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id="_NBK577896_"><span itemprop="name">Evidence review for monitoring</span></h1><div class="subtitle">Hyperparathyroidism (primary): diagnosis, assessment and initial management</div><p><b>Evidence review I</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 class="bkr_clear"></div></div><div id="ch9.s1"><h2 id="_ch9_s1_">1. Monitoring</h2><div id="ch9.s1.1"><h3>1.1. Review question: What is the optimum type and frequency of monitoring for people with primary hyperparathyroidism (for example, pre-operative, postoperative, non-surgical)?</h3></div><div id="ch9.s1.2"><h3>1.2. Introduction</h3><p>There is uncertainty regarding the long-term sequelae of primary hyperparathyroidism (PHPT) even in people who have undergone successful parathyroidectomy. This is reflected in variation in practice regarding what should be monitored and for how long. Monitoring for end organ damage is more established although monitoring for cardiovascular events and cancer is less clear. The purpose of this review is to identify the optimum type and frequency of monitoring for people with PHPT. One approach to this question is to understand the long-term outcomes in people with PHPT.</p><div id="ch9.s1.2.1"><h4>1.2.1. PICO table</h4><p>For full details see the review protocol in <a href="#ch9.appa">appendix A</a>.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figch9tab1"><a href="/books/NBK577896/table/ch9.tab1/?report=objectonly" target="object" title="Table 1" class="img_link icnblk_img figpopup" rid-figpopup="figch9tab1" rid-ob="figobch9tab1"><img class="small-thumb" src="/books/NBK577896/table/ch9.tab1/?report=thumb" src-large="/books/NBK577896/table/ch9.tab1/?report=previmg" alt="Table 1. PICO characteristics of review question." /></a><div class="icnblk_cntnt"><h4 id="ch9.tab1"><a href="/books/NBK577896/table/ch9.tab1/?report=objectonly" target="object" rid-ob="figobch9tab1">Table 1</a></h4><p class="float-caption no_bottom_margin">PICO characteristics of review question. </p></div></div></div></div><div id="ch9.s1.3"><h3>1.3. Review question: What are the long-term outcomes in people with primary hyperparathyroidism?</h3><div id="ch9.s1.3.1"><h4>1.3.1. PICO table</h4><p>For full details see the review protocol in <a href="#ch9.appa">appendix A</a>.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figch9tab2"><a href="/books/NBK577896/table/ch9.tab2/?report=objectonly" target="object" title="Table 2" class="img_link icnblk_img figpopup" rid-figpopup="figch9tab2" rid-ob="figobch9tab2"><img class="small-thumb" src="/books/NBK577896/table/ch9.tab2/?report=thumb" src-large="/books/NBK577896/table/ch9.tab2/?report=previmg" alt="Table 2. PICO characteristics of review question." /></a><div class="icnblk_cntnt"><h4 id="ch9.tab2"><a href="/books/NBK577896/table/ch9.tab2/?report=objectonly" target="object" rid-ob="figobch9tab2">Table 2</a></h4><p class="float-caption no_bottom_margin">PICO characteristics of review question. </p></div></div></div></div><div id="ch9.s1.4"><h3>1.4. Clinical evidence</h3><div id="ch9.s1.4.1"><h4>1.4.1. Included studies</h4><p>A search was conducted for assessing the optimum type and frequency of monitoring for people with PHPT. No evidence was identified for this review question. See the study selection flow chart in <a href="#ch9.appc">appendix C</a>.</p><p>A second search of the original PHPT search was conducted to determine whether PHPT is associated with poor long-term outcomes and to determine what monitoring strategies they need to undergo. The aim of the review was to look at the incidence of outcomes in people with PHPT compared with healthy controls. It was thought that any difference in all/some of the outcomes would mean that someone with PHPT would need to be monitored.</p><p>Eleven comparative studies: Clifton-Bligh 2015<a class="bibr" href="#ch9.ref21" rid="ch9.ref21"><sup>21</sup></a>; De Geronimo 2006<a class="bibr" href="#ch9.ref26" rid="ch9.ref26"><sup>26</sup></a>; Hedback 1998<a class="bibr" href="#ch9.ref38" rid="ch9.ref38"><sup>38</sup></a>; Kenny 1995<a class="bibr" href="#ch9.ref41" rid="ch9.ref41"><sup>41</sup></a>; Khosla 1999<a class="bibr" href="#ch9.ref42" rid="ch9.ref42"><sup>42</sup></a>; Larsson 1993<a class="bibr" href="#ch9.ref45" rid="ch9.ref45"><sup>45</sup></a>; Melton 1992<a class="bibr" href="#ch9.ref49" rid="ch9.ref49"><sup>49</sup></a>; Ronni-Sivula 1985<a class="bibr" href="#ch9.ref60" rid="ch9.ref60"><sup>60</sup></a>; Su 2008<a class="bibr" href="#ch9.ref69" rid="ch9.ref69"><sup>69</sup></a>; Wilson 1988<a class="bibr" href="#ch9.ref79" rid="ch9.ref79"><sup>79</sup></a>; Yu 2011<a class="bibr" href="#ch9.ref80" rid="ch9.ref80"><sup>80</sup></a> were included.</p><p>Only one prospective cohort study, Yu 2011<a class="bibr" href="#ch9.ref80" rid="ch9.ref80"><sup>80</sup></a>, adjusted for all key confounders. This study evaluated the risk of mortality and morbidity among untreated mild PHPT patients compared with a matched cohort. The study adjusted for a number of potential confounding variables (multiple deprivation index [SIMD], history of bisphosphonates prescription, history of hospital admitted CVD, cerebrovascular disease, hypertension, renal failure, renal stones, psychiatric disease, fractures, cancer and diabetes) and the propensity of having calcium checked in the analysis. In 5 studies (Clifton-Bligh, 2015<a class="bibr" href="#ch9.ref21" rid="ch9.ref21"><sup>21</sup></a>; De Geronimo, 2006<a class="bibr" href="#ch9.ref26" rid="ch9.ref26"><sup>26</sup></a>; Hedback 1998<a class="bibr" href="#ch9.ref38" rid="ch9.ref38"><sup>38</sup></a>; Melton, 1992<a class="bibr" href="#ch9.ref49" rid="ch9.ref49"><sup>49</sup></a>; Ronni-Sivula, 1985<a class="bibr" href="#ch9.ref60" rid="ch9.ref60"><sup>60</sup></a>) the control group was matched for factors such as age and gender but these studies did not adjust for serum calcium level and absence/presence of end organ effects (no multivariate analysis conducted). The remaining 5 studies did not match or adjust for any key confounders (no multivariate analysis conducted).</p><p>The definition of mild and non-mild PHPT was not consistent across the studies. The definitions reported in the studies are noted in their respective evidence tables.</p><p>The studies were stratified as non-surgical, pre-operative, mixed pre and post-operative (including surgery and non-surgery patients) and post-operative.</p><p>There were 2 studies in the strata non-surgical (mild asymptomatic patients) (Yu 2011; Wilson 1988); 1 study in pre-operative (Suh 2008); 5 studies in the mixed pre and post-operative (mild and non-mild patients): (Melton 1992; De Geronimo 2006; Clifton-Bligh 2015; Khosla 1999; Larsson 1993); and 3 studies in the post-operative (Ronni-Sivula 1985; Kenny 1995; Hedback 1998). No evidence was available for people on calcimimetics, bisphosphonates and normocalcaemic patients.</p><p>Evidence from the studies are summarised in the clinical evidence summary tables below (<a class="figpopup" href="/books/NBK577896/table/ch9.tab4/?report=objectonly" target="object" rid-figpopup="figch9tab4" rid-ob="figobch9tab4">Table 4</a>, <a class="figpopup" href="/books/NBK577896/table/ch9.tab5/?report=objectonly" target="object" rid-figpopup="figch9tab5" rid-ob="figobch9tab5">Table 5</a>, <a class="figpopup" href="/books/NBK577896/table/ch9.tab6/?report=objectonly" target="object" rid-figpopup="figch9tab6" rid-ob="figobch9tab6">Table 6</a>, <a class="figpopup" href="/books/NBK577896/table/ch9.tab7/?report=objectonly" target="object" rid-figpopup="figch9tab7" rid-ob="figobch9tab7">Table 7</a>, <a class="figpopup" href="/books/NBK577896/table/ch9.tab8/?report=objectonly" target="object" rid-figpopup="figch9tab8" rid-ob="figobch9tab8">Table 8</a>, <a class="figpopup" href="/books/NBK577896/table/ch9.tab9/?report=objectonly" target="object" rid-figpopup="figch9tab9" rid-ob="figobch9tab9">Table 9</a>). See also the study selection flow chart in <a href="#ch9.appc">appendix C</a>, study evidence tables in <a href="#ch9.appd">appendix D</a>, forest plots in <a href="#ch9.appe">appendix E</a>, and GRADE tables in <a href="#ch9.appf">appendix F</a>.</p></div><div id="ch9.s1.4.2"><h4>1.4.2. Excluded studies</h4><p>See the excluded studies list in <a href="#ch9.appi">appendix I</a>.</p></div><div id="ch9.s1.4.3"><h4>1.4.3. Summary of clinical studies included in the evidence review</h4><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figch9tab3"><a href="/books/NBK577896/table/ch9.tab3/?report=objectonly" target="object" title="Table 3" class="img_link icnblk_img figpopup" rid-figpopup="figch9tab3" rid-ob="figobch9tab3"><img class="small-thumb" src="/books/NBK577896/table/ch9.tab3/?report=thumb" src-large="/books/NBK577896/table/ch9.tab3/?report=previmg" alt="Table 3. Summary of studies included in the evidence review (comparative studies)." /></a><div class="icnblk_cntnt"><h4 id="ch9.tab3"><a href="/books/NBK577896/table/ch9.tab3/?report=objectonly" target="object" rid-ob="figobch9tab3">Table 3</a></h4><p class="float-caption no_bottom_margin">Summary of studies included in the evidence review (comparative studies). </p></div></div><p>See <a href="#ch9.appd">appendix D</a> for full evidence tables.</p></div><div id="ch9.s1.4.4"><h4>1.4.4. Quality assessment of clinical studies included in the evidence review</h4><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figch9tab4"><a href="/books/NBK577896/table/ch9.tab4/?report=objectonly" target="object" title="Table 4" class="img_link icnblk_img figpopup" rid-figpopup="figch9tab4" rid-ob="figobch9tab4"><img class="small-thumb" src="/books/NBK577896/table/ch9.tab4/?report=thumb" src-large="/books/NBK577896/table/ch9.tab4/?report=previmg" alt="Table 4. Clinical evidence summary: PHPT cases compared to matched comparators (adjusted for key confounders) (Stratum-Non-surgical)." /></a><div class="icnblk_cntnt"><h4 id="ch9.tab4"><a href="/books/NBK577896/table/ch9.tab4/?report=objectonly" target="object" rid-ob="figobch9tab4">Table 4</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: PHPT cases compared to matched comparators (adjusted for key confounders) (Stratum-Non-surgical). </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figch9tab5"><a href="/books/NBK577896/table/ch9.tab5/?report=objectonly" target="object" title="Table 5" class="img_link icnblk_img figpopup" rid-figpopup="figch9tab5" rid-ob="figobch9tab5"><img class="small-thumb" src="/books/NBK577896/table/ch9.tab5/?report=thumb" src-large="/books/NBK577896/table/ch9.tab5/?report=previmg" alt="Table 5. Clinical evidence summary: PHPT compared to control (no multivariate analysis) (Stratum – Pre-surgery)." /></a><div class="icnblk_cntnt"><h4 id="ch9.tab5"><a href="/books/NBK577896/table/ch9.tab5/?report=objectonly" target="object" rid-ob="figobch9tab5">Table 5</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: PHPT compared to control (no multivariate analysis) (Stratum – Pre-surgery). </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figch9tab6"><a href="/books/NBK577896/table/ch9.tab6/?report=objectonly" target="object" title="Table 6" class="img_link icnblk_img figpopup" rid-figpopup="figch9tab6" rid-ob="figobch9tab6"><img class="small-thumb" src="/books/NBK577896/table/ch9.tab6/?report=thumb" src-large="/books/NBK577896/table/ch9.tab6/?report=previmg" alt="Table 6. Clinical evidence summary: PHPT compared to control (no multivariate analysis) – Mixed strata – Pre and post-operative (surgery and non-surgery patients)." /></a><div class="icnblk_cntnt"><h4 id="ch9.tab6"><a href="/books/NBK577896/table/ch9.tab6/?report=objectonly" target="object" rid-ob="figobch9tab6">Table 6</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: PHPT compared to control (no multivariate analysis) – Mixed strata – Pre and post-operative (surgery and non-surgery patients). </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figch9tab7"><a href="/books/NBK577896/table/ch9.tab7/?report=objectonly" target="object" title="Table 7" class="img_link icnblk_img figpopup" rid-figpopup="figch9tab7" rid-ob="figobch9tab7"><img class="small-thumb" src="/books/NBK577896/table/ch9.tab7/?report=thumb" src-large="/books/NBK577896/table/ch9.tab7/?report=previmg" alt="Table 7. Clinical evidence summary (modified GRADE table): PHPT compared to control (no multivariate analysis) – Mixed strata-Pre and post-operative (surgery and surgery patients)." /></a><div class="icnblk_cntnt"><h4 id="ch9.tab7"><a href="/books/NBK577896/table/ch9.tab7/?report=objectonly" target="object" rid-ob="figobch9tab7">Table 7</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary (modified GRADE table): PHPT compared to control (no multivariate analysis) – Mixed strata-Pre and post-operative (surgery and surgery patients). </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figch9tab8"><a href="/books/NBK577896/table/ch9.tab8/?report=objectonly" target="object" title="Table 8" class="img_link icnblk_img figpopup" rid-figpopup="figch9tab8" rid-ob="figobch9tab8"><img class="small-thumb" src="/books/NBK577896/table/ch9.tab8/?report=thumb" src-large="/books/NBK577896/table/ch9.tab8/?report=previmg" alt="Table 8. Clinical evidence summary (modified GRADE table): PHPT (observed) versus expected numbers in the general population (no multivariate analysis) – Mixed strata – Pre and post-operative (surgery and non-surgery patients)." /></a><div class="icnblk_cntnt"><h4 id="ch9.tab8"><a href="/books/NBK577896/table/ch9.tab8/?report=objectonly" target="object" rid-ob="figobch9tab8">Table 8</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary (modified GRADE table): PHPT (observed) versus expected numbers in the general population (no multivariate analysis) – Mixed strata – Pre and post-operative (surgery and non-surgery patients). </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figch9tab9"><a href="/books/NBK577896/table/ch9.tab9/?report=objectonly" target="object" title="Table 9" class="img_link icnblk_img figpopup" rid-figpopup="figch9tab9" rid-ob="figobch9tab9"><img class="small-thumb" src="/books/NBK577896/table/ch9.tab9/?report=thumb" src-large="/books/NBK577896/table/ch9.tab9/?report=previmg" alt="Table 9. Clinical evidence summary: PHPT patients compared to control (no multivariate analysis) – Stratum post-operative." /></a><div class="icnblk_cntnt"><h4 id="ch9.tab9"><a href="/books/NBK577896/table/ch9.tab9/?report=objectonly" target="object" rid-ob="figobch9tab9">Table 9</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: PHPT patients compared to control (no multivariate analysis) – Stratum post-operative. </p></div></div><div id="ch9.s1.4.4.1"><h5>Narrative data</h5><div id="ch9.s1.4.4.1.1"><h5>1. Clifton-Bligh 2015<a class="bibr" href="#ch9.ref21" rid="ch9.ref21"><sup>21</sup></a></h5><p>n=561</p><p>448 had surgery and 113 did not have surgery.</p><p>There was no significant difference in the relative survival between surgically and non-surgically treated patients over a 10 year period (figures, no data). The average number of years of life lost by hyperparathyroid patients compared to control population was 7.5 years. There was no significant difference in the death rate between those with an initial serum calcium of >3.00 mmol/l compared with those with an initial serum calcium of <3.00 mmol/l (no data).</p><p>In a multivariate analysis in the surgically treated group, the serum calcium did not significantly influence survival (HR 1.57, 95% CI 0.30–8.30, p=0.593). In a multivariate analysis, risk factors associated with death in the surgically treated group were diabetes mellitus (HR 4.09, 95% CI 1.42–6.74, P=0.001), congestive cardiac failure (HR 5.46, 95% CI 1.31–22.87, P=0.002), coronary heart disease (HR 2.16, 95% CI 1.080.044). The presence of kidney stones before surgery was associated with reduced mortality (HR 0.364, 95% CI 0.22–0.68, P=0.001).</p><p>In the non-surgically treated group, death was significantly associated with a high serum PTH (HR 1.59, 95% CI 1.20–2.11, p=0.001), coronary heart disease (HR 3.10, 95% CI 1.42–6.74, P=0.004), and kidney stones (HR 2.48, 95% CI 1.07–5.76, p=0.035). This difference between the surgically treated and non-surgically treated group with respect to the impact of kidney stones is not clear. Compared with the non-surgically treated group, the hazard ratio of death for the surgically treated group adjusted for age, sex and time of diagnosis was 0.67 (95% 0.38–1.18, p=0.167).</p><p>Using a 20 year follow-up for the whole group, multivariate analysis did not show any survival difference between male and female, surgery versus non-surgery (p=0.867), serum calcium >3 mmol/l versus <3 mmol/l (p=0.794), or serum PTH analysed as quartiles (no data).</p></div><div id="ch9.s1.4.4.1.2"><h5>2. Hedback 1992<a class="bibr" href="#ch9.ref38" rid="ch9.ref38"><sup>38</sup></a></h5><div id="ch9.s1.4.4.1.2.1"><h5>Yearly death reduction</h5><p>Hyperparathyroid population operated on in 1987–94: mean (range)</p><p>Male: 17% (95% 7–26)</p><p>Female: 8% (2.00–13)</p><p>Swedish population 1974–1983: male: 0.95% (95% CI 0.81–1.09)</p><p>Female: 1.68% (1.53–1.83)</p><p>Swedish population 1987–94: male: 1.51% (1.34–1.67)</p><p>Female: 0.88% (0.70–1.05)</p></div></div><div id="ch9.s1.4.4.1.3"><h5>3. Melton 1992<a class="bibr" href="#ch9.ref49" rid="ch9.ref49"><sup>49</sup></a></h5><div id="ch9.s1.4.4.1.3.1"><h5>Fracture risk (after diagnosis)</h5><p>Overall: PHPT 50/90; control 52/90; RR 1.0 (95% CI 0.7–1.4)</p><p>Calcium ≥2.74 mmol/l: PHPT 34/90; control 24/90; RR 1.4 (95% CI 0.8–2.4)</p><p>Calcium <2.74 mmol/l: PHPT 16/90; control 27/90; RR 0.6 (95% CI 0.3–1.1)</p><p>Operated on: PHPT 19/90; control 26/90; RR 0.7 (95% CI 0.4–1.3)</p><p>Not operated on: PHPT 31/90; control 26/90; RR 1.2 (95% CI 0.7–2.0)</p><p>Comorbid conditions: PHPT 44/90; control 38/90; RR 1.2 (95% CI 0.8–1.8)</p><p>No comorbid conditions: PHPT 6/90; control 14/90; RR 0.4 (95% CI 0.2–1.1)</p><p>Women: 43/90; 42/90; RR 1.0 (95% CI 0.7–1.6)</p><p>Men: 7/90; 10/90; RR 0.7 (95% CI 0.3–1.8)</p><p>In a multivariate analysis, only age at diagnosis was an independent predictor of fracture risk in PHPT (P<0.2). A 10 year increase in age corresponded to a 36% increase in fracture risk.</p></div></div><div id="ch9.s1.4.4.1.4"><h5>4. Ronni-Sivula<a class="bibr" href="#ch9.ref60" rid="ch9.ref60"><sup>60</sup></a></h5><div id="ch9.s1.4.4.1.4.1"><h5>Mortality</h5><p>PHPT patients 34/334; control 21/334; RR 1.62 (0.96 to 2.73)</p><p>The mean age of PHPT patients at death was 65 years, 61 years in men and 66 years in women.</p><p>The mean age of control patients at death was 67 years, 62 years in men and 69 years in women.</p><p>The deceased patients in the PHPT group had a higher mean value of serum calcium pre-operatively than patients in the entire PHPT group (3.31 mmol/l versus 3.08 mmol/l).</p><p>In the deceased patients in the PHPT group, serum creatinine was elevated (>115 mmol/l) pre-operatively in 15 (44%) of the deceased patients. In the entire PHPT group serum creatinine was elevated pre-operatively in 57 patients (17%). In the deceased patients serum creatinine was most often elevated in the groups with hypercalcaemic crises (4/6) and cystic bone changes (3/4) and most rarely in the renal stone group (1/5).</p><p>PHPT patients who died had more severe form of disease: 55% had hypercalcaemic crises and 24% had cystic bone changes, 4% had renal stones.</p><p>Causes of death:</p><p>PHPT: n=18 cardiac disease; n=4 cerebrovascular death; n=1 vascular disease; n=4 uraemia; n=2 malignant tumour; n=2 hypercalcaemic crisis; n=3 other causes</p><p>Control: n=8 cardiac disease; n=5 malignant tumour; n=8 other causes</p></div></div></div></div></div><div id="ch9.s1.5"><h3>1.5. Economic evidence</h3><div id="ch9.s1.5.1"><h4>1.5.1. Included studies</h4><p>No relevant health economic studies were identified.</p></div><div id="ch9.s1.5.2"><h4>1.5.2. Excluded studies</h4><p>No health economic studies that were relevant to this question were excluded due to assessment of limited applicability or methodological limitations.</p><p>See also the health economic study selection flow chart in <a href="#ch9.appg">appendix G</a>.</p></div><div id="ch9.s1.5.3"><h4>1.5.3. Unit costs</h4><p>Unit costs for common clinical tests for monitoring PHPT were presented to the committee for consideration of cost effectiveness.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figch9tab10"><a href="/books/NBK577896/table/ch9.tab10/?report=objectonly" target="object" title="Table 10" class="img_link icnblk_img figpopup" rid-figpopup="figch9tab10" rid-ob="figobch9tab10"><img class="small-thumb" src="/books/NBK577896/table/ch9.tab10/?report=thumb" src-large="/books/NBK577896/table/ch9.tab10/?report=previmg" alt="Table 10. UK costs of monitoring procedures." /></a><div class="icnblk_cntnt"><h4 id="ch9.tab10"><a href="/books/NBK577896/table/ch9.tab10/?report=objectonly" target="object" rid-ob="figobch9tab10">Table 10</a></h4><p class="float-caption no_bottom_margin">UK costs of monitoring procedures. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figch9tab11"><a href="/books/NBK577896/table/ch9.tab11/?report=objectonly" target="object" title="Table 11" class="img_link icnblk_img figpopup" rid-figpopup="figch9tab11" rid-ob="figobch9tab11"><img class="small-thumb" src="/books/NBK577896/table/ch9.tab11/?report=thumb" src-large="/books/NBK577896/table/ch9.tab11/?report=previmg" alt="Table 11. UK cost of clinical events associated with PHPT." /></a><div class="icnblk_cntnt"><h4 id="ch9.tab11"><a href="/books/NBK577896/table/ch9.tab11/?report=objectonly" target="object" rid-ob="figobch9tab11">Table 11</a></h4><p class="float-caption no_bottom_margin">UK cost of clinical events associated with PHPT. </p></div></div></div></div><div id="ch9.s1.6"><h3>1.6. Resource costs</h3><p>The recommendations made by the committee based on this review are not expected to have a substantial impact on resources.</p></div><div id="ch9.s1.7"><h3>1.7. Evidence statements</h3><div id="ch9.s1.7.1"><h4>1.7.1. Clinical evidence statements</h4><div id="ch9.s1.7.1.1"><h5>1.7.1.1. Monitoring</h5><p>No evidence was identified for assessing the optimum type and frequency of monitoring for people with PHPT.</p></div><div id="ch9.s1.7.1.2"><h5>1.7.1.2. Monitoring long term outcomes</h5><div id="ch9.s1.7.1.2.1"><h5>1.7.1.2.1. PHPT cases versus matched comparators (adjusted for key confounders) in non-surgical stratum</h5><p>Evidence from one study (n=8544, median follow up 2.9 years, Low quality) suggested that there was increased risk of all-cause mortality, fatal CVD, non-fatal CVD, hypertension, cerebrovascular disease, renal stones, renal failure, all fractures and osteoporotic fracture associated with PHPT (all patients diagnosed but untreated, mild asymptomatic PHPT).</p><p>No evidence was identified for the outcomes of renal tract calcification, pancreatitis, myocardial infarction, number of people meeting the criteria for surgery, serum calcium (>2.85 mmol/litre), 24-hour urine for calcium (>10 mmol/dl) and BMD of proximal femur.</p></div><div id="ch9.s1.7.1.2.2"><h5>1.7.1.2.2. PHPT cases versus controls (no multivariate analysis) in pre-surgery stratum</h5><p>Evidence from one study (n=771, Very Low quality) suggested that there was increased risk of renal stones associated with PHPT.</p><p>No evidence was identified for the outcomes of mortality, fragility fracture, renal tract calcification, pancreatitis, stroke, hypertension, myocardial infarction, number of people meeting the criteria for surgery, serum calcium (>2.85 mmol/litre), 24-hour urine for calcium (>10 mmol/dl) and BMD of proximal femur.</p></div><div id="ch9.s1.7.1.2.3"><h5>1.7.1.2.3. PHPT cases versus controls (no multivariate analysis) in mixed pre and post-operative stratum</h5><p>Evidence for fractures (all) was inconsistent. One study (n=180, Very Low quality) suggested that there was no difference between PHPT and controls for fractures; another study (n=407, Very Low quality) suggested that there was increased risk of fractures associated with PHPT.</p><p>Evidence from one study (n=114, Very Low quality) suggested there was a reduced risk of non-vertebral fractures associated with mild PHPT. Evidence from two studies (n=114 for mild PHPT; n=162 for non-mild PHPT, Very Low quality) suggested that there was no difference between PHPT and controls for the outcome lumbar spine BMD. Evidence from one study (n=114, Very Low quality) suggested that there was no difference between PHPT and controls for the outcomes femoral neck BMD, total femur BMD, and non-vertebral fractures associated with non-mild PHPT.</p><p>Evidence from 3 studies (n=343; n=407; n=162, Very Low quality) suggested that there was increased risk of vertebral fractures associated with PHPT (both mild and non-mild).</p><p>Evidence from one study (n=1373 women; n=551 men, Very Low quality) suggested that there was no difference between PHPT and control for the outcome hip fractures in both men and women.</p><p>No evidence was identified for the outcomes of mortality, renal stones, renal tract calcification, pancreatitis, stroke, hypertension, myocardial infarction, number of people meeting the criteria for surgery, serum calcium (>2.85 mmol/litre) and 24-hour urine for calcium (>10 mmol/dl).</p></div><div id="ch9.s1.7.1.2.4"><h5>1.7.1.2.4. PHPT cases versus controls (no multivariate analysis) in post-operative stratum</h5><p>The evidence for the outcome mortality was not consistent. One study (n=668, Very Low quality) suggested that there was no difference between those PHPT patients who had surgery and healthy controls; another study (n=4461, Very Low quality) suggested that there was increased mortality in surgery patients compared to healthy controls.</p><p>Evidence from one study (n=90, Very Low quality) suggested that there was increased risk of fracture in PHPT patients compared to healthy controls.</p><p>No evidence was identified for the outcomes of renal stones, renal tract calcification, pancreatitis, stroke, hypertension, myocardial infarction, number of people meeting the criteria for surgery, serum calcium (>2.85 mmol/litre), 24-hour urine for calcium (>10 mmol/dl) and BMD of proximal femur.</p></div></div></div><div id="ch9.s1.7.2"><h4>1.7.2. Health economic evidence statements</h4><p>No relevant economic evaluations were identified.</p></div></div><div id="ch9.s1.8"><h3>1.8. The committee’s discussion of the evidence</h3><div id="ch9.s1.8.1"><h4>1.8.1. Interpreting the evidence</h4><div id="ch9.s1.8.1.1"><h5>1.8.1.1. The outcomes that matter most</h5><p>For the monitoring review the committee considered the outcomes of health-related quality of life and mortality as critical outcomes for decision making. Other important outcomes included deterioration in renal function, fractures (vertebral or long bone), occurrence of kidney stones, persistent hypercalcaemia, bone mass density (BMD) of the distal radius or the lumbar spine, cardiovascular events, adverse events (to include voice change, hypoparathyroidism, hypothyroidism/hyperthyroidism), cancer incidence and re-operation (for post-surgery stratum). No evidence was available for this review.</p><p>For the monitoring long-term outcomes review the committee considered the outcomes of mortality, fragility fracture, renal stones, renal tract calcification, pancreatitis, stroke, hypertension, myocardial infarction, number of people who become eligible for surgery/meet the criteria for surgery as critical outcomes for decision making. Other important outcomes included serum calcium (>2.85 mmol/litre), 24-hour urine for calcium (>10 mmol/dl) and BMD of proximal femur (T-score <2.5; Z score <2).</p><p>No evidence was identified for the outcomes of pancreatitis, myocardial infarction, number of people meeting the criteria for surgery, serum calcium (>2.85 mmol/litre) and 24-hour urine for calcium (>10 mmol/dl).</p></div><div id="ch9.s1.8.1.2"><h5>1.8.1.2. The quality of the evidence</h5><p>All the evidence in this review included the incidence of outcomes in people with primary hyperparathyroidism compared with healthy controls.</p><p>There were 11 observational studies, of which one was a prospective cohort study and the rest were retrospective cohort studies. The majority of evidence was of Very Low quality due to risk of bias and also, in most cases, imprecision. Only one prospective cohort study adjusted for all key confounders; in five studies the control group was matched for factors such as age and gender but these studies did not adjust for serum calcium level and absence/presence of end organ effects (no multivariate analysis conducted) and the remaining five studies did not have matched controls or adjust for any key confounders (no multivariate analysis conducted). These limitations were taken into account by the committee when interpreting the evidence.</p></div><div id="ch9.s1.8.1.3"><h5>1.8.1.3. Benefits and harms</h5><p>The studies in this review were stratified as non-surgical, pre-operative, mixed pre- and post-operative and post-operative. No evidence was available for people on calcimimetics, bisphosphonates and normocalcaemic patients.</p><p>Non-surgical: The evidence for this group suggested that compared to healthy controls there was increased risk of all-cause mortality, fatal and nonfatal cardiovascular disease (CVD), hypertension, cerebrovascular disease, all fractures, osteoporotic fractures, renal failure and renal stones in patients with asymptomatic primary hyperparathyroidism, with the risk of renal failure and renal stones being the highest.</p><p>Pre-operative: There was evidence from only one study for this stratum. The evidence suggested that there was an increased risk of renal stones in people with primary hyperparathyroidism compared to healthy controls.</p><p>Mixed pre and post-operative: The studies in this strata included both mild and non-mild primary hyperparathyroidism patients. Data were not available separately for surgical and non-surgical/pre-surgery patients. However, for some outcomes the evidence was reported separately for mild and non-mild patients. The evidence suggested that there was increased risk of vertebral fractures in both mild and non-mild primary hyperparathyroidism patients compared to healthy controls and there was no difference between the primary hyperparathyroidism and healthy controls for lumbar spine BMD, femoral neck BMD and total femur BMD for both mild and non-mild patients. The evidence for all fractures was not consistent; one study suggested that there was no difference and one study suggested that there was increased risk in primary hyperparathyroidism patients compared to healthy controls. The evidence suggested there was a reduced risk for non-vertebral fractures in mild primary hyperparathyroidism patients compared to healthy controls and there was no difference in non-vertebral fractures between non-mild primary hyperparathyroidism patients and healthy controls. The evidence also suggested that there was no difference between the primary hyperparathyroidism and healthy controls for the outcome hip fractures in both men and women.</p><p>Post-operative: The evidence for the outcome mortality was not consistent; one study suggested that there was no difference between those primary hyperparathyroidism patients who had surgery and healthy controls and one study suggested that there was increased mortality in surgery patients compared to healthy controls and this was mainly attributed to cardiovascular disease. The evidence also suggested that there was increased risk of fracture in primary hyperparathyroidism patients compared to healthy controls.</p><p>Overall the evidence suggested that there was increased risk of mortality, fractures, renal stones, renal failure, cardiovascular disease, low bone density and hypertension associated with untreated asymptomatic primary hyperparathyroidism patients. Due to the low quality of the evidence, the committee also took their clinical experiences into account when making their recommendations.</p><p>Based on their experience, the committee agreed that all patients diagnosed with primary hyperparathyroidism will need baseline assessment of their symptoms, BMD by DXA scan, and ultrasound of the renal tract to help determine the optimal management pathway. The committee considered that monitoring serum calcium level and symptoms of hypercalcaemia would support discussion of the most appropriate treatment strategy including surgery. Ultrasound of the kidneys would help in identifying cause for specific interventions or appropriate referral, and DXA scan would help in assessing fracture risk and/or the need for bisphosphonates.</p><p>The committee discussed the increased risk of mortality due to cardiovascular causes both before and after parathyroidectomy and hence felt that there is a need for monitoring cardiovascular risk in this group of patients. The committee also discussed the increased risk of renal stones and fractures in people with primary hyperparathyroidism (both before and after surgery) and therefore agreed that these people need to be monitored accordingly and consideration given to adjunctive treatments.</p><p>Based on their knowledge and experience, the committee agreed that people who have had parathyroid surgery can be considered biochemically cured if their albumin-adjusted serum calcium level is within the reference range 3 to 6 months after surgery. The committee considered that the risk of recurrent disease following successful removal of a solitary adenoma is very low and that, after the 6-month check, it is sufficient for calcium to be checked as part of routine blood testing to a maximum of once a year. The committee highlighted that for people with multigland disease there is a higher risk of recurrence than in those who had a single adenoma and in monitoring of such patients specialist opinion should be sought. However, the committee noted that the risk is still very low if the person has normal adjusted calcium at 3 to 6 months after surgery. The committee agreed that for people with osteoporosis, although bone density improves after surgery, skeletal recovery can take some time and would need specialist monitoring. Based on their experience, the committee discussed that risk of kidney stones decreases after successful surgery, but the residual risk persists and hence specialist opinion should be sought for monitoring of such patients.</p><p>The committee noted that in patients with multigland disease, a specialist will be aware of associated syndromes (for example multiple endocrine neoplasia type 1 [MEN1], MEN2A, familial isolated hyperparathyroidism, autosomal dominant mild hyperparathyroidism, familial hypocalciuric hypercalcaemia), and hence would be in a better position to make individualised assessment and determine the frequency of monitoring. The committee stated that for those patients with multigland disease discharged back to primary care, serum calcium tests will need to be conducted annually as part of their routine biochemical testing. Current practice is to conduct biochemical tests annually if there is no end organ damage.</p><p>The committee stated that in patients with genetic diseases such as MEN-1, primary hyperparathyroidism could be the first presentation so early detection of the disease, correct treatment, and continued care are of great importance; but noted that such cases are infrequent and beyond the scope of this guideline.</p><p>The committee discussed from clinical experience that there are no clinical factors that would predict the prognosis of patients with asymptomatic primary hyperparathyroidism. Evidence from the review suggested that around 35% of asymptomatic patients develop indications for surgery during follow-up. Hence the committee agreed that long-term medical monitoring for asymptomatic patients was essential to assess progression to meeting eligibility criteria for surgery and/or any evidence of end organ damage. The committee recommended the following monitoring strategies including assessment of symptoms and comorbidities annually; annual measurement of serum calcium test, estimated glomerular filtration rate (eGFR) or serum creatinine test; DXA scan every 2 to 3 years; ultrasound of the renal tract if renal stones are suspected (see NICE’s guideline on <a href="https://www.nice.org.uk/guidance/ng118" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">renal and ureteric stones</a>). The committee recognised that measurement of renal function is important in assessing calcium and PTH levels. Most patients will have eGFR measured with serum calcium. An elevated serum calcium should be investigated irrespective of eGFR and the proposed algorithms are designed to ensure that if eGFR has not been checked early in the diagnostic odyssey, it is done so as part of the investigation and assessment of patients with hypercalcaemia. Such monitoring may detect clinically relevant changes that may necessitate reconsideration of surgery and/or adjunctive medical therapies. The committee discussed that assessment of symptoms will be annually or when the patients presents with any of the symptoms of primary hyperparathyroidism such as fatigue, depression, abdominal pain, constipation, muscle weakness, loss of concentration, mild confusion etc. The committee discussed that for suspected renal stones patients could present with colic/severe pain, asymptomatic haematuria, passing grit, discomfort etc. Based on the evidence and their experience, the committee agreed that there was an increased risk of fracture associated with primary hyperparathyroidism and hence agreed that DXA scan should be done every 2–3 years in these patients.</p><p>The committee agreed that these recommendations could also apply to those people who have refused surgery and in people after failed primary surgery to assess progression of disease in these patients.</p><p>The committee also discussed the current National Institutes of Health (NIH) criteria<a class="bibr" href="#ch9.ref16" rid="ch9.ref16"><sup>16</sup></a> for monitoring in patients with asymptomatic primary hyperparathyroidism who do not undergo parathyroid surgery (2013). The current NIH criteria include the following monitoring strategies: serum calcium annually; skeletal – every 1–2 years (3 sites), X-ray or VFA of spine if clinically indicated (for example height loss, back pain); renal – eGFR, annually; serum creatinine, annually. If renal stones are suspected: 24-hour biochemical stone profile, renal imaging by X-ray, ultrasound, or CT.</p><p>The committee noted that there are no established guidelines/definitions of cure for primary hyperparathyroidism. The committee from their experience discussed that patients are considered to be biochemically cured if their PTH is in the reference range immediately following surgery and their serum calcium is within the reference range 3–6 months after surgery. The committee stated that post-operative PTH would still be performed if an intraoperative PTH was taken as a very small proportion of patients would show a change from intraoperative PTH level. Overall the committee did not think that a PTH test at 3–6 months would offer any additional clinical value. The committee noted that persistently high calcium at 3–6 months would trigger testing of plasma PTH (as per the recommendations on diagnosis). The committee considered that a 3–6 month post-operative calcium test could be done in secondary care.</p></div></div><div id="ch9.s1.8.2"><h4>1.8.2. Cost effectiveness and resource use</h4><p>No previously published economic evaluations were identified for the cost-effectiveness of monitoring people with primary hyperparathyroidism. Unit costs of monitoring procedures were presented to the committee for consideration. Costs of clinical events associated with primary hyperparathyroidism – including cardiovascular events, renal events and fragility fractures – were also presented to provide a more comprehensive picture of potential healthcare resource use of primary hyperparathyroidism if the condition is left unchecked. However, as there is no clinical evidence for the extent to which monitoring will prevent such events, cost effectiveness of monitoring could not be evaluated and therefore is highly uncertain.</p><p>For people who have had parathyroid surgery, the committee noted that a PTH test immediately following surgery provides a timely indication of whether a patient has been cured of primary hyperparathyroidism due to the short half-life of PTH compared to calcium in the blood and is the most clinically relevant indication of cure. The committee also highlighted that further confirmation of cure at 3 to 6 months is necessary to assess recurrent disease. However, they agreed that this can be achieved with a lower cost test for albumin-adjusted serum calcium rather than a repeated PTH test.</p><p>The committee discussed that those with successful parathyroid surgery are generally considered to return to general population risk levels for end organ disease such as renal stones and fractures and therefore do not require further monitoring. However, the committee considered that there may be cases where specialist endocrine opinion should be sought with regards to monitoring due to more complex issues such as multi-gland disease and recurrent disease, or due to comorbidities such as osteoporosis and renal stones. In these cases decisions on monitoring should be made on a case-by-case basis.</p><p>In addition, the committee considered that in the event that people who have been cured after parathyroid surgery have a routine blood test for another cause, incidental testing for serum calcium as part of these blood tests could be cost effective. The committee discussed that there is minimal added expense to such testing as this does not require additional time in taking blood, only in analysing the sample (estimated around an additional £0.30 to additionally analyse calcium). The committee highlighted that such incidental testing should be limited to once a year to avoid unnecessary testing for those who may have frequent routine blood tests. The committee discussed that incidental calcium testing could help identify recurrent disease prior to the onset of symptoms or potential consequential end organ damage as a result of hypercalcaemia and therefore avoid potential decrements in quality of life and associated costs of such events. The committee was of the consensus that this practice could therefore be cost effective. However, as there is no clinical evidence available to assess this, this is highly uncertain.</p><p>For patients who are either not eligible for surgery, or have chosen not to undergo surgery, consensus from the committee was that monitoring should occur. However, the committee noted that there is some variation in current practice with respect to some of the items tested as part of the monitoring regime. While most practitioners adopt a fairly standard practice of including tests as specified in the NIH guidance – including annual tests for serum calcium and serum creatinine – some practitioners also test for PTH as part of routine practice. The committee indicated that testing for serum calcium and serum creatinine as part of routine monitoring is sufficient to detect any signs of change in a patient’s condition, and are also less costly. It was noted that healthcare providers should use their judgement in determining whether a patient will require a further PTH test based on the results of their tests for serum calcium. Hence, routine testing of PTH levels has not been recommended. This is a potential area for some cost savings.</p><p>The committee considered that these recommendations are generally in line with current practice and therefore are not expected to have a significant impact on healthcare resource use.</p></div><div id="ch9.s1.8.3"><h4>1.8.3. Other factors the committee took into account</h4><p>The committee noted that the pre-operative population awaiting surgery are not considered to be in a monitoring setting (see recommendations on surgery).</p><p>The committee was aware of two studies<a class="bibr" href="#ch9.ref61" rid="ch9.ref61"><sup>61</sup></a><sup>,</sup><a class="bibr" href="#ch9.ref76" rid="ch9.ref76"><sup>76</sup></a> assessing long-term outcomes in patients with and without parathyroid surgery which were included in the indications for surgery evidence review.. The study<a class="bibr" href="#ch9.ref76" rid="ch9.ref76"><sup>76</sup></a> reported that the risks of mortality, fractures and gastric ulcers were lower in patients treated surgically than those treated conservatively. However there was a higher risk of kidney or urinary tract stones in patients treated surgically than patients treated conservatively. Another study<a class="bibr" href="#ch9.ref61" rid="ch9.ref61"><sup>61</sup></a> was a long-term prospective cohort study of asymptomatic primary hyperparathyroidism patients. The study reported that at 10 years, 25% of the asymptomatic primary hyperparathyroidism patients did show evidence of progressive disease with worsening hypercalcemia, hypercalciuria, and reductions in BMD being the most common complications. The study reported that 37% of asymptomatic patients developed new surgical criteria at any time point over the 15 years of observation. Meeting surgical criteria at study baseline did not predict who would have progressive disease. BMD did not change at any measurement site during the first 8 years of follow-up in the asymptomatic patients. The lumbar spine BMD was stable for the entire 15 years of follow-up. Overall, 59% of the asymptomatic patients had more than a 10% decline in BMD at one or more sites over the 15-year period. The study also reported that 15% of the patients who underwent surgery were symptomatic with kidney stones. At 15 years, serum calcium, PTH, and urinary calcium excretion were all significantly lower in comparison with the individual subjects’ baseline values and all well within normal limits. Post-operative increases in BMD were sustained with BMD remaining significantly above baseline for the entire 15 years of follow-up at all three skeletal sites. The committee noted that the findings of these studies were consistent with their clinical experience.</p></div></div></div><div id="ch9.rl.r1"><h2 id="_ch9_rl_r1_">References</h2><dl class="temp-labeled-list"><dl class="bkr_refwrap"><dt>1.</dt><dd><div class="bk_ref" id="ch9.ref1">Abdulkader
|
|
R, Dharmapalaiah
|
|
C, Stephenson
|
|
S, Clunie
|
|
G. The incidence of previously undiagnosed conditions in patients attending fracture liaison service. Annals of the Rheumatic Disease. 2012; 71:(Suppl 3):AB1040</div></dd></dl><dl class="bkr_refwrap"><dt>2.</dt><dd><div class="bk_ref" id="ch9.ref2">Agarwal
|
|
A, George
|
|
RK, Gupta
|
|
SK, Mishra
|
|
SK. Pancreatitis in patients with primary hyperparathyroidism. Indian Journal of Gastroenterology. 2003; 22(6):224–5 [<a href="https://pubmed.ncbi.nlm.nih.gov/15030035" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 15030035</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>3.</dt><dd><div class="bk_ref" id="ch9.ref3">Ahsan
|
|
T, Erum
|
|
U, Inam Pal
|
|
KM, Jabeen
|
|
R, Qureeshi
|
|
SG, Rehman
|
|
UL
|
|
et al. The many guises of primary hyperparathyroidism: An unchanged scenario. Journal of the Pakistan Medical Association. 2017; 67(4):580–5 [<a href="https://pubmed.ncbi.nlm.nih.gov/28420920" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28420920</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>4.</dt><dd><div class="bk_ref" id="ch9.ref4">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></dl><dl class="bkr_refwrap"><dt>5.</dt><dd><div class="bk_ref" id="ch9.ref5">Amaral
|
|
LM, Queiroz
|
|
DC, Marques
|
|
TF, Mendes
|
|
M, Bandeira
|
|
F. Normocalcemic versus hypercalcemic primary hyperparathyroidism: More stone than bone?
|
|
Journal of Osteoporosis. 2012; 2012:128352 [<a href="/pmc/articles/PMC3321560/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3321560</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/22545220" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 22545220</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>6.</dt><dd><div class="bk_ref" id="ch9.ref6">Antonelli
|
|
R, Falcone
|
|
S, Scillitani
|
|
A, Salcuni
|
|
AS, Carnevale
|
|
V, Battista
|
|
C
|
|
et al. Normocalcemic hyperparathyroidism: Studies on bone loss over a ten-year follow-up time. Endocrine Reviews. 2011; 32:(3 Suppl):P3–105</div></dd></dl><dl class="bkr_refwrap"><dt>7.</dt><dd><div class="bk_ref" id="ch9.ref7">Babey
|
|
M, Arampatzis
|
|
S, Popp
|
|
A, Schuematschek-Kainth
|
|
J, Kopp
|
|
PA, Lippuner
|
|
K. Normocalcemic primary hyperparathyroidism in patients with low bone mass: Biochemical and clinical characteristics. Journal of Bone and Mineral Research. 2010; 25(S1):S259</div></dd></dl><dl class="bkr_refwrap"><dt>8.</dt><dd><div class="bk_ref" id="ch9.ref8">Bai
|
|
HX, Giefer
|
|
M, Patel
|
|
M, Orabi
|
|
AI, Husain
|
|
SZ. The association of primary hyperparathyroidism with pancreatitis. Journal of Clinical Gastroenterology. 2012; 46(8):656–61 [<a href="/pmc/articles/PMC4428665/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4428665</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/22874807" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 22874807</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>9.</dt><dd><div class="bk_ref" id="ch9.ref9">Bailey
|
|
RR, Dann
|
|
E, Greenslade
|
|
NF, Little
|
|
PJ, McRae
|
|
CU, Utley
|
|
WL. Urinary stones: a prospective study of 350 patients. New Zealand Medical Journal. 1974; 79(516):961–5 [<a href="https://pubmed.ncbi.nlm.nih.gov/4528103" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 4528103</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>10.</dt><dd><div class="bk_ref" id="ch9.ref10">Bandeira
|
|
F, Griz
|
|
LH, Bandeira
|
|
C, Pinho
|
|
J, Lucena
|
|
CS, Alencar
|
|
C
|
|
et al. Prevalence of cortical osteoporosis in mild and severe primary hyperparathyroidism and its relationship with bone markers and vitamin D status. Journal of Clinical Densitometry. 2009; 12(2):195–9 [<a href="https://pubmed.ncbi.nlm.nih.gov/19138544" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19138544</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>11.</dt><dd><div class="bk_ref" id="ch9.ref11">Bandeira
|
|
L, Cozadd
|
|
D, Bucovsky
|
|
M, McMahon
|
|
DJ, Lee
|
|
JA, Silverberg
|
|
SJ
|
|
et al. Occult nephrolithiasis in primary hyperparathyroidism. Endocrine Reviews. 2016; 37(2 Suppl 1):FRI-333</div></dd></dl><dl class="bkr_refwrap"><dt>12.</dt><dd><div class="bk_ref" id="ch9.ref12">Bao
|
|
L, Li
|
|
Y, Lin
|
|
H. Effect of parathyroidectomy and pharmacotherapy in primary hyperthyroidism on bone metabolism. Osteoporosis International. 2013; 24:(Suppl 1):S125</div></dd></dl><dl class="bkr_refwrap"><dt>13.</dt><dd><div class="bk_ref" id="ch9.ref13">Battersby
|
|
C, Burnett
|
|
W, Winch
|
|
J. Pancreatitis associated with hyperparathyroidism. Medical Journal of Australia. 1969; 2(25):1268–70 [<a href="https://pubmed.ncbi.nlm.nih.gov/5309161" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 5309161</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>14.</dt><dd><div class="bk_ref" id="ch9.ref14">Beard
|
|
DE, Goodyear
|
|
WE. Hyperparathyroidism and urolithiasis. Journal of Urology. 1950; 64(5):638–42 [<a href="https://pubmed.ncbi.nlm.nih.gov/14785070" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 14785070</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>15.</dt><dd><div class="bk_ref" id="ch9.ref15">Bhadada
|
|
SK, Arya
|
|
AK, Mukhopadhyay
|
|
S, Khadgawat
|
|
R, Sukumar
|
|
S, Lodha
|
|
S
|
|
et al. Primary hyperparathyroidism: insights from the Indian PHPT registry. Journal of Bone and Mineral Metabolism. 2018; 36(2):238–45 [<a href="https://pubmed.ncbi.nlm.nih.gov/28364324" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28364324</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>16.</dt><dd><div class="bk_ref" id="ch9.ref16">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></dl><dl class="bkr_refwrap"><dt>17.</dt><dd><div class="bk_ref" id="ch9.ref17">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></dl><dl class="bkr_refwrap"><dt>18.</dt><dd><div class="bk_ref" id="ch9.ref18">Cannon
|
|
J, Lew
|
|
JI, Solorzano
|
|
CC. Parathyroidectomy for hypercalcemic crisis: 40 years’ experience and long-term outcomes. Surgery. 2010; 148(4):807–12; discussion 812–3 [<a href="https://pubmed.ncbi.nlm.nih.gov/20800863" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 20800863</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>19.</dt><dd><div class="bk_ref" id="ch9.ref19">Carnaille
|
|
B, Oudar
|
|
C, Pattou
|
|
F, Combemale
|
|
F, Rocha
|
|
J, Proye
|
|
C. Pancreatitis and primary hyperparathyroidism: forty cases. Australian and New Zealand Journal of Surgery. 1998; 68(2):117–9 [<a href="https://pubmed.ncbi.nlm.nih.gov/9494002" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9494002</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>20.</dt><dd><div class="bk_ref" id="ch9.ref20">Cassibba
|
|
S, Pellegrino
|
|
M, Gianotti
|
|
L, Baffoni
|
|
C, Baralis
|
|
E, Attanasio
|
|
R
|
|
et al. Silent renal stones in primary hyperparathyroidism: prevalence and clinical features. Endocrine Practice. 2014; 20(11):1137–42 [<a href="https://pubmed.ncbi.nlm.nih.gov/24936557" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24936557</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>21.</dt><dd><div class="bk_ref" id="ch9.ref21">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></dl><dl class="bkr_refwrap"><dt>22.</dt><dd><div class="bk_ref" id="ch9.ref22">Corlew
|
|
DS, Bryda
|
|
SL, Bradley
|
|
EL, 3rd, DiGirolamo
|
|
M. Observations on the course of untreated primary hyperparathyroidism. Surgery. 1985; 98(6):1064–71 [<a href="https://pubmed.ncbi.nlm.nih.gov/3878002" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 3878002</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>23.</dt><dd><div class="bk_ref" id="ch9.ref23">Csupor
|
|
E, Toth
|
|
E, Meszaros
|
|
S, Ferencz
|
|
V, Szucs
|
|
J, Lakatos
|
|
P
|
|
et al. Is there any connection between the presence of kidney stones in primary hyperparathyroidism and the location of an underlying adenoma?
|
|
Experimental and Clinical Endocrinology and Diabetes. 2005; 113(5):257–61 [<a href="https://pubmed.ncbi.nlm.nih.gov/15926110" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 15926110</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>24.</dt><dd><div class="bk_ref" id="ch9.ref24">Curtis
|
|
L, Burns
|
|
A. Unit costs of health and social care 2017. Canterbury. Personal Social Services Research Unit University of Kent, 2017. Available from: <a href="https://www.pssru.ac.uk/project-pages/unit-costs/unit-costs-2017/" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">https://www<wbr style="display:inline-block"></wbr>​.pssru.ac<wbr style="display:inline-block"></wbr>​.uk/project-pages/unit-costs<wbr style="display:inline-block"></wbr>​/unit-costs-2017/</a></div></dd></dl><dl class="bkr_refwrap"><dt>25.</dt><dd><div class="bk_ref" id="ch9.ref25">Danzi
|
|
JT, Farmer
|
|
RG, Esselstyn
|
|
CB, Jr.
|
|
Recurrent pancreatitis associated with normocalcemia, parathyroid hyperplasia, and increased serum parathormone. Cleveland Clinic Quarterly. 1974; 41(1):39–43 [<a href="https://pubmed.ncbi.nlm.nih.gov/4822430" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 4822430</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>26.</dt><dd><div class="bk_ref" id="ch9.ref26">De Geronimo
|
|
S, Romagnoli
|
|
E, Diacinti
|
|
D, D’Erasmo
|
|
E, Minisola
|
|
S. The risk of fractures in postmenopausal women with primary hyperparathyroidism. European Journal of Endocrinology. 2006; 155(3):415–20 [<a href="https://pubmed.ncbi.nlm.nih.gov/16914595" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 16914595</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>27.</dt><dd><div class="bk_ref" id="ch9.ref27">Deaconson
|
|
TF, Wilson
|
|
SD, Lemann
|
|
J, Jr.
|
|
The effect of parathyroidectomy on the recurrence of nephrolithiasis. Surgery. 1987; 102(6):910–3 [<a href="https://pubmed.ncbi.nlm.nih.gov/3686354" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 3686354</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>28.</dt><dd><div class="bk_ref" id="ch9.ref28">Department of Health. NHS reference costs 2016/2017. Available from: <a href="https://improvement.nhs.uk/resources/reference-costs/" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">https://improvement<wbr style="display:inline-block"></wbr>​.nhs<wbr style="display:inline-block"></wbr>​.uk/resources/reference-costs/</a> Last accessed: 17/01/2018.</div></dd></dl><dl class="bkr_refwrap"><dt>29.</dt><dd><div class="bk_ref" id="ch9.ref29">Department of Health. NHS reference costs 2010–11. 2012. Available from: <a href="http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_131140" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">http://www<wbr style="display:inline-block"></wbr>​.dh.gov.uk<wbr style="display:inline-block"></wbr>​/en/Publicationsandstatistics<wbr style="display:inline-block"></wbr>​/Publications<wbr style="display:inline-block"></wbr>​/PublicationsPolicyAndGuidance<wbr style="display:inline-block"></wbr>​/DH_131140</a> Last accessed: 05/10/2018.</div></dd></dl><dl class="bkr_refwrap"><dt>30.</dt><dd><div class="bk_ref" id="ch9.ref30">Diaz De La Guardia
|
|
FV, Martin
|
|
MA, Arrabal Polo
|
|
MA, Flores
|
|
SQ, Ortiz
|
|
JLM, Gomez
|
|
AZ. Renal lithiasis in patients with primary hyperparathyroidism. Evolution and treatment. Archivos Españoles de Urología. 2010; 63(1):32–40 [<a href="https://pubmed.ncbi.nlm.nih.gov/20157217" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 20157217</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>31.</dt><dd><div class="bk_ref" id="ch9.ref31">Dimkovic
|
|
NB, Wallele
|
|
AA, Oreopoulos
|
|
DG. Renal stone disease, elevated iPTH level and normocalcemia. International Urology and Nephrology. 2002; 34(1):135–41 [<a href="https://pubmed.ncbi.nlm.nih.gov/12549656" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12549656</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>32.</dt><dd><div class="bk_ref" id="ch9.ref32">Dolgin
|
|
C, Lo Gerfo
|
|
P, LiVolsi
|
|
V, Feind
|
|
C. Twenty-five year experience with primary hyperparathyroidism at Columbia Presbyterian Medical Center. Head and Neck Surgery. 1979; 2(2):92–8 [<a href="https://pubmed.ncbi.nlm.nih.gov/264110" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 264110</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>33.</dt><dd><div class="bk_ref" id="ch9.ref33">Dumitrescu
|
|
B, van Helden
|
|
S, ten Broeke
|
|
R, Nieuwenhuijzen-Kruseman
|
|
A, Wyers
|
|
C, Udrea
|
|
G
|
|
et al. Evaluation of patients with a recent clinical fracture and osteoporosis, a multidisciplinary approach. BMC Musculoskeletal Disorders. 2008; 9:109 [<a href="/pmc/articles/PMC2529301/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC2529301</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/18680609" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18680609</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>34.</dt><dd><div class="bk_ref" id="ch9.ref34">Eufrazino
|
|
C, Veras
|
|
A, Bandeira
|
|
F. Epidemiology of primary hyperparathyroidism and its non-classical manifestations in the city of Recife, Brazil. Clinical Medicine Insights: Endocrinology and Diabetes. 2013; 6:69–74 [<a href="/pmc/articles/PMC3864738/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3864738</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/24348080" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24348080</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>35.</dt><dd><div class="bk_ref" id="ch9.ref35">Falko
|
|
JM, Maeder
|
|
MC, Conway
|
|
C, Mazzaferri
|
|
EL, Skillman
|
|
TG. Primary hyperparathyroidism: Analysis of 220 patients with special emphasis on familial hypocalciuric hypercalcemia. Heart and Lung. 1984; 13(2):124–31 [<a href="https://pubmed.ncbi.nlm.nih.gov/6559790" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 6559790</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>36.</dt><dd><div class="bk_ref" id="ch9.ref36">Filby
|
|
A, Lewis
|
|
L, Taylor
|
|
M. An economic evaluation of interventions to improve the uptake of vitamin D supplements in England and Wales. London. National Institute for Health and Care Excellence, 2014. Available from: <a href="https://www.nice.org.uk/guidance/ph56/documents/economic-evaluation-report2" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">https://www<wbr style="display:inline-block"></wbr>​.nice.org<wbr style="display:inline-block"></wbr>​.uk/guidance/ph56/documents<wbr style="display:inline-block"></wbr>​/economic-evaluation-report2</a></div></dd></dl><dl class="bkr_refwrap"><dt>37.</dt><dd><div class="bk_ref" id="ch9.ref37">Heath
|
|
H, 3rd. Clinical spectrum of primary hyperparathyroidism: evolution with changes in medical practice and technology. Journal of Bone and Mineral Research. 1991; 6 (Suppl 2):S63–70; discussion S83–4 [<a href="https://pubmed.ncbi.nlm.nih.gov/1763671" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 1763671</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>38.</dt><dd><div class="bk_ref" id="ch9.ref38">Hedback
|
|
G, Oden
|
|
A. Increased risk of death from primary hyperparathyroidism-an update. European Journal of Clinical Investigation. 1998; 28(4):271–6 [<a href="https://pubmed.ncbi.nlm.nih.gov/9615902" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9615902</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>39.</dt><dd><div class="bk_ref" id="ch9.ref39">Hedback
|
|
GM, Oden
|
|
AS. Cardiovascular disease, hypertension and renal function in primary hyperparathyroidism. Journal of Internal Medicine. 2002; 251(6):476–83 [<a href="https://pubmed.ncbi.nlm.nih.gov/12028502" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12028502</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>40.</dt><dd><div class="bk_ref" id="ch9.ref40">Jha
|
|
S, Jayaraman
|
|
M, Jha
|
|
A, Jha
|
|
R, Modi
|
|
KD, Kelwadee
|
|
JV. Primary hyperparathyroidism: A changing scenario in India. Indian Journal of Endocrinology and Metabolism. 2016; 20(1):80–3 [<a href="/pmc/articles/PMC4743389/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4743389</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/26904473" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26904473</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>41.</dt><dd><div class="bk_ref" id="ch9.ref41">Kenny
|
|
AM, MacGillivray
|
|
DC, Pilbeam
|
|
CC, Crombie
|
|
HD, Raisz
|
|
LG. Fracture incidence in postmenopausal women with primary hyperparathyroidism. Surgery. 1995; 118(1):109–14 [<a href="https://pubmed.ncbi.nlm.nih.gov/7604371" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 7604371</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>42.</dt><dd><div class="bk_ref" id="ch9.ref42">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></dl><dl class="bkr_refwrap"><dt>43.</dt><dd><div class="bk_ref" id="ch9.ref43">Kobayashi
|
|
T, Sugimoto
|
|
T, Chihara
|
|
K. Clinical and biochemical presentation of primary hyperparathyroidism in Kansai district of Japan. Endocrine Journal. 1997; 44(4):595–601 [<a href="https://pubmed.ncbi.nlm.nih.gov/9447296" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9447296</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>44.</dt><dd><div class="bk_ref" id="ch9.ref44">Larsson
|
|
K, Lindh
|
|
E, Lind
|
|
L, Persson
|
|
I, Ljunghall
|
|
S. Increased fracture risk in hypercalcemia. Bone mineral content measured in hyperparathyroidism. Acta Orthopaedica Scandinavica. 1989; 60(3):268–70 [<a href="https://pubmed.ncbi.nlm.nih.gov/2750498" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 2750498</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>45.</dt><dd><div class="bk_ref" id="ch9.ref45">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></dl><dl class="bkr_refwrap"><dt>46.</dt><dd><div class="bk_ref" id="ch9.ref46">Lowe
|
|
H, McMahon
|
|
DJ, Rubin
|
|
MR, Bilezikian
|
|
JP, Silverberg
|
|
SJ. Normocalcemic primary hyperparathyroidism: further characterization of a new clinical phenotype. Journal of Clinical Endocrinology and Metabolism. 2007; 92(8):3001–5 [<a href="https://pubmed.ncbi.nlm.nih.gov/17536001" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 17536001</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>47.</dt><dd><div class="bk_ref" id="ch9.ref47">Lueg
|
|
MC. Hypertension and primary hyperparathyroidism: a five-year case review. Southern Medical Journal. 1982; 75(11):1371–4 [<a href="https://pubmed.ncbi.nlm.nih.gov/7146970" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 7146970</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>48.</dt><dd><div class="bk_ref" id="ch9.ref48">Marques
|
|
TF, Vasconcelos
|
|
R, Diniz
|
|
E, Rego
|
|
D, Griz
|
|
L, Bandeira
|
|
F. Normocalcemic primary hyperparathyroidism in clinical practice: an indolent condition or a silent threat?
|
|
Arquivos Brasileiros de Endocrinologia e Metabologia. 2011; 55(5):314–7 [<a href="/pmc/articles/PMC4357231/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4357231</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/21881813" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21881813</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>49.</dt><dd><div class="bk_ref" id="ch9.ref49">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></dl><dl class="bkr_refwrap"><dt>50.</dt><dd><div class="bk_ref" id="ch9.ref50">Misiorowski
|
|
W, Zgliczyski
|
|
W. Prevalence of primary hyperparathyroidism among patients with low bone mass. Advances in Medical Sciences. 2012; 57(2):308–13 [<a href="https://pubmed.ncbi.nlm.nih.gov/23314564" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23314564</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>51.</dt><dd><div class="bk_ref" id="ch9.ref51">Mollerup
|
|
CL, Lindewald
|
|
H. Renal stones and primary hyperparathyroidism: natural history of renal stone disease after successful parathyroidectomy. World Journal of Surgery. 1999; 23(2):173–5; discussion 176 [<a href="https://pubmed.ncbi.nlm.nih.gov/9880427" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9880427</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>52.</dt><dd><div class="bk_ref" id="ch9.ref52">National Clinical Guideline Centre. Hypertension: the clinical managment of primary hypertension in adults: update of clinical guidelines 18 and 34. NICE clinical guideline 127. London. National Clinical Guideline Centre, 2011. Available from: <a href="http://guidance.nice.org.uk/CG127" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">http://guidance<wbr style="display:inline-block"></wbr>​.nice.org.uk/CG127</a></div></dd></dl><dl class="bkr_refwrap"><dt>53.</dt><dd><div class="bk_ref" id="ch9.ref53">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></dl><dl class="bkr_refwrap"><dt>54.</dt><dd><div class="bk_ref" id="ch9.ref54">National Institute for Health and Care Excellence. Bisphosphonates for treating osteoporosis. NICE technology appraisal guidance 464. London. National Institute for Health and Care Excellence, 2017. Available from: <a href="http://guidance.nice.org.uk/TA464" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">http://guidance<wbr style="display:inline-block"></wbr>​.nice.org.uk/TA464</a></div></dd></dl><dl class="bkr_refwrap"><dt>55.</dt><dd><div class="bk_ref" id="ch9.ref55">Nilsson
|
|
IL, Aberg
|
|
J, Rastad
|
|
J, Lind
|
|
L. Maintained normalization of cardiovascular dysfunction 5 years after parathyroidectomy in primary hyperparathyroidism. Surgery. 2005; 137(6):632–8 [<a href="https://pubmed.ncbi.nlm.nih.gov/15933631" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 15933631</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>56.</dt><dd><div class="bk_ref" id="ch9.ref56">Pradeep
|
|
PV, Mishra
|
|
A, Agarwal
|
|
G, Agarwal
|
|
A, Verma
|
|
AK, Mishra
|
|
SK. Long-term outcome after parathyroidectomy in patients with advanced primary hyperparathyroidism and associated vitamin D deficiency. World Journal of Surgery. 2008; 32(5):829–35 [<a href="https://pubmed.ncbi.nlm.nih.gov/18204946" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18204946</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>57.</dt><dd><div class="bk_ref" id="ch9.ref57">Pratley
|
|
SK, Posen
|
|
S, Reeve
|
|
TS. Primary hyperparathyroidism. Experiences with 60 patients. Medical Journal of Australia. 1973; 1(9):421–6 [<a href="https://pubmed.ncbi.nlm.nih.gov/4708924" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 4708924</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>58.</dt><dd><div class="bk_ref" id="ch9.ref58">Purnell
|
|
DC, Smith
|
|
LH, Scholz
|
|
DA, Elveback
|
|
LR, Arnaud
|
|
CD. Primary hyperparathyroidism: a prospective clinical study. American Journal of Medicine. 1971; 50(5):670–8 [<a href="https://pubmed.ncbi.nlm.nih.gov/5575549" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 5575549</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>59.</dt><dd><div class="bk_ref" id="ch9.ref59">Rajeevan
|
|
T, Cunning
|
|
C, Abdulla
|
|
A. 26 management of primary hyperparathyroidism (PHPT) in older people: A series review. Age and Ageing. 2014; 43(Suppl_1):i6–i6</div></dd></dl><dl class="bkr_refwrap"><dt>60.</dt><dd><div class="bk_ref" id="ch9.ref60">Ronni-Sivula
|
|
H. Causes of death in patients previously operated on for primary hyperparathyroidism. Annales Chirurgiae et Gynaecologiae. 1985; 74(1):13–8 [<a href="https://pubmed.ncbi.nlm.nih.gov/4015016" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 4015016</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>61.</dt><dd><div class="bk_ref" id="ch9.ref61">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></dl><dl class="bkr_refwrap"><dt>62.</dt><dd><div class="bk_ref" id="ch9.ref62">Scholz
|
|
DA, Purnell
|
|
DC. Asymptomatic primary hyperparathyroidism. 10-year prospective study. Mayo Clinic Proceedings. 1981; 56(8):473–8 [<a href="https://pubmed.ncbi.nlm.nih.gov/7266058" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 7266058</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>63.</dt><dd><div class="bk_ref" id="ch9.ref63">Siilin
|
|
H, Lundgren
|
|
E, Mallmin
|
|
H, Mellstrom
|
|
D, Ohlsson
|
|
C, Karlsson
|
|
M
|
|
et al. Prevalence of primary hyperparathyroidism and impact on bone mineral density in elderly men: MrOs Sweden. World Journal of Surgery. 2011; 35(6):1266–72 [<a href="https://pubmed.ncbi.nlm.nih.gov/21445668" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21445668</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>64.</dt><dd><div class="bk_ref" id="ch9.ref64">Silverberg
|
|
SJ, Gartenberg
|
|
F, Jacobs
|
|
TP, Shane
|
|
E, Siris
|
|
E, Staron
|
|
RB
|
|
et al. Longitudinal measurements of bone density and biochemical indices in untreated primary hyperparathyroidism. Journal of Clinical Endocrinology and Metabolism. 1995; 80(3):723–8 [<a href="https://pubmed.ncbi.nlm.nih.gov/7883823" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 7883823</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>65.</dt><dd><div class="bk_ref" id="ch9.ref65">Silverberg
|
|
SJ, Shane
|
|
E, Jacobs
|
|
TP, Siris
|
|
ES, Gartenberg
|
|
F, Seldin
|
|
D
|
|
et al. Nephrolithiasis and bone involvement in primary hyperparathyroidism. American Journal of Medicine. 1990; 89(3):327–34 [<a href="https://pubmed.ncbi.nlm.nih.gov/2393037" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 2393037</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>66.</dt><dd><div class="bk_ref" id="ch9.ref66">Siminovitch
|
|
JM, James
|
|
RE, Esselstyn
|
|
CB, Jr., Straffon
|
|
RA, Banowsky
|
|
LH. The effect of parathyroidectomy in patients with normocalcemic calcium stones. Journal of Urology. 1980; 123(3):335–7 [<a href="https://pubmed.ncbi.nlm.nih.gov/7359630" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 7359630</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>67.</dt><dd><div class="bk_ref" id="ch9.ref67">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></dl><dl class="bkr_refwrap"><dt>68.</dt><dd><div class="bk_ref" id="ch9.ref68">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></dl><dl class="bkr_refwrap"><dt>69.</dt><dd><div class="bk_ref" id="ch9.ref69">Suh
|
|
JM, Cronan
|
|
JJ, Monchik
|
|
JM. Primary hyperparathyroidism: is there an increased prevalence of renal stone disease?
|
|
American Journal of Roentgenology. 2008; 191(3):908–11 [<a href="https://pubmed.ncbi.nlm.nih.gov/18716127" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18716127</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>70.</dt><dd><div class="bk_ref" id="ch9.ref70">Turchi
|
|
JJ, Flandreau
|
|
RH, Forte
|
|
AL, French
|
|
GN, Ludwig
|
|
GD. Hyperparathyroidism and pancreatitis. JAMA. 1962; 180(10):799–804 [<a href="https://pubmed.ncbi.nlm.nih.gov/13923130" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 13923130</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>71.</dt><dd><div class="bk_ref" id="ch9.ref71">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></dl><dl class="bkr_refwrap"><dt>72.</dt><dd><div class="bk_ref" id="ch9.ref72">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></dl><dl class="bkr_refwrap"><dt>73.</dt><dd><div class="bk_ref" id="ch9.ref73">Vestergaard
|
|
P, Mollerup
|
|
CL, Frokjaer
|
|
VG, Christiansen
|
|
P, Blichert-Toft
|
|
M, Mosekilde
|
|
L. Cohort study of risk of fracture before and after surgery for primary hyperparathyroidism. BMJ. 2000; 321(7261):598–602 [<a href="/pmc/articles/PMC27473/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC27473</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/10977834" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 10977834</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>74.</dt><dd><div class="bk_ref" id="ch9.ref74">Vestergaard
|
|
P, Mollerup
|
|
CL, Frokjaer
|
|
VG, Christiansen
|
|
P, Blichert-Toft
|
|
M, Mosekilde
|
|
L. Cardiovascular events before and after surgery for primary hyperparathyroidism. World Journal of Surgery. 2003; 27(2):216–22 [<a href="https://pubmed.ncbi.nlm.nih.gov/12616440" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12616440</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>75.</dt><dd><div class="bk_ref" id="ch9.ref75">Vestergaard
|
|
P, Mosekilde
|
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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></dl><dl class="bkr_refwrap"><dt>76.</dt><dd><div class="bk_ref" id="ch9.ref76">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></dl><dl class="bkr_refwrap"><dt>77.</dt><dd><div class="bk_ref" id="ch9.ref77">Vestergaard
|
|
P, Mosekilde
|
|
L. Parathyroid surgery is associated with a decreased risk of hip and upper arm fractures in primary hyperparathyroidism: a controlled cohort study. Journal of Internal Medicine. 2004; 255(1):108–14 [<a href="https://pubmed.ncbi.nlm.nih.gov/14687246" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 14687246</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>78.</dt><dd><div class="bk_ref" id="ch9.ref78">Wermers
|
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RA, Khosla
|
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S, Atkinson
|
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EJ, Grant
|
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CS, Hodgson
|
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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></dl><dl class="bkr_refwrap"><dt>79.</dt><dd><div class="bk_ref" id="ch9.ref79">Wilson
|
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RJ, Rao
|
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S, Ellis
|
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B, Kleerekoper
|
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M, Parfitt
|
|
AM. Mild asymptomatic primary hyperparathyroidism is not a risk factor for vertebral fractures. Annals of Internal Medicine. 1988; 109(12):959–62 [<a href="https://pubmed.ncbi.nlm.nih.gov/3195878" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 3195878</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>80.</dt><dd><div class="bk_ref" id="ch9.ref80">Yu
|
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N, Donnan
|
|
PT, Leese
|
|
GP. A record linkage study of outcomes in patients with mild primary hyperparathyroidism: the Parathyroid Epidemiology and Audit Research Study (PEARS). Clinical Endocrinology. 2011; 75(2):169–76 [<a href="https://pubmed.ncbi.nlm.nih.gov/21158894" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21158894</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>81.</dt><dd><div class="bk_ref" id="ch9.ref81">Yu
|
|
N, Donnan
|
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PT, Murphy
|
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MJ, Leese
|
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GP. Epidemiology of primary hyperparathyroidism in Tayside, Scotland, UK. Clinical Endocrinology. 2009; 71(4):485–93 [<a href="https://pubmed.ncbi.nlm.nih.gov/19751296" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19751296</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>82.</dt><dd><div class="bk_ref" id="ch9.ref82">Yu
|
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N, Leese
|
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GP, Donnan
|
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PT. What predicts adverse outcomes in untreated primary hyperparathyroidism? the Parathyroid Epidemiology and Audit Research Study (PEARS). Clinical Endocrinology. 2013; 79(1):27–34 [<a href="https://pubmed.ncbi.nlm.nih.gov/23506565" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23506565</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>83.</dt><dd><div class="bk_ref" id="ch9.ref83">Yu
|
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N, Leese
|
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GP, Smith
|
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D, Donnan
|
|
PT. The natural history of treated and untreated primary hyperparathyroidism: The parathyroid epidemiology and audit research study. QJM: An International Journal of Medicine. 2011; 104(6):513–21 [<a href="https://pubmed.ncbi.nlm.nih.gov/21266486" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21266486</span></a>]</div></dd></dl></dl></div><div id="appendixesappgroup9"><h2 id="_appendixesappgroup9_">Appendices</h2><div id="ch9.appa"><h3>Appendix A. Review protocols</h3><p id="ch9.appa.tab1"><a href="/books/NBK577896/table/ch9.appa.tab1/?report=objectonly" target="object" rid-ob="figobch9appatab1" class="figpopup">Table 12. Review protocol: Monitoring strategies</a></p><p id="ch9.appa.tab2"><a href="/books/NBK577896/table/ch9.appa.tab2/?report=objectonly" target="object" rid-ob="figobch9appatab2" class="figpopup">Table 13. Monitoring long term outcomes protocol</a></p><p id="ch9.appa.tab3"><a href="/books/NBK577896/table/ch9.appa.tab3/?report=objectonly" target="object" rid-ob="figobch9appatab3" class="figpopup">Table 14. Health economic review protocol</a></p></div><div id="ch9.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="ch9.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 are therefore difficult to retrieve. Search filters were applied to the search where appropriate.</p><p id="ch9.appb.tab1"><a href="/books/NBK577896/table/ch9.appb.tab1/?report=objectonly" target="object" rid-ob="figobch9appbtab1" class="figpopup">Table 15. Database date parameters and filters used</a></p><p id="ch9.appb.tab2"><a href="/books/NBK577896/table/ch9.appb.tab2/?report=objectonly" target="object" rid-ob="figobch9appbtab2" class="figpopup">Medline (Ovid) search terms</a></p><p id="ch9.appb.tab3"><a href="/books/NBK577896/table/ch9.appb.tab3/?report=objectonly" target="object" rid-ob="figobch9appbtab3" class="figpopup">Embase (Ovid) search terms</a></p><p id="ch9.appb.tab4"><a href="/books/NBK577896/table/ch9.appb.tab4/?report=objectonly" target="object" rid-ob="figobch9appbtab4" class="figpopup">Cochrane Library (Wiley) search terms</a></p><p id="ch9.appb.tab5"><a href="/books/NBK577896/table/ch9.appb.tab5/?report=objectonly" target="object" rid-ob="figobch9appbtab5" class="figpopup">CINAHL (EBSCO) search terms</a></p><p id="ch9.appb.tab6"><a href="/books/NBK577896/table/ch9.appb.tab6/?report=objectonly" target="object" rid-ob="figobch9appbtab6" class="figpopup">PsycINFO (ProQuest) search terms</a></p></div><div id="ch9.appb.s2"><h4>B.2. Health Economics literature search strategy</h4><p>Health economic evidence was identified by conducting a broad search relating to primary hyperparathyroidism population in 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. 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><p id="ch9.appb.tab7"><a href="/books/NBK577896/table/ch9.appb.tab7/?report=objectonly" target="object" rid-ob="figobch9appbtab7" class="figpopup">Table 16. Database date parameters and filters used</a></p><p id="ch9.appb.tab8"><a href="/books/NBK577896/table/ch9.appb.tab8/?report=objectonly" target="object" rid-ob="figobch9appbtab8" class="figpopup">Medline (Ovid) search terms</a></p><p id="ch9.appb.tab9"><a href="/books/NBK577896/table/ch9.appb.tab9/?report=objectonly" target="object" rid-ob="figobch9appbtab9" class="figpopup">Embase (Ovid) search terms</a></p><p id="ch9.appb.tab10"><a href="/books/NBK577896/table/ch9.appb.tab10/?report=objectonly" target="object" rid-ob="figobch9appbtab10" class="figpopup">NHS EED and HTA (CRD) search terms</a></p></div></div><div id="ch9.appc"><h3>Appendix C. Clinical evidence selection</h3><p id="ch9.appc.fig1"><a href="/books/NBK577896/figure/ch9.appc.fig1/?report=objectonly" target="object" rid-ob="figobch9appcfig1" class="figpopup">Figure 1. Flow chart of clinical study selection for the review of Monitoring strategies</a></p><p id="ch9.appc.fig2"><a href="/books/NBK577896/figure/ch9.appc.fig2/?report=objectonly" target="object" rid-ob="figobch9appcfig2" class="figpopup">Figure 2. Flow chart of clinical study selection for the review of Monitoring long-term outcomes</a></p></div><div id="ch9.appd"><h3>Appendix D. Clinical evidence tables</h3><p id="ch9.appd.et1"><a href="/books/NBK577896/bin/ch9-appd-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (383K)</span></p></div><div id="ch9.appe"><h3>Appendix E. Forest plots</h3><div id="ch9.appe.s1"><h4>E.1. PHPT cases versus matched comparators (adjusted for key confounders) Strata – Non-surgical</h4><p id="ch9.appe.fig1"><a href="/books/NBK577896/figure/ch9.appe.fig1/?report=objectonly" target="object" rid-ob="figobch9appefig1" class="figpopup">Figure 3. All-cause mortality</a></p><p id="ch9.appe.fig2"><a href="/books/NBK577896/figure/ch9.appe.fig2/?report=objectonly" target="object" rid-ob="figobch9appefig2" class="figpopup">Figure 4. Fatal CVD</a></p><p id="ch9.appe.fig3"><a href="/books/NBK577896/figure/ch9.appe.fig3/?report=objectonly" target="object" rid-ob="figobch9appefig3" class="figpopup">Figure 5. Non-fatal CVD</a></p><p id="ch9.appe.fig4"><a href="/books/NBK577896/figure/ch9.appe.fig4/?report=objectonly" target="object" rid-ob="figobch9appefig4" class="figpopup">Figure 6. Cerebrovascular disease</a></p><p id="ch9.appe.fig5"><a href="/books/NBK577896/figure/ch9.appe.fig5/?report=objectonly" target="object" rid-ob="figobch9appefig5" class="figpopup">Figure 7. Hypertension</a></p><p id="ch9.appe.fig6"><a href="/books/NBK577896/figure/ch9.appe.fig6/?report=objectonly" target="object" rid-ob="figobch9appefig6" class="figpopup">Figure 8. Renal failure</a></p><p id="ch9.appe.fig7"><a href="/books/NBK577896/figure/ch9.appe.fig7/?report=objectonly" target="object" rid-ob="figobch9appefig7" class="figpopup">Figure 9. Renal stones</a></p><p id="ch9.appe.fig8"><a href="/books/NBK577896/figure/ch9.appe.fig8/?report=objectonly" target="object" rid-ob="figobch9appefig8" class="figpopup">Figure 10. All fractures</a></p><p id="ch9.appe.fig9"><a href="/books/NBK577896/figure/ch9.appe.fig9/?report=objectonly" target="object" rid-ob="figobch9appefig9" class="figpopup">Figure 11. Osteoporotic fractures</a></p></div><div id="ch9.appe.s2"><h4>E.2. PHPT versus control (no multivariate analysis) Stratum-Pre-surgery</h4><p id="ch9.appe.fig10"><a href="/books/NBK577896/figure/ch9.appe.fig10/?report=objectonly" target="object" rid-ob="figobch9appefig10" class="figpopup">Figure 12. Renal stones</a></p></div><div id="ch9.appe.s3"><h4>E.3. PHPT cases versus control (no multivariate analysis)-Strata – Pre-operative and post-operative (surgery and non-surgery patients)</h4><p id="ch9.appe.fig11"><a href="/books/NBK577896/figure/ch9.appe.fig11/?report=objectonly" target="object" rid-ob="figobch9appefig11" class="figpopup">Figure 13. Fractures (all)</a></p><p id="ch9.appe.fig12"><a href="/books/NBK577896/figure/ch9.appe.fig12/?report=objectonly" target="object" rid-ob="figobch9appefig12" class="figpopup">Figure 14. Lumbar spine-BMD (gm/cm<sup>2</sup>) (mild PHPT versus healthy women)</a></p><p id="ch9.appe.fig13"><a href="/books/NBK577896/figure/ch9.appe.fig13/?report=objectonly" target="object" rid-ob="figobch9appefig13" class="figpopup">Figure 15. FN BMD (mg/cm<sup>2</sup>) (mild PHPT versus healthy women)</a></p><p id="ch9.appe.fig14"><a href="/books/NBK577896/figure/ch9.appe.fig14/?report=objectonly" target="object" rid-ob="figobch9appefig14" class="figpopup">Figure 16. FT BMD (mg/cm<sup>2</sup>) (mild PHPT versus healthy women)</a></p><p id="ch9.appe.fig15"><a href="/books/NBK577896/figure/ch9.appe.fig15/?report=objectonly" target="object" rid-ob="figobch9appefig15" class="figpopup">Figure 17. Vertebral fractures (mild PHPT versus control)</a></p><p id="ch9.appe.fig16"><a href="/books/NBK577896/figure/ch9.appe.fig16/?report=objectonly" target="object" rid-ob="figobch9appefig16" class="figpopup">Figure 18. Vertebral fractures (non-mild PHPT versus healthy women)</a></p><p id="ch9.appe.fig17"><a href="/books/NBK577896/figure/ch9.appe.fig17/?report=objectonly" target="object" rid-ob="figobch9appefig17" class="figpopup">Figure 19. Non-vertebral fractures (mild PHPT versus healthy women)</a></p><p id="ch9.appe.fig18"><a href="/books/NBK577896/figure/ch9.appe.fig18/?report=objectonly" target="object" rid-ob="figobch9appefig18" class="figpopup">Figure 20. Non-vertebral fractures (non-mild PHPT versus healthy women)</a></p><p id="ch9.appe.fig19"><a href="/books/NBK577896/figure/ch9.appe.fig19/?report=objectonly" target="object" rid-ob="figobch9appefig19" class="figpopup">Figure 21. LS-BMD (mg/cm<sup>2</sup>) (non-mild PHPT versus healthy women)</a></p><p id="ch9.appe.fig20"><a href="/books/NBK577896/figure/ch9.appe.fig20/?report=objectonly" target="object" rid-ob="figobch9appefig20" class="figpopup">Figure 22. Femur neck-BMD (mg/cm<sup>2</sup>) (non-mild PHPT versus healthy women)</a></p><p id="ch9.appe.fig21"><a href="/books/NBK577896/figure/ch9.appe.fig21/?report=objectonly" target="object" rid-ob="figobch9appefig21" class="figpopup">Figure 23. Total femur-BMD (mg/cm<sup>2</sup>) (non-mild PHPT versus healthy women)</a></p></div><div id="ch9.appe.s4"><h4>E.4. PHPT cases versus control (no multivariate analysis) – strata post-operative</h4><p id="ch9.appe.fig22"><a href="/books/NBK577896/figure/ch9.appe.fig22/?report=objectonly" target="object" rid-ob="figobch9appefig22" class="figpopup">Figure 24. Mortality</a></p><p id="ch9.appe.fig23"><a href="/books/NBK577896/figure/ch9.appe.fig23/?report=objectonly" target="object" rid-ob="figobch9appefig23" class="figpopup">Figure 25. Fractures</a></p></div></div><div id="ch9.appf"><h3>Appendix F. GRADE tables</h3><p id="ch9.appf.tab1"><a href="/books/NBK577896/table/ch9.appf.tab1/?report=objectonly" target="object" rid-ob="figobch9appftab1" class="figpopup">Table 17. Clinical evidence profile: PHPT cases versus matched comparators (adjusted for key confounders) – non-surgical</a></p><p id="ch9.appf.tab2"><a href="/books/NBK577896/table/ch9.appf.tab2/?report=objectonly" target="object" rid-ob="figobch9appftab2" class="figpopup">Table 18. Clinical evidence profile: PHPT versus control (no multivariate analysis) – Pre-operative</a></p><p id="ch9.appf.tab3"><a href="/books/NBK577896/table/ch9.appf.tab3/?report=objectonly" target="object" rid-ob="figobch9appftab3" class="figpopup">Table 19. Clinical evidence profile: PHPT versus control (no multivariate analysis) – Mixed pre-operative and post-operative (surgical and non-surgical patients)</a></p><p id="ch9.appf.tab4"><a href="/books/NBK577896/table/ch9.appf.tab4/?report=objectonly" target="object" rid-ob="figobch9appftab4" class="figpopup">Table 20. Clinical evidence profile: PHPT versus control (no multivariate analysis) – strata post-operative</a></p></div><div id="ch9.appg"><h3>Appendix G. Health economic evidence selection</h3><p id="ch9.appg.fig1"><a href="/books/NBK577896/figure/ch9.appg.fig1/?report=objectonly" target="object" rid-ob="figobch9appgfig1" class="figpopup">Figure 26. Flow chart of health economic study selection for the guideline</a></p></div><div id="ch9.apph"><h3>Appendix H. Health economic evidence tables</h3><p>No economic studies were included in this review.</p></div><div id="ch9.appi"><h3>Appendix I. Excluded studies</h3><div id="ch9.appi.s1"><h4>I.1. Excluded clinical studies</h4><p id="ch9.appi.tab1"><a href="/books/NBK577896/table/ch9.appi.tab1/?report=objectonly" target="object" rid-ob="figobch9appitab1" class="figpopup">Table 21. Studies excluded from the clinical review</a></p></div><div id="ch9.appi.s2"><h4>I.2. Excluded health economic studies</h4><p>None.</p></div></div><div id="ch9.appj"><h3>Appendix J. Research recommendations</h3><div id="ch9.appj.s1"><h4>J.1. Long-term consequences of management strategies for PHPT</h4><div id="ch9.appj.s1.1"><h5>Research question: What are the long-term outcomes of different management strategies for primary hyperparathyroidism? What strategies are most cost-effective?</h5><div id="ch9.appj.s1.1.1"><h5>Why this is important</h5><p>There is limited evidence on the long-term outcomes of the different management strategies such as surgery, calcimimetics and bisphosphonates (see evidence report C, evidence report G and evidence report H). In order for people to make an informed choice regarding their treatment research is needed on this topic.</p><p id="ch9.appj.tab1"><a href="/books/NBK577896/table/ch9.appj.tab1/?report=objectonly" target="object" rid-ob="figobch9appjtab1" class="figpopup">Criteria for selecting high-priority research recommendations</a></p></div></div></div></div></div></div><div class="fm-sec"><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 class="half_rhythm"><a href="/books/about/copyright/">Copyright</a> © NICE 2019.</div><div class="small"><span class="label">Bookshelf ID: NBK577896</span><span class="label">PMID: <a href="https://pubmed.ncbi.nlm.nih.gov/35167213" title="PubMed record of this title" ref="pagearea=meta&targetsite=entrez&targetcat=link&targettype=pubmed">35167213</a></span></div></div><div class="small-screen-prev"></div><div class="small-screen-next"></div></article><article data-type="table-wrap" id="figobch9tab1"><div id="ch9.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/NBK577896/table/ch9.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch9.tab1_lrgtbl__"><table><tbody><tr><th id="hd_b_ch9.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population</th><td headers="hd_b_ch9.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Adults (18 years or over) with primary hyperparathyroidism</p>
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<p>Strata:<ul id="ch9.l1"><li id="ch9.lt1" class="half_rhythm"><div>Pre-operative</div></li><li id="ch9.lt2" class="half_rhythm"><div>Post-operative</div></li><li id="ch9.lt3" class="half_rhythm"><div>Non-surgical</div></li><li id="ch9.lt4" class="half_rhythm"><div>Previous surgery</div></li><li id="ch9.lt5" class="half_rhythm"><div>Pregnant women</div></li></ul></p>
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</td></tr><tr><th id="hd_b_ch9.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Interventions</th><td headers="hd_b_ch9.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Different techniques/tools/variables being monitored<ul id="ch9.l2"><li id="ch9.lt6" class="half_rhythm"><div>blood tests (adjusted serum calcium, serum creatinine),</div></li><li id="ch9.lt7" class="half_rhythm"><div>imaging (DXA for bone disease (±VFA)</div></li><li id="ch9.lt8" class="half_rhythm"><div>US for kidney stones, renal tract calcification</div></li><li id="ch9.lt9" class="half_rhythm"><div>x-ray for fragility fracture for vertebral fracture</div></li><li id="ch9.lt10" class="half_rhythm"><div>other (24-hour urinary calcium, creatinine clearance)</div></li><li id="ch9.lt11" class="half_rhythm"><div>CV variables (BP, lipids, ECG),</div></li><li id="ch9.lt12" class="half_rhythm"><div>vitamin D (for post-operative monitoring)</div></li><li id="ch9.lt13" class="half_rhythm"><div>renal function</div></li></ul></p>
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<p>Different frequencies of monitoring (this may differ for the different tests – e.g. bloods 6–12 months, DXA 2–3 years)</p>
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<p>Different durations of monitoring (for post-surgery stratum, e.g. for 3 months or 6 months – to include the optimum timing of serum calcium assessment post-surgery to determine cure)</p>
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</td></tr><tr><th id="hd_b_ch9.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comparisons</th><td headers="hd_b_ch9.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul id="ch9.l3"><li id="ch9.lt14" class="half_rhythm"><div>Comparing types of monitoring strategies to each other</div></li><li id="ch9.lt15" class="half_rhythm"><div>Comparing different frequencies of the same strategy</div></li></ul>
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</td></tr><tr><th id="hd_b_ch9.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outcomes</th><td headers="hd_b_ch9.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Critical outcomes:<ul id="ch9.l4"><li id="ch9.lt16" class="half_rhythm"><div>HRQOL (continuous outcome)</div></li><li id="ch9.lt17" class="half_rhythm"><div>Mortality (dichotomous outcome)</div></li></ul></p>
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<p>Important outcomes:<ul id="ch9.l5"><li id="ch9.lt18" class="half_rhythm"><div>Deterioration in renal function (continuous – study may also report renal replacement)</div></li><li id="ch9.lt19" class="half_rhythm"><div>Fractures (vertebral or long bone) (dichotomous outcome)</div></li><li id="ch9.lt20" class="half_rhythm"><div>Occurrence of kidney stones (dichotomous outcome)</div></li><li id="ch9.lt21" class="half_rhythm"><div>Persistent hypercalcaemia (dichotomous outcome)</div></li><li id="ch9.lt22" class="half_rhythm"><div>BMD of the distal radius or the lumbar spine (continuous)</div></li><li id="ch9.lt23" class="half_rhythm"><div>Cardiovascular events (dichotomous outcome)</div></li><li id="ch9.lt24" class="half_rhythm"><div>Adverse events (to include voice change, hypoparathyroidism, hypothyroidism/hyperthyroidism; dichotomous outcome)</div></li><li id="ch9.lt25" class="half_rhythm"><div>Cancer incidence (dichotomous outcome)</div></li><li id="ch9.lt26" class="half_rhythm"><div>Reoperation (for post-surgery stratum)</div></li></ul></p>
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</td></tr><tr><th id="hd_b_ch9.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design</th><td headers="hd_b_ch9.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>RCTs and systematic reviews of RCTs</p>
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<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>
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<p>Key confounders:<ul id="ch9.l6"><li id="ch9.lt27" class="half_rhythm"><div>Age</div></li><li id="ch9.lt28" class="half_rhythm"><div>Absence/presence of end-organ effects</div></li><li id="ch9.lt29" class="half_rhythm"><div>Adjusted serum calcium level</div></li></ul></p>
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</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobch9tab2"><div id="ch9.tab2" class="table"><h3><span class="label">Table 2</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/NBK577896/table/ch9.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch9.tab2_lrgtbl__"><table><tbody><tr><th id="hd_b_ch9.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population</th><td headers="hd_b_ch9.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Adults (18 years or over) with primary hyperparathyroidism</p>
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<p>Strata:<ul id="ch9.l7"><li id="ch9.lt30" class="half_rhythm"><div>Preoperative</div></li><li id="ch9.lt31" class="half_rhythm"><div>Non-surgical</div></li><li id="ch9.lt32" class="half_rhythm"><div>Post-operative</div></li><li id="ch9.lt33" class="half_rhythm"><div>People on calcimimetics</div></li><li id="ch9.lt34" class="half_rhythm"><div>People on bisphosphonates</div></li><li id="ch9.lt35" class="half_rhythm"><div>Previous surgery</div></li><li id="ch9.lt36" class="half_rhythm"><div>Normocalcaemic patients</div></li></ul></p>
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<p>Subgroup:<ul id="ch9.l8"><li id="ch9.lt37" class="half_rhythm"><div>People on HRT</div></li></ul></p>
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</td></tr><tr><th id="hd_b_ch9.tab2_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Interventions and comparisons</th><td headers="hd_b_ch9.tab2_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">This review will be looking at the incidence of outcomes in people with PHPT compared with healthy controls</td></tr><tr><th id="hd_b_ch9.tab2_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outcomes</th><td headers="hd_b_ch9.tab2_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Critical outcomes:<ul id="ch9.l9"><li id="ch9.lt38" class="half_rhythm"><div>mortality (dichotomous outcome)</div></li><li id="ch9.lt39" class="half_rhythm"><div>fragility fracture (dichotomous outcome)</div></li><li id="ch9.lt40" class="half_rhythm"><div>renal stones (dichotomous outcome)</div></li><li id="ch9.lt41" class="half_rhythm"><div>renal tract calcification (dichotomous outcome)</div></li><li id="ch9.lt42" class="half_rhythm"><div>pancreatitis (dichotomous outcome)</div></li><li id="ch9.lt43" class="half_rhythm"><div>stroke (dichotomous outcome)</div></li><li id="ch9.lt44" class="half_rhythm"><div>hypertension (dichotomous outcome)</div></li><li id="ch9.lt45" class="half_rhythm"><div>myocardial infarction (dichotomous outcome)</div></li><li id="ch9.lt46" class="half_rhythm"><div>Number of people who become eligible for surgery/meet the criteria for surgery (dichotomous)</div></li><li id="ch9.lt47" class="half_rhythm"><div>serum calcium (>2.85 mmol/l) (dichotomous) (continuous if dichotomous not available)</div></li><li id="ch9.lt48" class="half_rhythm"><div>24-hour urine for calcium (>10 mmol/dl) (dichotomous) (continuous if dichotomous not available)</div></li><li id="ch9.lt49" class="half_rhythm"><div>BMD of proximal femur (T-score <2.5; Z score <2) (dichotomous) (continuous if dichotomous not available)</div></li></ul></p>
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<p>Follow-up: minimum 2 years</p>
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</td></tr><tr><th id="hd_b_ch9.tab2_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design</th><td headers="hd_b_ch9.tab2_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Prospective cohort studies</p>
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<p>Retrospective cohort studies will be included only if insufficient prospective cohort studies are identified</p>
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<p>Key confounders:<ul id="ch9.l10"><li id="ch9.lt50" class="half_rhythm"><div>Age</div></li><li id="ch9.lt51" class="half_rhythm"><div>Absence/presence of end-organ effects</div></li><li id="ch9.lt52" class="half_rhythm"><div>Adjusted serum calcium level</div></li></ul></p>
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</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobch9tab3"><div id="ch9.tab3" class="table"><h3><span class="label">Table 3</span><span class="title">Summary of studies included in the evidence review (comparative studies)</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577896/table/ch9.tab3/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch9.tab3_lrgtbl__"><table><thead><tr><th id="hd_h_ch9.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Study</th><th id="hd_h_ch9.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Comparison</th><th id="hd_h_ch9.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Population</th><th id="hd_h_ch9.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Outcomes</th><th id="hd_h_ch9.tab3_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Comments</th></tr></thead><tbody><tr><td headers="hd_h_ch9.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Yu 2011<a class="bibr" href="#ch9.ref80" rid="ch9.ref80"><sup>80</sup></a></p>
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<p>Prospective cohort study</p>
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<p>UK</p>
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<p>Setting: Tayside, Scotland, 1997–2006</p>
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</td><td headers="hd_h_ch9.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Each of the selected patients was then matched with five individuals, or comparators, by age, gender and calendar year of PHPT diagnosis, from the general Tayside population, with either no calcium records or normal serum calcium concentration during the study period. The calendar year of the matching was the index date for each comparator.</td><td headers="hd_h_ch9.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>All Tayside residents over 20 years of age were considered as potential cases.</p>
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<p>In conjunction with hospital admission records, nuclear medicine and histology data, the PHPT cohort was primarily diagnosed if they met either of the following biochemical criteria: albumin-corrected serum calcium >2.55 mm (10.22 mg/dl, reference range 2.10–2.55 mm) on at least two occasions, with plasma parathyroid hormone (PTH) concentration >3 pm (13.5 ng/l, reference range 1.0–6.9 pm); or, albumin-corrected serum calcium >2.55 mm (10.22 mg/dl) on a single occasion, with plasma PTH concentration >6.9 pm (31.05 ng/l).</p>
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<p>A subgroup of ‘mild PHPT’ patients was further selected for this study, these being patients with untreated PHPT, low concentrations of hypercalcaemia and an absence of renal stones, renal failure and osteoporotic fractures, at diagnosis.</p>
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<p>Mild untreated group were defined as untreated PHPT patients whose serum calcium concentrations were <2.9 mmol/l within the first 6 months after a positive diagnosis with absence of previous (prior to PHPT diagnosis) fracture fragility, renal stones and renal failure and not treated with cinacalcet.</p>
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<p>Further exclusion criteria were applied to the mild untreated group: serum calcium was followed up for >6 months; less than two serum calcium measurements within the first 6 months.</p>
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</td><td headers="hd_h_ch9.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul id="ch9.l11"><li id="ch9.lt53" class="half_rhythm"><div>All-cause mortality</div></li><li id="ch9.lt54" class="half_rhythm"><div>Fatal CVD</div></li><li id="ch9.lt55" class="half_rhythm"><div>Non-fatal CVD</div></li><li id="ch9.lt56" class="half_rhythm"><div>Cerebrovascular disease</div></li><li id="ch9.lt57" class="half_rhythm"><div>Hypertension</div></li><li id="ch9.lt58" class="half_rhythm"><div>Renal failure</div></li><li id="ch9.lt59" class="half_rhythm"><div>Renal stones</div></li><li id="ch9.lt60" class="half_rhythm"><div>All fractures</div></li><li id="ch9.lt61" class="half_rhythm"><div>Osteoporotic fractures</div></li></ul>
|
|
</td><td headers="hd_h_ch9.tab3_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>PHPT patients not fitting NIH criteria for referral.</p>
|
|
<p>Study used individual data for both cases and comparators.</p>
|
|
</td></tr><tr><td headers="hd_h_ch9.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Clifton-Bligh, 2015<a class="bibr" href="#ch9.ref21" rid="ch9.ref21"><sup>21</sup></a></p>
|
|
<p>Retrospective cohort study</p>
|
|
<p>Australia</p>
|
|
</td><td headers="hd_h_ch9.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>n=561 patients with PHPT</p>
|
|
<p>Patients diagnosed with PHPT between 1961 and 1994 were identified, medical records were obtained and examined, and a determination was made as to whether or not they were alive at the end of 1994.</p>
|
|
</td><td headers="hd_h_ch9.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Survival data of individuals with PHPT compared with expected survival in the general Australian population was obtained from the Life Tables.</p>
|
|
<p>The control population was the Australian population at large for whom Life Tables from 1961–1994 existed at the time (Life Tables are published by the Australian Government Actuary).</p>
|
|
<p>Control population matched for age, sex, the year observation began, and the duration of the observation.</p>
|
|
</td><td headers="hd_h_ch9.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Survival rate over a 10 and 20 year period</td><td headers="hd_h_ch9.tab3_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Follow-up: 10 years and 20 years</p>
|
|
<p>The relative survival over a 20 year time interval was calculated for the patients studied between 1972 and 2011. The group was divided into 2 cohorts: those diagnosed between 1972 and 1981 and those diagnosed between 1982 and 1991, and 20 year relative survival was calculated for each cohort.</p>
|
|
<p>Before 1972 diagnosis of PHPT was made if surgical removal of a parathyroid gland restored eucalcaemia, or if a full investigation failed to find another cause for hypercalcaemia. After 1972, the diagnosis of PHPT was made if the serum calcium and serum PTH was above the upper limit of the reference range.</p>
|
|
<p>Because of the concept that a person with mild PHPT might not require surgery, 113 of the patients with mild PHPT were not subjected to neck exploration and 448 patients had parathyroid surgery.</p>
|
|
</td></tr><tr><td headers="hd_h_ch9.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>De Geronimo, 2006<a class="bibr" href="#ch9.ref26" rid="ch9.ref26"><sup>26</sup></a></p>
|
|
<p>Cohort study</p>
|
|
<p>Italy</p>
|
|
<p>Setting: Mineral metabolic centre</p>
|
|
</td><td headers="hd_h_ch9.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>n=98 post-menopausal women with PHPT and 89 healthy women.</p>
|
|
<p>98 consecutive post-menopausal patients with PHPT. They were grouped as mild or non-mild according to criteria established by the Consensus Development conference on the management of asymptomatic primary hyperparathyroidism:</p>
|
|
<p>Serum calcium greater than 1m g/dl above the upper limits of normal; 24-h total urine calcium excretion of more than 400 mg; creatinine clearance reduced by more than 30% compared to age-matched persons; bone density at lumbar spine, hip or distal radius that is more than 2.5 SD below peak bone mass; patients under 50 years of age.</p>
|
|
<p>Based on these criteria, only 25 of the 98 patients were considered as suffering from mild disease. In this group of patients hypercalcaemia was occasionally detected in the course of the standard biochemical evaluation performed on all subjects undergoing BMD measurement.</p>
|
|
<p>None of the mild patients reported either height loss or clinical vertebral fractures at history.</p>
|
|
<p>In the remaining 73 patients, a severe disease was present; 13 of them had a history of nonvertebral fractures; 7 referred by GPs for nephrolithiasis; 21 referred by GPs for osteoporosis; 15 patients renal stones shown by ultrasonography; 3 were referred for hypercalcaemia; 2 had a life threatening episode of pancreatitis. The remaining 12 patients complained of bone pain and/or neuromuscular symptoms.</p>
|
|
</td><td headers="hd_h_ch9.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Mild or non-mild PHPT postmenopausal women</p>
|
|
<p>vs</p>
|
|
<p>Healthy subjects - 89 healthy postmenopausal women, matched for age, years since menopause, BMI. They were randomly selected from ambulatory post-menopausal women sent by their GPs to the hospital as part of a menopause-screening programme.</p>
|
|
</td><td headers="hd_h_ch9.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul id="ch9.l12"><li id="ch9.lt62" class="half_rhythm"><div>Vertebral fracture</div></li><li id="ch9.lt63" class="half_rhythm"><div>Non-vertebral fractures</div></li><li id="ch9.lt64" class="half_rhythm"><div>Lumbar spine – BMD</div></li><li id="ch9.lt65" class="half_rhythm"><div>Femoral neck – BM</div></li><li id="ch9.lt66" class="half_rhythm"><div>Total femur – BMD</div></li></ul>
|
|
</td><td headers="hd_h_ch9.tab3_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Control patients matched for age, years since menopause and BMI. Not adjusted for absence/presence of end-organ effects and serum calcium level.</p>
|
|
<p>Diagnosis of PHPT was made according to the conventional clinical and lab data, including a history of at least 1 year of prolonged hypercalcaemia without evidence of non-parathyroid aetiology and unsuppressed serum levels of immunoreactive PTH.</p>
|
|
</td></tr><tr><td headers="hd_h_ch9.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Headback 1998<a class="bibr" href="#ch9.ref38" rid="ch9.ref38"><sup>38</sup></a></p>
|
|
<p>Retrospective cohort study</p>
|
|
<p>Sweden</p>
|
|
</td><td headers="hd_h_ch9.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>n=4461 (915 men and 3546 women)</p>
|
|
<p>Patients diagnosed as having PHPT or parathyroid adenoma according to the International Classification of Diseases during 1987–94 from the Swedish national patient registry.</p>
|
|
<p>The patient series studied consisted of those individuals who at the same time were reported to have undergone removal of a parathyroid gland or adenoma. The inclusion date of a patient was the date of arrival at the hospital before surgery.</p>
|
|
</td><td headers="hd_h_ch9.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>PHPT patients</p>
|
|
<p>vs</p>
|
|
<p>Control</p>
|
|
<p>Whole Swedish population matched for age, sex and calendar year.</p>
|
|
<p>Strata: Post-operative</p>
|
|
</td><td headers="hd_h_ch9.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Death</p>
|
|
<p>Number of patients operated for PHPT</p>
|
|
</td><td headers="hd_h_ch9.tab3_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Total number of observation years was 3205 giving mean follow-up times of 3.6 and 3.5 years respectively (range 0–8 years)</td></tr><tr><td headers="hd_h_ch9.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Kenny 1995<a class="bibr" href="#ch9.ref41" rid="ch9.ref41"><sup>41</sup></a></p>
|
|
<p>Retrospective cohort study</p>
|
|
<p>USA</p>
|
|
</td><td headers="hd_h_ch9.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>n=46 Post-menopausal women who had undergone parathyroidectomy for hyperparathyroidism during a 5 year period (1986 to 1991)</p>
|
|
<p>Control – n=44 postmenopausal women without hyperparathyroidism contacted by random digit dialling and interviewed as controls.</p>
|
|
</td><td headers="hd_h_ch9.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>PHPT patients vs control</p>
|
|
<p>Strata: Post-operative</p>
|
|
</td><td headers="hd_h_ch9.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Fracture incidence</td><td headers="hd_h_ch9.tab3_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Follow-up: 5 years</p>
|
|
<p>The women in the control were group were similar to those with PHPT in regard to age, weight, and height.</p>
|
|
<p>Not adjusted for key confounders.</p>
|
|
</td></tr><tr><td headers="hd_h_ch9.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Khosla 1999<a class="bibr" href="#ch9.ref42" rid="ch9.ref42"><sup>42</sup></a></p>
|
|
<p>USA</p>
|
|
<p>Retrospective Cohort study</p>
|
|
</td><td headers="hd_h_ch9.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>n=407 patients with PHPT</p>
|
|
<p>Patients with PHPT:</p>
|
|
<p>The database the Rochester Epidemiology Project was used to identify 435 Rochester residents with PHPT during period, 1965–1992. Seven of these patients refused subsequent authorisation for chart review, and 21 had no follow-up after age 35 years, resulting in a final cohort of 407 subjects. These subjects were then followed forward in time through their linked medical records in the community (retrospective cohort study) until death or the most recent clinical contact and backward in time to the first medical record entry in the community.</p>
|
|
</td><td headers="hd_h_ch9.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Age related fractures in patients with PHPT (1965–1992)</p>
|
|
<p>vs</p>
|
|
<p>Age related fractures in general population</p>
|
|
<p>The majority were women (344, 775) and most were 45 years of age or older at the diagnosis of HPT (335, 82%). The mean age at diagnosis was 57.8 years. The average maximum serum calcium level was 10.9 (0.6) mg/dl. Median serum PTH, measured by a C-terminal assay, was 47 µl.eq/ml (25–75% interval, 33–71 µl.eq/ml; normal ≤50 µl.eq/ml). The majority of the patients were asymptomatic.</p>
|
|
</td><td headers="hd_h_ch9.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Fractures</td><td headers="hd_h_ch9.tab3_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Study - 28 year period</p>
|
|
<p>No multivariate analysis</p>
|
|
<p>Diagnosis of vertebral fracture was accepted on the basis of a radiologists’ report of compression or collapse of one or more thoracic or lumbar vertebrae. All fractures were classified according to the circumstances of the injury.</p>
|
|
</td></tr><tr><td headers="hd_h_ch9.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Larsson, 1993<a class="bibr" href="#ch9.ref45" rid="ch9.ref45"><sup>45</sup></a></p>
|
|
<p>Sweden</p>
|
|
<p>Retrospective cohort study</p>
|
|
</td><td headers="hd_h_ch9.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>n=1373 patients with PHPT</p>
|
|
<p>All patients who were admitted to hospital with the diagnosis of PHPT.</p>
|
|
<p>1318 patients (69%) had been subjected to parathyroidectomy at the same or a subsequent admission.</p>
|
|
<p>Mean serum calcium at the time of diagnosis for women with PHPT was 2.91 (0.22), and for men 2.79 (0.18) mmol/l; p<0.01. The serum calcium levels at diagnosis were stable during the study period.</p>
|
|
<p>For each patient the observation period started in 1965, or at the age of 30 for those below this age in 1965 and ended at the date of hip fracture diagnosis, death, or at the end of 1983.</p>
|
|
</td><td headers="hd_h_ch9.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Patients with PHPT</p>
|
|
<p>vs</p>
|
|
<p>Entire background population</p>
|
|
</td><td headers="hd_h_ch9.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Hip fracture</td><td headers="hd_h_ch9.tab3_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Follow-up - 19 years</p>
|
|
<p>No multivariable analysis</p>
|
|
</td></tr><tr><td headers="hd_h_ch9.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Melton, 1992<a class="bibr" href="#ch9.ref49" rid="ch9.ref49"><sup>49</sup></a></p>
|
|
<p>Rochester, USA</p>
|
|
<p>Population based retrospective cohort study</p>
|
|
</td><td headers="hd_h_ch9.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>n=90 patients with PHPT; n=90 matched control subjects</p>
|
|
<p>90 cases of PHPT newly diagnosed during the life among Rochester during 1965 through 1976; 83 subjects had histopathologic proof of parathyroid adenoma or hyperplasia or had hypercalcaemia with pathognomonic radiographic signs and/or elevated serum parathyroid hormone concentrations. The remainder had hypercalcaemia for more than a year without another cause being found after careful evaluation. Patients with an incidental autopsy diagnosis of parathyroid adenoma or hyperplasia were excluded.</p>
|
|
<p>The 90 patients were matched by age and gender to control subjects from the local population who had no evidence of PHPT.</p>
|
|
</td><td headers="hd_h_ch9.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Patients with PHPT</p>
|
|
<p>vs</p>
|
|
<p>matched control subjects</p>
|
|
<p>Controls matched by age and gender.</p>
|
|
</td><td headers="hd_h_ch9.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Fractures</p>
|
|
<p>Age interaction (narrative)</p>
|
|
</td><td headers="hd_h_ch9.tab3_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Proportional hazards model was used to determine the relative influence of various clinical characteristics on subsequent fracture risk among those with HPT. The factors evaluated included age at diagnosis, gender, initial serum calcium (<2.74 vs >2.74 mmol/L), comorbid conditions related to HPT and parathyroid surgery.</p>
|
|
<p>Not adjusted for serum calcium level and absence/presence of end organ effects.</p>
|
|
</td></tr><tr><td headers="hd_h_ch9.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Ronni-Sivula, 1985<a class="bibr" href="#ch9.ref60" rid="ch9.ref60"><sup>60</sup></a></p>
|
|
<p>Finland</p>
|
|
<p>Retrospective cohort study</p>
|
|
<p>Setting: department of surgery</p>
|
|
</td><td headers="hd_h_ch9.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>n=334 (PHPT); n= 334 healthy controls</p>
|
|
<p>334 patients (83 men and 251 women) were operated on for PHPT in the years 1956–79. A follow-up study of this material was performed in the years 1980–82. 34 patients had died before the end of the year 1980. All clinical data as well as causes of death of these patients were collected and examined.</p>
|
|
</td><td headers="hd_h_ch9.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>PHPT patients operated in the years 1956–79</p>
|
|
<p>vs</p>
|
|
<p>Control.</p>
|
|
<p>Each PHPT patient in the original material was given a pair who was sex and age matched and operated on for appendicitis, varicose veins or haemorrhoids in the same year</p>
|
|
<p>Strata: Post-operative</p>
|
|
</td><td headers="hd_h_ch9.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Mortality</td><td headers="hd_h_ch9.tab3_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>No multivariate analysis</p>
|
|
<p>Not adjusted for serum calcium level and absence/presence of end organ effects.</p>
|
|
</td></tr><tr><td headers="hd_h_ch9.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Suh 2008<a class="bibr" href="#ch9.ref69" rid="ch9.ref69"><sup>69</sup></a></p>
|
|
<p>Retrospective cohort study</p>
|
|
<p>USA</p>
|
|
</td><td headers="hd_h_ch9.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>n=271</p>
|
|
<p>All patients who had undergone renal imaging within 6 months before parathyroid surgery for PHPT</p>
|
|
</td><td headers="hd_h_ch9.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>n=500</p>
|
|
<p>Age matched subjects who had right upper quadrant sonograms obtained for various reasons</p>
|
|
<p>Strata: Post-operative</p>
|
|
</td><td headers="hd_h_ch9.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Renal stones</td><td headers="hd_h_ch9.tab3_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No multivariate analysis</td></tr><tr><td headers="hd_h_ch9.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Wilson, 1988<a class="bibr" href="#ch9.ref79" rid="ch9.ref79"><sup>79</sup></a></p>
|
|
<p>Retrospective cohort study</p>
|
|
<p>USA</p>
|
|
<p>Setting: Outpatient department of a bone and mineral metabolism clinic.</p>
|
|
</td><td headers="hd_h_ch9.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>n=174 PHPT; n=200 control</p>
|
|
<p>All patients with mild asymptomatic PHPT.</p>
|
|
<p>Diagnostic criteria for PHPT:</p>
|
|
<p>persistent hypercalcaemia (calcium ≥2.65 mmol/L), with no clinical indication of another cause, and evidence of parathyroid hormone hypersecretion, with increased or non-suppressed values of radioimmunoassay of parathyroid hormone or nephrogenous cyclic adenosine monophosphate excretion per unit of glomerular filtrate.</p>
|
|
<p>The diagnosis was made at the clinic between 1 January 1976 and December 1985.</p>
|
|
<p>None of the post-menopausal women were receiving oestrogen replacement therapy at the time of initial diagnosis.</p>
|
|
<p>Inclusion criteria:</p>
|
|
<p>Absence of symptoms due to PHPT, no current kidney stone disease, a plasma calcium level of less than 3.00 mmol/L, a plasma creatinine level of less than 133µmol/L, no radiographic evidence of osteitis fibrosa, and a forearm bone densitometry not more than 2.5 standard deviations below the mean value expected for age, sex and race.</p>
|
|
</td><td headers="hd_h_ch9.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>PHPT group</p>
|
|
<p>vs</p>
|
|
<p>Healthy white women. These data had been obtained in 200 ambulatory white female patients having routine annual physical examination.</p>
|
|
<p>In almost every patient hypercalcaemia was an incidental finding. The mean plasma calcium level was 2.77 (0.09) mmol/L (reference value, 2.40 [0.08]).</p>
|
|
</td><td headers="hd_h_ch9.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Prevalence of vertebral fractures</p>
|
|
<p>Follow-up: 10 years</p>
|
|
<p>A reduction in anterior height of more than 20% compared with an adjacent vertebra was classified as a fracture.</p>
|
|
</td><td headers="hd_h_ch9.tab3_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Prospectively collected data were retrospectively analysed and compared with data from historical control group.</p>
|
|
<p>No multivariate analysis</p>
|
|
</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobch9tab4"><div id="ch9.tab4" class="table"><h3><span class="label">Table 4</span><span class="title">Clinical evidence summary: PHPT cases compared to matched comparators (adjusted for key confounders) (Stratum-Non-surgical)</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577896/table/ch9.tab4/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch9.tab4_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_ch9.tab4_1_1_1_1" rowspan="2" colspan="1" headers="hd_h_ch9.tab4_1_1_1_1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_ch9.tab4_1_1_1_2" rowspan="2" colspan="1" headers="hd_h_ch9.tab4_1_1_1_2" style="text-align:left;vertical-align:bottom;">No of Participants (studies) Follow up</th><th id="hd_h_ch9.tab4_1_1_1_3" rowspan="2" colspan="1" headers="hd_h_ch9.tab4_1_1_1_3" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_ch9.tab4_1_1_1_4" rowspan="2" colspan="1" headers="hd_h_ch9.tab4_1_1_1_4" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th><th id="hd_h_ch9.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_ch9.tab4_1_1_1_5" id="hd_h_ch9.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk with Control</th><th headers="hd_h_ch9.tab4_1_1_1_5" id="hd_h_ch9.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk difference with Cases (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_ch9.tab4_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">All-cause mortality</td><td headers="hd_h_ch9.tab4_1_1_1_2" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>8544</p>
|
|
<p>(1 study)</p>
|
|
<p>median 2.9 years</p>
|
|
</td><td headers="hd_h_ch9.tab4_1_1_1_3" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">LOW<sup>c</sup></td><td headers="hd_h_ch9.tab4_1_1_1_4" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>HR 1.64</p>
|
|
<p>(1.43 to 1.87)<sup>b</sup></p>
|
|
</td><td headers="hd_h_ch9.tab4_1_1_1_5 hd_h_ch9.tab4_1_1_2_1 hd_h_ch9.tab4_1_1_2_2" colspan="2" rowspan="1" style="text-align:left;vertical-align:top;">Moderate</td></tr><tr><td headers="hd_h_ch9.tab4_1_1_1_5 hd_h_ch9.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_ch9.tab4_1_1_1_5 hd_h_ch9.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-<sup>a</sup></td></tr><tr><td headers="hd_h_ch9.tab4_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Fatal CVD</td><td headers="hd_h_ch9.tab4_1_1_1_2" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>8544</p>
|
|
<p>(1 study)</p>
|
|
<p>median 2.9 years</p>
|
|
</td><td headers="hd_h_ch9.tab4_1_1_1_3" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">LOW<sup>c</sup></td><td headers="hd_h_ch9.tab4_1_1_1_4" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>HR 1.64</p>
|
|
<p>(1.32 to 2.04)<sup>b</sup></p>
|
|
</td><td headers="hd_h_ch9.tab4_1_1_1_5 hd_h_ch9.tab4_1_1_2_1 hd_h_ch9.tab4_1_1_2_2" colspan="2" rowspan="1" style="text-align:left;vertical-align:top;">Moderate</td></tr><tr><td headers="hd_h_ch9.tab4_1_1_1_5 hd_h_ch9.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_ch9.tab4_1_1_1_5 hd_h_ch9.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-<sup>a</sup></td></tr><tr><td headers="hd_h_ch9.tab4_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Nonfatal CVD</td><td headers="hd_h_ch9.tab4_1_1_1_2" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>8544</p>
|
|
<p>(1 study)</p>
|
|
<p>median 2.9 years</p>
|
|
</td><td headers="hd_h_ch9.tab4_1_1_1_3" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">LOW<sup>c</sup></td><td headers="hd_h_ch9.tab4_1_1_1_4" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>HR 2.48</p>
|
|
<p>(2.13 to 2.89)<sup>b</sup></p>
|
|
</td><td headers="hd_h_ch9.tab4_1_1_1_5 hd_h_ch9.tab4_1_1_2_1 hd_h_ch9.tab4_1_1_2_2" colspan="2" rowspan="1" style="text-align:left;vertical-align:top;">Moderate</td></tr><tr><td headers="hd_h_ch9.tab4_1_1_1_5 hd_h_ch9.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_ch9.tab4_1_1_1_5 hd_h_ch9.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-<sup>a</sup></td></tr><tr><td headers="hd_h_ch9.tab4_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Hypertension</td><td headers="hd_h_ch9.tab4_1_1_1_2" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>8544</p>
|
|
<p>(1 study)</p>
|
|
<p>median 2.9 years</p>
|
|
</td><td headers="hd_h_ch9.tab4_1_1_1_3" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">LOW<sup>c</sup></td><td headers="hd_h_ch9.tab4_1_1_1_4" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>HR 2.60</p>
|
|
<p>(2.04 to 3.31)<sup>b</sup></p>
|
|
</td><td headers="hd_h_ch9.tab4_1_1_1_5 hd_h_ch9.tab4_1_1_2_1 hd_h_ch9.tab4_1_1_2_2" colspan="2" rowspan="1" style="text-align:left;vertical-align:top;">Moderate</td></tr><tr><td headers="hd_h_ch9.tab4_1_1_1_5 hd_h_ch9.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_ch9.tab4_1_1_1_5 hd_h_ch9.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-<sup>a</sup></td></tr><tr><td headers="hd_h_ch9.tab4_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Cerebrovascular disease</td><td headers="hd_h_ch9.tab4_1_1_1_2" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>8544</p>
|
|
<p>(1 study)</p>
|
|
<p>median 2.9 years</p>
|
|
</td><td headers="hd_h_ch9.tab4_1_1_1_3" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">LOW<sup>c</sup></td><td headers="hd_h_ch9.tab4_1_1_1_4" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>HR 2.51</p>
|
|
<p>(1.95 to 3.22)<sup>b</sup></p>
|
|
</td><td headers="hd_h_ch9.tab4_1_1_1_5 hd_h_ch9.tab4_1_1_2_1 hd_h_ch9.tab4_1_1_2_2" colspan="2" rowspan="1" style="text-align:left;vertical-align:top;">Moderate</td></tr><tr><td headers="hd_h_ch9.tab4_1_1_1_5 hd_h_ch9.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_ch9.tab4_1_1_1_5 hd_h_ch9.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-<sup>a</sup></td></tr><tr><td headers="hd_h_ch9.tab4_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Renal failure</td><td headers="hd_h_ch9.tab4_1_1_1_2" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>8544</p>
|
|
<p>(1 study)</p>
|
|
<p>median 2.9 years</p>
|
|
</td><td headers="hd_h_ch9.tab4_1_1_1_3" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">LOW<sup>c</sup></td><td headers="hd_h_ch9.tab4_1_1_1_4" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>HR 13.83</p>
|
|
<p>(10.41 to 18.37)<sup>b</sup></p>
|
|
</td><td headers="hd_h_ch9.tab4_1_1_1_5 hd_h_ch9.tab4_1_1_2_1 hd_h_ch9.tab4_1_1_2_2" colspan="2" rowspan="1" style="text-align:left;vertical-align:top;">Moderate</td></tr><tr><td headers="hd_h_ch9.tab4_1_1_1_5 hd_h_ch9.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_ch9.tab4_1_1_1_5 hd_h_ch9.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-<sup>a</sup></td></tr><tr><td headers="hd_h_ch9.tab4_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Renal stones</td><td headers="hd_h_ch9.tab4_1_1_1_2" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>8544</p>
|
|
<p>(1 study)</p>
|
|
<p>median 2.9 years</p>
|
|
</td><td headers="hd_h_ch9.tab4_1_1_1_3" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">LOW<sup>c</sup></td><td headers="hd_h_ch9.tab4_1_1_1_4" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>HR 5.15</p>
|
|
<p>(2.69 to 9.83)<sup>b</sup></p>
|
|
</td><td headers="hd_h_ch9.tab4_1_1_1_5 hd_h_ch9.tab4_1_1_2_1 hd_h_ch9.tab4_1_1_2_2" colspan="2" rowspan="1" style="text-align:left;vertical-align:top;">Moderate</td></tr><tr><td headers="hd_h_ch9.tab4_1_1_1_5 hd_h_ch9.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_ch9.tab4_1_1_1_5 hd_h_ch9.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-<sup>a</sup></td></tr><tr><td headers="hd_h_ch9.tab4_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">All fractures</td><td headers="hd_h_ch9.tab4_1_1_1_2" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>8544</p>
|
|
<p>(1 study)</p>
|
|
<p>median 2.9 years</p>
|
|
</td><td headers="hd_h_ch9.tab4_1_1_1_3" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">LOW<sup>c</sup></td><td headers="hd_h_ch9.tab4_1_1_1_4" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>HR 1.75</p>
|
|
<p>(1.36 to 2.26)<sup>b</sup></p>
|
|
</td><td headers="hd_h_ch9.tab4_1_1_1_5 hd_h_ch9.tab4_1_1_2_1 hd_h_ch9.tab4_1_1_2_2" colspan="2" rowspan="1" style="text-align:left;vertical-align:top;">Moderate</td></tr><tr><td headers="hd_h_ch9.tab4_1_1_1_5 hd_h_ch9.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_ch9.tab4_1_1_1_5 hd_h_ch9.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-<sup>a</sup></td></tr><tr><td headers="hd_h_ch9.tab4_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Osteoporotic fractures</td><td headers="hd_h_ch9.tab4_1_1_1_2" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>8544</p>
|
|
<p>(1 study)</p>
|
|
<p>median 2.9 years</p>
|
|
</td><td headers="hd_h_ch9.tab4_1_1_1_3" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">LOW<sup>c</sup></td><td headers="hd_h_ch9.tab4_1_1_1_4" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>HR 1.63</p>
|
|
<p>(1.22 to 2.19)<sup>b</sup></p>
|
|
</td><td headers="hd_h_ch9.tab4_1_1_1_5 hd_h_ch9.tab4_1_1_2_1 hd_h_ch9.tab4_1_1_2_2" colspan="2" rowspan="1" style="text-align:left;vertical-align:top;">Moderate</td></tr><tr><td headers="hd_h_ch9.tab4_1_1_1_5 hd_h_ch9.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_ch9.tab4_1_1_1_5 hd_h_ch9.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-<sup>a</sup></td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>a</dt><dd><div id="ch9.tab4_1"><p class="no_margin">Absolute effect cannot be calculated as adjusted control group event rate not reported.</p></div></dd></dl><dl class="bkr_refwrap"><dt>b</dt><dd><div id="ch9.tab4_2"><p class="no_margin">Confounding covariates considered were multiple deprivation index, history of bisphosphonates prescription, history of hospital-admitted CVD, cerebrovascular disease, hypertension, renal failure, renal stones, psychiatric disease, fractures, cancer and diabetes.</p></div></dd></dl><dl class="bkr_refwrap"><dt>c</dt><dd><div id="ch9.tab4_3"><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 (used the non-randomised studies checklist on evibase for assessment for risk of bias).</p></div></dd></dl><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin">Note: All patients with diagnosed but untreated, mild asymptomatic PHPT.</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobch9tab5"><div id="ch9.tab5" class="table"><h3><span class="label">Table 5</span><span class="title">Clinical evidence summary: PHPT compared to control (no multivariate analysis) (Stratum – Pre-surgery)</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577896/table/ch9.tab5/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch9.tab5_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_ch9.tab5_1_1_1_1" rowspan="2" colspan="1" headers="hd_h_ch9.tab5_1_1_1_1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_ch9.tab5_1_1_1_2" rowspan="2" colspan="1" headers="hd_h_ch9.tab5_1_1_1_2" style="text-align:left;vertical-align:bottom;">No of Participants (studies) Follow up</th><th id="hd_h_ch9.tab5_1_1_1_3" rowspan="2" colspan="1" headers="hd_h_ch9.tab5_1_1_1_3" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_ch9.tab5_1_1_1_4" rowspan="2" colspan="1" headers="hd_h_ch9.tab5_1_1_1_4" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th><th id="hd_h_ch9.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_ch9.tab5_1_1_1_5" id="hd_h_ch9.tab5_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk with Control</th><th headers="hd_h_ch9.tab5_1_1_1_5" id="hd_h_ch9.tab5_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk difference with Monitoring long term outcomes - PHPT (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_ch9.tab5_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Renal stones</p>
|
|
<p>(definitive calculi)</p>
|
|
</td><td headers="hd_h_ch9.tab5_1_1_1_2" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>771</p>
|
|
<p>(1 study)</p>
|
|
</td><td headers="hd_h_ch9.tab5_1_1_1_3" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>VERY LOW<sup>a</sup></p>
|
|
<p>due to risk of bias</p>
|
|
</td><td headers="hd_h_ch9.tab5_1_1_1_4" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>RR 4.38</p>
|
|
<p>(1.94 to 9.88)</p>
|
|
</td><td headers="hd_h_ch9.tab5_1_1_1_5 hd_h_ch9.tab5_1_1_2_1 hd_h_ch9.tab5_1_1_2_2" colspan="2" rowspan="1" style="text-align:left;vertical-align:top;">Moderate</td></tr><tr><td headers="hd_h_ch9.tab5_1_1_1_5 hd_h_ch9.tab5_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">16 per 1000</td><td headers="hd_h_ch9.tab5_1_1_1_5 hd_h_ch9.tab5_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>54 more per 1000</p>
|
|
<p>(from 15 more to 142 more)</p>
|
|
<p>PHPT group: 19/271</p>
|
|
<p>Control: 8/500</p>
|
|
</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>a</dt><dd><div id="ch9.tab5_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 (used the non-randomised studies checklist on evibase for assessment for risk of bias).</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobch9tab6"><div id="ch9.tab6" class="table"><h3><span class="label">Table 6</span><span class="title">Clinical evidence summary: PHPT compared to control (no multivariate analysis) – Mixed strata – Pre and post-operative (surgery and non-surgery patients)</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577896/table/ch9.tab6/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch9.tab6_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_ch9.tab6_1_1_1_1" rowspan="2" colspan="1" headers="hd_h_ch9.tab6_1_1_1_1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_ch9.tab6_1_1_1_2" rowspan="2" colspan="1" headers="hd_h_ch9.tab6_1_1_1_2" style="text-align:left;vertical-align:bottom;">No of Participants (studies) Follow up</th><th id="hd_h_ch9.tab6_1_1_1_3" rowspan="2" colspan="1" headers="hd_h_ch9.tab6_1_1_1_3" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_ch9.tab6_1_1_1_4" rowspan="2" colspan="1" headers="hd_h_ch9.tab6_1_1_1_4" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th><th id="hd_h_ch9.tab6_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_ch9.tab6_1_1_1_5" id="hd_h_ch9.tab6_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk with Control</th><th headers="hd_h_ch9.tab6_1_1_1_5" id="hd_h_ch9.tab6_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk difference with Monitoring long term outcomes - PHPT (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_ch9.tab6_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Fractures (all)</td><td headers="hd_h_ch9.tab6_1_1_1_2" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>180</p>
|
|
<p>(1 study)</p>
|
|
</td><td headers="hd_h_ch9.tab6_1_1_1_3" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>VERY LOW<sup>a</sup></p>
|
|
<p>due to risk of bias,</p>
|
|
</td><td headers="hd_h_ch9.tab6_1_1_1_4" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>RR 0.96</p>
|
|
<p>(0.74 to 1.24)</p>
|
|
</td><td headers="hd_h_ch9.tab6_1_1_1_5 hd_h_ch9.tab6_1_1_2_1 hd_h_ch9.tab6_1_1_2_2" colspan="2" rowspan="1" style="text-align:left;vertical-align:top;">Moderate</td></tr><tr><td headers="hd_h_ch9.tab6_1_1_1_5 hd_h_ch9.tab6_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">414 per 1000</td><td headers="hd_h_ch9.tab6_1_1_1_5 hd_h_ch9.tab6_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>17 fewer per 1000</p>
|
|
<p>(from 108 fewer to 99 more)</p>
|
|
</td></tr><tr><td headers="hd_h_ch9.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Lumbar spine BMD (mg/cm<sup>2</sup>) (mild PHPT vs healthy women)</td><td headers="hd_h_ch9.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>114</p>
|
|
<p>(1 study)</p>
|
|
</td><td headers="hd_h_ch9.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>VERY LOW<sup>a</sup></p>
|
|
<p>due to risk of bias</p>
|
|
</td><td headers="hd_h_ch9.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-</td><td headers="hd_h_ch9.tab6_1_1_1_5 hd_h_ch9.tab6_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-</td><td headers="hd_h_ch9.tab6_1_1_1_5 hd_h_ch9.tab6_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>The mean lumbar spine BMD (mg/cm<sup>2</sup>) (mild PHPT vs healthy women) in the intervention groups was</p>
|
|
<p>77.1 higher (31.61 to 122.59 higher)</p>
|
|
</td></tr><tr><td headers="hd_h_ch9.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Femoral neck-BMD (mg/cm<sup>2</sup>) (mild PHPT vs healthy women)</td><td headers="hd_h_ch9.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>114</p>
|
|
<p>(1 study)</p>
|
|
</td><td headers="hd_h_ch9.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>VERY LOW<sup>a</sup><sup>,</sup><sup>c</sup></p>
|
|
<p>due to risk of bias, imprecision</p>
|
|
</td><td headers="hd_h_ch9.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-</td><td headers="hd_h_ch9.tab6_1_1_1_5 hd_h_ch9.tab6_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-</td><td headers="hd_h_ch9.tab6_1_1_1_5 hd_h_ch9.tab6_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>The mean femoral neck - BMD (mg/cm<sup>2</sup>) (mild PHPT vs healthy women) in the intervention groups was</p>
|
|
<p>18.4 higher</p>
|
|
<p>(24.43 lower to 61.23 higher)</p>
|
|
</td></tr><tr><td headers="hd_h_ch9.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Total femur - BMD (mg/cm<sup>2</sup>) (mild PHPT vs healthy women)</td><td headers="hd_h_ch9.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>114</p>
|
|
<p>(1 study)</p>
|
|
</td><td headers="hd_h_ch9.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>VERY LOW<sup>a</sup><sup>,</sup><sup>c</sup></p>
|
|
<p>due to risk of bias, imprecision</p>
|
|
</td><td headers="hd_h_ch9.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-</td><td headers="hd_h_ch9.tab6_1_1_1_5 hd_h_ch9.tab6_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-</td><td headers="hd_h_ch9.tab6_1_1_1_5 hd_h_ch9.tab6_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">The mean total femur - BMD (mg/cm<sup>2</sup>) (mild PHPT vs healthy women) in the intervention groups was 21.2 higher (30.33 lower to 72.73 higher)</td></tr><tr><td headers="hd_h_ch9.tab6_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Vertebral fractures (mild PHPT vs healthy controls)</td><td headers="hd_h_ch9.tab6_1_1_1_2" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>343</p>
|
|
<p>(2 studies)</p>
|
|
</td><td headers="hd_h_ch9.tab6_1_1_1_3" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>VERY LOW<sup>a</sup><sup>,</sup><sup>b</sup></p>
|
|
<p>due to risk of bias, inconsistency</p>
|
|
</td><td headers="hd_h_ch9.tab6_1_1_1_4" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>RR 2.31</p>
|
|
<p>(1.26 to 4.21)</p>
|
|
</td><td headers="hd_h_ch9.tab6_1_1_1_5 hd_h_ch9.tab6_1_1_2_1 hd_h_ch9.tab6_1_1_2_2" colspan="2" rowspan="1" style="text-align:left;vertical-align:top;">Moderate</td></tr><tr><td headers="hd_h_ch9.tab6_1_1_1_5 hd_h_ch9.tab6_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">72 per 1000</td><td headers="hd_h_ch9.tab6_1_1_1_5 hd_h_ch9.tab6_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>94 more per 1000</p>
|
|
<p>(from 19 more to 231 more)</p>
|
|
</td></tr><tr><td headers="hd_h_ch9.tab6_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Vertebral fractures (non-mild PHPT vs healthy women)</td><td headers="hd_h_ch9.tab6_1_1_1_2" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>162</p>
|
|
<p>(1 study)</p>
|
|
</td><td headers="hd_h_ch9.tab6_1_1_1_3" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>VERY LOW<sup>a</sup></p>
|
|
<p>due to risk of bias</p>
|
|
</td><td headers="hd_h_ch9.tab6_1_1_1_4" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>RR 5.33</p>
|
|
<p>(2.64 to 10.77)</p>
|
|
</td><td headers="hd_h_ch9.tab6_1_1_1_5 hd_h_ch9.tab6_1_1_2_1 hd_h_ch9.tab6_1_1_2_2" colspan="2" rowspan="1" style="text-align:left;vertical-align:top;">Moderate</td></tr><tr><td headers="hd_h_ch9.tab6_1_1_1_5 hd_h_ch9.tab6_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">90 per 1000</td><td headers="hd_h_ch9.tab6_1_1_1_5 hd_h_ch9.tab6_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>390 more per 1000</p>
|
|
<p>(from 148 more to 879 more)</p>
|
|
</td></tr><tr><td headers="hd_h_ch9.tab6_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Non-vertebral fractures (mild PHPT vs healthy women)</td><td headers="hd_h_ch9.tab6_1_1_1_2" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>114</p>
|
|
<p>(1 study)</p>
|
|
</td><td headers="hd_h_ch9.tab6_1_1_1_3" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>VERY LOW<sup>a</sup><sup>,</sup><sup>c</sup></p>
|
|
<p>due to risk of bias, imprecision</p>
|
|
</td><td headers="hd_h_ch9.tab6_1_1_1_4" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Peto OR 0.22</p>
|
|
<p>(0.07 to 0.78)</p>
|
|
</td><td headers="hd_h_ch9.tab6_1_1_1_5 hd_h_ch9.tab6_1_1_2_1 hd_h_ch9.tab6_1_1_2_2" colspan="2" rowspan="1" style="text-align:left;vertical-align:top;">Moderate</td></tr><tr><td headers="hd_h_ch9.tab6_1_1_1_5 hd_h_ch9.tab6_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">191 per 1000</td><td headers="hd_h_ch9.tab6_1_1_1_5 hd_h_ch9.tab6_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>190 fewer per 1000</p>
|
|
<p>(from 290 to 90 fewer)</p>
|
|
</td></tr><tr><td headers="hd_h_ch9.tab6_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Non-vertebral fractures (non-mild PHPT vs healthy women)</td><td headers="hd_h_ch9.tab6_1_1_1_2" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>162</p>
|
|
<p>(1 study)</p>
|
|
</td><td headers="hd_h_ch9.tab6_1_1_1_3" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>VERY LOW<sup>a</sup><sup>,</sup><sup>c</sup></p>
|
|
<p>due to risk of bias, imprecision</p>
|
|
</td><td headers="hd_h_ch9.tab6_1_1_1_4" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>RR 0.93</p>
|
|
<p>(0.49 to 1.79)</p>
|
|
</td><td headers="hd_h_ch9.tab6_1_1_1_5 hd_h_ch9.tab6_1_1_2_1 hd_h_ch9.tab6_1_1_2_2" colspan="2" rowspan="1" style="text-align:left;vertical-align:top;">Moderate</td></tr><tr><td headers="hd_h_ch9.tab6_1_1_1_5 hd_h_ch9.tab6_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">191 per 1000</td><td headers="hd_h_ch9.tab6_1_1_1_5 hd_h_ch9.tab6_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>13 fewer per 1000</p>
|
|
<p>(from 97 fewer to 151 more)</p>
|
|
</td></tr><tr><td headers="hd_h_ch9.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Lumbar spine-BMD (mg/cm<sup>2</sup>) (non-mild PHPT vs healthy women)</td><td headers="hd_h_ch9.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>162</p>
|
|
<p>(1 study)</p>
|
|
</td><td headers="hd_h_ch9.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>VERY LOW<sup>a</sup></p>
|
|
<p>due to risk of bias</p>
|
|
</td><td headers="hd_h_ch9.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-</td><td headers="hd_h_ch9.tab6_1_1_1_5 hd_h_ch9.tab6_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-</td><td headers="hd_h_ch9.tab6_1_1_1_5 hd_h_ch9.tab6_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>The mean lumbar spine - BMD (mg/cm<sup>2</sup>) (non-mild PHPT vs healthy women) in the intervention groups was 73.6 lower</p>
|
|
<p>(116.15 to 31.05 lower)</p>
|
|
</td></tr><tr><td headers="hd_h_ch9.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Femoral neck-BMD (mg/cm<sup>2</sup>) (non-mild PHPT vs healthy women)</td><td headers="hd_h_ch9.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>162</p>
|
|
<p>(1 study)</p>
|
|
</td><td headers="hd_h_ch9.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>VERY LOW<sup>a</sup></p>
|
|
<p>due to risk of bias</p>
|
|
</td><td headers="hd_h_ch9.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-</td><td headers="hd_h_ch9.tab6_1_1_1_5 hd_h_ch9.tab6_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-</td><td headers="hd_h_ch9.tab6_1_1_1_5 hd_h_ch9.tab6_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>The mean femoral neck - BMD (mg/cm<sup>2</sup>) in the intervention groups was</p>
|
|
<p>89.3 lower</p>
|
|
<p>(121.96 to 56.64 lower)</p>
|
|
</td></tr><tr><td headers="hd_h_ch9.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Total femur-BMD (mg/cm<sup>2</sup>) (non-mild PHPT vs healthy women)</td><td headers="hd_h_ch9.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>162</p>
|
|
<p>(1 study)</p>
|
|
</td><td headers="hd_h_ch9.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>VERY LOW<sup>a</sup></p>
|
|
<p>due to risk of bias</p>
|
|
</td><td headers="hd_h_ch9.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-</td><td headers="hd_h_ch9.tab6_1_1_1_5 hd_h_ch9.tab6_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-</td><td headers="hd_h_ch9.tab6_1_1_1_5 hd_h_ch9.tab6_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>The mean total femur - BMD (mg/cm<sup>2</sup>) in the intervention groups was 102.5 lower</p>
|
|
<p>(140.13 to 64.87 lower)</p>
|
|
</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>a</dt><dd><div id="ch9.tab6_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 (used the non-randomised studies checklist on evibase for assessment for risk of bias).</p></div></dd></dl><dl class="bkr_refwrap"><dt>b</dt><dd><div id="ch9.tab6_2"><p class="no_margin">Heterogeneity, I<sup>2</sup>=90%</p></div></dd></dl><dl class="bkr_refwrap"><dt>c</dt><dd><div id="ch9.tab6_3"><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></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobch9tab7"><div id="ch9.tab7" class="table"><h3><span class="label">Table 7</span><span class="title">Clinical evidence summary (modified GRADE table): PHPT compared to control (no multivariate analysis) – Mixed strata-Pre and post-operative (surgery and surgery patients)</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577896/table/ch9.tab7/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch9.tab7_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_ch9.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_ch9.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">No of Participants (studies) Follow up</th><th id="hd_h_ch9.tab7_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_ch9.tab7_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Relative survival rate<sup>*</sup> for the PHPT group compared to control</th><th id="hd_h_ch9.tab7_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Anticipated absolute effects</th></tr></thead><tbody><tr><td headers="hd_h_ch9.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Relative survival</td><td headers="hd_h_ch9.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">561 (1 study)</td><td headers="hd_h_ch9.tab7_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>VERY LOW<sup>a</sup></p>
|
|
<p>due to risk of bias</p>
|
|
</td><td headers="hd_h_ch9.tab7_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>86.8% (95% CI 84.9–86.2, p<0.001)</p>
|
|
<p>(10 years)</p>
|
|
</td><td headers="hd_h_ch9.tab7_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">124/561 patients died between 1961 and 1994<sup>b</sup></td></tr><tr><td headers="hd_h_ch9.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Relative survival</td><td headers="hd_h_ch9.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">561 (1 study)</td><td headers="hd_h_ch9.tab7_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>VERY LOW<sup>a</sup></p>
|
|
<p>due to risk of bias</p>
|
|
</td><td headers="hd_h_ch9.tab7_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>62.9% (95% CI 58.5–67.4, P<0.001).</p>
|
|
<p>(20 years)</p>
|
|
</td><td headers="hd_h_ch9.tab7_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>a</dt><dd><div id="ch9.tab7_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 (used the non-randomised studies checklist on evibase for assessment of risk of bias).</p></div></dd></dl><dl class="bkr_refwrap"><dt>b</dt><dd><div id="ch9.tab7_2"><p class="no_margin">Control group event rate not reported</p></div></dd></dl><dl class="bkr_refwrap"><dt>*</dt><dd><div id="ch9.tab7_3"><p class="no_margin">Relative survival rate - is a way of comparing the survival of people who have a specific disease with those who do not, over a certain period of time.</p></div></dd></dl><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin">It is calculated by dividing the percentage of patients with the disease who are still alive at the end of the period of time by the percentage of people in the general population/control who are alive at the end of the same time period.</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobch9tab8"><div id="ch9.tab8" class="table"><h3><span class="label">Table 8</span><span class="title">Clinical evidence summary (modified GRADE table): PHPT (observed) versus expected numbers in the general population (no multivariate analysis) – Mixed strata – Pre and post-operative (surgery and non-surgery patients)</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577896/table/ch9.tab8/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch9.tab8_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_ch9.tab8_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_ch9.tab8_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">No of Participants (studies) Follow up</th><th id="hd_h_ch9.tab8_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_ch9.tab8_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Standardised Incidence Ratio<sup>*</sup> (SIR) 95% CI and Risk ratio (RR)</th><th id="hd_h_ch9.tab8_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Anticipated absolute effects</th></tr></thead><tbody><tr><td headers="hd_h_ch9.tab8_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Any Fracture (at all skeletal sites)<sup>b</sup></td><td headers="hd_h_ch9.tab8_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">407 (1 study)</td><td headers="hd_h_ch9.tab8_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>VERY LOW<sup>a</sup></p>
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<p>due to risk of bias</p>
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|
</td><td headers="hd_h_ch9.tab8_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">SIR 1.3 (95% CI 1.1–1.5)<sup>*</sup></td><td headers="hd_h_ch9.tab8_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">observed: n=202; expected: n=154.6</td></tr><tr><td headers="hd_h_ch9.tab8_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Vertebral fracture</td><td headers="hd_h_ch9.tab8_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">407 (1 study)</td><td headers="hd_h_ch9.tab8_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>VERY LOW<sup>a</sup></p>
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<p>due to risk of bias</p>
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</td><td headers="hd_h_ch9.tab8_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">SIR 3.2 (95% CI 2.5–4.0)</td><td headers="hd_h_ch9.tab8_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">observed: n=79; expected: n= 24.6</td></tr><tr><td headers="hd_h_ch9.tab8_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Hip fractures (women)</td><td headers="hd_h_ch9.tab8_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1373 (1 study)</td><td headers="hd_h_ch9.tab8_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>VERY LOW<sup>a</sup></p>
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<p>due to risk of bias</p>
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</td><td headers="hd_h_ch9.tab8_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RR 0.93 (95% CI 0.72–1.19)</td><td headers="hd_h_ch9.tab8_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">observed: 67/1373; expected: 71.76</td></tr><tr><td headers="hd_h_ch9.tab8_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Hip fractures (men)</td><td headers="hd_h_ch9.tab8_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">551 (1 study)</td><td headers="hd_h_ch9.tab8_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>VERY LOW<sup>a</sup></p>
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<p>due to risk of bias</p>
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</td><td headers="hd_h_ch9.tab8_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RR 1.39 (95% CI 0.69–2.50)</td><td headers="hd_h_ch9.tab8_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">observed 11/551; expected 7.9</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>a</dt><dd><div id="ch9.tab8_1"><p class="no_top_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 (used the non-randomised studies checklist on evibase for assessment of risk of bias).</p></div></dd></dl><dl class="bkr_refwrap"><dt>b</dt><dd><div id="ch9.tab8_2"><p class="no_top_margin">A total of 471 fractures occurred in 202 patients after the index date. The majority of fractures of the vertebrae (92%), distal forearm (91%), pelvis (75%), and proximal femur (90%) were due to mild or moderate trauma.</p></div></dd></dl><dl class="bkr_refwrap"><dt>*</dt><dd><div id="ch9.tab8_3"><p class="no_top_margin">Predictors of the risk of mild/moderate trauma, vertebral, distal forearm or proximal femur fractures:</p><p>Multivariate model</p><p>Age (per 10 year increase): relative hazard 1.6 (95% 1.4–1.9)</p><p>Female gender: relative hazard 2.3 (95% CI 1.2–4.1)</p><p>By multivariate analysis, only age and female gender were significant independent predictors of fracture risk.</p></div></dd></dl><dl class="bkr_refwrap"><dt>**</dt><dd><div id="ch9.tab8_4"><p class="no_top_margin">Fracture risk was assessed by comparing new fractures at each site to the number expected from gender and age specific fracture incidence rates for the general population (SIRs).</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobch9tab9"><div id="ch9.tab9" class="table"><h3><span class="label">Table 9</span><span class="title">Clinical evidence summary: PHPT patients compared to control (no multivariate analysis) – Stratum post-operative</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577896/table/ch9.tab9/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch9.tab9_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_ch9.tab9_1_1_1_1" rowspan="2" colspan="1" headers="hd_h_ch9.tab9_1_1_1_1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_ch9.tab9_1_1_1_2" rowspan="2" colspan="1" headers="hd_h_ch9.tab9_1_1_1_2" style="text-align:left;vertical-align:bottom;">No of Participants (studies) Follow up</th><th id="hd_h_ch9.tab9_1_1_1_3" rowspan="2" colspan="1" headers="hd_h_ch9.tab9_1_1_1_3" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_ch9.tab9_1_1_1_4" rowspan="2" colspan="1" headers="hd_h_ch9.tab9_1_1_1_4" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th><th id="hd_h_ch9.tab9_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_ch9.tab9_1_1_1_5" id="hd_h_ch9.tab9_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk with Control</th><th headers="hd_h_ch9.tab9_1_1_1_5" id="hd_h_ch9.tab9_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk difference with Monitoring - no MV analysis-strata post-operative (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_ch9.tab9_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Mortality</td><td headers="hd_h_ch9.tab9_1_1_1_2" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">668 (1 study)</td><td headers="hd_h_ch9.tab9_1_1_1_3" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">
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<p>VERY LOW<sup>a</sup><sup>,</sup><sup>b</sup></p>
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<p>due to risk of bias, imprecision</p>
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</td><td headers="hd_h_ch9.tab9_1_1_1_4" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">
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<p>RR 1.62 (0.96 to 2.73)</p>
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</td><td headers="hd_h_ch9.tab9_1_1_1_5 hd_h_ch9.tab9_1_1_2_1 hd_h_ch9.tab9_1_1_2_2" colspan="2" rowspan="1" style="text-align:left;vertical-align:top;">Moderate</td></tr><tr><td headers="hd_h_ch9.tab9_1_1_1_5 hd_h_ch9.tab9_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">63 per 1000</td><td headers="hd_h_ch9.tab9_1_1_1_5 hd_h_ch9.tab9_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>39 more per 1000 (from 3 fewer to 109 more)</p>
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<p>PHPT: 34/334</p>
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<p>Control: 21/334</p>
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</td></tr><tr><td headers="hd_h_ch9.tab9_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">mortality<sup>c</sup></td><td headers="hd_h_ch9.tab9_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4461 (1 study)</td><td headers="hd_h_ch9.tab9_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>VERY LOW<sup>a</sup></p>
|
|
<p>due to risk of bias</p>
|
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</td><td headers="hd_h_ch9.tab9_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Male: RR 1.30 (95% CI 1.07–1.57)</p>
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<p>Female: RR 1.61 (95% CI 1.46–1.78)</p>
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</td><td headers="hd_h_ch9.tab9_1_1_1_5 hd_h_ch9.tab9_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-</td><td headers="hd_h_ch9.tab9_1_1_1_5 hd_h_ch9.tab9_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Male: observed: n=107; expected: n=82.2</p>
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<p>Female: observed: n=396; expected: n=245.6</p>
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<p>Altogether: observed: n-=503; expected: n=327.8</p>
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</td></tr><tr><td headers="hd_h_ch9.tab9_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Fracture<sup>d</sup></td><td headers="hd_h_ch9.tab9_1_1_1_2" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">90 (1 study)</td><td headers="hd_h_ch9.tab9_1_1_1_3" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">
|
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<p>VERY LOW<sup>a</sup><sup>,</sup><sup>b</sup></p>
|
|
<p>due to risk of bias, imprecision</p>
|
|
</td><td headers="hd_h_ch9.tab9_1_1_1_4" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">RR 1.91 (1.06 to 3.47)</td><td headers="hd_h_ch9.tab9_1_1_1_5 hd_h_ch9.tab9_1_1_2_1 hd_h_ch9.tab9_1_1_2_2" colspan="2" rowspan="1" style="text-align:left;vertical-align:top;">Moderate</td></tr><tr><td headers="hd_h_ch9.tab9_1_1_1_5 hd_h_ch9.tab9_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">250 per 1000</td><td headers="hd_h_ch9.tab9_1_1_1_5 hd_h_ch9.tab9_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>227 more (from 15 more to 618 more)</p>
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<p>PHPT: 22/46</p>
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<p>Control: 11/44</p>
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</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>a</dt><dd><div id="ch9.tab9_1"><p class="no_top_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 (used the non-randomised studies checklist on evibase for assessment of risk of bias).</p></div></dd></dl><dl class="bkr_refwrap"><dt>b</dt><dd><div id="ch9.tab9_2"><p class="no_top_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></dl><dl class="bkr_refwrap"><dt>c</dt><dd><div id="ch9.tab9_3"><p class="no_top_margin">The cause of increased risk of death was cardiovascular disease</p><p>Men: RR 1.71 (95% CI 1.34–2.15)</p><p>Women: RR 1.85 (955 CI 1.62–2.11)</p></div></dd></dl><dl class="bkr_refwrap"><dt>d</dt><dd><div id="ch9.tab9_4"><p class="no_top_margin">92% of the total fractures and all of the post-menopausal fractures occurred after minor trauma.</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobch9tab10"><div id="ch9.tab10" class="table"><h3><span class="label">Table 10</span><span class="title">UK costs of monitoring procedures</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577896/table/ch9.tab10/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch9.tab10_lrgtbl__"><table><thead><tr><th id="hd_h_ch9.tab10_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Monitoring procedure</th><th id="hd_h_ch9.tab10_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Cost (average)</th><th id="hd_h_ch9.tab10_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Notes</th><th id="hd_h_ch9.tab10_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Source</th></tr></thead><tbody><tr><td headers="hd_h_ch9.tab10_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">GP consultation</td><td headers="hd_h_ch9.tab10_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">£37.00</td><td headers="hd_h_ch9.tab10_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Assumed average duration of 9.22 minutes</td><td headers="hd_h_ch9.tab10_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">PSSRU 2017<a class="bibr" href="#ch9.ref24" rid="ch9.ref24"><sup>24</sup></a></td></tr><tr><td headers="hd_h_ch9.tab10_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Blood tests (adjusted serum calcium, serum creatinine, renal function, lipids)</td><td headers="hd_h_ch9.tab10_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">£1.13</td><td headers="hd_h_ch9.tab10_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Clinical biochemistry test</td><td headers="hd_h_ch9.tab10_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">NHS Reference Costs 16/17<a class="bibr" href="#ch9.ref28" rid="ch9.ref28"><sup>28</sup></a></td></tr><tr><td headers="hd_h_ch9.tab10_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">PTH test</td><td headers="hd_h_ch9.tab10_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">£8.00</td><td headers="hd_h_ch9.tab10_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Average of 12 test costs sought by the committee from laboratories in their local areas.</td><td headers="hd_h_ch9.tab10_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Committee estimate</td></tr><tr><td headers="hd_h_ch9.tab10_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Vitamin D</td><td headers="hd_h_ch9.tab10_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">£16.50</td><td headers="hd_h_ch9.tab10_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Average of two NHS hospitals<sup>(b)</sup></td><td headers="hd_h_ch9.tab10_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Filby 2014<a class="bibr" href="#ch9.ref36" rid="ch9.ref36"><sup>36</sup></a></td></tr><tr><td headers="hd_h_ch9.tab10_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">DXA scan</td><td headers="hd_h_ch9.tab10_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">£83.00</td><td headers="hd_h_ch9.tab10_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Performed in an outpatient setting</td><td headers="hd_h_ch9.tab10_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">NHS Reference Costs 16/17<a class="bibr" href="#ch9.ref28" rid="ch9.ref28"><sup>28</sup></a></td></tr><tr><td headers="hd_h_ch9.tab10_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Ultrasound</td><td headers="hd_h_ch9.tab10_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">£52.00</td><td headers="hd_h_ch9.tab10_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">US with duration <20 minutes, without contrast, outpatient setting</td><td headers="hd_h_ch9.tab10_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">NHS Reference Costs 16/17<a class="bibr" href="#ch9.ref28" rid="ch9.ref28"><sup>28</sup></a></td></tr><tr><td headers="hd_h_ch9.tab10_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">X-ray</td><td headers="hd_h_ch9.tab10_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">£30.00</td><td headers="hd_h_ch9.tab10_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Direct access plain film</td><td headers="hd_h_ch9.tab10_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">NHS Reference Costs 16/17<a class="bibr" href="#ch9.ref28" rid="ch9.ref28"><sup>28</sup></a></td></tr><tr><td headers="hd_h_ch9.tab10_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Blood pressure</td><td headers="hd_h_ch9.tab10_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">£6.00</td><td headers="hd_h_ch9.tab10_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Calculation based on average cost of 15min contact with community or hospital based nurse</td><td headers="hd_h_ch9.tab10_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">PSSRU 2017<a class="bibr" href="#ch9.ref24" rid="ch9.ref24"><sup>24</sup></a></td></tr><tr><td headers="hd_h_ch9.tab10_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">ECG</td><td headers="hd_h_ch9.tab10_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">£ 37.00</td><td headers="hd_h_ch9.tab10_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">ECG not included in 16/17 NHS reference costs. The committee did not consider it is likely to have changed significantly in cost since 2010/11.</td><td headers="hd_h_ch9.tab10_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">NHS Reference costs 10/11<a class="bibr" href="#ch9.ref29" rid="ch9.ref29"><sup>29</sup></a>.</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobch9tab11"><div id="ch9.tab11" class="table"><h3><span class="label">Table 11</span><span class="title">UK cost of clinical events associated with PHPT</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577896/table/ch9.tab11/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch9.tab11_lrgtbl__"><table><thead><tr><th id="hd_h_ch9.tab11_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Event</th><th id="hd_h_ch9.tab11_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Cost</th><th id="hd_h_ch9.tab11_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Notes</th><th id="hd_h_ch9.tab11_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Source</th></tr></thead><tbody><tr><td headers="hd_h_ch9.tab11_1_1_1_1 hd_h_ch9.tab11_1_1_1_2 hd_h_ch9.tab11_1_1_1_3 hd_h_ch9.tab11_1_1_1_4" colspan="4" rowspan="1" style="text-align:left;vertical-align:middle;">Cardiovascular events</td></tr><tr><td headers="hd_h_ch9.tab11_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Acute coronary syndrome (including myocardial infarction)</td><td headers="hd_h_ch9.tab11_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">£4,933</td><td headers="hd_h_ch9.tab11_1_1_1_3" rowspan="3" colspan="1" style="text-align:left;vertical-align:middle;">Cost of initial 6 months</td><td headers="hd_h_ch9.tab11_1_1_1_4" rowspan="3" colspan="1" style="text-align:left;vertical-align:middle;">NICE Hypertension Guideline (update 2011)<a class="bibr" href="#ch9.ref52" rid="ch9.ref52"><sup>52</sup></a></td></tr><tr><td headers="hd_h_ch9.tab11_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Stroke</td><td headers="hd_h_ch9.tab11_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">£10,190</td></tr><tr><td headers="hd_h_ch9.tab11_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Heart failure</td><td headers="hd_h_ch9.tab11_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">£2,649</td></tr><tr><td headers="hd_h_ch9.tab11_1_1_1_1 hd_h_ch9.tab11_1_1_1_2 hd_h_ch9.tab11_1_1_1_3 hd_h_ch9.tab11_1_1_1_4" colspan="4" rowspan="1" style="text-align:left;vertical-align:middle;">Renal events</td></tr><tr><td headers="hd_h_ch9.tab11_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Renal dysfunction</td><td headers="hd_h_ch9.tab11_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">£803</td><td headers="hd_h_ch9.tab11_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">General renal disorders without interventions, national average, day case, CC score 0–2</td><td headers="hd_h_ch9.tab11_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">NHS Reference costs 16/17<a class="bibr" href="#ch9.ref28" rid="ch9.ref28"><sup>28</sup></a></td></tr><tr><td headers="hd_h_ch9.tab11_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Renal stones – shockwave therapy</td><td headers="hd_h_ch9.tab11_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">£452</td><td headers="hd_h_ch9.tab11_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Day case</td><td headers="hd_h_ch9.tab11_1_1_1_4" rowspan="3" colspan="1" style="text-align:left;vertical-align:middle;">NHS Reference costs 16/17<a class="bibr" href="#ch9.ref28" rid="ch9.ref28"><sup>28</sup></a></td></tr><tr><td headers="hd_h_ch9.tab11_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Renal stones – ureteroscopy</td><td headers="hd_h_ch9.tab11_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">£2,172</td><td headers="hd_h_ch9.tab11_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">50% elective weighted average, and 50% day case weighted average to reflect UK practice</td></tr><tr><td headers="hd_h_ch9.tab11_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Renal stones – percutaneous nephrolithotomy</td><td headers="hd_h_ch9.tab11_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">£5,195</td><td headers="hd_h_ch9.tab11_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Elective weighted average</td></tr><tr><td headers="hd_h_ch9.tab11_1_1_1_1 hd_h_ch9.tab11_1_1_1_2 hd_h_ch9.tab11_1_1_1_3 hd_h_ch9.tab11_1_1_1_4" colspan="4" rowspan="1" style="text-align:left;vertical-align:middle;">Fragility fractures<sup>(a)</sup></td></tr><tr><td headers="hd_h_ch9.tab11_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Hip</td><td headers="hd_h_ch9.tab11_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">£15,722</td><td headers="hd_h_ch9.tab11_1_1_1_3" rowspan="4" colspan="1" style="text-align:left;vertical-align:middle;">Total cost of initial hospitalisation and costs in year following fracture.</td><td headers="hd_h_ch9.tab11_1_1_1_4" rowspan="4" colspan="1" style="text-align:left;vertical-align:middle;">NICE TA464<a class="bibr" href="#ch9.ref54" rid="ch9.ref54"><sup>54</sup></a></td></tr><tr><td headers="hd_h_ch9.tab11_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Vertebrae</td><td headers="hd_h_ch9.tab11_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">£8,019</td></tr><tr><td headers="hd_h_ch9.tab11_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Proximal humerus</td><td headers="hd_h_ch9.tab11_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">£6,625</td></tr><tr><td headers="hd_h_ch9.tab11_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Wrist</td><td headers="hd_h_ch9.tab11_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">£4,523</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobch9appatab1"><div id="ch9.appa.tab1" class="table"><h3><span class="label">Table 12</span><span class="title">Review protocol: Monitoring strategies</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577896/table/ch9.appa.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch9.appa.tab1_lrgtbl__"><table><thead><tr><th id="hd_h_ch9.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Field</th><th id="hd_h_ch9.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Content</th></tr></thead><tbody><tr><td headers="hd_h_ch9.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Review question</td><td headers="hd_h_ch9.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">6.1 What is the optimum type and frequency of monitoring for people with PHPT (for example, pre-operative, postoperative, non-surgical)?</td></tr><tr><td headers="hd_h_ch9.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_ch9.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Intervention</p>
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<p>The optimum use of monitoring for people with PHPT – looking at patient outcomes for different strategies or frequencies of monitoring. This will cover pre-operative, post-operative and non-surgical monitoring.</p>
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</td></tr><tr><td headers="hd_h_ch9.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_ch9.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 different strategies or frequencies of monitoring, at the pre-operative and postoperative stage as well as in people with PHPT not undergoing surgery.</td></tr><tr><td headers="hd_h_ch9.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_ch9.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Adults (18 years or over) with primary hyperparathyroidism</p>
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<p>Strata:<ul id="ch9.l13"><li id="ch9.lt67" class="half_rhythm"><div>Pre-operative</div></li><li id="ch9.lt68" class="half_rhythm"><div>Post-operative</div></li><li id="ch9.lt69" class="half_rhythm"><div>Non-surgical</div></li><li id="ch9.lt70" class="half_rhythm"><div>Previous surgery</div></li><li id="ch9.lt71" class="half_rhythm"><div>Pregnant women</div></li></ul></p>
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<p>Exclude people:<ul id="ch9.l14"><li id="ch9.lt72" class="half_rhythm"><div>with secondary and tertiary HPT</div></li><li id="ch9.lt73" class="half_rhythm"><div>with multiple endocrine neoplasia</div></li><li id="ch9.lt74" class="half_rhythm"><div>with familial hyperparathyroidism</div></li><li id="ch9.lt75" class="half_rhythm"><div>with parathyroid carcinoma</div></li><li id="ch9.lt76" class="half_rhythm"><div>on medications interfering with calcium metabolism (lithium).</div></li></ul></p>
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<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>
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</td></tr><tr><td headers="hd_h_ch9.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_ch9.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Different techniques/tools/variables being monitored:<ul id="ch9.l15"><li id="ch9.lt77" class="half_rhythm"><div>Blood tests (adjusted serum calcium, serum creatinine)</div></li><li id="ch9.lt78" class="half_rhythm"><div>Imaging (DXA for bone disease) (±VFA)</div></li><li id="ch9.lt79" class="half_rhythm"><div>US for kidney stones, renal tract calcification</div></li><li id="ch9.lt80" class="half_rhythm"><div>X-ray for fragility fracture for vertebral fracture</div></li><li id="ch9.lt81" class="half_rhythm"><div>Other (24-hour urinary calcium, creatinine clearance</div></li><li id="ch9.lt82" class="half_rhythm"><div>CV variables (BP, lipids, ECG)</div></li><li id="ch9.lt83" class="half_rhythm"><div>Vitamin D (for post-operative monitoring)</div></li><li id="ch9.lt84" class="half_rhythm"><div>Renal function</div></li></ul></p>
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<p>Different frequencies of monitoring (acceptable frequencies – this may differ for the different tests – e.g. bloods 6–12 months, DXA 2–3 years)</p>
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<p>Different durations of monitoring (for post-surgery stratum, e.g. for 3 months or 6 months – to include the optimum timing of serum calcium assessment post-surgery to determine cure)</p>
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</td></tr><tr><td headers="hd_h_ch9.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_ch9.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul id="ch9.l16"><li id="ch9.lt85" class="half_rhythm"><div>Comparing types of strategies to each other</div></li><li id="ch9.lt86" class="half_rhythm"><div>Comparing different frequencies of the same strategy</div></li></ul>
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</td></tr><tr><td headers="hd_h_ch9.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_ch9.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>
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<b>Report all outcomes separately for <6 months and ≥6 months</b>
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</p>
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<p>
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<b>Critical outcomes:</b>
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<ul id="ch9.l17"><li id="ch9.lt87" class="half_rhythm"><div>HRQOL (continuous outcome)</div></li><li id="ch9.lt88" class="half_rhythm"><div>Mortality (dichotomous outcome)</div></li></ul>
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</p>
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<p>
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<b>Important outcomes:</b>
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<ul id="ch9.l18"><li id="ch9.lt89" class="half_rhythm"><div>Deterioration in renal function (continuous – study may also report renal replacement)</div></li><li id="ch9.lt90" class="half_rhythm"><div>Fractures (vertebral or long bone) (dichotomous outcome)</div></li><li id="ch9.lt91" class="half_rhythm"><div>Occurrence of kidney stones (dichotomous outcome)</div></li><li id="ch9.lt92" class="half_rhythm"><div>Persistent hypercalcaemia (dichotomous outcome)</div></li><li id="ch9.lt93" class="half_rhythm"><div>BMD of the distal radius or the lumbar spine (continuous)</div></li><li id="ch9.lt94" class="half_rhythm"><div>Cardiovascular events (dichotomous outcome)</div></li><li id="ch9.lt95" class="half_rhythm"><div>Adverse events (to include voice change, hypoparathyroidism, hypothyroidism/hyperthyroidism; dichotomous outcome)</div></li><li id="ch9.lt96" class="half_rhythm"><div>Cancer incidence (dichotomous outcome)</div></li><li id="ch9.lt97" class="half_rhythm"><div>Reoperation (for post-surgery stratum)</div></li></ul>
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</p>
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</td></tr><tr><td headers="hd_h_ch9.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_ch9.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>RCTs and systematic reviews of RCTs</p>
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<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>
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<p>Key confounders:<ul id="ch9.l19"><li id="ch9.lt98" class="half_rhythm"><div>Age</div></li><li id="ch9.lt99" class="half_rhythm"><div>Absence/presence of end-organ effects</div></li><li id="ch9.lt100" class="half_rhythm"><div>Adjusted serum calcium level</div></li></ul></p>
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</td></tr><tr><td headers="hd_h_ch9.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_ch9.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul id="ch9.l20"><li id="ch9.lt101" class="half_rhythm"><div>Non-English language articles</div></li><li id="ch9.lt102" class="half_rhythm"><div>Conference abstracts</div></li></ul>
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</td></tr><tr><td headers="hd_h_ch9.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_ch9.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_ch9.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_ch9.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_ch9.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_ch9.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul id="ch9.l21"><li id="ch9.lt103" class="half_rhythm"><div>Pairwise meta-analyses were performed using Cochrane Review Manager (RevMan5).</div></li><li id="ch9.lt104" class="half_rhythm"><div>GRADEpro was used to assess the quality of evidence for each outcome.</div></li><li id="ch9.lt105" class="half_rhythm"><div>Endnote for bibliography, citations, sifting and reference management.</div></li><li id="ch9.lt106" class="half_rhythm"><div>Data extractions performed using EviBase, a platform designed and maintained by the National Guideline Centre (NGC).</div></li></ul>
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</td></tr><tr><td headers="hd_h_ch9.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_ch9.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Clinical search databases to be used: Medline, Embase, Cochrane Library, CINAHL, PsycINFO</p>
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<p>Date: all years</p>
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<p>Health economics search databases to be used: Medline, Embase, NHSEED, HTA</p>
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<p>Date: Medline, Embase from 2002</p>
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<p>NHSEED, HTA – all years</p>
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<p>Language: Restrict to English only</p>
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<p>Supplementary search techniques: backward citation searching</p>
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<p>Key papers: Not known</p>
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</td></tr><tr><td headers="hd_h_ch9.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_ch9.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_ch9.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Author contacts</td><td headers="hd_h_ch9.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<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>
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</td></tr><tr><td headers="hd_h_ch9.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_ch9.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_ch9.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_ch9.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">For details please see <a href="#ch9.appb">appendix B</a></td></tr><tr><td headers="hd_h_ch9.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_ch9.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="#ch9.appd">appendix D</a> of the evidence report.</td></tr><tr><td headers="hd_h_ch9.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_ch9.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="#ch9.appd">appendix D</a> (clinical evidence tables) or <a href="#ch9.apph">H</a> (health economic evidence tables).</td></tr><tr><td headers="hd_h_ch9.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_ch9.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<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>
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<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>
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</td></tr><tr><td headers="hd_h_ch9.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_ch9.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_ch9.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_ch9.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_ch9.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_ch9.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_ch9.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_ch9.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_ch9.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_ch9.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_ch9.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_ch9.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<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>
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<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.</p>
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<p>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>
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</td></tr><tr><td headers="hd_h_ch9.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_ch9.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_ch9.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_ch9.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_ch9.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_ch9.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_ch9.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_ch9.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></article><article data-type="table-wrap" id="figobch9appatab2"><div id="ch9.appa.tab2" class="table"><h3><span class="label">Table 13</span><span class="title">Monitoring long term outcomes protocol</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577896/table/ch9.appa.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch9.appa.tab2_lrgtbl__"><table><thead><tr><th id="hd_h_ch9.appa.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Field</th><th id="hd_h_ch9.appa.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Content</th></tr></thead><tbody><tr><td headers="hd_h_ch9.appa.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Review question</td><td headers="hd_h_ch9.appa.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">What are the long-term outcomes in people with PHPT?</td></tr><tr><td headers="hd_h_ch9.appa.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Type of review question</td><td headers="hd_h_ch9.appa.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Prognostic</td></tr><tr><td headers="hd_h_ch9.appa.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Objective of the review</td><td headers="hd_h_ch9.appa.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">To determine whether PHPT is associated with poor long-term outcomes to determine what monitoring they need to undergo</td></tr><tr><td headers="hd_h_ch9.appa.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Eligibility criteria – population / disease / condition / issue / domain</td><td headers="hd_h_ch9.appa.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Adults (18 years or over) with primary hyperparathyroidism</p>
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<p>Strata:<ul id="ch9.l22"><li id="ch9.lt107" class="half_rhythm"><div>Preoperative</div></li><li id="ch9.lt108" class="half_rhythm"><div>Non-surgical</div></li><li id="ch9.lt109" class="half_rhythm"><div>Post-operative</div></li><li id="ch9.lt110" class="half_rhythm"><div>People on calcimimetics</div></li><li id="ch9.lt111" class="half_rhythm"><div>People on bisphosphonates</div></li><li id="ch9.lt112" class="half_rhythm"><div>Previous surgery</div></li><li id="ch9.lt113" class="half_rhythm"><div>Normocalcaemic patients</div></li></ul></p>
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<p>Subgroup:<ul id="ch9.l23"><li id="ch9.lt114" class="half_rhythm"><div>People on HRT</div></li></ul></p>
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<p>Exclude people:<ul id="ch9.l24"><li id="ch9.lt115" class="half_rhythm"><div>with secondary and tertiary HPT</div></li><li id="ch9.lt116" class="half_rhythm"><div>with multiple endocrine neoplasia</div></li><li id="ch9.lt117" class="half_rhythm"><div>with familial hyperparathyroidism</div></li><li id="ch9.lt118" class="half_rhythm"><div>with parathyroid carcinoma</div></li><li id="ch9.lt119" class="half_rhythm"><div>people on medications interfering with calcium metabolism (lithium).</div></li></ul></p>
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</td></tr><tr><td headers="hd_h_ch9.appa.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outcomes and prioritisation</td><td headers="hd_h_ch9.appa.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul id="ch9.l25"><li id="ch9.lt120" class="half_rhythm"><div>Mortality (dichotomous)</div></li><li id="ch9.lt121" class="half_rhythm"><div>Fragility fracture (dichotomous)</div></li><li id="ch9.lt122" class="half_rhythm"><div>Renal stones (dichotomous)</div></li><li id="ch9.lt123" class="half_rhythm"><div>Renal tract calcification (dichotomous)</div></li><li id="ch9.lt124" class="half_rhythm"><div>Pancreatitis (dichotomous)</div></li><li id="ch9.lt125" class="half_rhythm"><div>Stroke (dichotomous)</div></li><li id="ch9.lt126" class="half_rhythm"><div>Hypertension (dichotomous)</div></li><li id="ch9.lt127" class="half_rhythm"><div>Myocardial infarction (dichotomous)</div></li><li id="ch9.lt128" class="half_rhythm"><div>Number of people who become eligible for surgery/meet the criteria for surgery (dichotomous)</div></li><li id="ch9.lt129" class="half_rhythm"><div>Serum calcium (>2.85 mmol/L) (dichotomous) (continuous if dichotomous not available)</div></li><li id="ch9.lt130" class="half_rhythm"><div>24-hour urine for calcium (>10 mmol/dl) (dichotomous) (continuous if dichotomous not available)</div></li><li id="ch9.lt131" class="half_rhythm"><div>BMD of proximal femur (T-score <2.5; Z score <2) (dichotomous) (continuous if dichotomous not available)</div></li></ul>
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<p>Report age interaction (this will be a narrative – how age interacts with the outcome of interest)</p>
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<p>Follow-up: minimum 2 years</p>
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</td></tr><tr><td headers="hd_h_ch9.appa.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Eligibility criteria – study design</td><td headers="hd_h_ch9.appa.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Prospective cohort studies</p>
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<p>Retrospective cohort studies will be included only if insufficient prospective cohort studies are identified.</p>
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<p>Key confounders:<ul id="ch9.l26"><li id="ch9.lt132" class="half_rhythm"><div>Age</div></li><li id="ch9.lt133" class="half_rhythm"><div>Absence/presence of end-organ effects</div></li><li id="ch9.lt134" class="half_rhythm"><div>Adjusted serum calcium level</div></li></ul></p>
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</td></tr><tr><td headers="hd_h_ch9.appa.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Other inclusion exclusion criteria</td><td headers="hd_h_ch9.appa.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Exclusions:<ul id="ch9.l27"><li id="ch9.lt135" class="half_rhythm"><div>Non-English language papers</div></li><li id="ch9.lt136" class="half_rhythm"><div>Conference abstracts</div></li><li id="ch9.lt137" class="half_rhythm"><div>Not compared to healthy controls</div></li><li id="ch9.lt138" class="half_rhythm"><div>Studies <50 participants</div></li></ul></p>
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<p>Note: This review will be looking at the incidence of outcomes in people with PHPT compared with healthy controls. We will not be looking at studies reporting the incidence in people with PHPT as this is less informative.</p>
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</td></tr><tr><td headers="hd_h_ch9.appa.tab2_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_ch9.appa.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">N/A</td></tr><tr><td headers="hd_h_ch9.appa.tab2_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_ch9.appa.tab2_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_ch9.appa.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Data management (software)</td><td headers="hd_h_ch9.appa.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul id="ch9.l28"><li id="ch9.lt139" class="half_rhythm"><div>Pairwise meta-analyses were performed using Cochrane Review Manager (RevMan5).</div></li><li id="ch9.lt140" class="half_rhythm"><div>GRADEpro was used to assess the quality of evidence for each outcome.</div></li><li id="ch9.lt141" class="half_rhythm"><div>Endnote for bibliography, citations, sifting and reference management</div></li><li id="ch9.lt142" class="half_rhythm"><div>Data extractions performed using EviBase, a platform designed and maintained by the National Guideline Centre (NGC).</div></li></ul>
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</td></tr><tr><td headers="hd_h_ch9.appa.tab2_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_ch9.appa.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Clinical search databases to be used: Medline, Embase, Cochrane Library</p>
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<p>Date: all years</p>
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<p>Health economics search databases to be used: Medline, Embase, NHSEED, HTA</p>
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<p>Date: Medline, Embase from 2014</p>
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<p>NHSEED, HTA – all years</p>
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<p>Language: Restrict to English only</p>
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<p>Supplementary search techniques: backward citation searching</p>
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<p>Key papers: Not known</p>
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</td></tr><tr><td headers="hd_h_ch9.appa.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Identify if an update</td><td headers="hd_h_ch9.appa.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">N/A</td></tr><tr><td headers="hd_h_ch9.appa.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Author contacts</td><td headers="hd_h_ch9.appa.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<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>
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</td></tr><tr><td headers="hd_h_ch9.appa.tab2_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_ch9.appa.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">For details please see section 4.5 of <a href="https://www.nice.org.uk/article/pmg20/chapter/4-Developing-review-questions-and-planning-the-evidence-review#planning-the-evidence-review" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Developing NICE guidelines: the manual</a>.</td></tr><tr><td headers="hd_h_ch9.appa.tab2_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_ch9.appa.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">For details please see <a href="#ch9.appb">appendix B</a></td></tr><tr><td headers="hd_h_ch9.appa.tab2_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_ch9.appa.tab2_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="#ch9.appd">appendix D</a> of the evidence report.</td></tr><tr><td headers="hd_h_ch9.appa.tab2_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_ch9.appa.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">For details please see evidence tables in <a href="#ch9.appd">appendix D</a> (clinical evidence tables) or <a href="#ch9.apph">H</a> (health economic evidence tables).</td></tr><tr><td headers="hd_h_ch9.appa.tab2_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_ch9.appa.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<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>
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<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>
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</td></tr><tr><td headers="hd_h_ch9.appa.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Criteria for quantitative synthesis</td><td headers="hd_h_ch9.appa.tab2_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_ch9.appa.tab2_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_ch9.appa.tab2_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_ch9.appa.tab2_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_ch9.appa.tab2_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_ch9.appa.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Confidence in cumulative evidence</td><td headers="hd_h_ch9.appa.tab2_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_ch9.appa.tab2_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_ch9.appa.tab2_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_ch9.appa.tab2_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_ch9.appa.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<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>
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<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.</p>
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<p>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>
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</td></tr><tr><td headers="hd_h_ch9.appa.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Sources of funding / support</td><td headers="hd_h_ch9.appa.tab2_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_ch9.appa.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Name of sponsor</td><td headers="hd_h_ch9.appa.tab2_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_ch9.appa.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Roles of sponsor</td><td headers="hd_h_ch9.appa.tab2_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_ch9.appa.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">PROSPERO registration number</td><td headers="hd_h_ch9.appa.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not registered</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobch9appatab3"><div id="ch9.appa.tab3" class="table"><h3><span class="label">Table 14</span><span class="title">Health economic review protocol</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577896/table/ch9.appa.tab3/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch9.appa.tab3_lrgtbl__"><table><thead><tr><th id="hd_h_ch9.appa.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Review question</th><th id="hd_h_ch9.appa.tab3_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_ch9.appa.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<b>Objectives</b>
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</td><td headers="hd_h_ch9.appa.tab3_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_ch9.appa.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<b>Search criteria</b>
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</td><td headers="hd_h_ch9.appa.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><ul id="ch9.l29"><li id="ch9.lt143" class="half_rhythm"><div>Populations, interventions and comparators must be as specified in the clinical review protocol above.</div></li><li id="ch9.lt144" 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="ch9.lt145" 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="ch9.lt146" 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_ch9.appa.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<b>Search strategy</b>
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</td><td headers="hd_h_ch9.appa.tab3_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="#ch9.appb">appendix B</a> below.</td></tr><tr><td headers="hd_h_ch9.appa.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<b>Review strategy</b>
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</td><td headers="hd_h_ch9.appa.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<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>
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<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="#ch9.apph">appendix H</a> of Developing NICE guidelines: the manual (2014).<a class="bibr" href="#ch9.ref53" rid="ch9.ref53"><sup>53</sup></a></p>
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<p>
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<b>Inclusion and exclusion criteria</b>
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<ul id="ch9.l30"><li id="ch9.lt147" 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="ch9.lt148" 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="ch9.lt149" 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>
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</p>
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<p>
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<b>Where there is discretion</b>
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</p>
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<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>
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<p>The health economist will be guided by the following hierarchies.</p>
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<p>
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<i>Setting:</i>
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<ul id="ch9.l31"><li id="ch9.lt150" class="half_rhythm"><div>UK NHS (most applicable).</div></li><li id="ch9.lt151" class="half_rhythm"><div>OECD countries with predominantly public health insurance systems (for example, France, Germany, Sweden).</div></li><li id="ch9.lt152" class="half_rhythm"><div>OECD countries with predominantly private health insurance systems (for example, Switzerland).</div></li><li id="ch9.lt153" 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>
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</p>
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<p>
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<i>Health economic study type:</i>
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<ul id="ch9.l32"><li id="ch9.lt154" class="half_rhythm"><div>Cost–utility analysis (most applicable).</div></li><li id="ch9.lt155" class="half_rhythm"><div>Other type of full economic evaluation (cost–benefit analysis, costeffectiveness analysis, cost–consequences analysis).</div></li><li id="ch9.lt156" class="half_rhythm"><div>Comparative cost analysis.</div></li><li id="ch9.lt157" 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>
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</p>
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<p>
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<i>Year of analysis:</i>
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<ul id="ch9.l33"><li id="ch9.lt158" class="half_rhythm"><div>The more recent the study, the more applicable it will be.</div></li><li id="ch9.lt159" 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="ch9.lt160" class="half_rhythm"><div>Studies published before 2002 will be excluded before being assessed for applicability and methodological limitations.</div></li></ul>
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</p>
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<p>
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<i>Quality and relevance of effectiveness data used in the health economic analysis:</i>
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<ul id="ch9.l34"><li id="ch9.lt161" 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>
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</p>
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</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobch9appbtab1"><div id="ch9.appb.tab1" class="table"><h3><span class="label">Table 15</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/NBK577896/table/ch9.appb.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch9.appb.tab1_lrgtbl__"><table><thead><tr><th id="hd_h_ch9.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Database</th><th id="hd_h_ch9.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Dates searched</th><th id="hd_h_ch9.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_ch9.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Medline (OVID)</td><td headers="hd_h_ch9.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_ch9.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_ch9.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Embase (OVID)</td><td headers="hd_h_ch9.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_ch9.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_ch9.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_ch9.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Cochrane Reviews to 2018 Issue 8 of 12</p>
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<p>CENTRAL to 2018 Issue 7 of 12</p>
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<p>DARE, and NHSEED to 2015 Issue 2 of 4</p>
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<p>HTA to 2016 Issue 4 of 4</p>
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</td><td headers="hd_h_ch9.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_ch9.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_ch9.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_ch9.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_ch9.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">PsycINFO (ProQuest)</td><td headers="hd_h_ch9.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_ch9.appb.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Exclusions</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobch9appbtab2"><div id="ch9.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/NBK577896/table/ch9.appb.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch9.appb.tab2_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;">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></article><article data-type="table-wrap" id="figobch9appbtab3"><div id="ch9.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/NBK577896/table/ch9.appb.tab3/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch9.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></article><article data-type="table-wrap" id="figobch9appbtab4"><div id="ch9.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/NBK577896/table/ch9.appb.tab4/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch9.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></article><article data-type="table-wrap" id="figobch9appbtab5"><div id="ch9.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/NBK577896/table/ch9.appb.tab5/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch9.appb.tab5_lrgtbl__"><table><tbody><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">S1.</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></article><article data-type="table-wrap" id="figobch9appbtab6"><div id="ch9.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/NBK577896/table/ch9.appb.tab6/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch9.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.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></tbody></table></div></div></article><article data-type="table-wrap" id="figobch9appbtab7"><div id="ch9.appb.tab7" class="table"><h3><span class="label">Table 16</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/NBK577896/table/ch9.appb.tab7/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch9.appb.tab7_lrgtbl__"><table><thead><tr><th id="hd_h_ch9.appb.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Database</th><th id="hd_h_ch9.appb.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Dates searched</th><th id="hd_h_ch9.appb.tab7_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Search filter used</th></tr></thead><tbody><tr><td headers="hd_h_ch9.appb.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Medline</td><td headers="hd_h_ch9.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_ch9.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_ch9.appb.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Embase</td><td headers="hd_h_ch9.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_ch9.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_ch9.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_ch9.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_ch9.appb.tab7_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">None</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobch9appbtab8"><div id="ch9.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/NBK577896/table/ch9.appb.tab8/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch9.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></article><article data-type="table-wrap" id="figobch9appbtab9"><div id="ch9.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/NBK577896/table/ch9.appb.tab9/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch9.appb.tab9_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><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></tbody></table></div></div></article><article data-type="table-wrap" id="figobch9appbtab10"><div id="ch9.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/NBK577896/table/ch9.appb.tab10/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch9.appb.tab10_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) 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></tbody></table></div></div></article><article data-type="fig" id="figobch9appcfig1"><div id="ch9.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%20Monitoring%20strategies.&p=BOOKS&id=577896_ch9appcf1.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 data-src="/books/NBK577896/bin/ch9appcf1.jpg" alt="Figure 1. Flow chart of clinical study selection for the review of Monitoring strategies." 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 Monitoring strategies</span></h3></div></article><article data-type="fig" id="figobch9appcfig2"><div id="ch9.appc.fig2" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%202.%20Flow%20chart%20of%20clinical%20study%20selection%20for%20the%20review%20of%20Monitoring%20long-term%20outcomes.&p=BOOKS&id=577896_ch9appcf2.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 data-src="/books/NBK577896/bin/ch9appcf2.jpg" alt="Figure 2. Flow chart of clinical study selection for the review of Monitoring long-term outcomes." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 2</span><span class="title">Flow chart of clinical study selection for the review of Monitoring long-term outcomes</span></h3></div></article><article data-type="fig" id="figobch9appefig1"><div id="ch9.appe.fig1" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%203.%20All-cause%20mortality.&p=BOOKS&id=577896_ch9appef1.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 data-src="/books/NBK577896/bin/ch9appef1.jpg" alt="Figure 3. All-cause mortality." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 3</span><span class="title">All-cause mortality</span></h3></div></article><article data-type="fig" id="figobch9appefig2"><div id="ch9.appe.fig2" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%204.%20Fatal%20CVD.&p=BOOKS&id=577896_ch9appef2.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 data-src="/books/NBK577896/bin/ch9appef2.jpg" alt="Figure 4. Fatal CVD." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 4</span><span class="title">Fatal CVD</span></h3></div></article><article data-type="fig" id="figobch9appefig3"><div id="ch9.appe.fig3" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%205.%20Non-fatal%20CVD.&p=BOOKS&id=577896_ch9appef3.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 data-src="/books/NBK577896/bin/ch9appef3.jpg" alt="Figure 5. Non-fatal CVD." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 5</span><span class="title">Non-fatal CVD</span></h3></div></article><article data-type="fig" id="figobch9appefig4"><div id="ch9.appe.fig4" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%206.%20Cerebrovascular%20disease.&p=BOOKS&id=577896_ch9appef4.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 data-src="/books/NBK577896/bin/ch9appef4.jpg" alt="Figure 6. Cerebrovascular disease." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 6</span><span class="title">Cerebrovascular disease</span></h3></div></article><article data-type="fig" id="figobch9appefig5"><div id="ch9.appe.fig5" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%207.%20Hypertension.&p=BOOKS&id=577896_ch9appef5.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 data-src="/books/NBK577896/bin/ch9appef5.jpg" alt="Figure 7. Hypertension." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 7</span><span class="title">Hypertension</span></h3></div></article><article data-type="fig" id="figobch9appefig6"><div id="ch9.appe.fig6" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%208.%20Renal%20failure.&p=BOOKS&id=577896_ch9appef6.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 data-src="/books/NBK577896/bin/ch9appef6.jpg" alt="Figure 8. Renal failure." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 8</span><span class="title">Renal failure</span></h3></div></article><article data-type="fig" id="figobch9appefig7"><div id="ch9.appe.fig7" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%209.%20Renal%20stones.&p=BOOKS&id=577896_ch9appef7.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 data-src="/books/NBK577896/bin/ch9appef7.jpg" alt="Figure 9. Renal stones." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 9</span><span class="title">Renal stones</span></h3></div></article><article data-type="fig" id="figobch9appefig8"><div id="ch9.appe.fig8" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%2010.%20All%20fractures.&p=BOOKS&id=577896_ch9appef8.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 data-src="/books/NBK577896/bin/ch9appef8.jpg" alt="Figure 10. All fractures." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 10</span><span class="title">All fractures</span></h3></div></article><article data-type="fig" id="figobch9appefig9"><div id="ch9.appe.fig9" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%2011.%20Osteoporotic%20fractures.&p=BOOKS&id=577896_ch9appef9.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 data-src="/books/NBK577896/bin/ch9appef9.jpg" alt="Figure 11. Osteoporotic fractures." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 11</span><span class="title">Osteoporotic fractures</span></h3></div></article><article data-type="fig" id="figobch9appefig10"><div id="ch9.appe.fig10" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%2012.%20Renal%20stones.&p=BOOKS&id=577896_ch9appef10.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 data-src="/books/NBK577896/bin/ch9appef10.jpg" alt="Figure 12. Renal stones." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 12</span><span class="title">Renal stones</span></h3></div></article><article data-type="fig" id="figobch9appefig11"><div id="ch9.appe.fig11" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%2013.%20Fractures%20(all).&p=BOOKS&id=577896_ch9appef11.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 data-src="/books/NBK577896/bin/ch9appef11.jpg" alt="Figure 13. Fractures (all)." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 13</span><span class="title">Fractures (all)</span></h3></div></article><article data-type="fig" id="figobch9appefig12"><div id="ch9.appe.fig12" 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-BMD%20(gm%2Fcm2)%20(mild%20PHPT%20versus%20healthy%20women).&p=BOOKS&id=577896_ch9appef12.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 data-src="/books/NBK577896/bin/ch9appef12.jpg" alt="Figure 14. Lumbar spine-BMD (gm/cm2) (mild PHPT versus healthy women)." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 14</span><span class="title">Lumbar spine-BMD (gm/cm<sup>2</sup>) (mild PHPT versus healthy women)</span></h3></div></article><article data-type="fig" id="figobch9appefig13"><div id="ch9.appe.fig13" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%2015.%20FN%20BMD%20(mg%2Fcm2)%20(mild%20PHPT%20versus%20healthy%20women).&p=BOOKS&id=577896_ch9appef13.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 data-src="/books/NBK577896/bin/ch9appef13.jpg" alt="Figure 15. FN BMD (mg/cm2) (mild PHPT versus healthy women)." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 15</span><span class="title">FN BMD (mg/cm<sup>2</sup>) (mild PHPT versus healthy women)</span></h3></div></article><article data-type="fig" id="figobch9appefig14"><div id="ch9.appe.fig14" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%2016.%20FT%20BMD%20(mg%2Fcm2)%20(mild%20PHPT%20versus%20healthy%20women).&p=BOOKS&id=577896_ch9appef14.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 data-src="/books/NBK577896/bin/ch9appef14.jpg" alt="Figure 16. FT BMD (mg/cm2) (mild PHPT versus healthy women)." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 16</span><span class="title">FT BMD (mg/cm<sup>2</sup>) (mild PHPT versus healthy women)</span></h3></div></article><article data-type="fig" id="figobch9appefig15"><div id="ch9.appe.fig15" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%2017.%20Vertebral%20fractures%20(mild%20PHPT%20versus%20control).&p=BOOKS&id=577896_ch9appef15.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 data-src="/books/NBK577896/bin/ch9appef15.jpg" alt="Figure 17. Vertebral fractures (mild PHPT versus control)." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 17</span><span class="title">Vertebral fractures (mild PHPT versus control)</span></h3></div></article><article data-type="fig" id="figobch9appefig16"><div id="ch9.appe.fig16" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%2018.%20Vertebral%20fractures%20(non-mild%20PHPT%20versus%20healthy%20women).&p=BOOKS&id=577896_ch9appef16.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 data-src="/books/NBK577896/bin/ch9appef16.jpg" alt="Figure 18. Vertebral fractures (non-mild PHPT versus healthy women)." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 18</span><span class="title">Vertebral fractures (non-mild PHPT versus healthy women)</span></h3></div></article><article data-type="fig" id="figobch9appefig17"><div id="ch9.appe.fig17" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%2019.%20Non-vertebral%20fractures%20(mild%20PHPT%20versus%20healthy%20women).&p=BOOKS&id=577896_ch9appef17.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 data-src="/books/NBK577896/bin/ch9appef17.jpg" alt="Figure 19. Non-vertebral fractures (mild PHPT versus healthy women)." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 19</span><span class="title">Non-vertebral fractures (mild PHPT versus healthy women)</span></h3></div></article><article data-type="fig" id="figobch9appefig18"><div id="ch9.appe.fig18" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%2020.%20Non-vertebral%20fractures%20(non-mild%20PHPT%20versus%20healthy%20women).&p=BOOKS&id=577896_ch9appef18.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 data-src="/books/NBK577896/bin/ch9appef18.jpg" alt="Figure 20. Non-vertebral fractures (non-mild PHPT versus healthy women)." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 20</span><span class="title">Non-vertebral fractures (non-mild PHPT versus healthy women)</span></h3></div></article><article data-type="fig" id="figobch9appefig19"><div id="ch9.appe.fig19" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%2021.%20LS-BMD%20(mg%2Fcm2)%20(non-mild%20PHPT%20versus%20healthy%20women).&p=BOOKS&id=577896_ch9appef19.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 data-src="/books/NBK577896/bin/ch9appef19.jpg" alt="Figure 21. LS-BMD (mg/cm2) (non-mild PHPT versus healthy women)." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 21</span><span class="title">LS-BMD (mg/cm<sup>2</sup>) (non-mild PHPT versus healthy women)</span></h3></div></article><article data-type="fig" id="figobch9appefig20"><div id="ch9.appe.fig20" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%2022.%20Femur%20neck-BMD%20(mg%2Fcm2)%20(non-mild%20PHPT%20versus%20healthy%20women).&p=BOOKS&id=577896_ch9appef20.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 data-src="/books/NBK577896/bin/ch9appef20.jpg" alt="Figure 22. Femur neck-BMD (mg/cm2) (non-mild PHPT versus healthy women)." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 22</span><span class="title">Femur neck-BMD (mg/cm<sup>2</sup>) (non-mild PHPT versus healthy women)</span></h3></div></article><article data-type="fig" id="figobch9appefig21"><div id="ch9.appe.fig21" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%2023.%20Total%20femur-BMD%20(mg%2Fcm2)%20(non-mild%20PHPT%20versus%20healthy%20women).&p=BOOKS&id=577896_ch9appef21.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 data-src="/books/NBK577896/bin/ch9appef21.jpg" alt="Figure 23. Total femur-BMD (mg/cm2) (non-mild PHPT versus healthy women)." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 23</span><span class="title">Total femur-BMD (mg/cm<sup>2</sup>) (non-mild PHPT versus healthy women)</span></h3></div></article><article data-type="fig" id="figobch9appefig22"><div id="ch9.appe.fig22" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%2024.%20Mortality.&p=BOOKS&id=577896_ch9appef22.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 data-src="/books/NBK577896/bin/ch9appef22.jpg" alt="Figure 24. Mortality." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 24</span><span class="title">Mortality</span></h3></div></article><article data-type="fig" id="figobch9appefig23"><div id="ch9.appe.fig23" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%2025.%20Fractures.&p=BOOKS&id=577896_ch9appef23.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 data-src="/books/NBK577896/bin/ch9appef23.jpg" alt="Figure 25. Fractures." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 25</span><span class="title">Fractures</span></h3></div></article><article data-type="table-wrap" id="figobch9appftab1"><div id="ch9.appf.tab1" class="table"><h3><span class="label">Table 17</span><span class="title">Clinical evidence profile: PHPT cases versus matched comparators (adjusted for key confounders) – non-surgical</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577896/table/ch9.appf.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch9.appf.tab1_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_ch9.appf.tab1_1_1_1_1" colspan="7" rowspan="1" style="text-align:center;vertical-align:middle;">Quality assessment</th><th id="hd_h_ch9.appf.tab1_1_1_1_2" colspan="2" rowspan="1" style="text-align:center;vertical-align:middle;">No of patients</th><th id="hd_h_ch9.appf.tab1_1_1_1_3" colspan="2" rowspan="1" style="text-align:center;vertical-align:middle;">Effect</th><th id="hd_h_ch9.appf.tab1_1_1_1_4" rowspan="2" colspan="1" headers="hd_h_ch9.appf.tab1_1_1_1_4" style="text-align:center;vertical-align:middle;">Quality</th><th id="hd_h_ch9.appf.tab1_1_1_1_5" rowspan="2" colspan="1" headers="hd_h_ch9.appf.tab1_1_1_1_5" style="text-align:center;vertical-align:middle;">Importance</th></tr><tr><th headers="hd_h_ch9.appf.tab1_1_1_1_1" id="hd_h_ch9.appf.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">No of studies</th><th headers="hd_h_ch9.appf.tab1_1_1_1_1" id="hd_h_ch9.appf.tab1_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Design</th><th headers="hd_h_ch9.appf.tab1_1_1_1_1" id="hd_h_ch9.appf.tab1_1_1_2_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Risk of bias</th><th headers="hd_h_ch9.appf.tab1_1_1_1_1" id="hd_h_ch9.appf.tab1_1_1_2_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Inconsistency</th><th headers="hd_h_ch9.appf.tab1_1_1_1_1" id="hd_h_ch9.appf.tab1_1_1_2_5" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Indirectness</th><th headers="hd_h_ch9.appf.tab1_1_1_1_1" id="hd_h_ch9.appf.tab1_1_1_2_6" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Imprecision</th><th headers="hd_h_ch9.appf.tab1_1_1_1_1" id="hd_h_ch9.appf.tab1_1_1_2_7" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Other considerations</th><th headers="hd_h_ch9.appf.tab1_1_1_1_2" id="hd_h_ch9.appf.tab1_1_1_2_8" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Cases</th><th headers="hd_h_ch9.appf.tab1_1_1_1_2" id="hd_h_ch9.appf.tab1_1_1_2_9" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Control</th><th headers="hd_h_ch9.appf.tab1_1_1_1_3" id="hd_h_ch9.appf.tab1_1_1_2_10" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Relative (95% CI)</th><th headers="hd_h_ch9.appf.tab1_1_1_1_3" id="hd_h_ch9.appf.tab1_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_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_1 hd_h_ch9.appf.tab1_1_1_2_2 hd_h_ch9.appf.tab1_1_1_2_3 hd_h_ch9.appf.tab1_1_1_2_4 hd_h_ch9.appf.tab1_1_1_2_5 hd_h_ch9.appf.tab1_1_1_2_6 hd_h_ch9.appf.tab1_1_1_2_7 hd_h_ch9.appf.tab1_1_1_1_2 hd_h_ch9.appf.tab1_1_1_2_8 hd_h_ch9.appf.tab1_1_1_2_9 hd_h_ch9.appf.tab1_1_1_1_3 hd_h_ch9.appf.tab1_1_1_2_10 hd_h_ch9.appf.tab1_1_1_2_11 hd_h_ch9.appf.tab1_1_1_1_4 hd_h_ch9.appf.tab1_1_1_1_5" id="hd_b_ch9.appf.tab1_1_1_1_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:middle;">All-cause mortality (follow-up median 2.9 years)</th></tr><tr><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_1 hd_b_ch9.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_2 hd_b_ch9.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">observational studies</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_3 hd_b_ch9.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup>a</sup></td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_4 hd_b_ch9.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_5 hd_b_ch9.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious indirectness</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_6 hd_b_ch9.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious imprecision</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_7 hd_b_ch9.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">None</td><td headers="hd_h_ch9.appf.tab1_1_1_1_2 hd_h_ch9.appf.tab1_1_1_2_8 hd_b_ch9.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">NR</td><td headers="hd_h_ch9.appf.tab1_1_1_1_2 hd_h_ch9.appf.tab1_1_1_2_9 hd_b_ch9.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">NR</td><td headers="hd_h_ch9.appf.tab1_1_1_1_3 hd_h_ch9.appf.tab1_1_1_2_10 hd_b_ch9.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">HR 1.64 (1.43 to 1.87)<sup>b</sup></td><td headers="hd_h_ch9.appf.tab1_1_1_1_3 hd_h_ch9.appf.tab1_1_1_2_11 hd_b_ch9.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">-<sup>c</sup></td><td headers="hd_h_ch9.appf.tab1_1_1_1_4 hd_b_ch9.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
|
<p>⊕⊕◯◯</p>
|
|
<p>LOW</p>
|
|
</td><td headers="hd_h_ch9.appf.tab1_1_1_1_5 hd_b_ch9.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">CRITICAL</td></tr><tr><th headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_1 hd_h_ch9.appf.tab1_1_1_2_2 hd_h_ch9.appf.tab1_1_1_2_3 hd_h_ch9.appf.tab1_1_1_2_4 hd_h_ch9.appf.tab1_1_1_2_5 hd_h_ch9.appf.tab1_1_1_2_6 hd_h_ch9.appf.tab1_1_1_2_7 hd_h_ch9.appf.tab1_1_1_1_2 hd_h_ch9.appf.tab1_1_1_2_8 hd_h_ch9.appf.tab1_1_1_2_9 hd_h_ch9.appf.tab1_1_1_1_3 hd_h_ch9.appf.tab1_1_1_2_10 hd_h_ch9.appf.tab1_1_1_2_11 hd_h_ch9.appf.tab1_1_1_1_4 hd_h_ch9.appf.tab1_1_1_1_5" id="hd_b_ch9.appf.tab1_1_1_3_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:middle;">Fatal CVD (follow-up median 2.9 years)</th></tr><tr><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_1 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_2 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">observational studies</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_3 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup>a</sup></td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_4 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_5 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious indirectness</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_6 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious imprecision</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_7 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">None</td><td headers="hd_h_ch9.appf.tab1_1_1_1_2 hd_h_ch9.appf.tab1_1_1_2_8 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">NR</td><td headers="hd_h_ch9.appf.tab1_1_1_1_2 hd_h_ch9.appf.tab1_1_1_2_9 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">NR</td><td headers="hd_h_ch9.appf.tab1_1_1_1_3 hd_h_ch9.appf.tab1_1_1_2_10 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">HR 1.64 (1.32 to 2.04)<sup>b</sup></td><td headers="hd_h_ch9.appf.tab1_1_1_1_3 hd_h_ch9.appf.tab1_1_1_2_11 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">-<sup>c</sup></td><td headers="hd_h_ch9.appf.tab1_1_1_1_4 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
|
<p>⊕⊕◯◯</p>
|
|
<p>LOW</p>
|
|
</td><td headers="hd_h_ch9.appf.tab1_1_1_1_5 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">CRITICAL</td></tr><tr><th headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_1 hd_h_ch9.appf.tab1_1_1_2_2 hd_h_ch9.appf.tab1_1_1_2_3 hd_h_ch9.appf.tab1_1_1_2_4 hd_h_ch9.appf.tab1_1_1_2_5 hd_h_ch9.appf.tab1_1_1_2_6 hd_h_ch9.appf.tab1_1_1_2_7 hd_h_ch9.appf.tab1_1_1_1_2 hd_h_ch9.appf.tab1_1_1_2_8 hd_h_ch9.appf.tab1_1_1_2_9 hd_h_ch9.appf.tab1_1_1_1_3 hd_h_ch9.appf.tab1_1_1_2_10 hd_h_ch9.appf.tab1_1_1_2_11 hd_h_ch9.appf.tab1_1_1_1_4 hd_h_ch9.appf.tab1_1_1_1_5" id="hd_b_ch9.appf.tab1_1_1_5_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:middle;">Non-fatal CVD (follow-up median 2.9 years)</th></tr><tr><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_1 hd_b_ch9.appf.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_2 hd_b_ch9.appf.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">observational studies</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_3 hd_b_ch9.appf.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup>a</sup></td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_4 hd_b_ch9.appf.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_5 hd_b_ch9.appf.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious indirectness</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_6 hd_b_ch9.appf.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious imprecision</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_7 hd_b_ch9.appf.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">None</td><td headers="hd_h_ch9.appf.tab1_1_1_1_2 hd_h_ch9.appf.tab1_1_1_2_8 hd_b_ch9.appf.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">NR</td><td headers="hd_h_ch9.appf.tab1_1_1_1_2 hd_h_ch9.appf.tab1_1_1_2_9 hd_b_ch9.appf.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">NR</td><td headers="hd_h_ch9.appf.tab1_1_1_1_3 hd_h_ch9.appf.tab1_1_1_2_10 hd_b_ch9.appf.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">HR 2.48 (2.13 to 2.89)<sup>b</sup></td><td headers="hd_h_ch9.appf.tab1_1_1_1_3 hd_h_ch9.appf.tab1_1_1_2_11 hd_b_ch9.appf.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">-<sup>c</sup></td><td headers="hd_h_ch9.appf.tab1_1_1_1_4 hd_b_ch9.appf.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
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<p>⊕⊕◯◯</p>
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<p>LOW</p>
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</td><td headers="hd_h_ch9.appf.tab1_1_1_1_5 hd_b_ch9.appf.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">CRITICAL</td></tr><tr><th headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_1 hd_h_ch9.appf.tab1_1_1_2_2 hd_h_ch9.appf.tab1_1_1_2_3 hd_h_ch9.appf.tab1_1_1_2_4 hd_h_ch9.appf.tab1_1_1_2_5 hd_h_ch9.appf.tab1_1_1_2_6 hd_h_ch9.appf.tab1_1_1_2_7 hd_h_ch9.appf.tab1_1_1_1_2 hd_h_ch9.appf.tab1_1_1_2_8 hd_h_ch9.appf.tab1_1_1_2_9 hd_h_ch9.appf.tab1_1_1_1_3 hd_h_ch9.appf.tab1_1_1_2_10 hd_h_ch9.appf.tab1_1_1_2_11 hd_h_ch9.appf.tab1_1_1_1_4 hd_h_ch9.appf.tab1_1_1_1_5" id="hd_b_ch9.appf.tab1_1_1_7_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:middle;">Hypertension (follow-up median 2.9 years)</th></tr><tr><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_1 hd_b_ch9.appf.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_2 hd_b_ch9.appf.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">observational studies</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_3 hd_b_ch9.appf.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup>a</sup></td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_4 hd_b_ch9.appf.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_5 hd_b_ch9.appf.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious indirectness</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_6 hd_b_ch9.appf.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious imprecision</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_7 hd_b_ch9.appf.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">None</td><td headers="hd_h_ch9.appf.tab1_1_1_1_2 hd_h_ch9.appf.tab1_1_1_2_8 hd_b_ch9.appf.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">NR</td><td headers="hd_h_ch9.appf.tab1_1_1_1_2 hd_h_ch9.appf.tab1_1_1_2_9 hd_b_ch9.appf.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">NR</td><td headers="hd_h_ch9.appf.tab1_1_1_1_3 hd_h_ch9.appf.tab1_1_1_2_10 hd_b_ch9.appf.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">HR 2.60 (2.04 to 3.31)<sup>b</sup></td><td headers="hd_h_ch9.appf.tab1_1_1_1_3 hd_h_ch9.appf.tab1_1_1_2_11 hd_b_ch9.appf.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">-<sup>c</sup></td><td headers="hd_h_ch9.appf.tab1_1_1_1_4 hd_b_ch9.appf.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
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<p>⊕⊕◯◯</p>
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<p>LOW</p>
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</td><td headers="hd_h_ch9.appf.tab1_1_1_1_5 hd_b_ch9.appf.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">CRITICAL</td></tr><tr><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_1 hd_b_ch9.appf.tab1_1_1_7_1 hd_h_ch9.appf.tab1_1_1_2_2 hd_h_ch9.appf.tab1_1_1_2_3 hd_h_ch9.appf.tab1_1_1_2_4 hd_h_ch9.appf.tab1_1_1_2_5 hd_h_ch9.appf.tab1_1_1_2_6 hd_h_ch9.appf.tab1_1_1_2_7 hd_h_ch9.appf.tab1_1_1_1_2 hd_h_ch9.appf.tab1_1_1_2_8 hd_h_ch9.appf.tab1_1_1_2_9 hd_h_ch9.appf.tab1_1_1_1_3 hd_h_ch9.appf.tab1_1_1_2_10 hd_h_ch9.appf.tab1_1_1_2_11 hd_h_ch9.appf.tab1_1_1_1_4 hd_h_ch9.appf.tab1_1_1_1_5" colspan="13" rowspan="1" style="text-align:left;vertical-align:middle;">
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<b>Cerebrovascular disease (follow-up median 2.9 years)</b>
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</td></tr><tr><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_1 hd_b_ch9.appf.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_2 hd_b_ch9.appf.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">observational studies</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_3 hd_b_ch9.appf.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup>a</sup></td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_4 hd_b_ch9.appf.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_5 hd_b_ch9.appf.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious indirectness</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_6 hd_b_ch9.appf.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious imprecision</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_7 hd_b_ch9.appf.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">None</td><td headers="hd_h_ch9.appf.tab1_1_1_1_2 hd_h_ch9.appf.tab1_1_1_2_8 hd_b_ch9.appf.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">NR</td><td headers="hd_h_ch9.appf.tab1_1_1_1_2 hd_h_ch9.appf.tab1_1_1_2_9 hd_b_ch9.appf.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">NR</td><td headers="hd_h_ch9.appf.tab1_1_1_1_3 hd_h_ch9.appf.tab1_1_1_2_10 hd_b_ch9.appf.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">HR 2.51 (1.95 to 3.22)<sup>b</sup></td><td headers="hd_h_ch9.appf.tab1_1_1_1_3 hd_h_ch9.appf.tab1_1_1_2_11 hd_b_ch9.appf.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">-<sup>c</sup></td><td headers="hd_h_ch9.appf.tab1_1_1_1_4 hd_b_ch9.appf.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
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<p>⊕⊕◯◯</p>
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<p>LOW</p>
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</td><td headers="hd_h_ch9.appf.tab1_1_1_1_5 hd_b_ch9.appf.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">CRITICAL</td></tr><tr><th headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_1 hd_h_ch9.appf.tab1_1_1_2_2 hd_h_ch9.appf.tab1_1_1_2_3 hd_h_ch9.appf.tab1_1_1_2_4 hd_h_ch9.appf.tab1_1_1_2_5 hd_h_ch9.appf.tab1_1_1_2_6 hd_h_ch9.appf.tab1_1_1_2_7 hd_h_ch9.appf.tab1_1_1_1_2 hd_h_ch9.appf.tab1_1_1_2_8 hd_h_ch9.appf.tab1_1_1_2_9 hd_h_ch9.appf.tab1_1_1_1_3 hd_h_ch9.appf.tab1_1_1_2_10 hd_h_ch9.appf.tab1_1_1_2_11 hd_h_ch9.appf.tab1_1_1_1_4 hd_h_ch9.appf.tab1_1_1_1_5" id="hd_b_ch9.appf.tab1_1_1_11_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:middle;">Renal failure (follow-up median 2.9 years)</th></tr><tr><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_1 hd_b_ch9.appf.tab1_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_2 hd_b_ch9.appf.tab1_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">observational studies</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_3 hd_b_ch9.appf.tab1_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup>a</sup></td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_4 hd_b_ch9.appf.tab1_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_5 hd_b_ch9.appf.tab1_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious indirectness</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_6 hd_b_ch9.appf.tab1_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious imprecision</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_7 hd_b_ch9.appf.tab1_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">None</td><td headers="hd_h_ch9.appf.tab1_1_1_1_2 hd_h_ch9.appf.tab1_1_1_2_8 hd_b_ch9.appf.tab1_1_1_11_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">NR</td><td headers="hd_h_ch9.appf.tab1_1_1_1_2 hd_h_ch9.appf.tab1_1_1_2_9 hd_b_ch9.appf.tab1_1_1_11_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">NR</td><td headers="hd_h_ch9.appf.tab1_1_1_1_3 hd_h_ch9.appf.tab1_1_1_2_10 hd_b_ch9.appf.tab1_1_1_11_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">HR 13.83 (10.41 to 18.37)<sup>b</sup></td><td headers="hd_h_ch9.appf.tab1_1_1_1_3 hd_h_ch9.appf.tab1_1_1_2_11 hd_b_ch9.appf.tab1_1_1_11_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">-<sup>c</sup></td><td headers="hd_h_ch9.appf.tab1_1_1_1_4 hd_b_ch9.appf.tab1_1_1_11_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
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<p>⊕⊕◯◯</p>
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<p>LOW</p>
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</td><td headers="hd_h_ch9.appf.tab1_1_1_1_5 hd_b_ch9.appf.tab1_1_1_11_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">CRITICAL</td></tr><tr><th headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_1 hd_h_ch9.appf.tab1_1_1_2_2 hd_h_ch9.appf.tab1_1_1_2_3 hd_h_ch9.appf.tab1_1_1_2_4 hd_h_ch9.appf.tab1_1_1_2_5 hd_h_ch9.appf.tab1_1_1_2_6 hd_h_ch9.appf.tab1_1_1_2_7 hd_h_ch9.appf.tab1_1_1_1_2 hd_h_ch9.appf.tab1_1_1_2_8 hd_h_ch9.appf.tab1_1_1_2_9 hd_h_ch9.appf.tab1_1_1_1_3 hd_h_ch9.appf.tab1_1_1_2_10 hd_h_ch9.appf.tab1_1_1_2_11 hd_h_ch9.appf.tab1_1_1_1_4 hd_h_ch9.appf.tab1_1_1_1_5" id="hd_b_ch9.appf.tab1_1_1_13_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:middle;">Renal stones (follow-up median 2.9 years)</th></tr><tr><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_1 hd_b_ch9.appf.tab1_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_2 hd_b_ch9.appf.tab1_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">observational studies</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_3 hd_b_ch9.appf.tab1_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup>a</sup></td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_4 hd_b_ch9.appf.tab1_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_5 hd_b_ch9.appf.tab1_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious indirectness</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_6 hd_b_ch9.appf.tab1_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious imprecision</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_7 hd_b_ch9.appf.tab1_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">None</td><td headers="hd_h_ch9.appf.tab1_1_1_1_2 hd_h_ch9.appf.tab1_1_1_2_8 hd_b_ch9.appf.tab1_1_1_13_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">NR</td><td headers="hd_h_ch9.appf.tab1_1_1_1_2 hd_h_ch9.appf.tab1_1_1_2_9 hd_b_ch9.appf.tab1_1_1_13_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">NR</td><td headers="hd_h_ch9.appf.tab1_1_1_1_3 hd_h_ch9.appf.tab1_1_1_2_10 hd_b_ch9.appf.tab1_1_1_13_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">HR 5.15 (2.69 to 9.83)<sup>b</sup></td><td headers="hd_h_ch9.appf.tab1_1_1_1_3 hd_h_ch9.appf.tab1_1_1_2_11 hd_b_ch9.appf.tab1_1_1_13_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">-<sup>c</sup></td><td headers="hd_h_ch9.appf.tab1_1_1_1_4 hd_b_ch9.appf.tab1_1_1_13_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
|
<p>⊕⊕◯◯</p>
|
|
<p>LOW</p>
|
|
</td><td headers="hd_h_ch9.appf.tab1_1_1_1_5 hd_b_ch9.appf.tab1_1_1_13_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">CRITICAL</td></tr><tr><th headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_1 hd_h_ch9.appf.tab1_1_1_2_2 hd_h_ch9.appf.tab1_1_1_2_3 hd_h_ch9.appf.tab1_1_1_2_4 hd_h_ch9.appf.tab1_1_1_2_5 hd_h_ch9.appf.tab1_1_1_2_6 hd_h_ch9.appf.tab1_1_1_2_7 hd_h_ch9.appf.tab1_1_1_1_2 hd_h_ch9.appf.tab1_1_1_2_8 hd_h_ch9.appf.tab1_1_1_2_9 hd_h_ch9.appf.tab1_1_1_1_3 hd_h_ch9.appf.tab1_1_1_2_10 hd_h_ch9.appf.tab1_1_1_2_11 hd_h_ch9.appf.tab1_1_1_1_4 hd_h_ch9.appf.tab1_1_1_1_5" id="hd_b_ch9.appf.tab1_1_1_15_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:middle;">All fractures (follow-up median 2.9 years)</th></tr><tr><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_1 hd_b_ch9.appf.tab1_1_1_15_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_2 hd_b_ch9.appf.tab1_1_1_15_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">observational studies</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_3 hd_b_ch9.appf.tab1_1_1_15_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup>a</sup></td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_4 hd_b_ch9.appf.tab1_1_1_15_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_5 hd_b_ch9.appf.tab1_1_1_15_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious indirectness</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_6 hd_b_ch9.appf.tab1_1_1_15_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious imprecision</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_7 hd_b_ch9.appf.tab1_1_1_15_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">None</td><td headers="hd_h_ch9.appf.tab1_1_1_1_2 hd_h_ch9.appf.tab1_1_1_2_8 hd_b_ch9.appf.tab1_1_1_15_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">NR</td><td headers="hd_h_ch9.appf.tab1_1_1_1_2 hd_h_ch9.appf.tab1_1_1_2_9 hd_b_ch9.appf.tab1_1_1_15_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">NR</td><td headers="hd_h_ch9.appf.tab1_1_1_1_3 hd_h_ch9.appf.tab1_1_1_2_10 hd_b_ch9.appf.tab1_1_1_15_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">HR 1.75 (1.36 to 2.26)<sup>b</sup></td><td headers="hd_h_ch9.appf.tab1_1_1_1_3 hd_h_ch9.appf.tab1_1_1_2_11 hd_b_ch9.appf.tab1_1_1_15_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">-<sup>c</sup></td><td headers="hd_h_ch9.appf.tab1_1_1_1_4 hd_b_ch9.appf.tab1_1_1_15_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
|
<p>⊕⊕◯◯</p>
|
|
<p>LOW</p>
|
|
</td><td headers="hd_h_ch9.appf.tab1_1_1_1_5 hd_b_ch9.appf.tab1_1_1_15_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">CRITICAL</td></tr><tr><th headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_1 hd_h_ch9.appf.tab1_1_1_2_2 hd_h_ch9.appf.tab1_1_1_2_3 hd_h_ch9.appf.tab1_1_1_2_4 hd_h_ch9.appf.tab1_1_1_2_5 hd_h_ch9.appf.tab1_1_1_2_6 hd_h_ch9.appf.tab1_1_1_2_7 hd_h_ch9.appf.tab1_1_1_1_2 hd_h_ch9.appf.tab1_1_1_2_8 hd_h_ch9.appf.tab1_1_1_2_9 hd_h_ch9.appf.tab1_1_1_1_3 hd_h_ch9.appf.tab1_1_1_2_10 hd_h_ch9.appf.tab1_1_1_2_11 hd_h_ch9.appf.tab1_1_1_1_4 hd_h_ch9.appf.tab1_1_1_1_5" id="hd_b_ch9.appf.tab1_1_1_17_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:middle;">Osteoporotic fractures (follow-up median 2.9 years)</th></tr><tr><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_1 hd_b_ch9.appf.tab1_1_1_17_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_2 hd_b_ch9.appf.tab1_1_1_17_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">observational studies</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_3 hd_b_ch9.appf.tab1_1_1_17_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup>a</sup></td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_4 hd_b_ch9.appf.tab1_1_1_17_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_5 hd_b_ch9.appf.tab1_1_1_17_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious indirectness</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_6 hd_b_ch9.appf.tab1_1_1_17_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious imprecision</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_7 hd_b_ch9.appf.tab1_1_1_17_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">None</td><td headers="hd_h_ch9.appf.tab1_1_1_1_2 hd_h_ch9.appf.tab1_1_1_2_8 hd_b_ch9.appf.tab1_1_1_17_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">NR</td><td headers="hd_h_ch9.appf.tab1_1_1_1_2 hd_h_ch9.appf.tab1_1_1_2_9 hd_b_ch9.appf.tab1_1_1_17_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">NR</td><td headers="hd_h_ch9.appf.tab1_1_1_1_3 hd_h_ch9.appf.tab1_1_1_2_10 hd_b_ch9.appf.tab1_1_1_17_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">HR 1.63 (1.22 to 2.19)<sup>b</sup></td><td headers="hd_h_ch9.appf.tab1_1_1_1_3 hd_h_ch9.appf.tab1_1_1_2_11 hd_b_ch9.appf.tab1_1_1_17_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">-<sup>c</sup></td><td headers="hd_h_ch9.appf.tab1_1_1_1_4 hd_b_ch9.appf.tab1_1_1_17_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
|
<p>⊕⊕◯◯</p>
|
|
<p>LOW</p>
|
|
</td><td headers="hd_h_ch9.appf.tab1_1_1_1_5 hd_b_ch9.appf.tab1_1_1_17_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">CRITICAL</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>a</dt><dd><div id="ch9.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></dl><dl class="bkr_refwrap"><dt>b</dt><dd><div id="ch9.appf.tab1_2"><p class="no_margin">Confounding covariates considered were multiple deprivation index, history of bisphosphonates prescription, history of hospital admitted CVD, cerebrovascular disease, hypertension, renal failure, renal stones, psychiatric disease, fractures, cancer and diabetes.</p></div></dd></dl><dl class="bkr_refwrap"><dt>c</dt><dd><div id="ch9.appf.tab1_3"><p class="no_margin">Absolute effect cannot be calculated as adjusted control group event rate not reported.</p></div></dd></dl><dl class="bkr_refwrap"><dt>*</dt><dd><div id="ch9.appf.tab1_4"><p class="no_margin">All patients with diagnosed but untreated, mild asymptomatic PHPT.</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobch9appftab2"><div id="ch9.appf.tab2" class="table"><h3><span class="label">Table 18</span><span class="title">Clinical evidence profile: PHPT versus control (no multivariate analysis) – Pre-operative</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577896/table/ch9.appf.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch9.appf.tab2_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_ch9.appf.tab2_1_1_1_1" colspan="7" rowspan="1" style="text-align:center;vertical-align:middle;">Quality assessment</th><th id="hd_h_ch9.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_ch9.appf.tab2_1_1_1_3" colspan="2" rowspan="1" style="text-align:center;vertical-align:middle;">Effect</th><th id="hd_h_ch9.appf.tab2_1_1_1_4" rowspan="2" colspan="1" headers="hd_h_ch9.appf.tab2_1_1_1_4" style="text-align:center;vertical-align:middle;">Quality</th><th id="hd_h_ch9.appf.tab2_1_1_1_5" rowspan="2" colspan="1" headers="hd_h_ch9.appf.tab2_1_1_1_5" style="text-align:center;vertical-align:middle;">Importance</th></tr><tr><th headers="hd_h_ch9.appf.tab2_1_1_1_1" id="hd_h_ch9.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_ch9.appf.tab2_1_1_1_1" id="hd_h_ch9.appf.tab2_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Design</th><th headers="hd_h_ch9.appf.tab2_1_1_1_1" id="hd_h_ch9.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_ch9.appf.tab2_1_1_1_1" id="hd_h_ch9.appf.tab2_1_1_2_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Inconsistency</th><th headers="hd_h_ch9.appf.tab2_1_1_1_1" id="hd_h_ch9.appf.tab2_1_1_2_5" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Indirectness</th><th headers="hd_h_ch9.appf.tab2_1_1_1_1" id="hd_h_ch9.appf.tab2_1_1_2_6" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Imprecision</th><th headers="hd_h_ch9.appf.tab2_1_1_1_1" id="hd_h_ch9.appf.tab2_1_1_2_7" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Other considerations</th><th headers="hd_h_ch9.appf.tab2_1_1_1_2" id="hd_h_ch9.appf.tab2_1_1_2_8" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">PHPT</th><th headers="hd_h_ch9.appf.tab2_1_1_1_2" id="hd_h_ch9.appf.tab2_1_1_2_9" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Control</th><th headers="hd_h_ch9.appf.tab2_1_1_1_3" id="hd_h_ch9.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_ch9.appf.tab2_1_1_1_3" id="hd_h_ch9.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_ch9.appf.tab2_1_1_1_1 hd_h_ch9.appf.tab2_1_1_2_1 hd_h_ch9.appf.tab2_1_1_2_2 hd_h_ch9.appf.tab2_1_1_2_3 hd_h_ch9.appf.tab2_1_1_2_4 hd_h_ch9.appf.tab2_1_1_2_5 hd_h_ch9.appf.tab2_1_1_2_6 hd_h_ch9.appf.tab2_1_1_2_7 hd_h_ch9.appf.tab2_1_1_1_2 hd_h_ch9.appf.tab2_1_1_2_8 hd_h_ch9.appf.tab2_1_1_2_9 hd_h_ch9.appf.tab2_1_1_1_3 hd_h_ch9.appf.tab2_1_1_2_10 hd_h_ch9.appf.tab2_1_1_2_11 hd_h_ch9.appf.tab2_1_1_1_4 hd_h_ch9.appf.tab2_1_1_1_5" id="hd_b_ch9.appf.tab2_1_1_1_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:middle;">Renal stones</th></tr><tr><td headers="hd_h_ch9.appf.tab2_1_1_1_1 hd_h_ch9.appf.tab2_1_1_2_1 hd_b_ch9.appf.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_h_ch9.appf.tab2_1_1_1_1 hd_h_ch9.appf.tab2_1_1_2_2 hd_b_ch9.appf.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">observational studies</td><td headers="hd_h_ch9.appf.tab2_1_1_1_1 hd_h_ch9.appf.tab2_1_1_2_3 hd_b_ch9.appf.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">very serious<sup>a</sup></td><td headers="hd_h_ch9.appf.tab2_1_1_1_1 hd_h_ch9.appf.tab2_1_1_2_4 hd_b_ch9.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_ch9.appf.tab2_1_1_1_1 hd_h_ch9.appf.tab2_1_1_2_5 hd_b_ch9.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_ch9.appf.tab2_1_1_1_1 hd_h_ch9.appf.tab2_1_1_2_6 hd_b_ch9.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_ch9.appf.tab2_1_1_1_1 hd_h_ch9.appf.tab2_1_1_2_7 hd_b_ch9.appf.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">None</td><td headers="hd_h_ch9.appf.tab2_1_1_1_2 hd_h_ch9.appf.tab2_1_1_2_8 hd_b_ch9.appf.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">19/271 (7%)</td><td headers="hd_h_ch9.appf.tab2_1_1_1_2 hd_h_ch9.appf.tab2_1_1_2_9 hd_b_ch9.appf.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">1.6%</td><td headers="hd_h_ch9.appf.tab2_1_1_1_3 hd_h_ch9.appf.tab2_1_1_2_10 hd_b_ch9.appf.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">RR 4.38 (1.94 to 9.88)</td><td headers="hd_h_ch9.appf.tab2_1_1_1_3 hd_h_ch9.appf.tab2_1_1_2_11 hd_b_ch9.appf.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">54 more per 1000 (from 15 more to 142 more)</td><td headers="hd_h_ch9.appf.tab2_1_1_1_4 hd_b_ch9.appf.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
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<p>⊕◯◯◯</p>
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<p>VERY LOW</p>
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</td><td headers="hd_h_ch9.appf.tab2_1_1_1_5 hd_b_ch9.appf.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">CRITICAL</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>a</dt><dd><div id="ch9.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></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobch9appftab3"><div id="ch9.appf.tab3" class="table"><h3><span class="label">Table 19</span><span class="title">Clinical evidence profile: PHPT versus control (no multivariate analysis) – Mixed pre-operative and post-operative (surgical and non-surgical patients)</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577896/table/ch9.appf.tab3/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch9.appf.tab3_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_ch9.appf.tab3_1_1_1_1" colspan="7" rowspan="1" style="text-align:center;vertical-align:middle;">Quality assessment</th><th id="hd_h_ch9.appf.tab3_1_1_1_2" colspan="2" rowspan="1" style="text-align:center;vertical-align:middle;">No of patients</th><th id="hd_h_ch9.appf.tab3_1_1_1_3" colspan="2" rowspan="1" style="text-align:center;vertical-align:middle;">Effect</th><th id="hd_h_ch9.appf.tab3_1_1_1_4" rowspan="2" colspan="1" headers="hd_h_ch9.appf.tab3_1_1_1_4" style="text-align:center;vertical-align:middle;">Quality</th><th id="hd_h_ch9.appf.tab3_1_1_1_5" rowspan="2" colspan="1" headers="hd_h_ch9.appf.tab3_1_1_1_5" style="text-align:center;vertical-align:middle;">Importance</th></tr><tr><th headers="hd_h_ch9.appf.tab3_1_1_1_1" id="hd_h_ch9.appf.tab3_1_1_2_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">No of studies</th><th headers="hd_h_ch9.appf.tab3_1_1_1_1" id="hd_h_ch9.appf.tab3_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Design</th><th headers="hd_h_ch9.appf.tab3_1_1_1_1" id="hd_h_ch9.appf.tab3_1_1_2_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Risk of bias</th><th headers="hd_h_ch9.appf.tab3_1_1_1_1" id="hd_h_ch9.appf.tab3_1_1_2_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Inconsistency</th><th headers="hd_h_ch9.appf.tab3_1_1_1_1" id="hd_h_ch9.appf.tab3_1_1_2_5" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Indirectness</th><th headers="hd_h_ch9.appf.tab3_1_1_1_1" id="hd_h_ch9.appf.tab3_1_1_2_6" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Imprecision</th><th headers="hd_h_ch9.appf.tab3_1_1_1_1" id="hd_h_ch9.appf.tab3_1_1_2_7" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Other considerations</th><th headers="hd_h_ch9.appf.tab3_1_1_1_2" id="hd_h_ch9.appf.tab3_1_1_2_8" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">PHPT</th><th headers="hd_h_ch9.appf.tab3_1_1_1_2" id="hd_h_ch9.appf.tab3_1_1_2_9" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">CONTROL</th><th headers="hd_h_ch9.appf.tab3_1_1_1_3" id="hd_h_ch9.appf.tab3_1_1_2_10" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Relative (95% CI)</th><th headers="hd_h_ch9.appf.tab3_1_1_1_3" id="hd_h_ch9.appf.tab3_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_ch9.appf.tab3_1_1_1_1 hd_h_ch9.appf.tab3_1_1_2_1 hd_h_ch9.appf.tab3_1_1_2_2 hd_h_ch9.appf.tab3_1_1_2_3 hd_h_ch9.appf.tab3_1_1_2_4 hd_h_ch9.appf.tab3_1_1_2_5 hd_h_ch9.appf.tab3_1_1_2_6 hd_h_ch9.appf.tab3_1_1_2_7 hd_h_ch9.appf.tab3_1_1_1_2 hd_h_ch9.appf.tab3_1_1_2_8 hd_h_ch9.appf.tab3_1_1_2_9 hd_h_ch9.appf.tab3_1_1_1_3 hd_h_ch9.appf.tab3_1_1_2_10 hd_h_ch9.appf.tab3_1_1_2_11 hd_h_ch9.appf.tab3_1_1_1_4 hd_h_ch9.appf.tab3_1_1_1_5" id="hd_b_ch9.appf.tab3_1_1_1_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:middle;">Fracture</th></tr><tr><td headers="hd_h_ch9.appf.tab3_1_1_1_1 hd_h_ch9.appf.tab3_1_1_2_1 hd_b_ch9.appf.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_h_ch9.appf.tab3_1_1_1_1 hd_h_ch9.appf.tab3_1_1_2_2 hd_b_ch9.appf.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">observational studies</td><td headers="hd_h_ch9.appf.tab3_1_1_1_1 hd_h_ch9.appf.tab3_1_1_2_3 hd_b_ch9.appf.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup>a</sup></td><td headers="hd_h_ch9.appf.tab3_1_1_1_1 hd_h_ch9.appf.tab3_1_1_2_4 hd_b_ch9.appf.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_h_ch9.appf.tab3_1_1_1_1 hd_h_ch9.appf.tab3_1_1_2_5 hd_b_ch9.appf.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious indirectness</td><td headers="hd_h_ch9.appf.tab3_1_1_1_1 hd_h_ch9.appf.tab3_1_1_2_6 hd_b_ch9.appf.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious imprecision</td><td headers="hd_h_ch9.appf.tab3_1_1_1_1 hd_h_ch9.appf.tab3_1_1_2_7 hd_b_ch9.appf.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">None</td><td headers="hd_h_ch9.appf.tab3_1_1_1_2 hd_h_ch9.appf.tab3_1_1_2_8 hd_b_ch9.appf.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">50/90 (55.6%)</td><td headers="hd_h_ch9.appf.tab3_1_1_1_2 hd_h_ch9.appf.tab3_1_1_2_9 hd_b_ch9.appf.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">41.4%</td><td headers="hd_h_ch9.appf.tab3_1_1_1_3 hd_h_ch9.appf.tab3_1_1_2_10 hd_b_ch9.appf.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">RR 0.96 (0.74 to 1.24)</td><td headers="hd_h_ch9.appf.tab3_1_1_1_3 hd_h_ch9.appf.tab3_1_1_2_11 hd_b_ch9.appf.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">17 fewer per 1000 (from 108 fewer to 99 more)</td><td headers="hd_h_ch9.appf.tab3_1_1_1_4 hd_b_ch9.appf.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
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<p>⊕◯◯◯</p>
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<p>VERY LOW</p>
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</td><td headers="hd_h_ch9.appf.tab3_1_1_1_5 hd_b_ch9.appf.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">CRITICAL</td></tr><tr><th headers="hd_h_ch9.appf.tab3_1_1_1_1 hd_h_ch9.appf.tab3_1_1_2_1 hd_h_ch9.appf.tab3_1_1_2_2 hd_h_ch9.appf.tab3_1_1_2_3 hd_h_ch9.appf.tab3_1_1_2_4 hd_h_ch9.appf.tab3_1_1_2_5 hd_h_ch9.appf.tab3_1_1_2_6 hd_h_ch9.appf.tab3_1_1_2_7 hd_h_ch9.appf.tab3_1_1_1_2 hd_h_ch9.appf.tab3_1_1_2_8 hd_h_ch9.appf.tab3_1_1_2_9 hd_h_ch9.appf.tab3_1_1_1_3 hd_h_ch9.appf.tab3_1_1_2_10 hd_h_ch9.appf.tab3_1_1_2_11 hd_h_ch9.appf.tab3_1_1_1_4 hd_h_ch9.appf.tab3_1_1_1_5" id="hd_b_ch9.appf.tab3_1_1_3_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:middle;">Lumbar spine BMD (mg/cm<sup>2</sup>) (mild PHPT vs healthy women) (Better indicated by higher values)</th></tr><tr><td headers="hd_h_ch9.appf.tab3_1_1_1_1 hd_h_ch9.appf.tab3_1_1_2_1 hd_b_ch9.appf.tab3_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_h_ch9.appf.tab3_1_1_1_1 hd_h_ch9.appf.tab3_1_1_2_2 hd_b_ch9.appf.tab3_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">observational studies</td><td headers="hd_h_ch9.appf.tab3_1_1_1_1 hd_h_ch9.appf.tab3_1_1_2_3 hd_b_ch9.appf.tab3_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup>c</sup></td><td headers="hd_h_ch9.appf.tab3_1_1_1_1 hd_h_ch9.appf.tab3_1_1_2_4 hd_b_ch9.appf.tab3_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_h_ch9.appf.tab3_1_1_1_1 hd_h_ch9.appf.tab3_1_1_2_5 hd_b_ch9.appf.tab3_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious indirectness</td><td headers="hd_h_ch9.appf.tab3_1_1_1_1 hd_h_ch9.appf.tab3_1_1_2_6 hd_b_ch9.appf.tab3_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious imprecision</td><td headers="hd_h_ch9.appf.tab3_1_1_1_1 hd_h_ch9.appf.tab3_1_1_2_7 hd_b_ch9.appf.tab3_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">None</td><td headers="hd_h_ch9.appf.tab3_1_1_1_2 hd_h_ch9.appf.tab3_1_1_2_8 hd_b_ch9.appf.tab3_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">25</td><td headers="hd_h_ch9.appf.tab3_1_1_1_2 hd_h_ch9.appf.tab3_1_1_2_9 hd_b_ch9.appf.tab3_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">89</td><td headers="hd_h_ch9.appf.tab3_1_1_1_3 hd_h_ch9.appf.tab3_1_1_2_10 hd_b_ch9.appf.tab3_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">-</td><td headers="hd_h_ch9.appf.tab3_1_1_1_3 hd_h_ch9.appf.tab3_1_1_2_11 hd_b_ch9.appf.tab3_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">MD 77.1 higher (31.61 to 122.59 higher)</td><td headers="hd_h_ch9.appf.tab3_1_1_1_4 hd_b_ch9.appf.tab3_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
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<p>⊕◯◯◯</p>
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<p>VERY LOW</p>
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</td><td headers="hd_h_ch9.appf.tab3_1_1_1_5 hd_b_ch9.appf.tab3_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">CRITICAL</td></tr><tr><th headers="hd_h_ch9.appf.tab3_1_1_1_1 hd_h_ch9.appf.tab3_1_1_2_1 hd_h_ch9.appf.tab3_1_1_2_2 hd_h_ch9.appf.tab3_1_1_2_3 hd_h_ch9.appf.tab3_1_1_2_4 hd_h_ch9.appf.tab3_1_1_2_5 hd_h_ch9.appf.tab3_1_1_2_6 hd_h_ch9.appf.tab3_1_1_2_7 hd_h_ch9.appf.tab3_1_1_1_2 hd_h_ch9.appf.tab3_1_1_2_8 hd_h_ch9.appf.tab3_1_1_2_9 hd_h_ch9.appf.tab3_1_1_1_3 hd_h_ch9.appf.tab3_1_1_2_10 hd_h_ch9.appf.tab3_1_1_2_11 hd_h_ch9.appf.tab3_1_1_1_4 hd_h_ch9.appf.tab3_1_1_1_5" id="hd_b_ch9.appf.tab3_1_1_5_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:middle;">Femoral neck-BMD (mg/cm<sup>2</sup>) (mild PHPT vs healthy women) (Better indicated by higher values)</th></tr><tr><td headers="hd_h_ch9.appf.tab3_1_1_1_1 hd_h_ch9.appf.tab3_1_1_2_1 hd_b_ch9.appf.tab3_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_h_ch9.appf.tab3_1_1_1_1 hd_h_ch9.appf.tab3_1_1_2_2 hd_b_ch9.appf.tab3_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">observational studies</td><td headers="hd_h_ch9.appf.tab3_1_1_1_1 hd_h_ch9.appf.tab3_1_1_2_3 hd_b_ch9.appf.tab3_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup>c</sup></td><td headers="hd_h_ch9.appf.tab3_1_1_1_1 hd_h_ch9.appf.tab3_1_1_2_4 hd_b_ch9.appf.tab3_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_h_ch9.appf.tab3_1_1_1_1 hd_h_ch9.appf.tab3_1_1_2_5 hd_b_ch9.appf.tab3_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious indirectness</td><td headers="hd_h_ch9.appf.tab3_1_1_1_1 hd_h_ch9.appf.tab3_1_1_2_6 hd_b_ch9.appf.tab3_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup>c</sup></td><td headers="hd_h_ch9.appf.tab3_1_1_1_1 hd_h_ch9.appf.tab3_1_1_2_7 hd_b_ch9.appf.tab3_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">None</td><td headers="hd_h_ch9.appf.tab3_1_1_1_2 hd_h_ch9.appf.tab3_1_1_2_8 hd_b_ch9.appf.tab3_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">25</td><td headers="hd_h_ch9.appf.tab3_1_1_1_2 hd_h_ch9.appf.tab3_1_1_2_9 hd_b_ch9.appf.tab3_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">89</td><td headers="hd_h_ch9.appf.tab3_1_1_1_3 hd_h_ch9.appf.tab3_1_1_2_10 hd_b_ch9.appf.tab3_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">-</td><td headers="hd_h_ch9.appf.tab3_1_1_1_3 hd_h_ch9.appf.tab3_1_1_2_11 hd_b_ch9.appf.tab3_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">MD 18.4 higher (24.43 lower to 61.23 higher)</td><td headers="hd_h_ch9.appf.tab3_1_1_1_4 hd_b_ch9.appf.tab3_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
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<p>⊕◯◯◯</p>
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<p>VERY LOW</p>
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</td><td headers="hd_h_ch9.appf.tab3_1_1_1_5 hd_b_ch9.appf.tab3_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">CRITICAL</td></tr><tr><th headers="hd_h_ch9.appf.tab3_1_1_1_1 hd_h_ch9.appf.tab3_1_1_2_1 hd_h_ch9.appf.tab3_1_1_2_2 hd_h_ch9.appf.tab3_1_1_2_3 hd_h_ch9.appf.tab3_1_1_2_4 hd_h_ch9.appf.tab3_1_1_2_5 hd_h_ch9.appf.tab3_1_1_2_6 hd_h_ch9.appf.tab3_1_1_2_7 hd_h_ch9.appf.tab3_1_1_1_2 hd_h_ch9.appf.tab3_1_1_2_8 hd_h_ch9.appf.tab3_1_1_2_9 hd_h_ch9.appf.tab3_1_1_1_3 hd_h_ch9.appf.tab3_1_1_2_10 hd_h_ch9.appf.tab3_1_1_2_11 hd_h_ch9.appf.tab3_1_1_1_4 hd_h_ch9.appf.tab3_1_1_1_5" id="hd_b_ch9.appf.tab3_1_1_7_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:middle;">Total femur-BMD (mg/cm<sup>2</sup>) (mild PHPT vs healthy women) (Better indicated by higher values)</th></tr><tr><td headers="hd_h_ch9.appf.tab3_1_1_1_1 hd_h_ch9.appf.tab3_1_1_2_1 hd_b_ch9.appf.tab3_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_h_ch9.appf.tab3_1_1_1_1 hd_h_ch9.appf.tab3_1_1_2_2 hd_b_ch9.appf.tab3_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">observational studies</td><td headers="hd_h_ch9.appf.tab3_1_1_1_1 hd_h_ch9.appf.tab3_1_1_2_3 hd_b_ch9.appf.tab3_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup>a</sup></td><td headers="hd_h_ch9.appf.tab3_1_1_1_1 hd_h_ch9.appf.tab3_1_1_2_4 hd_b_ch9.appf.tab3_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_h_ch9.appf.tab3_1_1_1_1 hd_h_ch9.appf.tab3_1_1_2_5 hd_b_ch9.appf.tab3_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious indirectness</td><td headers="hd_h_ch9.appf.tab3_1_1_1_1 hd_h_ch9.appf.tab3_1_1_2_6 hd_b_ch9.appf.tab3_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup>c</sup></td><td headers="hd_h_ch9.appf.tab3_1_1_1_1 hd_h_ch9.appf.tab3_1_1_2_7 hd_b_ch9.appf.tab3_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">None</td><td headers="hd_h_ch9.appf.tab3_1_1_1_2 hd_h_ch9.appf.tab3_1_1_2_8 hd_b_ch9.appf.tab3_1_1_7_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">25</td><td headers="hd_h_ch9.appf.tab3_1_1_1_2 hd_h_ch9.appf.tab3_1_1_2_9 hd_b_ch9.appf.tab3_1_1_7_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">89</td><td headers="hd_h_ch9.appf.tab3_1_1_1_3 hd_h_ch9.appf.tab3_1_1_2_10 hd_b_ch9.appf.tab3_1_1_7_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">-</td><td headers="hd_h_ch9.appf.tab3_1_1_1_3 hd_h_ch9.appf.tab3_1_1_2_11 hd_b_ch9.appf.tab3_1_1_7_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">MD 21.2 higher (30.33 lower to 72.73 higher)</td><td headers="hd_h_ch9.appf.tab3_1_1_1_4 hd_b_ch9.appf.tab3_1_1_7_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
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<p>⊕◯◯◯</p>
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<p>VERY LOW</p>
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</td><td headers="hd_h_ch9.appf.tab3_1_1_1_5 hd_b_ch9.appf.tab3_1_1_7_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">CRITICAL</td></tr><tr><th headers="hd_h_ch9.appf.tab3_1_1_1_1 hd_h_ch9.appf.tab3_1_1_2_1 hd_h_ch9.appf.tab3_1_1_2_2 hd_h_ch9.appf.tab3_1_1_2_3 hd_h_ch9.appf.tab3_1_1_2_4 hd_h_ch9.appf.tab3_1_1_2_5 hd_h_ch9.appf.tab3_1_1_2_6 hd_h_ch9.appf.tab3_1_1_2_7 hd_h_ch9.appf.tab3_1_1_1_2 hd_h_ch9.appf.tab3_1_1_2_8 hd_h_ch9.appf.tab3_1_1_2_9 hd_h_ch9.appf.tab3_1_1_1_3 hd_h_ch9.appf.tab3_1_1_2_10 hd_h_ch9.appf.tab3_1_1_2_11 hd_h_ch9.appf.tab3_1_1_1_4 hd_h_ch9.appf.tab3_1_1_1_5" id="hd_b_ch9.appf.tab3_1_1_9_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:middle;">Vertebral fractures (mild PHPT vs control)</th></tr><tr><td headers="hd_h_ch9.appf.tab3_1_1_1_1 hd_h_ch9.appf.tab3_1_1_2_1 hd_b_ch9.appf.tab3_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2</td><td headers="hd_h_ch9.appf.tab3_1_1_1_1 hd_h_ch9.appf.tab3_1_1_2_2 hd_b_ch9.appf.tab3_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">observational studies</td><td headers="hd_h_ch9.appf.tab3_1_1_1_1 hd_h_ch9.appf.tab3_1_1_2_3 hd_b_ch9.appf.tab3_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup>a</sup></td><td headers="hd_h_ch9.appf.tab3_1_1_1_1 hd_h_ch9.appf.tab3_1_1_2_4 hd_b_ch9.appf.tab3_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">very serious<sup>b</sup></td><td headers="hd_h_ch9.appf.tab3_1_1_1_1 hd_h_ch9.appf.tab3_1_1_2_5 hd_b_ch9.appf.tab3_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious indirectness</td><td headers="hd_h_ch9.appf.tab3_1_1_1_1 hd_h_ch9.appf.tab3_1_1_2_6 hd_b_ch9.appf.tab3_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious imprecision</td><td headers="hd_h_ch9.appf.tab3_1_1_1_1 hd_h_ch9.appf.tab3_1_1_2_7 hd_b_ch9.appf.tab3_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">None</td><td headers="hd_h_ch9.appf.tab3_1_1_1_2 hd_h_ch9.appf.tab3_1_1_2_8 hd_b_ch9.appf.tab3_1_1_9_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">14/199 (7%)</td><td headers="hd_h_ch9.appf.tab3_1_1_1_2 hd_h_ch9.appf.tab3_1_1_2_9 hd_b_ch9.appf.tab3_1_1_9_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">7.2%</td><td headers="hd_h_ch9.appf.tab3_1_1_1_3 hd_h_ch9.appf.tab3_1_1_2_10 hd_b_ch9.appf.tab3_1_1_9_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">RR 2.31 (1.26 to 4.21)</td><td headers="hd_h_ch9.appf.tab3_1_1_1_3 hd_h_ch9.appf.tab3_1_1_2_11 hd_b_ch9.appf.tab3_1_1_9_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">94 more per 1000 (from 19 more to 231 more)</td><td headers="hd_h_ch9.appf.tab3_1_1_1_4 hd_b_ch9.appf.tab3_1_1_9_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
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<p>⊕◯◯◯</p>
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<p>VERY LOW</p>
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</td><td headers="hd_h_ch9.appf.tab3_1_1_1_5 hd_b_ch9.appf.tab3_1_1_9_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">CRITICAL</td></tr><tr><th headers="hd_h_ch9.appf.tab3_1_1_1_1 hd_h_ch9.appf.tab3_1_1_2_1 hd_h_ch9.appf.tab3_1_1_2_2 hd_h_ch9.appf.tab3_1_1_2_3 hd_h_ch9.appf.tab3_1_1_2_4 hd_h_ch9.appf.tab3_1_1_2_5 hd_h_ch9.appf.tab3_1_1_2_6 hd_h_ch9.appf.tab3_1_1_2_7 hd_h_ch9.appf.tab3_1_1_1_2 hd_h_ch9.appf.tab3_1_1_2_8 hd_h_ch9.appf.tab3_1_1_2_9 hd_h_ch9.appf.tab3_1_1_1_3 hd_h_ch9.appf.tab3_1_1_2_10 hd_h_ch9.appf.tab3_1_1_2_11 hd_h_ch9.appf.tab3_1_1_1_4 hd_h_ch9.appf.tab3_1_1_1_5" id="hd_b_ch9.appf.tab3_1_1_11_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:middle;">Vertebral fractures (non-mild PHPT vs healthy women)</th></tr><tr><td headers="hd_h_ch9.appf.tab3_1_1_1_1 hd_h_ch9.appf.tab3_1_1_2_1 hd_b_ch9.appf.tab3_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_h_ch9.appf.tab3_1_1_1_1 hd_h_ch9.appf.tab3_1_1_2_2 hd_b_ch9.appf.tab3_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">observational studies</td><td headers="hd_h_ch9.appf.tab3_1_1_1_1 hd_h_ch9.appf.tab3_1_1_2_3 hd_b_ch9.appf.tab3_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup>c</sup></td><td headers="hd_h_ch9.appf.tab3_1_1_1_1 hd_h_ch9.appf.tab3_1_1_2_4 hd_b_ch9.appf.tab3_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_h_ch9.appf.tab3_1_1_1_1 hd_h_ch9.appf.tab3_1_1_2_5 hd_b_ch9.appf.tab3_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious indirectness</td><td headers="hd_h_ch9.appf.tab3_1_1_1_1 hd_h_ch9.appf.tab3_1_1_2_6 hd_b_ch9.appf.tab3_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious imprecision</td><td headers="hd_h_ch9.appf.tab3_1_1_1_1 hd_h_ch9.appf.tab3_1_1_2_7 hd_b_ch9.appf.tab3_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">None</td><td headers="hd_h_ch9.appf.tab3_1_1_1_2 hd_h_ch9.appf.tab3_1_1_2_8 hd_b_ch9.appf.tab3_1_1_11_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">35/73 (47.9%)</td><td headers="hd_h_ch9.appf.tab3_1_1_1_2 hd_h_ch9.appf.tab3_1_1_2_9 hd_b_ch9.appf.tab3_1_1_11_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">9%</td><td headers="hd_h_ch9.appf.tab3_1_1_1_3 hd_h_ch9.appf.tab3_1_1_2_10 hd_b_ch9.appf.tab3_1_1_11_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">RR 5.33 (2.64 to 10.77)</td><td headers="hd_h_ch9.appf.tab3_1_1_1_3 hd_h_ch9.appf.tab3_1_1_2_11 hd_b_ch9.appf.tab3_1_1_11_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">390 more per 1000 (from 148 more to 879 more)</td><td headers="hd_h_ch9.appf.tab3_1_1_1_4 hd_b_ch9.appf.tab3_1_1_11_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
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<p>⊕◯◯◯</p>
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<p>VERY LOW</p>
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</td><td headers="hd_h_ch9.appf.tab3_1_1_1_5 hd_b_ch9.appf.tab3_1_1_11_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">CRITICAL</td></tr><tr><th headers="hd_h_ch9.appf.tab3_1_1_1_1 hd_h_ch9.appf.tab3_1_1_2_1 hd_h_ch9.appf.tab3_1_1_2_2 hd_h_ch9.appf.tab3_1_1_2_3 hd_h_ch9.appf.tab3_1_1_2_4 hd_h_ch9.appf.tab3_1_1_2_5 hd_h_ch9.appf.tab3_1_1_2_6 hd_h_ch9.appf.tab3_1_1_2_7 hd_h_ch9.appf.tab3_1_1_1_2 hd_h_ch9.appf.tab3_1_1_2_8 hd_h_ch9.appf.tab3_1_1_2_9 hd_h_ch9.appf.tab3_1_1_1_3 hd_h_ch9.appf.tab3_1_1_2_10 hd_h_ch9.appf.tab3_1_1_2_11 hd_h_ch9.appf.tab3_1_1_1_4 hd_h_ch9.appf.tab3_1_1_1_5" id="hd_b_ch9.appf.tab3_1_1_13_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:middle;">Non-vertebral fractures (mild PHPT vs healthy women)</th></tr><tr><td headers="hd_h_ch9.appf.tab3_1_1_1_1 hd_h_ch9.appf.tab3_1_1_2_1 hd_b_ch9.appf.tab3_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_h_ch9.appf.tab3_1_1_1_1 hd_h_ch9.appf.tab3_1_1_2_2 hd_b_ch9.appf.tab3_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">observational studies</td><td headers="hd_h_ch9.appf.tab3_1_1_1_1 hd_h_ch9.appf.tab3_1_1_2_3 hd_b_ch9.appf.tab3_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup>a</sup></td><td headers="hd_h_ch9.appf.tab3_1_1_1_1 hd_h_ch9.appf.tab3_1_1_2_4 hd_b_ch9.appf.tab3_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_h_ch9.appf.tab3_1_1_1_1 hd_h_ch9.appf.tab3_1_1_2_5 hd_b_ch9.appf.tab3_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious indirectness</td><td headers="hd_h_ch9.appf.tab3_1_1_1_1 hd_h_ch9.appf.tab3_1_1_2_6 hd_b_ch9.appf.tab3_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">very serious<sup>c</sup></td><td headers="hd_h_ch9.appf.tab3_1_1_1_1 hd_h_ch9.appf.tab3_1_1_2_7 hd_b_ch9.appf.tab3_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">None</td><td headers="hd_h_ch9.appf.tab3_1_1_1_2 hd_h_ch9.appf.tab3_1_1_2_8 hd_b_ch9.appf.tab3_1_1_13_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">0/25 (0%)</td><td headers="hd_h_ch9.appf.tab3_1_1_1_2 hd_h_ch9.appf.tab3_1_1_2_9 hd_b_ch9.appf.tab3_1_1_13_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">19.1%</td><td headers="hd_h_ch9.appf.tab3_1_1_1_3 hd_h_ch9.appf.tab3_1_1_2_10 hd_b_ch9.appf.tab3_1_1_13_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Peto OR 0.22 (0.07 to 0.78)</td><td headers="hd_h_ch9.appf.tab3_1_1_1_3 hd_h_ch9.appf.tab3_1_1_2_11 hd_b_ch9.appf.tab3_1_1_13_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">190 fewer per 1000 (from 290 to 90 fewer)</td><td headers="hd_h_ch9.appf.tab3_1_1_1_4 hd_b_ch9.appf.tab3_1_1_13_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
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<p>⊕◯◯◯</p>
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<p>VERY LOW</p>
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</td><td headers="hd_h_ch9.appf.tab3_1_1_1_5 hd_b_ch9.appf.tab3_1_1_13_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">CRITICAL</td></tr><tr><th headers="hd_h_ch9.appf.tab3_1_1_1_1 hd_h_ch9.appf.tab3_1_1_2_1 hd_h_ch9.appf.tab3_1_1_2_2 hd_h_ch9.appf.tab3_1_1_2_3 hd_h_ch9.appf.tab3_1_1_2_4 hd_h_ch9.appf.tab3_1_1_2_5 hd_h_ch9.appf.tab3_1_1_2_6 hd_h_ch9.appf.tab3_1_1_2_7 hd_h_ch9.appf.tab3_1_1_1_2 hd_h_ch9.appf.tab3_1_1_2_8 hd_h_ch9.appf.tab3_1_1_2_9 hd_h_ch9.appf.tab3_1_1_1_3 hd_h_ch9.appf.tab3_1_1_2_10 hd_h_ch9.appf.tab3_1_1_2_11 hd_h_ch9.appf.tab3_1_1_1_4 hd_h_ch9.appf.tab3_1_1_1_5" id="hd_b_ch9.appf.tab3_1_1_15_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:middle;">Non-vertebral fractures (non-mild PHPT vs healthy women)</th></tr><tr><td headers="hd_h_ch9.appf.tab3_1_1_1_1 hd_h_ch9.appf.tab3_1_1_2_1 hd_b_ch9.appf.tab3_1_1_15_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_h_ch9.appf.tab3_1_1_1_1 hd_h_ch9.appf.tab3_1_1_2_2 hd_b_ch9.appf.tab3_1_1_15_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">observational studies</td><td headers="hd_h_ch9.appf.tab3_1_1_1_1 hd_h_ch9.appf.tab3_1_1_2_3 hd_b_ch9.appf.tab3_1_1_15_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup>a</sup></td><td headers="hd_h_ch9.appf.tab3_1_1_1_1 hd_h_ch9.appf.tab3_1_1_2_4 hd_b_ch9.appf.tab3_1_1_15_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_h_ch9.appf.tab3_1_1_1_1 hd_h_ch9.appf.tab3_1_1_2_5 hd_b_ch9.appf.tab3_1_1_15_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious indirectness</td><td headers="hd_h_ch9.appf.tab3_1_1_1_1 hd_h_ch9.appf.tab3_1_1_2_6 hd_b_ch9.appf.tab3_1_1_15_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">very serious<sup>c</sup></td><td headers="hd_h_ch9.appf.tab3_1_1_1_1 hd_h_ch9.appf.tab3_1_1_2_7 hd_b_ch9.appf.tab3_1_1_15_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">None</td><td headers="hd_h_ch9.appf.tab3_1_1_1_2 hd_h_ch9.appf.tab3_1_1_2_8 hd_b_ch9.appf.tab3_1_1_15_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">13/73 (17.8%)</td><td headers="hd_h_ch9.appf.tab3_1_1_1_2 hd_h_ch9.appf.tab3_1_1_2_9 hd_b_ch9.appf.tab3_1_1_15_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">19.1%</td><td headers="hd_h_ch9.appf.tab3_1_1_1_3 hd_h_ch9.appf.tab3_1_1_2_10 hd_b_ch9.appf.tab3_1_1_15_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">RR 0.93 (0.49 to 1.79)</td><td headers="hd_h_ch9.appf.tab3_1_1_1_3 hd_h_ch9.appf.tab3_1_1_2_11 hd_b_ch9.appf.tab3_1_1_15_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">13 fewer per 1000 (from 97 fewer to 151 more)</td><td headers="hd_h_ch9.appf.tab3_1_1_1_4 hd_b_ch9.appf.tab3_1_1_15_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
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<p>⊕◯◯◯</p>
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<p>VERY LOW</p>
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</td><td headers="hd_h_ch9.appf.tab3_1_1_1_5 hd_b_ch9.appf.tab3_1_1_15_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">CRITICAL</td></tr><tr><th headers="hd_h_ch9.appf.tab3_1_1_1_1 hd_h_ch9.appf.tab3_1_1_2_1 hd_h_ch9.appf.tab3_1_1_2_2 hd_h_ch9.appf.tab3_1_1_2_3 hd_h_ch9.appf.tab3_1_1_2_4 hd_h_ch9.appf.tab3_1_1_2_5 hd_h_ch9.appf.tab3_1_1_2_6 hd_h_ch9.appf.tab3_1_1_2_7 hd_h_ch9.appf.tab3_1_1_1_2 hd_h_ch9.appf.tab3_1_1_2_8 hd_h_ch9.appf.tab3_1_1_2_9 hd_h_ch9.appf.tab3_1_1_1_3 hd_h_ch9.appf.tab3_1_1_2_10 hd_h_ch9.appf.tab3_1_1_2_11 hd_h_ch9.appf.tab3_1_1_1_4 hd_h_ch9.appf.tab3_1_1_1_5" id="hd_b_ch9.appf.tab3_1_1_17_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:middle;">Lumbar spine-BMD (mg/cm<sup>2</sup>) (non-mild PHPT vs healthy women) (Better indicated by higher values)</th></tr><tr><td headers="hd_h_ch9.appf.tab3_1_1_1_1 hd_h_ch9.appf.tab3_1_1_2_1 hd_b_ch9.appf.tab3_1_1_17_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_h_ch9.appf.tab3_1_1_1_1 hd_h_ch9.appf.tab3_1_1_2_2 hd_b_ch9.appf.tab3_1_1_17_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">observational studies</td><td headers="hd_h_ch9.appf.tab3_1_1_1_1 hd_h_ch9.appf.tab3_1_1_2_3 hd_b_ch9.appf.tab3_1_1_17_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup>a</sup></td><td headers="hd_h_ch9.appf.tab3_1_1_1_1 hd_h_ch9.appf.tab3_1_1_2_4 hd_b_ch9.appf.tab3_1_1_17_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_h_ch9.appf.tab3_1_1_1_1 hd_h_ch9.appf.tab3_1_1_2_5 hd_b_ch9.appf.tab3_1_1_17_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious indirectness</td><td headers="hd_h_ch9.appf.tab3_1_1_1_1 hd_h_ch9.appf.tab3_1_1_2_6 hd_b_ch9.appf.tab3_1_1_17_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious imprecision</td><td headers="hd_h_ch9.appf.tab3_1_1_1_1 hd_h_ch9.appf.tab3_1_1_2_7 hd_b_ch9.appf.tab3_1_1_17_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">None</td><td headers="hd_h_ch9.appf.tab3_1_1_1_2 hd_h_ch9.appf.tab3_1_1_2_8 hd_b_ch9.appf.tab3_1_1_17_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">73</td><td headers="hd_h_ch9.appf.tab3_1_1_1_2 hd_h_ch9.appf.tab3_1_1_2_9 hd_b_ch9.appf.tab3_1_1_17_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">89</td><td headers="hd_h_ch9.appf.tab3_1_1_1_3 hd_h_ch9.appf.tab3_1_1_2_10 hd_b_ch9.appf.tab3_1_1_17_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">-</td><td headers="hd_h_ch9.appf.tab3_1_1_1_3 hd_h_ch9.appf.tab3_1_1_2_11 hd_b_ch9.appf.tab3_1_1_17_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">MD 73.6 lower (116.15 to 31.05 lower)</td><td headers="hd_h_ch9.appf.tab3_1_1_1_4 hd_b_ch9.appf.tab3_1_1_17_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
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<p>⊕◯◯◯</p>
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<p>VERY LOW</p>
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</td><td headers="hd_h_ch9.appf.tab3_1_1_1_5 hd_b_ch9.appf.tab3_1_1_17_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">CRITICAL</td></tr><tr><th headers="hd_h_ch9.appf.tab3_1_1_1_1 hd_h_ch9.appf.tab3_1_1_2_1 hd_h_ch9.appf.tab3_1_1_2_2 hd_h_ch9.appf.tab3_1_1_2_3 hd_h_ch9.appf.tab3_1_1_2_4 hd_h_ch9.appf.tab3_1_1_2_5 hd_h_ch9.appf.tab3_1_1_2_6 hd_h_ch9.appf.tab3_1_1_2_7 hd_h_ch9.appf.tab3_1_1_1_2 hd_h_ch9.appf.tab3_1_1_2_8 hd_h_ch9.appf.tab3_1_1_2_9 hd_h_ch9.appf.tab3_1_1_1_3 hd_h_ch9.appf.tab3_1_1_2_10 hd_h_ch9.appf.tab3_1_1_2_11 hd_h_ch9.appf.tab3_1_1_1_4 hd_h_ch9.appf.tab3_1_1_1_5" id="hd_b_ch9.appf.tab3_1_1_19_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:middle;">Femoral neck-BMD (mg/cm<sup>2</sup>) (non-mild PHPT vs healthy women) (Better indicated by higher values)</th></tr><tr><td headers="hd_h_ch9.appf.tab3_1_1_1_1 hd_h_ch9.appf.tab3_1_1_2_1 hd_b_ch9.appf.tab3_1_1_19_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_h_ch9.appf.tab3_1_1_1_1 hd_h_ch9.appf.tab3_1_1_2_2 hd_b_ch9.appf.tab3_1_1_19_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">observational studies</td><td headers="hd_h_ch9.appf.tab3_1_1_1_1 hd_h_ch9.appf.tab3_1_1_2_3 hd_b_ch9.appf.tab3_1_1_19_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup>a</sup></td><td headers="hd_h_ch9.appf.tab3_1_1_1_1 hd_h_ch9.appf.tab3_1_1_2_4 hd_b_ch9.appf.tab3_1_1_19_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_h_ch9.appf.tab3_1_1_1_1 hd_h_ch9.appf.tab3_1_1_2_5 hd_b_ch9.appf.tab3_1_1_19_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious indirectness</td><td headers="hd_h_ch9.appf.tab3_1_1_1_1 hd_h_ch9.appf.tab3_1_1_2_6 hd_b_ch9.appf.tab3_1_1_19_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious imprecision</td><td headers="hd_h_ch9.appf.tab3_1_1_1_1 hd_h_ch9.appf.tab3_1_1_2_7 hd_b_ch9.appf.tab3_1_1_19_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">None</td><td headers="hd_h_ch9.appf.tab3_1_1_1_2 hd_h_ch9.appf.tab3_1_1_2_8 hd_b_ch9.appf.tab3_1_1_19_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">73</td><td headers="hd_h_ch9.appf.tab3_1_1_1_2 hd_h_ch9.appf.tab3_1_1_2_9 hd_b_ch9.appf.tab3_1_1_19_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">89</td><td headers="hd_h_ch9.appf.tab3_1_1_1_3 hd_h_ch9.appf.tab3_1_1_2_10 hd_b_ch9.appf.tab3_1_1_19_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">-</td><td headers="hd_h_ch9.appf.tab3_1_1_1_3 hd_h_ch9.appf.tab3_1_1_2_11 hd_b_ch9.appf.tab3_1_1_19_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">MD 89.3 lower (121.96 to 56.64 lower)</td><td headers="hd_h_ch9.appf.tab3_1_1_1_4 hd_b_ch9.appf.tab3_1_1_19_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
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<p>⊕◯◯◯</p>
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<p>VERY LOW</p>
|
|
</td><td headers="hd_h_ch9.appf.tab3_1_1_1_5 hd_b_ch9.appf.tab3_1_1_19_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">CRITICAL</td></tr><tr><th headers="hd_h_ch9.appf.tab3_1_1_1_1 hd_h_ch9.appf.tab3_1_1_2_1 hd_h_ch9.appf.tab3_1_1_2_2 hd_h_ch9.appf.tab3_1_1_2_3 hd_h_ch9.appf.tab3_1_1_2_4 hd_h_ch9.appf.tab3_1_1_2_5 hd_h_ch9.appf.tab3_1_1_2_6 hd_h_ch9.appf.tab3_1_1_2_7 hd_h_ch9.appf.tab3_1_1_1_2 hd_h_ch9.appf.tab3_1_1_2_8 hd_h_ch9.appf.tab3_1_1_2_9 hd_h_ch9.appf.tab3_1_1_1_3 hd_h_ch9.appf.tab3_1_1_2_10 hd_h_ch9.appf.tab3_1_1_2_11 hd_h_ch9.appf.tab3_1_1_1_4 hd_h_ch9.appf.tab3_1_1_1_5" id="hd_b_ch9.appf.tab3_1_1_21_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:middle;">Total femur-BMD (mg/cm<sup>2</sup>) (non-mild PHPT vs healthy women) (Better indicated by higher values)</th></tr><tr><td headers="hd_h_ch9.appf.tab3_1_1_1_1 hd_h_ch9.appf.tab3_1_1_2_1 hd_b_ch9.appf.tab3_1_1_21_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_h_ch9.appf.tab3_1_1_1_1 hd_h_ch9.appf.tab3_1_1_2_2 hd_b_ch9.appf.tab3_1_1_21_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">observational studies</td><td headers="hd_h_ch9.appf.tab3_1_1_1_1 hd_h_ch9.appf.tab3_1_1_2_3 hd_b_ch9.appf.tab3_1_1_21_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup>a</sup></td><td headers="hd_h_ch9.appf.tab3_1_1_1_1 hd_h_ch9.appf.tab3_1_1_2_4 hd_b_ch9.appf.tab3_1_1_21_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_h_ch9.appf.tab3_1_1_1_1 hd_h_ch9.appf.tab3_1_1_2_5 hd_b_ch9.appf.tab3_1_1_21_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious indirectness</td><td headers="hd_h_ch9.appf.tab3_1_1_1_1 hd_h_ch9.appf.tab3_1_1_2_6 hd_b_ch9.appf.tab3_1_1_21_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious imprecision</td><td headers="hd_h_ch9.appf.tab3_1_1_1_1 hd_h_ch9.appf.tab3_1_1_2_7 hd_b_ch9.appf.tab3_1_1_21_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">None</td><td headers="hd_h_ch9.appf.tab3_1_1_1_2 hd_h_ch9.appf.tab3_1_1_2_8 hd_b_ch9.appf.tab3_1_1_21_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">73</td><td headers="hd_h_ch9.appf.tab3_1_1_1_2 hd_h_ch9.appf.tab3_1_1_2_9 hd_b_ch9.appf.tab3_1_1_21_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">89</td><td headers="hd_h_ch9.appf.tab3_1_1_1_3 hd_h_ch9.appf.tab3_1_1_2_10 hd_b_ch9.appf.tab3_1_1_21_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">-</td><td headers="hd_h_ch9.appf.tab3_1_1_1_3 hd_h_ch9.appf.tab3_1_1_2_11 hd_b_ch9.appf.tab3_1_1_21_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">MD 102.5 lower (140.13 to 64.87 lower)</td><td headers="hd_h_ch9.appf.tab3_1_1_1_4 hd_b_ch9.appf.tab3_1_1_21_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
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<p>⊕◯◯◯</p>
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<p>VERY LOW</p>
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|
</td><td headers="hd_h_ch9.appf.tab3_1_1_1_5 hd_b_ch9.appf.tab3_1_1_21_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">CRITICAL</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>a</dt><dd><div id="ch9.appf.tab3_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></dl><dl class="bkr_refwrap"><dt>b</dt><dd><div id="ch9.appf.tab3_2"><p class="no_margin">Heterogeneity, I<sup>2</sup>=90%.</p></div></dd></dl><dl class="bkr_refwrap"><dt>c</dt><dd><div id="ch9.appf.tab3_3"><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></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobch9appftab4"><div id="ch9.appf.tab4" class="table"><h3><span class="label">Table 20</span><span class="title">Clinical evidence profile: PHPT versus control (no multivariate analysis) – strata post-operative</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577896/table/ch9.appf.tab4/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch9.appf.tab4_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_ch9.appf.tab4_1_1_1_1" colspan="7" rowspan="1" style="text-align:center;vertical-align:middle;">Quality assessment</th><th id="hd_h_ch9.appf.tab4_1_1_1_2" colspan="2" rowspan="1" style="text-align:center;vertical-align:middle;">No of patients</th><th id="hd_h_ch9.appf.tab4_1_1_1_3" colspan="2" rowspan="1" style="text-align:center;vertical-align:middle;">Effect</th><th id="hd_h_ch9.appf.tab4_1_1_1_4" rowspan="2" colspan="1" headers="hd_h_ch9.appf.tab4_1_1_1_4" style="text-align:center;vertical-align:middle;">Quality</th><th id="hd_h_ch9.appf.tab4_1_1_1_5" rowspan="2" colspan="1" headers="hd_h_ch9.appf.tab4_1_1_1_5" style="text-align:center;vertical-align:middle;">Importance</th></tr><tr><th headers="hd_h_ch9.appf.tab4_1_1_1_1" id="hd_h_ch9.appf.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">No of studies</th><th headers="hd_h_ch9.appf.tab4_1_1_1_1" id="hd_h_ch9.appf.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Design</th><th headers="hd_h_ch9.appf.tab4_1_1_1_1" id="hd_h_ch9.appf.tab4_1_1_2_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Risk of bias</th><th headers="hd_h_ch9.appf.tab4_1_1_1_1" id="hd_h_ch9.appf.tab4_1_1_2_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Inconsistency</th><th headers="hd_h_ch9.appf.tab4_1_1_1_1" id="hd_h_ch9.appf.tab4_1_1_2_5" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Indirectness</th><th headers="hd_h_ch9.appf.tab4_1_1_1_1" id="hd_h_ch9.appf.tab4_1_1_2_6" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Imprecision</th><th headers="hd_h_ch9.appf.tab4_1_1_1_1" id="hd_h_ch9.appf.tab4_1_1_2_7" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Other considerations</th><th headers="hd_h_ch9.appf.tab4_1_1_1_2" id="hd_h_ch9.appf.tab4_1_1_2_8" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">PHPT</th><th headers="hd_h_ch9.appf.tab4_1_1_1_2" id="hd_h_ch9.appf.tab4_1_1_2_9" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Control</th><th headers="hd_h_ch9.appf.tab4_1_1_1_3" id="hd_h_ch9.appf.tab4_1_1_2_10" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Relative (95% CI)</th><th headers="hd_h_ch9.appf.tab4_1_1_1_3" id="hd_h_ch9.appf.tab4_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_ch9.appf.tab4_1_1_1_1 hd_h_ch9.appf.tab4_1_1_2_1 hd_h_ch9.appf.tab4_1_1_2_2 hd_h_ch9.appf.tab4_1_1_2_3 hd_h_ch9.appf.tab4_1_1_2_4 hd_h_ch9.appf.tab4_1_1_2_5 hd_h_ch9.appf.tab4_1_1_2_6 hd_h_ch9.appf.tab4_1_1_2_7 hd_h_ch9.appf.tab4_1_1_1_2 hd_h_ch9.appf.tab4_1_1_2_8 hd_h_ch9.appf.tab4_1_1_2_9 hd_h_ch9.appf.tab4_1_1_1_3 hd_h_ch9.appf.tab4_1_1_2_10 hd_h_ch9.appf.tab4_1_1_2_11 hd_h_ch9.appf.tab4_1_1_1_4 hd_h_ch9.appf.tab4_1_1_1_5" id="hd_b_ch9.appf.tab4_1_1_1_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:middle;">Mortality</th></tr><tr><td headers="hd_h_ch9.appf.tab4_1_1_1_1 hd_h_ch9.appf.tab4_1_1_2_1 hd_b_ch9.appf.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_h_ch9.appf.tab4_1_1_1_1 hd_h_ch9.appf.tab4_1_1_2_2 hd_b_ch9.appf.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">observational studies</td><td headers="hd_h_ch9.appf.tab4_1_1_1_1 hd_h_ch9.appf.tab4_1_1_2_3 hd_b_ch9.appf.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">very serious<sup>a</sup></td><td headers="hd_h_ch9.appf.tab4_1_1_1_1 hd_h_ch9.appf.tab4_1_1_2_4 hd_b_ch9.appf.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_h_ch9.appf.tab4_1_1_1_1 hd_h_ch9.appf.tab4_1_1_2_5 hd_b_ch9.appf.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious indirectness</td><td headers="hd_h_ch9.appf.tab4_1_1_1_1 hd_h_ch9.appf.tab4_1_1_2_6 hd_b_ch9.appf.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious imprecision<sup>b</sup></td><td headers="hd_h_ch9.appf.tab4_1_1_1_1 hd_h_ch9.appf.tab4_1_1_2_7 hd_b_ch9.appf.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">None</td><td headers="hd_h_ch9.appf.tab4_1_1_1_2 hd_h_ch9.appf.tab4_1_1_2_8 hd_b_ch9.appf.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">34/334 (10.2%)</td><td headers="hd_h_ch9.appf.tab4_1_1_1_2 hd_h_ch9.appf.tab4_1_1_2_9 hd_b_ch9.appf.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">6.3%</td><td headers="hd_h_ch9.appf.tab4_1_1_1_3 hd_h_ch9.appf.tab4_1_1_2_10 hd_b_ch9.appf.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">RR 1.62 (0.96 to 2.73)</td><td headers="hd_h_ch9.appf.tab4_1_1_1_3 hd_h_ch9.appf.tab4_1_1_2_11 hd_b_ch9.appf.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">39 more per 1000 (from 3 fewer to 109 more)</td><td headers="hd_h_ch9.appf.tab4_1_1_1_4 hd_b_ch9.appf.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
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<p>⊕◯◯◯</p>
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<p>VERY LOW</p>
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|
</td><td headers="hd_h_ch9.appf.tab4_1_1_1_5 hd_b_ch9.appf.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">CRITICAL</td></tr><tr><th headers="hd_h_ch9.appf.tab4_1_1_1_1 hd_h_ch9.appf.tab4_1_1_2_1 hd_h_ch9.appf.tab4_1_1_2_2 hd_h_ch9.appf.tab4_1_1_2_3 hd_h_ch9.appf.tab4_1_1_2_4 hd_h_ch9.appf.tab4_1_1_2_5 hd_h_ch9.appf.tab4_1_1_2_6 hd_h_ch9.appf.tab4_1_1_2_7 hd_h_ch9.appf.tab4_1_1_1_2 hd_h_ch9.appf.tab4_1_1_2_8 hd_h_ch9.appf.tab4_1_1_2_9 hd_h_ch9.appf.tab4_1_1_1_3 hd_h_ch9.appf.tab4_1_1_2_10 hd_h_ch9.appf.tab4_1_1_2_11 hd_h_ch9.appf.tab4_1_1_1_4 hd_h_ch9.appf.tab4_1_1_1_5" id="hd_b_ch9.appf.tab4_1_1_3_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:middle;">Fracture</th></tr><tr><td headers="hd_h_ch9.appf.tab4_1_1_1_1 hd_h_ch9.appf.tab4_1_1_2_1 hd_b_ch9.appf.tab4_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_h_ch9.appf.tab4_1_1_1_1 hd_h_ch9.appf.tab4_1_1_2_2 hd_b_ch9.appf.tab4_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">observational studies</td><td headers="hd_h_ch9.appf.tab4_1_1_1_1 hd_h_ch9.appf.tab4_1_1_2_3 hd_b_ch9.appf.tab4_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">very serious<sup>a</sup></td><td headers="hd_h_ch9.appf.tab4_1_1_1_1 hd_h_ch9.appf.tab4_1_1_2_4 hd_b_ch9.appf.tab4_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_h_ch9.appf.tab4_1_1_1_1 hd_h_ch9.appf.tab4_1_1_2_5 hd_b_ch9.appf.tab4_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious indirectness</td><td headers="hd_h_ch9.appf.tab4_1_1_1_1 hd_h_ch9.appf.tab4_1_1_2_6 hd_b_ch9.appf.tab4_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious imprecision<sup>b</sup></td><td headers="hd_h_ch9.appf.tab4_1_1_1_1 hd_h_ch9.appf.tab4_1_1_2_7 hd_b_ch9.appf.tab4_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">None</td><td headers="hd_h_ch9.appf.tab4_1_1_1_2 hd_h_ch9.appf.tab4_1_1_2_8 hd_b_ch9.appf.tab4_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">22/46 (47.8%)</td><td headers="hd_h_ch9.appf.tab4_1_1_1_2 hd_h_ch9.appf.tab4_1_1_2_9 hd_b_ch9.appf.tab4_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">25%</td><td headers="hd_h_ch9.appf.tab4_1_1_1_3 hd_h_ch9.appf.tab4_1_1_2_10 hd_b_ch9.appf.tab4_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">RR 1.91 (1.06 to 3.47)</td><td headers="hd_h_ch9.appf.tab4_1_1_1_3 hd_h_ch9.appf.tab4_1_1_2_11 hd_b_ch9.appf.tab4_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">227 more (from 15 more to 618 more)</td><td headers="hd_h_ch9.appf.tab4_1_1_1_4 hd_b_ch9.appf.tab4_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
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<p>⊕◯◯◯</p>
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<p>VERY LOW</p>
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</td><td headers="hd_h_ch9.appf.tab4_1_1_1_5 hd_b_ch9.appf.tab4_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">CRITICAL</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>a</dt><dd><div id="ch9.appf.tab4_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></dl><dl class="bkr_refwrap"><dt>b</dt><dd><div id="ch9.appf.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></dl></dl></div></div></div></article><article data-type="fig" id="figobch9appgfig1"><div id="ch9.appg.fig1" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%2026.%20Flow%20chart%20of%20health%20economic%20study%20selection%20for%20the%20guideline.&p=BOOKS&id=577896_ch9appgf1.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 data-src="/books/NBK577896/bin/ch9appgf1.jpg" alt="Figure 26. 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 26</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></article><article data-type="table-wrap" id="figobch9appitab1"><div id="ch9.appi.tab1" class="table"><h3><span class="label">Table 21</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/NBK577896/table/ch9.appi.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch9.appi.tab1_lrgtbl__"><table><thead><tr><th id="hd_h_ch9.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Study</th><th id="hd_h_ch9.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Exclusion reason</th></tr></thead><tbody><tr><td headers="hd_h_ch9.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Abdulkader 2012<a class="bibr" href="#ch9.ref1" rid="ch9.ref1"><sup>1</sup></a></td><td headers="hd_h_ch9.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_ch9.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Agarwal 2003<a class="bibr" href="#ch9.ref2" rid="ch9.ref2"><sup>2</sup></a></td><td headers="hd_h_ch9.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Incorrect study design. Case report.</td></tr><tr><td headers="hd_h_ch9.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Ahsan 2017<a class="bibr" href="#ch9.ref3" rid="ch9.ref3"><sup>3</sup></a></td><td headers="hd_h_ch9.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">n=25. Excluding studies less than 50 participants.</td></tr><tr><td headers="hd_h_ch9.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Alvarez-Allende 2014<a class="bibr" href="#ch9.ref4" rid="ch9.ref4"><sup>4</sup></a></td><td headers="hd_h_ch9.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_ch9.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Amaral 2012<a class="bibr" href="#ch9.ref5" rid="ch9.ref5"><sup>5</sup></a></td><td headers="hd_h_ch9.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Inappropriate comparison. Study compared the clinical and laboratory data between the normocalcaemic and mild hypercalcaemic patients.</td></tr><tr><td headers="hd_h_ch9.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Antonelli 2011<a class="bibr" href="#ch9.ref6" rid="ch9.ref6"><sup>6</sup></a></td><td headers="hd_h_ch9.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_ch9.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Babey 2010<a class="bibr" href="#ch9.ref7" rid="ch9.ref7"><sup>7</sup></a></td><td headers="hd_h_ch9.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_ch9.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Bai 2012<a class="bibr" href="#ch9.ref8" rid="ch9.ref8"><sup>8</sup></a></td><td headers="hd_h_ch9.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Incorrect study design – literature review to explore association between primary hyperparathyroidism (PHPT) and acute or chronic pancreatitis.</td></tr><tr><td headers="hd_h_ch9.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Bailey 1974<a class="bibr" href="#ch9.ref9" rid="ch9.ref9"><sup>9</sup></a></td><td headers="hd_h_ch9.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Incorrect study design</td></tr><tr><td headers="hd_h_ch9.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Bandeira 2009<a class="bibr" href="#ch9.ref10" rid="ch9.ref10"><sup>10</sup></a></td><td headers="hd_h_ch9.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Inappropriate comparison. Study aims to determine the prevalence of cortical osteoporosis in patients with symptomatic PHPT and compare it with the asymptomatic form.</td></tr><tr><td headers="hd_h_ch9.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Bandeira 2016<a class="bibr" href="#ch9.ref11" rid="ch9.ref11"><sup>11</sup></a></td><td headers="hd_h_ch9.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_ch9.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Bao 2013<a class="bibr" href="#ch9.ref12" rid="ch9.ref12"><sup>12</sup></a></td><td headers="hd_h_ch9.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_ch9.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Battersby 1969<a class="bibr" href="#ch9.ref13" rid="ch9.ref13"><sup>13</sup></a></td><td headers="hd_h_ch9.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Incorrect study design – case report (of pancreatitis with PHPT)</td></tr><tr><td headers="hd_h_ch9.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Beard 1950<a class="bibr" href="#ch9.ref14" rid="ch9.ref14"><sup>14</sup></a></td><td headers="hd_h_ch9.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_ch9.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Bhadada 2018<a class="bibr" href="#ch9.ref15" rid="ch9.ref15"><sup>15</sup></a></td><td headers="hd_h_ch9.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_ch9.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Bonzelaar 2016<a class="bibr" href="#ch9.ref17" rid="ch9.ref17"><sup>17</sup></a></td><td headers="hd_h_ch9.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_ch9.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cannon 2010<a class="bibr" href="#ch9.ref18" rid="ch9.ref18"><sup>18</sup></a></td><td headers="hd_h_ch9.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Inappropriate comparison. Study describes the surgical outcome and long term results of hypercalcaemic crisis patients after parathyroidectomy compared to non-crisis patients.</td></tr><tr><td headers="hd_h_ch9.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Carnaille 1998<a class="bibr" href="#ch9.ref19" rid="ch9.ref19"><sup>19</sup></a></td><td headers="hd_h_ch9.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Incorrect comparison. Study looked at association of pancreatitis with PHPT.</td></tr><tr><td headers="hd_h_ch9.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cassibba 2014<a class="bibr" href="#ch9.ref20" rid="ch9.ref20"><sup>20</sup></a></td><td headers="hd_h_ch9.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Incorrect study design – retrospective analysis of a case series</td></tr><tr><td headers="hd_h_ch9.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Corlew 1985<a class="bibr" href="#ch9.ref22" rid="ch9.ref22"><sup>22</sup></a></td><td headers="hd_h_ch9.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">n=47. Excluding studies less than 50 participants.</td></tr><tr><td headers="hd_h_ch9.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Csupor 2005<a class="bibr" href="#ch9.ref23" rid="ch9.ref23"><sup>23</sup></a></td><td headers="hd_h_ch9.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Inappropriate comparison. Study aimed to assess the potential association between the surgically confirmed location of the disease and the presence of kidney stone.</td></tr><tr><td headers="hd_h_ch9.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Danzi 1974<a class="bibr" href="#ch9.ref25" rid="ch9.ref25"><sup>25</sup></a></td><td headers="hd_h_ch9.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Incorrect study design – case report.</td></tr><tr><td headers="hd_h_ch9.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Deaconson 1987<a class="bibr" href="#ch9.ref27" rid="ch9.ref27"><sup>27</sup></a></td><td headers="hd_h_ch9.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Inappropriate population group. Study reports the influence of parathyroidectomy on the natural history of nephrolithiasis and changes in the rates of new stone formation.</td></tr><tr><td headers="hd_h_ch9.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Diaz de la Guardia 2010<a class="bibr" href="#ch9.ref30" rid="ch9.ref30"><sup>30</sup></a></td><td headers="hd_h_ch9.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not in English</td></tr><tr><td headers="hd_h_ch9.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Dimkovic 2002<a class="bibr" href="#ch9.ref31" rid="ch9.ref31"><sup>31</sup></a></td><td headers="hd_h_ch9.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Inappropriate population. Study aimed to examine patients with kidney stone disease, elevated iPTH, but normal serum calcium level and normal urinary excretion of calcium.</td></tr><tr><td headers="hd_h_ch9.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Dolgin 1979<a class="bibr" href="#ch9.ref32" rid="ch9.ref32"><sup>32</sup></a></td><td headers="hd_h_ch9.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study analysed the effect of routine screening of calcium and phosphate levels on the incidence and spectrum of PHPT. No useable outcomes.</td></tr><tr><td headers="hd_h_ch9.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Dumitrescu 2008<a class="bibr" href="#ch9.ref33" rid="ch9.ref33"><sup>33</sup></a></td><td headers="hd_h_ch9.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Incorrect population. Study aimed to determine the prevalence of contributors to secondary osteoporosis in patients presenting with a clinical vertebral or non-vertebral fracture.</td></tr><tr><td headers="hd_h_ch9.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Eufrazino 2013<a class="bibr" href="#ch9.ref34" rid="ch9.ref34"><sup>34</sup></a></td><td headers="hd_h_ch9.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Incorrect study design – cross-sectional study</td></tr><tr><td headers="hd_h_ch9.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Falko 1984<a class="bibr" href="#ch9.ref35" rid="ch9.ref35"><sup>35</sup></a></td><td headers="hd_h_ch9.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No comparison group. Study assessed clinical and biochemical spectrum of patients with PHPT who had surgery.</td></tr><tr><td headers="hd_h_ch9.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Heath 1991<a class="bibr" href="#ch9.ref37" rid="ch9.ref37"><sup>37</sup></a></td><td headers="hd_h_ch9.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_ch9.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Hedback 2002<a class="bibr" href="#ch9.ref39" rid="ch9.ref39"><sup>39</sup></a></td><td headers="hd_h_ch9.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_ch9.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Jha 2016<a class="bibr" href="#ch9.ref40" rid="ch9.ref40"><sup>40</sup></a></td><td headers="hd_h_ch9.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_ch9.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Kobayashi 1997<a class="bibr" href="#ch9.ref43" rid="ch9.ref43"><sup>43</sup></a></td><td headers="hd_h_ch9.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_ch9.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Larsson 1989<a class="bibr" href="#ch9.ref44" rid="ch9.ref44"><sup>44</sup></a></td><td headers="hd_h_ch9.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No useable outcomes</td></tr><tr><td headers="hd_h_ch9.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Lowe 2007<a class="bibr" href="#ch9.ref46" rid="ch9.ref46"><sup>46</sup></a></td><td headers="hd_h_ch9.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No comparison group. Study described the clinical course of 37 patients with normocalcaemic PHPT who were followed for up to 8 years.</td></tr><tr><td headers="hd_h_ch9.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Lueg 1982<a class="bibr" href="#ch9.ref47" rid="ch9.ref47"><sup>47</sup></a></td><td headers="hd_h_ch9.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_ch9.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Marques 2011<a class="bibr" href="#ch9.ref48" rid="ch9.ref48"><sup>48</sup></a></td><td headers="hd_h_ch9.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Incorrect study design. Retrospective review of medical records to describe the characteristics of normocalcaemic primary hyperparathyroidism (NPHPT) in patients seen for osteoporosis evaluation.</td></tr><tr><td headers="hd_h_ch9.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Misiorowski 2012<a class="bibr" href="#ch9.ref50" rid="ch9.ref50"><sup>50</sup></a></td><td headers="hd_h_ch9.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No useable outcomes. The aim of the study was to evaluate the diagnostic power of the bone densitometry in diagnosis of PHPT.</td></tr><tr><td headers="hd_h_ch9.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Mollerup 1999<a class="bibr" href="#ch9.ref51" rid="ch9.ref51"><sup>51</sup></a></td><td headers="hd_h_ch9.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Inappropriate comparison – before and after surgery. The study aimed to evaluate the risk of renal stone recurrence after successful surgical treatment of PHPT.</td></tr><tr><td headers="hd_h_ch9.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Nilsson 2005<a class="bibr" href="#ch9.ref55" rid="ch9.ref55"><sup>55</sup></a></td><td headers="hd_h_ch9.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Inappropriate population and outcomes. Study explored long-term effects of parathyroidectomy on cardiovascular functions in PHPT.</td></tr><tr><td headers="hd_h_ch9.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Pradeep 2008<a class="bibr" href="#ch9.ref56" rid="ch9.ref56"><sup>56</sup></a></td><td headers="hd_h_ch9.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_ch9.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Pratley 1973<a class="bibr" href="#ch9.ref57" rid="ch9.ref57"><sup>57</sup></a></td><td headers="hd_h_ch9.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_ch9.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Purnell 1971<a class="bibr" href="#ch9.ref58" rid="ch9.ref58"><sup>58</sup></a></td><td headers="hd_h_ch9.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_ch9.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Rajeevan 2014<a class="bibr" href="#ch9.ref59" rid="ch9.ref59"><sup>59</sup></a></td><td headers="hd_h_ch9.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Incorrect study design – series review</td></tr><tr><td headers="hd_h_ch9.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Rubin 2008<a class="bibr" href="#ch9.ref61" rid="ch9.ref61"><sup>61</sup></a></td><td headers="hd_h_ch9.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Inappropriate comparison. Study compared PHPT patients who had undergone surgery vs those without surgery.</td></tr><tr><td headers="hd_h_ch9.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Scholz 1981<a class="bibr" href="#ch9.ref62" rid="ch9.ref62"><sup>62</sup></a></td><td headers="hd_h_ch9.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_ch9.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Siilin 2011<a class="bibr" href="#ch9.ref63" rid="ch9.ref63"><sup>63</sup></a></td><td headers="hd_h_ch9.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study assessed BMD between PHPT and men without PHPT. No clinical outcomes.</td></tr><tr><td headers="hd_h_ch9.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Silverberg 1990<a class="bibr" href="#ch9.ref65" rid="ch9.ref65"><sup>65</sup></a></td><td headers="hd_h_ch9.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No comparison group</td></tr><tr><td headers="hd_h_ch9.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Silverberg 1995<a class="bibr" href="#ch9.ref64" rid="ch9.ref64"><sup>64</sup></a></td><td headers="hd_h_ch9.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_ch9.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Siminovitch 1980<a class="bibr" href="#ch9.ref66" rid="ch9.ref66"><sup>66</sup></a></td><td headers="hd_h_ch9.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study assessed the effect of parathyroidectomy in patients with normocalcaemic calcium stones. No useable outcomes.</td></tr><tr><td headers="hd_h_ch9.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Soreide 1997<a class="bibr" href="#ch9.ref67" rid="ch9.ref67"><sup>67</sup></a></td><td headers="hd_h_ch9.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Inappropriate comparison. The study evaluated survival after surgical treatment for primary hyperparathyroidism.</td></tr><tr><td headers="hd_h_ch9.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Strewler 1995<a class="bibr" href="#ch9.ref68" rid="ch9.ref68"><sup>68</sup></a></td><td headers="hd_h_ch9.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Literature review. Screened for references.</td></tr><tr><td headers="hd_h_ch9.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Turchi 1962<a class="bibr" href="#ch9.ref70" rid="ch9.ref70"><sup>70</sup></a></td><td headers="hd_h_ch9.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Incorrect study design – case report.</td></tr><tr><td headers="hd_h_ch9.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Vanderwalde 2006<a class="bibr" href="#ch9.ref71" rid="ch9.ref71"><sup>71</sup></a></td><td headers="hd_h_ch9.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study aimed to determine the effect of parathyroidectomy on fracture risk in patients with PHPT. Inappropriate comparison-comparison groups were parathyroidectomy vs observation.</td></tr><tr><td headers="hd_h_ch9.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Vanderwalde 2009<a class="bibr" href="#ch9.ref72" rid="ch9.ref72"><sup>72</sup></a></td><td headers="hd_h_ch9.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Inappropriate comparison – comparison groups were parathyroidectomy vs observation</td></tr><tr><td headers="hd_h_ch9.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Vestergaard 2000<a class="bibr" href="#ch9.ref73" rid="ch9.ref73"><sup>73</sup></a></td><td headers="hd_h_ch9.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_ch9.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Vestergaard 2003<a class="bibr" href="#ch9.ref75" rid="ch9.ref75"><sup>75</sup></a></td><td headers="hd_h_ch9.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study included in surgery review</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobch9appjtab1"><div id="ch9.appj.tab1" class="table"><h3><span class="title">Criteria for selecting high-priority research recommendations</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577896/table/ch9.appj.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch9.appj.tab1_lrgtbl__"><table><tbody><tr><th id="hd_b_ch9.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">PICO question</th><td headers="hd_b_ch9.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Population: People diagnosed with PHPT</p>
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<p>Intervention(s): Surgery, calcimimetics and bisphosphonates (or any combination, no treatment (surveillance/conservative management)</p>
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<p>Comparison: Compared to each other</p>
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<p>Outcome(s): Health-related quality of life, mortality, preservation of end organ function (bone mineral density, fractures, renal stones and renal function), persistent hypercalcaemia, cardiovascular events, adverse events, cancer incidence.</p>
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</td></tr><tr><th id="hd_b_ch9.appj.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Importance to patients or the population</th><td headers="hd_b_ch9.appj.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">There is limited evidence on the long-term outcomes of the different management strategies. In order for people to make an informed choice regarding their treatment research is needed on this topic.</td></tr><tr><th id="hd_b_ch9.appj.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Relevance to NICE guidance</th><td headers="hd_b_ch9.appj.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Limited recommendations were made on surgery, calcimimetics and bisphosphonates.</td></tr><tr><th id="hd_b_ch9.appj.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Relevance to the NHS</th><td headers="hd_b_ch9.appj.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Altered guidance may have a financial impact on the NHS depending on whether the evidence either supports or does not support certain management strategies.</td></tr><tr><th id="hd_b_ch9.appj.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">National priorities</th><td headers="hd_b_ch9.appj.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">None</td></tr><tr><th id="hd_b_ch9.appj.tab1_1_1_6_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Current evidence base</th><td headers="hd_b_ch9.appj.tab1_1_1_6_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>The majority of randomised evidence compared parathyroidectomy versus conservative management. The longest follow up period was 5 years.</p>
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<p>One very small study reported at 17 years but only a very limited number of outcomes were reported.</p></td></tr><tr><th id="hd_b_ch9.appj.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Equality</th><td headers="hd_b_ch9.appj.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">None</td></tr><tr><th id="hd_b_ch9.appj.tab1_1_1_8_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design</th><td headers="hd_b_ch9.appj.tab1_1_1_8_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RCT</td></tr><tr><th id="hd_b_ch9.appj.tab1_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Feasibility</th><td headers="hd_b_ch9.appj.tab1_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">20-year follow up period to ensure all patient outcomes are captured.</td></tr><tr><th id="hd_b_ch9.appj.tab1_1_1_10_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Other comments</th><td headers="hd_b_ch9.appj.tab1_1_1_10_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">None</td></tr><tr><th id="hd_b_ch9.appj.tab1_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Importance</th><td headers="hd_b_ch9.appj.tab1_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul id="ch9.l35"><li id="ch9.lt162" class="half_rhythm"><div>High: the research is essential to inform future updates of key recommendations in the guideline.</div></li></ul>
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