Primary hyperparathyroidism (PHPT) increases the risk of renal stones and progressive renal dysfunction. Parathyroidectomy is recommended for patients with renal involvement, yet whether surgery improves renal outcomes compared with non-surgical management remains unclear. Prior reviews have focused mainly on biochemical or skeletal outcomes, included few renal events and largely predate recent large cohort studies using contemporary methods to evaluate renal stones, chronic kidney disease (CKD) progression and long-term estimated glomerular filtration rate (eGFR) decline. A contemporary renal-focused synthesis is needed to clarify the true renal benefits of parathyroidectomy. We aim to evaluate the effect of parathyroidectomy versus non-surgical management on renal stones and broader renal outcomes in adults with PHPT.

This Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P)-aligned protocol describes a systematic review and meta-analysis comparing parathyroidectomy with non-surgical management in adults (≥18 years) with PHPT. MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials will be searched from inception to 5 November 2025. Eligible studies include randomised trials, non-randomised interventional studies and observational comparative designs. Studies without a comparator, those focused exclusively on secondary or normocalcaemic hyperparathyroidism and case reports or series will be excluded. Primary outcomes are renal stones and renal functional outcomes (eg, CKD progression, ≥30% decline in eGFR, dialysis initiation). Secondary outcomes include health-related quality of life and adverse events. Two reviewers will independently screen records, extract data and assess risk of bias (Cochrane Risk-of-Bias 2 and Risk Of Bias In Non-randomised Studies of Interventions). Random-effects models will be used where appropriate, and heterogeneity assessed using I². Publication bias will be assessed using appropriate quantitative or qualitative methods based on the available evidence.

Ethics approval is not required as only published data will be used. Findings will be disseminated through peer-reviewed publication and conference presentations.

CRD420251240480.

The emergency department (ED) often serves as a crucial pathway for cancer diagnosis. However, little is known about the management of patients with new suspected cancer diagnoses in the ED. The objective of this study was to explore emergency physicians’ experiences in managing patients with a newly suspected cancer diagnosis in the ED.

Between January and April 2024, we conducted a qualitative descriptive study. Interviews were conducted by trained research personnel using a semistructured interview guide. Interviews were conducted until thematic saturation was achieved. The interview transcripts were coded and thematic analysis was used to uncover key themes.

Emergency physicians practising in Ontario, Canada.

20 emergency physicians were interviewed. Four themes around the management of patients with new suspected cancer diagnoses in the ED were identified: (1) healthcare system-level factors that impact suspected cancer diagnosis through the ED, (2) institutional and provider-level challenges associated with managing patients with a suspected cancer diagnosis in the ED, (3) patient-level characteristics and experiences of receiving a cancer diagnosis in the ED and (4) the need for care coordination for patients with suspected cancer in the ED.

Physicians experienced several unique challenges in managing patients with a suspected cancer diagnosis in the ED. Overall, the findings of this study suggest these challenges often make the ED a difficult environment in which to deliver a suspected cancer diagnosis.