Diagnosis of Asymptomatic Primary Hyperparathyroidism: Proceedings of the Fourth International Workshop

Objective: Asymptomatic primary hyperparathyroidism (PHPT) is a common clinical problem. the purpose of this report is to provide an update on the use of diagnostic tests for this condition in clinical practice.Participants: This subgroup was constituted by the Steering Committee to address key questions related to the diagnosis of PHPT. Consensus was established at a closed meeting of the Expert Panel that followed.Evidence: Each question was addressed by a relevant literature search (on PubMed), and the data were presented for discussion at the group meeting.Consensus Process: Consensus was achieved by a group meeting. Statements were prepared by all authors, with comments relating to accuracy from the diagnosis subgroup and by representatives from the participating professional societies.Conclusions: We conclude that: 1) reference ranges should be established for serum PTH in vitamin D-replete healthy individuals; 2) second-and third-generation PTH assays are both helpful in the diagnosis of PHPT; 3) normocalcemic PHPT is a variant of the more common presentation of PHPT with hypercalcemia; 4) serum 25-hydroxyvitamin D concentrations should be measured and, if vitamin D insufficiency is present, it should be treated as part of any management course; 5) genetic testing has the potential to be useful in the differential diagnosis of familial hyperparathyroidism or hypercalcemia.Univ Sheffield, Acad Unit Bone Metab, Sheffield S5 7AU, S Yorkshire, EnglandUniv Florence, I-50133 Florence, ItalyColumbia Univ, Dept Med, Div Endocrinol, Metab Bone Dis Unit,Coll Phys & Surg, New York, NY 10032 USAUniversidade Federal de São Paulo, Dept Med, Div Endocrinol, BR-04021001 São Paulo, BrazilUniv Montreal, Ctr Hosp Univ Montreal, Hop St Luc, Montreal, PQ H3C 3J7, CanadaUniv Montreal, Dept Med, Montreal, PQ H3C 3J7, CanadaUniv Calif San Francisco, Endocrine Res Unit, San Francisco Dept Vet Affairs Med Ctr, San Francisco, CA 94121 USAUniv Oxford, Acad Endocrine Unit, Radcliffe Dept Med, Oxford OX3 7LJ, EnglandUniversidade Federal de São Paulo, Dept Med, Div Endocrinol, BR-04021001 São Paulo, BrazilWeb of Scienc

Advancing theories, models and measurement for an interprofessional approach to shared decision making in primary care: a study protocol.

Contains fulltext : 69578.pdf (publisher's version ) (Open Access)BACKGROUND: Shared decision-making (SDM) is defined as a process by which a healthcare choice is made by practitioners together with the patient. Although many diagnostic and therapeutic processes in primary care integrate more than one type of health professional, most SDM conceptual models and theories appear to be limited to the patient-physician dyad. The objectives of this study are to develop a conceptual model and propose a set of measurement tools for enhancing an interprofessional approach to SDM in primary healthcare. METHODS/DESIGN: An inventory of SDM conceptual models, theories and measurement tools will be created. Models will be critically assessed and compared according to their strengths, limitations, acknowledgement of interprofessional roles in the process of SDM and relevance to primary care. Based on the theory analysis, a conceptual model and a set of measurements tools that could be used to enhance an interprofessional approach to SDM in primary healthcare will be proposed and pilot-tested with key stakeholders and primary healthcare teams. DISCUSSION: This study protocol is informative for researchers and clinicians interested in designing and/or conducting future studies and educating health professionals to improve how primary healthcare teams foster active participation of patients in making health decisions using a more coordinated approach