The complications and symptoms of hypoparathyroidism remain incompletely defined. Measuring serum parathyroid hormone (PTH) and calcium levels early after total thyroidectomy may predict the development of chronic hypoparathyroidism. The study aimed (i) to identify symptoms and complications associated with chronic hypoparathyroidism and determine the prevalence of those symptoms and complications (Part I), and (ii) to examine the utility of early postoperative measurements of PTH and calcium in predicting chronic hypoparathyroidism (Part II). We searched Medline, Medline In-Process, EMBASE, and Cochrane CENTRAL to identify complications and symptoms associated with chronic hypoparathyroidism. We used two predefined criteria (at least three studies reported the complication and symptom and had statistically significantly greater pooled relative estimates). To estimate prevalence, we used the median and interquartile range (IQR) of the studies reporting complications and symptoms. For testing the predictive values of early postoperative measurements of PTH and calcium, we used a bivariate model to perform diagnostic test meta-analysis. In Part I, the 93 eligible studies enrolled a total of 18,973 patients and reported on 170 complications and symptoms. We identified nine most common complications or symptoms probably associated with chronic hypoparathyroidism. The complications or symptoms and the prevalence are as follows: nephrocalcinosis/nephrolithiasis (median prevalence among all studies 15%), renal insufficiency (12%), cataract (17%), seizures (11%), arrhythmia (7%), ischemic heart disease (7%), depression (9%), infection (11%), and all-cause mortality (6%). In Part II, 18 studies with 4325 patients proved eligible. For PTH measurement, regarding the posttest probability, PTH values above 10 pg/mL 12-24 hours postsurgery virtually exclude chronic hypoparathyroidism irrespective of pretest probability (100%). When PTH values are below 10 pg/mL, posttest probabilities range from 3% to 64%. Nine complications and symptoms are probably associated with chronic hypoparathyroidism. A PTH value above a threshold of 10 pg/mL 12-24 hours after total thyroidectomy is a strong predictor that the patients will not develop chronic hypoparathyroidism. Patients with PTH values below the threshold need careful monitoring as some will develop chronic hypoparathyroidism. (c) 2022 American Society for Bone and Mineral Research (ASBMR).

Healthcare systems across the world are increasingly challenged by workforce shortages and misdistribution of skills. Yet, no comprehensive European approach to health human resources (HHR) policy exists and action remains fragmented. This scoping study seeks to contribute to the debates by providing an overview of existing HHR research, and by exploring the challenges of a European approach with a focus on workforce planning. In terms of methods, we build on a scoping review comprising literature analysis and qualitative data gathered from policy experts. In our analysis we observe an overall lack of integrated HHR approaches as major obstacle of efficient HHR planning, and find that five dimensions of integration in HHR policy are needed: system, occupational, sector, gender, and socio-cultural integration. Increasing the analytical complexity of HHR planning models does not automatically bring about more reliable and efficient planning, as the added value of these models is highly context-dependent. Yet Europe is highly diverse and we therefore argue the need for a strategic HHR perspective that is capable of bridging many different HHR policies and planning systems, and combining national and European solutions efficiently.

Background Right to health indicators have been subject to debate. Indeed, inadequate monitoring or reporting by states, missing or contradicting data as well as a lack of consensus on what is an appropriate right to health indicator call for new approaches and new ideas in this field. One right to health indicator might be patient satisfaction, a widely collected indicator, yet not always beyond bias nor adequately monitored, neither well used. Methods We compared, applying the concept analysis of Rodgers, key-items of patient satisfaction surveys/reviews to key concepts of right to health as developed in the General Comment 14/2000 of the ICESCR. Inclusion criteria of the selected patient satisfaction papers were: number of citations in Scholar Google, various care settings, various cultural contexts, methodological reviews and time frame. Results High correspondence between recommended or collected patient satisfaction items and patients’ rights as defined by the GC 14/2000 were observed, i.e. accessibility of care (information, financial, physical), availability (services, programs, personal), acceptability (cultural, gender-related), quality of care (scientific, medical). Conclusion Patient satisfaction could prove a useful right to health indicator.

Authors' objectives: Research question: In people with newly diagnosed epilepsy, is pharmacogentic testing effective for detecting and reducing the risk of adverse reactions to anti-epileptic medications?