Objectives : To systematically review the literature regarding the reliability and validity of assessment methods available in primary care for bladder outlet obstruction or benign prostatic obstruction in men with lower urinary tract symptoms (LUTS). Design : Systematic review with best evidence synthesis. Setting : Primary care. Participants : Men with LUTS due to bladder outlet obstruction or benign prostatic obstruction. Review methods: PubMed, Ebsco/CINAHL and Embase databases were searched for studies on the validity and reliability of assessment methods for bladder outlet obstruction and benign prostatic obstruction in primary care. Methodological quality was assessed with the COSMIN checklist. Studies with poor methodology were excluded from the best evidence synthesis. Results : Of the 5644 studies identified, 61 were scored with the COSMIN checklist, 37 studies were included in the best evidence synthesis, 18 evaluated bladder outlet obstruction and 17 benign prostatic obstruction, 2 evaluated both. Overall, reliability was poorly evaluated. Transrectal and transabdominal ultrasound showed moderate to good validity to evaluate bladder outlet obstruction. Measured prostate volume with these ultrasound methods, to identify benign prostatic obstruction, showed moderate to good accuracy, supported by a moderate to high level of evidence. Uroflowmetry for bladder outlet obstruction showed poor to moderate diagnostic accuracy, depending on used cut-off values. Questionnaires were supported by high-quality evidence, although correlations and diagnostic accuracy were poor to moderate compared with criterion tests. Other methods were supported by low level evidence. Conclusion :Clinicians in primary care can incorporate transabdominal and transrectal ultrasound or uroflowmetry in the evaluation of men with LUTS but should not solely rely on these methods as the diagnostic accuracy is insufficient and reliability remains insufficiently researched. Low-to-moderate levels of evidence for most assessment methods were due to methodological shortcomings and inconsistency in the studies. This highlights the need for better study designs in this domain.
MULTIFILE
To adequately deal with the challenges faced within residential care for older people, such as the increasing complexity of care and a call for more person-centred practices, it is important that health care providers learn from their work. This study investigates both the nature of learning, among staff and students working within care for older people, and how workplace learning can be promoted and researched. During a longitudinal study within a nursing home, participatory and democratic research methods were used to collaborate with stakeholders to improve the quality of care and to promote learning in the workplace. The rich descriptions of these processes show that workplace learning is a complex phenomenon. It arises continuously in reciprocal relationship with all those present through which both individuals and environment change and co-evolve enabling enlargement of the space for possible action. This complexity perspective on learning refines and expands conventional beliefs about workplace learning and has implications for advancing and researching learning. It explains that research on workplace learning is itself a form of learning that is aimed at promoting and accelerating learning. Such research requires dialogic and creative methods. This study illustrates that workplace learning has the potential to develop new shared values and ways of working, but that such processes and outcomes are difficult to control. It offers inspiration for educators, supervisors, managers and researchers as to promoting conditions that embrace complexity and provides insight into the role and position of self in such processes.
