Background The timing of symptom improvement after parathyroidectomy for primary hyperparathyroidism (PHPT) has not been well characterized. Methods This prospective study involved administering a questionnaire to patients with PHPT who underwent curative parathyroidectomy over an 11-month period. The questionnaire evaluated the frequency of 18 symptoms of PHPT on a 5-point Likert scale, and was administered pre-operatively, and 1 week, 6 weeks, and 6 months postoperatively. Results Of 197 eligible patients, 132 (67%) participated in the study. The questionnaires were completed at a rate of 91%, 92%, and 86% at 1 week, 6 weeks, and 6 months post-operatively, respectively. The most commonly reported pre-operative symptoms were fatigue (98%), muscle aches (89%), and bone/joint pain (87%). Improvement in symptom severity occurred across all symptoms and was separated into three categories based on the timing of improvement. Fatigue and bone/joint pain demonstrated ‘Immediate Improvement’ (>50% of patients reporting improvement by post-operative week 1), whereas the majority of symptoms showed peak improvement at 6 weeks (‘Delayed Improvement’). Symptoms categorized as ‘Continuous Improvement’ were those showing progressive improvement up to 6 months post-operatively (polydipsia, headaches, and nausea/vomiting). Conclusions Symptom improvement was most prominent 6 weeks post-parathyroidectomy, though some symptoms showed continued improvement at 6 months.

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Background The COVID-19 pandemic has necessitated rapid changes in healthcare delivery in the United States, including changes in the care of hospitalized children. The objectives of this study were to identify major changes in healthcare delivery for hospitalized children during the COVID-19 pandemic, identify lessons learned from these changes, and compare and contrast the experiences of children’s and community hospitals. Methods We purposefully sampled participants from both community and children’s hospitals serving pediatric patients in the six U.S. states with the highest COVID-19 hospitalization rates at the onset of the pandemic. We recruited 2–3 participants from each hospital (mix of administrators, front-line physicians, nurses, and parents/caregivers) for semi-structured interviews. We analyzed interview data using constant comparative methods to identify major themes. Results We interviewed 30 participants from 12 hospitals. Participants described how leaders rapidly developed new hospital policies (e.g., directing use of personal protective equipment) and how this was facilitated by reviewing internal and external data frequently and engaging all relevant stakeholders. Hospital leaders optimized communication through regular, transparent, multi-modal, and bi-directional communication. Clinicians increased use of videoconference and telehealth to facilitate physical distancing, but these technologies may have disadvantaged non-English speakers. Due to declining volumes of hospitalized children and surges of adult patients, clinicians newly provided care for hospitalized adults. This was facilitated by developing care teams supported by adult hospitalists, multidisciplinary support via videoconference, and educational resources. Participants described how the pandemic negatively impacted clinicians’ mental health, and they stressed the importance of mental health resources and wellness activities/spaces. Conclusions We identified several major changes in inpatient pediatric care delivery during the COVID-19 pandemic, including the adoption of new hospital policies, video communication, staffing models, education strategies, and staff mental health supports. We outline important lessons learned, including strategies for successfully developing new policies, effectively communicating with staff, and supporting clinicians’ expanding scope of practice. Potentially important focus areas in pandemic recovery include assessing and supporting clinicians’ mental health and well-being, re-evaluating trainees’ skills/competencies, and adapting educational strategies as needed. These findings can help guide hospital leaders in supporting pandemic recovery and addressing future crises.

Background Our aim was to investigate the incidence of sleep disturbance and insomnia in patients with primary hyperparathyroidism (PHPT), and to evaluate the effect of parathyroidectomy. Methods A questionnaire was prospectively administered to adult patients with PHPT who underwent curative parathyroidectomy over an 11-month period. The questionnaire, administered pre- and 6-months post-operatively, included the Insomnia Severity Index (ISI) and eight additional questions regarding sleep pattern. Total ISI scores range from 0 to 28, with >7 signifying sleep difficulties and scores >14 indicating clinical insomnia. Results Of 197 eligible patients undergoing parathyroidectomy for PHPT, 115 (58.3%) completed the pre- and post-operative questionnaires. The mean age was 60.0±1.2 years and 80.0% were female. Pre-operatively, 72 patients (62.6%) had sleep difficulties, and 29 patients (25.2%) met criteria for clinical insomnia. Clinicopathologic variables were not predictive of clinical insomnia. There was a significant reduction in mean ISI score after parathyroidectomy (10.3±0.6 vs 6.2±0.5, p<0.0001). Post-operatively, 79 patients (68.7%) had an improved ISI score. Of the 29 patients with pre-operative clinical insomnia, 21 (72.4%) had resolution after parathyroidectomy. Pre-operative insomnia patients had an increase in total hours slept after parathyroidectomy (5.4±0.3 vs 6.1±0.3 hours, p=0.02), whereas both insomnia and non-insomnia patients had a decrease in the number of awakenings (3.7±0.4 vs 1.9±0.2 times, p=0.0001). Conclusion Sleep disturbances and insomnia are common in patients with PHPT, and the majority of patients will improve after curative parathyroidectomy.

Background Curative parathyroidectomy for primary hyperparathyroidism (PHPT) resolves various nonspecific symptoms related to the disease. Between 8 to 40% of patients with normocalcemia after parathyroidectomy have persistently elevated parathyroid hormone levels (ePTH) at follow-up. We investigated whether ePTH in the early post-operative period was associated with the timing of symptom improvement. Materials and Methods This prospective study included adult patients with PHPT who underwent curative parathyroidectomy from November 2011 to September 2012. Biochemical testing 2 weeks post-operatively identified ePTH (defined as PTH > 72 pg/mL) versus normal PTH (nPTH). A questionnaire administered pre- and post-operatively at 6 weeks and 6 months asked patients to rate the frequency of 18 symptoms of PHPT on a 5-point Likert scale. Student’s T-tests were used to compare pre- to post-operative changes in scores for individual symptoms. Results Of 194 patients that underwent parathyroidectomy, 129 (66%) participated in the study. Pre-operatively, all patients were symptomatic, with a mean of 13±4 symptoms. Two weeks post-operatively, 20 patients (16%) had ePTH. The percentage of patients with post-operative improvement for individual symptoms was compared between groups. At the early time point (6 weeks), the ePTH group showed less improvement in 14 of 18 symptoms. This difference reached statistical significance for four symptoms: anxiety, constipation, thirst, and polyuria. By the 6 month time point, these differences had resolved and symptom improvement was similar between groups. Conclusions Elevated PTH after curative parathyroidectomy may result in a delay in symptom improvement 6 weeks post-operatively, however, this difference resolves by 6 months.