Women at least 5 years after menopause with persistent albumin-adjusted serum calcium level 10.1–11.5 mg/dL (2.52–2.87mmol/L) from at least 3 measurements over a period of at least 3 months; intact parathyroid hormone level > 20 pg/mL; no other cause for hypercalcaemia.</p>
|
||
<p>Protocol subgroups:
|
||
<ol id="ch3.l12"><li id="ch3.lt56" class="half_rhythm"><div>Adjusted serum calcium: <2.85 mmol/L</div></li><li id="ch3.lt57" class="half_rhythm"><div>Age: ≥50 years old</div></li><li id="ch3.lt58" class="half_rhythm"><div>Creatinine clearance: ≥ 60 mL/min (study reports an exclusion criteria of having a creatinine clearance level < 70%).</div></li><li id="ch3.lt59" class="half_rhythm"><div>End-organ effects: absent (excluded people with a forearm BMD >2 SD below the expected value, vertebral compression fractures, urolithiasis on kidneys, history of non-traumatic vertebral/hip fractures; nephrolithiasis in the past 2 years)</div></li></ol></p>
|
||
</td><td headers="hd_h_ch3.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<ul id="ch3.l13"><li id="ch3.lt60" class="half_rhythm"><div>QOL: SF-36 (all domains reported separately)</div></li></ul></td><td headers="hd_h_ch3.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr></tbody></table></div><div><div><dl class="temp-labeled-list small"><dt>(a)</dt><dd><div id="ch3.tab2_1"><p class="no_margin">The study began before the 2002 Workshop on Asymptomatic PHPT, therefore, the older guidelines formed the basis for the inclusion criteria. Had the criteria of the 2002 Workshop on Asymptomatic PHPT been adopted, 29 of the 50 participants would have met these criteria for surgery.</p></div></dd><dt>(b)</dt><dd><div id="ch3.tab2_2"><p class="no_margin">In the medical observation group, 9 patients received oestrogens and 3 bisphosphonates.</p></div></dd></dl></div></div></div></div><div class="whole_rhythm bk_prnt_obj"><div id="ch3.tab3" class="table"><h3><span class="label">Table 3</span><span class="title">Summary of NRSs included in the evidence review</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577892/table/ch3.tab3/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch3.tab3_lrgtbl__"><table><thead><tr><th id="hd_h_ch3.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Study</th><th id="hd_h_ch3.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Intervention and comparison</th><th id="hd_h_ch3.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Population</th><th id="hd_h_ch3.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_ch3.tab3_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Comments</th></tr></thead><tbody><tr><td headers="hd_h_ch3.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Clifton-Bligh 2015<a class="bk_pop" href="#ch3.ref27"><sup>27</sup></a></td><td headers="hd_h_ch3.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>Parathyroidectomy vs Conservative management</p>
|
||
<p>Follow-up: Not reported</p>
|
||
</td><td headers="hd_h_ch3.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>n=561</p>
|
||
<p>Diagnosed with PHPT either because surgery restored eucalcaemia, full investigation failed to find another cause of hypercalcaemia or serum calcium and PTH were above the upper limits of the reference range</p>
|
||
<p>No details of severity of PHPT</p>
|
||
<p>Protocol subgroups:
|
||
<ol id="ch3.l14"><li id="ch3.lt61" class="half_rhythm"><div>Adjusted serum calcium: not stated</div></li><li id="ch3.lt62" class="half_rhythm"><div>Age: not stated</div></li><li id="ch3.lt63" class="half_rhythm"><div>Creatinine clearance: not stated</div></li><li id="ch3.lt64" class="half_rhythm"><div>End-organ effects: not stated</div></li></ol></p>
|
||
</td><td headers="hd_h_ch3.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<ul id="ch3.l15"><li id="ch3.lt65" class="half_rhythm"><div>Mortality</div></li></ul></td><td headers="hd_h_ch3.tab3_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>Adjusted for age, sex and time of diagnosis.</p>
|
||
<p>Confounders in our protocol not adjusted for: serum calcium and end-organ effects.</p>
|
||
<p>Retrospective cohort study</p>
|
||
</td></tr><tr><td headers="hd_h_ch3.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>Vanderwalde 2006<a class="bk_pop" href="#ch3.ref87"><sup>87</sup></a> (Vanderwalde 2009<a class="bk_pop" href="#ch3.ref88"><sup>88</sup></a>)</p>
|
||
<p>(Results from second paper used: same study but second paper adjusted for BMD)</p>
|
||
</td><td headers="hd_h_ch3.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>Parathyroidectomy vs Conservative management</p>
|
||
<p>Follow-up: 7.4 years (range: 13 days to 10 years)</p>
|
||
</td><td headers="hd_h_ch3.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>n=533 (n=1569 in original study but BMD data not available for all people for adjusted analysis)</p>
|
||
<p>People on the database defined as having PHPT if they had an intact parathyroid hormone (PTH) level greater than 65 pg/mL, a calcium level greater than 10.5 mg/dL (>2.6 mmol/L), and a creatinine level less than 2.5 mg/dL (<221.0 µmol/L).</p>
|
||
<p>No details of severity of PHPT</p>
|
||
<p>Protocol subgroups:
|
||
<ol id="ch3.l16"><li id="ch3.lt66" class="half_rhythm"><div>Adjusted serum calcium: not stated</div></li><li id="ch3.lt67" class="half_rhythm"><div>Age: ≥50 years old (89% ≥ 50 years old)</div></li><li id="ch3.lt68" class="half_rhythm"><div>Creatinine clearance: not stated</div></li><li id="ch3.lt69" class="half_rhythm"><div>End-organ effects: not stated (22% had osteoporosis at baseline; kidney stones or history of fragility fractures not reported)</div></li></ol></p>
|
||
</td><td headers="hd_h_ch3.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<ul id="ch3.l17"><li id="ch3.lt70" class="half_rhythm"><div>Fractures (hospitalised fractures)</div></li></ul></td><td headers="hd_h_ch3.tab3_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>Adjusted for age, sex, Charlson comorbidity index (CCI); levels of calcium, PTH, and creatinine; BMD (T score femur)</p>
|
||
<p>Confounders in our protocol not adjusted for: end-organ effects.</p>
|
||
<p>Retrospective cohort study</p>
|
||
<p>Outcome of fracture taken from records of hospitalised fractures (so would not pick up all vertebral fractures on radiograph or outpatient fractures of the extremities).</p>
|
||
</td></tr><tr><td headers="hd_h_ch3.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Vestergaard 2003<a class="bk_pop" href="#ch3.ref90"><sup>90</sup></a></td><td headers="hd_h_ch3.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>Parathyroidectomy vs Conservative management</p>
|
||
<p>Follow-up: 6.1 years</p>
|
||
</td><td headers="hd_h_ch3.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>n=3213</p>
|
||
<p>First time diagnosis from national hospital discharge database</p>
|
||
<p>No details of severity of PHPT</p>
|
||
<p>Protocol subgroups:
|
||
<ol id="ch3.l18"><li id="ch3.lt71" class="half_rhythm"><div>Adjusted serum calcium: not stated</div></li><li id="ch3.lt72" class="half_rhythm"><div>Age: not stated</div></li><li id="ch3.lt73" class="half_rhythm"><div>Creatinine clearance: not stated</div></li><li id="ch3.lt74" class="half_rhythm"><div>End-organ effects: not stated</div></li></ol></p>
|
||
</td><td headers="hd_h_ch3.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<ul id="ch3.l19"><li id="ch3.lt75" class="half_rhythm"><div>Mortality</div></li><li id="ch3.lt76" class="half_rhythm"><div>Fracture</div></li><li id="ch3.lt77" class="half_rhythm"><div>Kidney stones</div></li><li id="ch3.lt78" class="half_rhythm"><div>Cancer</div></li></ul></td><td headers="hd_h_ch3.tab3_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>Adjusted for age, sex and presence of the endpoint in question at baseline.</p>
|
||
<p>Confounders in our protocol not adjusted for: serum calcium and end-organ effects.</p>
|
||
<p>Retrospective cohort study</p>
|
||
<p>Outcomes are based on whether the person had a hospital contact for that outcome in the records.</p>
|
||
</td></tr></tbody></table></div></div></div><div class="whole_rhythm bk_prnt_obj"><div id="ch3.tab4" class="table"><h3><span class="label">Table 4</span><span class="title">Clinical evidence summary: Surgery versus conservative management</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577892/table/ch3.tab4/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch3.tab4_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_ch3.tab4_1_1_1_1" rowspan="2" colspan="1" headers="hd_h_ch3.tab4_1_1_1_1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_ch3.tab4_1_1_1_2" rowspan="2" colspan="1" headers="hd_h_ch3.tab4_1_1_1_2" style="text-align:left;vertical-align:bottom;">No of Participants (studies) Follow up</th><th id="hd_h_ch3.tab4_1_1_1_3" rowspan="2" colspan="1" headers="hd_h_ch3.tab4_1_1_1_3" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_ch3.tab4_1_1_1_4" rowspan="2" colspan="1" headers="hd_h_ch3.tab4_1_1_1_4" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th><th id="hd_h_ch3.tab4_1_1_1_5" colspan="2" rowspan="1" style="text-align:left;vertical-align:bottom;">Anticipated absolute effects</th></tr><tr><th headers="hd_h_ch3.tab4_1_1_1_5" id="hd_h_ch3.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk with No surgery (in mild PHPT)</th><th headers="hd_h_ch3.tab4_1_1_1_5" id="hd_h_ch3.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk difference with Surgery (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_ch3.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">QOL (SF-36 Physical functioning subscale) annual change estimate. Scale from: 0 to 100.</td><td headers="hd_h_ch3.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>53</p>
|
||
<p>(1 study)</p>
|
||
<p>2 years</p>
|
||
</td><td headers="hd_h_ch3.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>VERY LOW<sup><a class="bk_pop" href="#ch3.tab4_1">a</a></sup><sup>,</sup><sup><a class="bk_pop" href="#ch3.tab4_2">b</a></sup></p>
|
||
<p>due to risk of bias, imprecision</p>
|
||
</td><td headers="hd_h_ch3.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-</td><td headers="hd_h_ch3.tab4_1_1_1_5 hd_h_ch3.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>The mean QOL (SF-36 physical functioning subscale) in the control groups was</p>
|
||
<p>-0.552 annual change estimate</p>
|
||
</td><td headers="hd_h_ch3.tab4_1_1_1_5 hd_h_ch3.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>The mean QOL (SF-36 physical functioning subscale) in the intervention groups was</p>
|
||
<p>2.1 lower (5.43 lower to 1.23 higher)</p>
|
||
</td></tr><tr><td headers="hd_h_ch3.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">QOL (SF-36 Social functioning subscale) annual change estimate. Scale from: 0 to 100.</td><td headers="hd_h_ch3.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>53</p>
|
||
<p>(1 study)</p>
|
||
<p>2 years</p>
|
||
</td><td headers="hd_h_ch3.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>VERY LOW<sup><a class="bk_pop" href="#ch3.tab4_1">a</a></sup><sup>,</sup><sup><a class="bk_pop" href="#ch3.tab4_2">b</a></sup></p>
|
||
<p>due to risk of bias, imprecision</p>
|
||
</td><td headers="hd_h_ch3.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-</td><td headers="hd_h_ch3.tab4_1_1_1_5 hd_h_ch3.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>The mean QOL (SF-36 social functioning subscale) in the control groups was</p>
|
||
<p>-3.653 annual change estimate</p>
|
||
</td><td headers="hd_h_ch3.tab4_1_1_1_5 hd_h_ch3.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>The mean QOL (SF-36 social functioning subscale) in the intervention groups was</p>
|
||
<p>3.92 higher (1.19 to 6.64 higher)</p>
|
||
</td></tr><tr><td headers="hd_h_ch3.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">QOL (SF-36 Physical role functioning subscale) annual change estimate. Scale from: 0 to 100.</td><td headers="hd_h_ch3.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>53</p>
|
||
<p>(1 study)</p>
|
||
<p>2 years</p>
|
||
</td><td headers="hd_h_ch3.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>VERY LOW<sup><a class="bk_pop" href="#ch3.tab4_1">a</a></sup><sup>,</sup><sup><a class="bk_pop" href="#ch3.tab4_2">b</a></sup></p>
|
||
<p>due to risk of bias, imprecision</p>
|
||
</td><td headers="hd_h_ch3.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-</td><td headers="hd_h_ch3.tab4_1_1_1_5 hd_h_ch3.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>The mean QOL (SF-36 physical role functioning subscale) in the control groups was</p>
|
||
<p>-4.47 annual change estimate</p>
|
||
</td><td headers="hd_h_ch3.tab4_1_1_1_5 hd_h_ch3.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>The mean QOL (SF-36 physical role functioning subscale) in the intervention groups was</p>
|
||
<p>0.39 higher (5.82 lower to 6.61 higher)</p>
|
||
</td></tr><tr><td headers="hd_h_ch3.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">QOL (SF-36 Emotional role functioning subscale) annual change estimate. Scale from: 0 to 100.</td><td headers="hd_h_ch3.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>53</p>
|
||
<p>(1 study)</p>
|
||
<p>2 years</p>
|
||
</td><td headers="hd_h_ch3.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>VERY LOW<sup><a class="bk_pop" href="#ch3.tab4_1">a</a></sup><sup>,</sup><sup><a class="bk_pop" href="#ch3.tab4_2">b</a></sup></p>
|
||
<p>due to risk of bias, imprecision</p>
|
||
</td><td headers="hd_h_ch3.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-</td><td headers="hd_h_ch3.tab4_1_1_1_5 hd_h_ch3.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>The mean QOL (SF-36 emotional role functioning subscale) in the control groups was</p>
|
||
<p>-5.536 annual change estimate</p>
|
||
</td><td headers="hd_h_ch3.tab4_1_1_1_5 hd_h_ch3.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>The mean QOL (SF-36 emotional role functioning subscale) in the intervention groups was</p>
|
||
<p>5.96 higher (1.47 to 10.44 higher)</p>
|
||
</td></tr><tr><td headers="hd_h_ch3.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">QOL (SF-36 mental health subscale) annual change estimate. Scale from: 0 to 100.</td><td headers="hd_h_ch3.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>50</p>
|
||
<p>(1 study)</p>
|
||
<p>2 years</p>
|
||
</td><td headers="hd_h_ch3.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>LOW<sup><a class="bk_pop" href="#ch3.tab4_1">a</a></sup></p>
|
||
<p>due to risk of bias</p>
|
||
</td><td headers="hd_h_ch3.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-</td><td headers="hd_h_ch3.tab4_1_1_1_5 hd_h_ch3.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>The mean QOL (SF-36 mental health subscale) in the control groups was</p>
|
||
<p>0.17 annual change estimate</p>
|
||
</td><td headers="hd_h_ch3.tab4_1_1_1_5 hd_h_ch3.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>The mean QOL (SF-36 mental health subscale) in the intervention groups</p>
|
||
<p>was 0.23 higher</p>
|
||
<p>(1.58 lower to 2.03 higher)</p>
|
||
</td></tr><tr><td headers="hd_h_ch3.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">QOL (SF-36 vitality subscale) annual change estimate. Scale from: 0 to 100.</td><td headers="hd_h_ch3.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>53</p>
|
||
<p>(1 study)</p>
|
||
<p>2 years</p>
|
||
</td><td headers="hd_h_ch3.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>VERY LOW<sup><a class="bk_pop" href="#ch3.tab4_1">a</a></sup><sup>,</sup><sup><a class="bk_pop" href="#ch3.tab4_2">b</a></sup></p>
|
||
<p>due to risk of bias, imprecision</p>
|
||
</td><td headers="hd_h_ch3.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-</td><td headers="hd_h_ch3.tab4_1_1_1_5 hd_h_ch3.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>The mean QOL (SF-36 vitality subscale) in the control groups was</p>
|
||
<p>-1.77 annual change estimate</p>
|
||
</td><td headers="hd_h_ch3.tab4_1_1_1_5 hd_h_ch3.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>The mean QOL (SF-36 vitality subscale) in the intervention groups</p>
|
||
<p>was 0.97 higher</p>
|
||
<p>(1.19 lower to 3.13 higher)</p>
|
||
</td></tr><tr><td headers="hd_h_ch3.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">QOL (SF-36 Bodily pain subscale) annual change estimate. Scale from: 0 to 100.</td><td headers="hd_h_ch3.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>53</p>
|
||
<p>(1 study)</p>
|
||
<p>2 years</p>
|
||
</td><td headers="hd_h_ch3.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>VERY LOW<sup><a class="bk_pop" href="#ch3.tab4_1">a</a></sup><sup>,</sup><sup><a class="bk_pop" href="#ch3.tab4_2">b</a></sup></p>
|
||
<p>due to risk of bias, imprecision</p>
|
||
</td><td headers="hd_h_ch3.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-</td><td headers="hd_h_ch3.tab4_1_1_1_5 hd_h_ch3.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>The mean QOL (SF-36 bodily pain subscale) in the control groups was</p>
|
||
<p>-1.977 annual change estimate</p>
|
||
</td><td headers="hd_h_ch3.tab4_1_1_1_5 hd_h_ch3.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>The mean QOL (SF-36 bodily pain subscale) in the intervention groups</p>
|
||
<p>was 0.65 higher</p>
|
||
<p>(2.55 lower to 3.84 higher)</p>
|
||
</td></tr><tr><td headers="hd_h_ch3.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">QOL (SF-36 General health subscale) annual change estimate. Scale from: 0 to 100.</td><td headers="hd_h_ch3.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>53</p>
|
||
<p>(1 study)</p>
|
||
<p>2 years</p>
|
||
</td><td headers="hd_h_ch3.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>VERY LOW<sup><a class="bk_pop" href="#ch3.tab4_1">a</a></sup><sup>,</sup><sup><a class="bk_pop" href="#ch3.tab4_2">b</a></sup></p>
|
||
<p>due to risk of bias, imprecision</p>
|
||
</td><td headers="hd_h_ch3.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-</td><td headers="hd_h_ch3.tab4_1_1_1_5 hd_h_ch3.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>The mean QOL (SF-36 general health subscale) in the control groups was</p>
|
||
<p>-2.961 annual change estimate</p>
|
||
</td><td headers="hd_h_ch3.tab4_1_1_1_5 hd_h_ch3.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>The mean QOL (SF-36 general health subscale) in the intervention groups</p>
|
||
<p>was 1.81 higher</p>
|
||
<p>(0.38 lower to 4.01 higher)</p>
|
||
</td></tr><tr><td headers="hd_h_ch3.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">QOL (SF-36 Health transition) annual change estimate. Scale from: 0 to 100.</td><td headers="hd_h_ch3.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>53</p>
|
||
<p>(1 study)</p>
|
||
<p>2 years</p>
|
||
</td><td headers="hd_h_ch3.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>VERY LOW<sup><a class="bk_pop" href="#ch3.tab4_1">a</a></sup><sup>,</sup><sup><a class="bk_pop" href="#ch3.tab4_2">b</a></sup><sup>,</sup><sup><a class="bk_pop" href="#ch3.tab4_3">c</a></sup></p>
|
||
<p>due to risk of bias, imprecision</p>
|
||
</td><td headers="hd_h_ch3.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-</td><td headers="hd_h_ch3.tab4_1_1_1_5 hd_h_ch3.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>The mean QOL (SF-36 health transition) in the control groups was</p>
|
||
<p>-1.154</p>
|
||
</td><td headers="hd_h_ch3.tab4_1_1_1_5 hd_h_ch3.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>The mean QOL (SF-36 health transition) in the intervention groups</p>
|
||
<p>was 0.12 higher (3.1 lower to 3.33 higher)</p>
|
||
</td></tr><tr><td headers="hd_h_ch3.tab4_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Mortality</td><td headers="hd_h_ch3.tab4_1_1_1_2" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>191</p>
|
||
<p>(1 study)</p>
|
||
<p>5 years</p>
|
||
</td><td headers="hd_h_ch3.tab4_1_1_1_3" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>VERY LOW<sup><a class="bk_pop" href="#ch3.tab4_1">a</a></sup><sup>,</sup><sup><a class="bk_pop" href="#ch3.tab4_2">b</a></sup></p>
|
||
<p>due to risk of bias, imprecision</p>
|
||
</td><td headers="hd_h_ch3.tab4_1_1_1_4" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">RR 1.98 (0.18 to 21.46)</td><td headers="hd_h_ch3.tab4_1_1_1_5 hd_h_ch3.tab4_1_1_2_1 hd_h_ch3.tab4_1_1_2_2" colspan="2" rowspan="1" style="text-align:left;vertical-align:top;">Moderate</td></tr><tr><td headers="hd_h_ch3.tab4_1_1_1_5 hd_h_ch3.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">11 per 1000</td><td headers="hd_h_ch3.tab4_1_1_1_5 hd_h_ch3.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">11 more per 1000 (from 9 fewer to 225 more)</td></tr><tr><td headers="hd_h_ch3.tab4_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Renal dysfunction</td><td headers="hd_h_ch3.tab4_1_1_1_2" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>73</p>
|
||
<p>(2 studies)</p>
|
||
<p>2–17 years</p>
|
||
</td><td headers="hd_h_ch3.tab4_1_1_1_3" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>LOW<sup><a class="bk_pop" href="#ch3.tab4_1">a</a></sup><sup>,</sup><sup><a class="bk_pop" href="#ch3.tab4_5">e</a></sup></p>
|
||
<p>due to risk of bias, imprecision</p>
|
||
</td><td headers="hd_h_ch3.tab4_1_1_1_4" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Not estimable</td><td headers="hd_h_ch3.tab4_1_1_1_5 hd_h_ch3.tab4_1_1_2_1 hd_h_ch3.tab4_1_1_2_2" colspan="2" rowspan="1" style="text-align:left;vertical-align:top;">Moderate</td></tr><tr><td headers="hd_h_ch3.tab4_1_1_1_5 hd_h_ch3.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0 per 1000</td><td headers="hd_h_ch3.tab4_1_1_1_5 hd_h_ch3.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0 more per 1000 (from 180 fewer to 180 more)<sup><a class="bk_pop" href="#ch3.tab4_4">d</a></sup></td></tr><tr><td headers="hd_h_ch3.tab4_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Vertebral fractures</td><td headers="hd_h_ch3.tab4_1_1_1_2" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>208</p>
|
||
<p>(3 studies)</p>
|
||
<p>1–5 years</p>
|
||
</td><td headers="hd_h_ch3.tab4_1_1_1_3" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>LOW<sup><a class="bk_pop" href="#ch3.tab4_1">a</a></sup></p>
|
||
<p>due to risk of bias</p>
|
||
</td><td headers="hd_h_ch3.tab4_1_1_1_4" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">OR 0.14 (0.03 to 0.69)</td><td headers="hd_h_ch3.tab4_1_1_1_5 hd_h_ch3.tab4_1_1_2_1 hd_h_ch3.tab4_1_1_2_2" colspan="2" rowspan="1" style="text-align:left;vertical-align:top;">Moderate</td></tr><tr><td headers="hd_h_ch3.tab4_1_1_1_5 hd_h_ch3.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">40 per 1000</td><td headers="hd_h_ch3.tab4_1_1_1_5 hd_h_ch3.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">60 fewer per 1000 (from 110 fewer to 0 more)<sup><a class="bk_pop" href="#ch3.tab4_4">d</a></sup></td></tr><tr><td headers="hd_h_ch3.tab4_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Peripheral skeletal fractures</td><td headers="hd_h_ch3.tab4_1_1_1_2" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>106</p>
|
||
<p>(1 study)</p>
|
||
<p>5 years</p>
|
||
</td><td headers="hd_h_ch3.tab4_1_1_1_3" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>VERY LOW<sup><a class="bk_pop" href="#ch3.tab4_1">a</a></sup><sup>,</sup><sup><a class="bk_pop" href="#ch3.tab4_2">b</a></sup></p>
|
||
<p>due to risk of bias, imprecision</p>
|
||
</td><td headers="hd_h_ch3.tab4_1_1_1_4" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">RR 0.81 (0.19 to 3.44)</td><td headers="hd_h_ch3.tab4_1_1_1_5 hd_h_ch3.tab4_1_1_2_1 hd_h_ch3.tab4_1_1_2_2" colspan="2" rowspan="1" style="text-align:left;vertical-align:top;">Moderate</td></tr><tr><td headers="hd_h_ch3.tab4_1_1_1_5 hd_h_ch3.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">73 per 1000</td><td headers="hd_h_ch3.tab4_1_1_1_5 hd_h_ch3.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">14 fewer per 1000 (from 59 fewer to 178 more)</td></tr><tr><td headers="hd_h_ch3.tab4_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Kidney stones</td><td headers="hd_h_ch3.tab4_1_1_1_2" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>208</p>
|
||
<p>(3 studies)</p>
|
||
<p>1–5 years</p>
|
||
</td><td headers="hd_h_ch3.tab4_1_1_1_3" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>VERY LOW<sup><a class="bk_pop" href="#ch3.tab4_1">a</a></sup><sup>,</sup><sup><a class="bk_pop" href="#ch3.tab4_2">b</a></sup></p>
|
||
<p>due to risk of bias, imprecision</p>
|
||
</td><td headers="hd_h_ch3.tab4_1_1_1_4" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Peto OR 0.39 (0.06 to 2.82)</td><td headers="hd_h_ch3.tab4_1_1_1_5 hd_h_ch3.tab4_1_1_2_1 hd_h_ch3.tab4_1_1_2_2" colspan="2" rowspan="1" style="text-align:left;vertical-align:top;">Moderate</td></tr><tr><td headers="hd_h_ch3.tab4_1_1_1_5 hd_h_ch3.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">36 per 1000</td><td headers="hd_h_ch3.tab4_1_1_1_5 hd_h_ch3.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">20 fewer per 1000 (from 60 fewer to 30 more)</td></tr><tr><td headers="hd_h_ch3.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Lumbar spine BMD Z score (final value)</td><td headers="hd_h_ch3.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>111</p>
|
||
<p>(1 study)</p>
|
||
<p>5 years</p>
|
||
</td><td headers="hd_h_ch3.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>VERY LOW<sup><a class="bk_pop" href="#ch3.tab4_1">a</a></sup><sup>,</sup><sup><a class="bk_pop" href="#ch3.tab4_2">b</a></sup></p>
|
||
<p>due to risk of bias, imprecision</p>
|
||
</td><td headers="hd_h_ch3.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-</td><td headers="hd_h_ch3.tab4_1_1_1_5 hd_h_ch3.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">The mean lumbar spine BMD Z score in the control groups was 0.09</td><td headers="hd_h_ch3.tab4_1_1_1_5 hd_h_ch3.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>The mean lumbar spine BMD in the intervention groups was</p>
|
||
<p>0.48 higher (0.03 lower to 0.99 higher)</p>
|
||
</td></tr><tr><td headers="hd_h_ch3.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Lumbar spine BMD % change from baseline</td><td headers="hd_h_ch3.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>49</p>
|
||
<p>(1 study)</p>
|
||
<p>1 years</p>
|
||
</td><td headers="hd_h_ch3.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>VERY LOW<sup><a class="bk_pop" href="#ch3.tab4_1">a</a></sup><sup>,</sup><sup><a class="bk_pop" href="#ch3.tab4_2">b</a></sup></p>
|
||
<p>due to risk of bias, imprecision</p>
|
||
</td><td headers="hd_h_ch3.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-</td><td headers="hd_h_ch3.tab4_1_1_1_5 hd_h_ch3.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">The mean lumbar spine BMD in the control groups was −1.12% change from baseline</td><td headers="hd_h_ch3.tab4_1_1_1_5 hd_h_ch3.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>The mean lumbar spine BMD in the intervention groups was</p>
|
||
<p>5.28 higher (4.76 to 5.8 higher)</p>
|
||
</td></tr><tr><td headers="hd_h_ch3.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Distal radius BMD g/cm<sup>2</sup></td><td headers="hd_h_ch3.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>20</p>
|
||
<p>(1 study)</p>
|
||
<p>17 years</p>
|
||
</td><td headers="hd_h_ch3.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>VERY LOW<sup><a class="bk_pop" href="#ch3.tab4_1">a</a></sup><sup>,</sup><sup><a class="bk_pop" href="#ch3.tab4_2">b</a></sup></p>
|
||
<p>due to risk of bias</p>
|
||
</td><td headers="hd_h_ch3.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-</td><td headers="hd_h_ch3.tab4_1_1_1_5 hd_h_ch3.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">The mean distal radius BMD in the control groups was 1.03 g/cm<sup>2</sup></td><td headers="hd_h_ch3.tab4_1_1_1_5 hd_h_ch3.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>The mean distal radius BMD in the intervention groups was</p>
|
||
<p>0.05 lower (0.22 lower to 0.12 higher)</p>
|
||
</td></tr><tr><td headers="hd_h_ch3.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Distal radius BMD % change from baseline</td><td headers="hd_h_ch3.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>49</p>
|
||
<p>(1 study)</p>
|
||
<p>1 years</p>
|
||
</td><td headers="hd_h_ch3.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>LOW<sup><a class="bk_pop" href="#ch3.tab4_1">a</a></sup><sup>,</sup><sup><a class="bk_pop" href="#ch3.tab4_2">b</a></sup></p>
|
||
<p>due to risk of bias, imprecision</p>
|
||
</td><td headers="hd_h_ch3.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-</td><td headers="hd_h_ch3.tab4_1_1_1_5 hd_h_ch3.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">The mean distal radius BMD in the control groups was −0.55% change from baseline</td><td headers="hd_h_ch3.tab4_1_1_1_5 hd_h_ch3.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>The mean distal radius BMD in the intervention group was</p>
|
||
<p>0.21 higher (0.1 lower to 0.52 higher)</p>
|
||
</td></tr><tr><td headers="hd_h_ch3.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Radius 33% (BMD, g/cm<sup>2</sup>) (5 years)</td><td headers="hd_h_ch3.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>86</p>
|
||
<p>(1 study)</p>
|
||
<p>5 years</p>
|
||
</td><td headers="hd_h_ch3.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>VERY LOW<sup><a class="bk_pop" href="#ch3.tab4_1">a</a></sup><sup>,</sup><sup><a class="bk_pop" href="#ch3.tab4_2">b</a></sup></p>
|
||
<p>due to risk of bias, imprecision</p>
|
||
</td><td headers="hd_h_ch3.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-</td><td headers="hd_h_ch3.tab4_1_1_1_5 hd_h_ch3.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">The mean radius 33% BMD in the control groups was 0.584 g/cm<sup>2</sup></td><td headers="hd_h_ch3.tab4_1_1_1_5 hd_h_ch3.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>The mean radius 33% (BMD, g/cm<sup>2</sup>) in the intervention groups was</p>
|
||
<p>0.03 higher (0.02 lower to 0.08 higher)</p>
|
||
</td></tr><tr><td headers="hd_h_ch3.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Ultra-distal radius (BMD, g/cm<sup>2</sup>) (5 years)</td><td headers="hd_h_ch3.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>85</p>
|
||
<p>(1 study)</p>
|
||
<p>5 years</p>
|
||
</td><td headers="hd_h_ch3.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>LOW<sup><a class="bk_pop" href="#ch3.tab4_1">a</a></sup></p>
|
||
<p>due to risk of bias</p>
|
||
</td><td headers="hd_h_ch3.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-</td><td headers="hd_h_ch3.tab4_1_1_1_5 hd_h_ch3.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">The mean ultra-distal radius BMD in the control groups was 0.297 g/cm<sup>2</sup></td><td headers="hd_h_ch3.tab4_1_1_1_5 hd_h_ch3.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>The mean ultra-distal radius (BMD, g/cm<sup>2</sup>) in the intervention groups was</p>
|
||
<p>0.01 higher (0.03 lower to 0.04 higher)</p>
|
||
</td></tr><tr><td headers="hd_h_ch3.tab4_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Cardiovascular events</td><td headers="hd_h_ch3.tab4_1_1_1_2" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>145</p>
|
||
<p>(1 study)</p>
|
||
<p>5 years</p>
|
||
</td><td headers="hd_h_ch3.tab4_1_1_1_3" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>VERY LOW<sup><a class="bk_pop" href="#ch3.tab4_1">a</a></sup><sup>,</sup><sup><a class="bk_pop" href="#ch3.tab4_2">b</a></sup></p>
|
||
<p>due to risk of bias, imprecision</p>
|
||
</td><td headers="hd_h_ch3.tab4_1_1_1_4" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">RR 0.63 (0.22 to 1.85)</td><td headers="hd_h_ch3.tab4_1_1_1_5 hd_h_ch3.tab4_1_1_2_1 hd_h_ch3.tab4_1_1_2_2" colspan="2" rowspan="1" style="text-align:left;vertical-align:top;">Moderate</td></tr><tr><td headers="hd_h_ch3.tab4_1_1_1_5 hd_h_ch3.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">110 per 1000</td><td headers="hd_h_ch3.tab4_1_1_1_5 hd_h_ch3.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">41 fewer per 1000 (from 86 fewer to 94 more)</td></tr><tr><td headers="hd_h_ch3.tab4_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Adverse events</td><td headers="hd_h_ch3.tab4_1_1_1_2" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>102</p>
|
||
<p>(2 studies)</p>
|
||
<p>1–2 years</p>
|
||
</td><td headers="hd_h_ch3.tab4_1_1_1_3" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>VERY LOW<sup><a class="bk_pop" href="#ch3.tab4_1">a</a></sup><sup>,</sup><sup><a class="bk_pop" href="#ch3.tab4_2">b</a></sup></p>
|
||
<p>due to risk of bias, imprecision</p>
|
||
</td><td headers="hd_h_ch3.tab4_1_1_1_4" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">RR 0.75 (0.14 to 4.11)</td><td headers="hd_h_ch3.tab4_1_1_1_5 hd_h_ch3.tab4_1_1_2_1 hd_h_ch3.tab4_1_1_2_2" colspan="2" rowspan="1" style="text-align:left;vertical-align:top;">Moderate</td></tr><tr><td headers="hd_h_ch3.tab4_1_1_1_5 hd_h_ch3.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">54 per 1000</td><td headers="hd_h_ch3.tab4_1_1_1_5 hd_h_ch3.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">14 fewer per 1000 (from 46 fewer to 168 more)</td></tr><tr><td headers="hd_h_ch3.tab4_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Cancer</td><td headers="hd_h_ch3.tab4_1_1_1_2" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>194</p>
|
||
<p>(2 studies)</p>
|
||
<p>1–5 years</p>
|
||
</td><td headers="hd_h_ch3.tab4_1_1_1_3" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>VERY LOW<sup><a class="bk_pop" href="#ch3.tab4_1">a</a></sup><sup>,</sup><sup><a class="bk_pop" href="#ch3.tab4_2">b</a></sup><sup>,</sup></p>
|
||
<p>due to risk of bias, imprecision</p>
|
||
</td><td headers="hd_h_ch3.tab4_1_1_1_4" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Peto OR 1.53 (0.26 to 8.97)</td><td headers="hd_h_ch3.tab4_1_1_1_5 hd_h_ch3.tab4_1_1_2_1 hd_h_ch3.tab4_1_1_2_2" colspan="2" rowspan="1" style="text-align:left;vertical-align:top;">Moderate</td></tr><tr><td headers="hd_h_ch3.tab4_1_1_1_5 hd_h_ch3.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">27 per 1000</td><td headers="hd_h_ch3.tab4_1_1_1_5 hd_h_ch3.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">10 more per 1000 (from 40 fewer to 60 more)</td></tr></tbody></table></div><div><div><dl class="temp-labeled-list small"><dt>a</dt><dd><div id="ch3.tab4_1"><p class="no_margin">Downgraded by 1 increment if the majority of the evidence was at high risk of bias, and downgraded by 2 increments if the majority of the evidence was at very high risk of bias.</p></div></dd><dt>b</dt><dd><div id="ch3.tab4_2"><p class="no_margin">Downgraded by 1 increment if the confidence interval crossed 1 MID, and downgraded by 2 increments if the confidence interval crossed both MIDs.</p></div></dd><dt>c</dt><dd><div id="ch3.tab4_3"><p class="no_margin">Established MID not available for this domain of the SF-36, therefore default MID used.</p></div></dd><dt>d</dt><dd><div id="ch3.tab4_4"><p class="no_margin">Manual calculation of absolute risk difference.</p></div></dd><dt>e</dt><dd><div id="ch3.tab4_5"><p class="no_margin">Downgraded by 1 increment as both studies had 0 events in both arms and sample size was >70<350</p></div></dd></dl></div></div></div></div><div class="whole_rhythm bk_prnt_obj"><div id="ch3.tab5" class="table"><h3><span class="label">Table 5</span><span class="title">Clinical evidence summary: Surgery versus conservative treatment (non-randomised studies)</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577892/table/ch3.tab5/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch3.tab5_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_ch3.tab5_1_1_1_1" rowspan="2" colspan="1" headers="hd_h_ch3.tab5_1_1_1_1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_ch3.tab5_1_1_1_2" rowspan="2" colspan="1" headers="hd_h_ch3.tab5_1_1_1_2" style="text-align:left;vertical-align:bottom;">No of Participants (studies) Follow up</th><th id="hd_h_ch3.tab5_1_1_1_3" rowspan="2" colspan="1" headers="hd_h_ch3.tab5_1_1_1_3" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_ch3.tab5_1_1_1_4" rowspan="2" colspan="1" headers="hd_h_ch3.tab5_1_1_1_4" style="text-align:left;vertical-align:bottom;">Relative effect (95% Cl)</th><th id="hd_h_ch3.tab5_1_1_1_5" colspan="2" rowspan="1" style="text-align:left;vertical-align:bottom;">Anticipated absolute effects</th></tr><tr><th headers="hd_h_ch3.tab5_1_1_1_5" id="hd_h_ch3.tab5_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Risk with Conservative treatment (NRS)</th><th headers="hd_h_ch3.tab5_1_1_1_5" id="hd_h_ch3.tab5_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Risk difference with Surgery (95% Cl)</th></tr></thead><tbody><tr><td headers="hd_h_ch3.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Mortality</td><td headers="hd_h_ch3.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>3774</p>
|
||
<p>(2 studies)</p>
|
||
<p>6.1 years</p>
|
||
</td><td headers="hd_h_ch3.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>VERY LOW<sup><a class="bk_pop" href="#ch3.tab5_1">a</a></sup></p>
|
||
<p>due to risk of bias</p>
|
||
</td><td headers="hd_h_ch3.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">HR0.65 (0.57 to 0.74)</td><td headers="hd_h_ch3.tab5_1_1_1_5 hd_h_ch3.tab5_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">See comment<sup><a class="bk_pop" href="#ch3.tab5_3">c</a></sup></td><td headers="hd_h_ch3.tab5_1_1_1_5 hd_h_ch3.tab5_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">See comment<sup><a class="bk_pop" href="#ch3.tab5_3">c</a></sup></td></tr><tr><td headers="hd_h_ch3.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Fractures</td><td headers="hd_h_ch3.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>3746</p>
|
||
<p>(2 studies)</p>
|
||
<p>6.1–7.4 years</p>
|
||
</td><td headers="hd_h_ch3.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>VERY LOW<sup><a class="bk_pop" href="#ch3.tab5_1">a</a></sup><sup>,</sup><sup><a class="bk_pop" href="#ch3.tab5_2">b</a></sup></p>
|
||
<p>due to risk of bias, imprecision</p>
|
||
</td><td headers="hd_h_ch3.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">HR0.67 (0.55 to 0.82)</td><td headers="hd_h_ch3.tab5_1_1_1_5 hd_h_ch3.tab5_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">See comment<sup><a class="bk_pop" href="#ch3.tab5_3">c</a></sup></td><td headers="hd_h_ch3.tab5_1_1_1_5 hd_h_ch3.tab5_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">See comment<sup><a class="bk_pop" href="#ch3.tab5_3">c</a></sup></td></tr><tr><td headers="hd_h_ch3.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cancer</td><td headers="hd_h_ch3.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>3213</p>
|
||
<p>(1 study)</p>
|
||
<p>6.1 years</p>
|
||
</td><td headers="hd_h_ch3.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>VERY LOW<sup><a class="bk_pop" href="#ch3.tab5_1">a</a></sup><sup>,</sup><sup><a class="bk_pop" href="#ch3.tab5_2">b</a></sup></p>
|
||
<p>due to risk of bias, imprecision</p>
|
||
</td><td headers="hd_h_ch3.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">HR1.11 (0.9 to 1.37)</td><td headers="hd_h_ch3.tab5_1_1_1_5 hd_h_ch3.tab5_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">65 per 1000</td><td headers="hd_h_ch3.tab5_1_1_1_5 hd_h_ch3.tab5_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">10 more per 1000 (from 9 fewer to 32 more)</td></tr><tr><td headers="hd_h_ch3.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Kidney stones</td><td headers="hd_h_ch3.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>3213</p>
|
||
<p>(1 study)</p>
|
||
<p>6.1 years</p>
|
||
</td><td headers="hd_h_ch3.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>VERY LOW<sup><a class="bk_pop" href="#ch3.tab5_1">a</a></sup></p>
|
||
<p>due to risk of bias</p>
|
||
</td><td headers="hd_h_ch3.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">HR1.87 (1.3 to 2.69)</td><td headers="hd_h_ch3.tab5_1_1_1_5 hd_h_ch3.tab5_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">65 per 1000</td><td headers="hd_h_ch3.tab5_1_1_1_5 hd_h_ch3.tab5_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">53 more per 1000 (from 19 more to 100 more)</td></tr></tbody></table></div><div><div><dl class="temp-labeled-list small"><dt>a</dt><dd><div id="ch3.tab5_1"><p class="no_margin">Downgraded by 1 increment if the majority of studies were at high risk of bias, and downgraded by 2 increments if the majority of studies were at very high risk of bias.</p></div></dd><dt>b</dt><dd><div id="ch3.tab5_2"><p class="no_margin">Downgraded by 1 increment if the confidence interval crossed 1 MID, and downgraded by 2 increments if the confidence interval crossed both MIDs.</p></div></dd><dt>c</dt><dd><div id="ch3.tab5_3"><p class="no_margin">Control group risk not reported.</p></div></dd></dl></div></div></div></div><div class="whole_rhythm bk_prnt_obj"><div id="ch3.tab6" class="table"><h3><span class="label">Table 6</span><span class="title">Parathyroid procedures costs (elective inpatient schedule)</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577892/table/ch3.tab6/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch3.tab6_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_ch3.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">HRG code</th><th id="hd_h_ch3.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Description</th><th id="hd_h_ch3.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Activity</th><th id="hd_h_ch3.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">National average unit cost</th><th id="hd_h_ch3.tab6_1_1_1_5" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Average cost of excess bed day</th><th id="hd_h_ch3.tab6_1_1_1_6" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Average Length of Stay-Days</th><th id="hd_h_ch3.tab6_1_1_1_7" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">No. Data Submissions</th></tr></thead><tbody><tr><td headers="hd_h_ch3.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">KA03C</td><td headers="hd_h_ch3.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Parathyroid Procedures with CC Score 2+</td><td headers="hd_h_ch3.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1,444</td><td headers="hd_h_ch3.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£3,227</td><td headers="hd_h_ch3.tab6_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£432</td><td headers="hd_h_ch3.tab6_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1.47</td><td headers="hd_h_ch3.tab6_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">189</td></tr><tr><td headers="hd_h_ch3.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">KA03D</td><td headers="hd_h_ch3.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Parathyroid Procedures with CC Score 0–1</td><td headers="hd_h_ch3.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1,883</td><td headers="hd_h_ch3.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£2,851</td><td headers="hd_h_ch3.tab6_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£578</td><td headers="hd_h_ch3.tab6_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1.00</td><td headers="hd_h_ch3.tab6_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">186</td></tr><tr><td headers="hd_h_ch3.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_ch3.tab6_1_1_1_2 hd_h_ch3.tab6_1_1_1_3 hd_h_ch3.tab6_1_1_1_4 hd_h_ch3.tab6_1_1_1_5 hd_h_ch3.tab6_1_1_1_6 hd_h_ch3.tab6_1_1_1_7" colspan="6" rowspan="1" style="text-align:left;vertical-align:top;">Weighted average (including complications and excess bed days)</td></tr><tr><td headers="hd_h_ch3.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">KA03C and KA03D</td><td headers="hd_h_ch3.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Parathyroid procedures</td><td headers="hd_h_ch3.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3,327</td><td headers="hd_h_ch3.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£3,154</td><td headers="hd_h_ch3.tab6_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_ch3.tab6_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1.2</td><td headers="hd_h_ch3.tab6_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr></tbody></table></div><div><div><dl class="temp-labeled-list small"><dt></dt><dd><div><p class="no_margin">Source: NHS reference costs 2016–17<a class="bk_pop" href="#ch3.ref30"><sup>30</sup></a></p></div></dd></dl></div></div></div></div></div><div><p>Final</p></div><div><p>Intervention evidence review</p><p>This evidence review was developed by the National Guideline Centre</p></div><div><p><b>Disclaimer</b>: The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or service users. The recommendations in this guideline are not mandatory and the guideline does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.</p><p>Local commissioners and/or providers have a responsibility to enable the guideline to be applied when individual health professionals and their patients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with compliance with those duties.</p><p>NICE guidelines cover health and care in England. Decisions on how they apply in other UK countries are made by ministers in the <a href="http://wales.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Welsh Government</a>, <a href="http://www.scotland.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Scottish Government</a>, and <a href="http://www.northernireland.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Northern Ireland Executive</a>. All NICE guidance is subject to regular review and may be updated or withdrawn.</p></div></div></div>
|
||
<div class="post-content"><div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright</a> © NICE 2019.</div><div class="small"><span class="label">Bookshelf ID: NBK577892</span><span class="label">PMID: <a href="https://pubmed.ncbi.nlm.nih.gov/35167216" title="PubMed record of this title" ref="pagearea=meta&targetsite=entrez&targetcat=link&targettype=pubmed">35167216</a></span></div></div></div>
|
||
|
||
</div>
|
||
</div>
|
||
</div>
|
||
<div class="bottom">
|
||
|
||
<div id="NCBIFooter_dynamic">
|
||
<!--<component id="Breadcrumbs" label="breadcrumbs"/>
|
||
<component id="Breadcrumbs" label="helpdesk"/>-->
|
||
|
||
</div>
|
||
|
||
<script type="text/javascript" src="/portal/portal3rc.fcgi/rlib/js/InstrumentNCBIBaseJS/InstrumentPageStarterJS.js"> </script>
|
||
</div>
|
||
</div>
|
||
<!--/.page-->
|
||
</div>
|
||
<!--/.wrap-->
|
||
</div><!-- /.twelve_col -->
|
||
</div>
|
||
<!-- /.grid -->
|
||
|
||
<span class="PAFAppResources"></span>
|
||
|
||
<!-- BESelector tab -->
|
||
|
||
|
||
|
||
<noscript><img alt="statistics" src="/stat?jsdisabled=true&ncbi_db=books&ncbi_pdid=book-toc&ncbi_acc=NBK577892&ncbi_domain=niceng132er3&ncbi_report=printable&ncbi_type=fulltext&ncbi_objectid=&ncbi_pcid=/NBK577892/?report=printable&ncbi_app=bookshelf" /></noscript>
|
||
|
||
|
||
<!-- usually for JS scripts at page bottom -->
|
||
<!--<component id="PageFixtures" label="styles"></component>-->
|
||
|
||
|
||
<!-- CE8B5AF87C7FFCB1_0191SID /projects/books/PBooks@9.11 portal107 v4.1.r689238 Tue, Oct 22 2024 16:10:51 -->
|
||
<span id="portal-csrf-token" style="display:none" data-token="CE8B5AF87C7FFCB1_0191SID"></span>
|
||
|
||
<script type="text/javascript" src="//static.pubmed.gov/portal/portal3rc.fcgi/4216699/js/3879255/4121861/3501987/4008961/3893018/3821238/3400083/3426610.js" snapshot="books"></script></body>
|
||
</html> |