Objective To compare efficacy and safety outcomes of GreenLight, Holmium and Thulium laser  techniques with standard monopolar and bipolar transurethral resection of the prostate (TURP) in high-risk patients with lower urinary tract symptoms (LUTS) secondary to benign prostatic obstruction (BPO). Methods We conducted a systematic literature review of studies in patients undergoing BPO surgeries who may be considered high-risk for standard TURP, with higher risk defined as follows: large prostates (≥80 mL) and/or taking antithrombotic agents and/or urinary retention and/or age >80 years and/or significant comorbidity.  Outcomes summarised included bleeding complications, re-intervention rates, hospital length of stay, and standard measures of disease and symptom severity for all available timepoints. Results A total of 276 studies of 32,722 patients reported relevant data. Studies were heterogeneous in methodology, population and outcomes reported. IPSS reduction, Qmax improvement and PVR were similar across all interventions. Mean values at baseline and after 12 months across interventions were 13.2−29 falling to 2.3−10.8 for IPSS, 0−19 mL/s increasing to 7.5−34.1 mL/s for Qmax and 41.4−954 mL falling to 5.1−138.3 mL for PVR. Laser treatments show some advantages compared with monopolar and bipolar TURP for some adverse events and safety parameters such as bleeding complications. Duration of hospital stay, reinterventions and recatheterisations were lower with GreenLight, HoLEP, Thulium lasers, and bipolar enucleation than TURP. Conclusions Laser therapies are effective and well-tolerated treatment options in high-risk patients with BPO compared with monopolar or bipolar TURP. The advantageous safety profile of laser treatments means that patients with a higher bleeding risk should be offered laser surgery preferentially to mTURP or bTURP.

ObjectivesAssess the impact of single rooms versus multioccupancy accommodation on inpatient healthcare outcomes and processes.DesignSystematic review and narrative synthesis.Data sourcesMedline, Embase, Google Scholar and the National Institute for Health and Care Excellence website up to 17 February 2022.Eligibility criteriaEligible papers assessed the effect on inpatients staying in hospital of being assigned to a either a single room or shared accommodation, except where that assignment was for a direct clinical reason like preventing infection spread.Data extraction and synthesisData were extracted and synthesised narratively, according to the methods of Campbellet al.ResultsOf 4861 citations initially identified, 145 were judged to be relevant to this review. Five main method types were reported. All studies had methodological issues that potentially biased the results by not adjusting for confounding factors that are likely to have contributed to the outcomes. Ninety-two papers compared clinical outcomes for patients in single rooms versus shared accommodation. No clearly consistent conclusions could be drawn about overall benefits of single rooms. Single rooms were most likely to be associated with a small overall clinical benefit for the most severely ill patients, especially neonates in intensive care. Patients who preferred single rooms tended to do so for privacy and for reduced disturbances. By contrast, some groups were more likely to prefer shared accommodation to avoid loneliness. Greater costs associated with building single rooms were small and likely to be recouped over time by other efficiencies.ConclusionsThe lack of difference between inpatient accommodation types in a large number of studies suggests that there would be little effect on clinical outcomes, particularly in routine care. Patients in intensive care areas are most likely to benefit from single rooms. Most patients preferred single rooms for privacy and some preferred shared accommodation for avoiding loneliness.PROSPERO registration numberCRD42022311689.

Objectives: Assess the impact of single rooms versus multioccupancy accommodation on inpatient health-care outcomes and processes. Design: Systematic review. Setting: Hospitals and secondary care units. Participants: Inpatients receiving routine, emergency, high-dependency, or intensive care with a named type of hospital accommodation. Main outcome measures: Qualitative synthesis of findings. Results: Of 4,861 citations initially identified, 215 were deemed suitable for full-text review, of which 145 were judged to be relevant to this review. Five main method types were reported: 60 before-and-after comparisons, 75 contemporaneous comparisons, 18 qualitative studies of accommodation preferences, 10 evidence syntheses. All studies had methodological issues that potentially biased the results by not adjusting for confounding factors that are likely to have contributed to the outcomes. Ninety-two papers compared clinical outcomes for patients in single rooms versus shared accommodation, but no clearly consistent conclusions could be drawn about overall benefits of single rooms versus shared accommodation (multioccupancy rooms, bays, or wards). Single rooms were most likely to be associated with a small overall clinical benefit for the most severely ill patients, especially neonates in intensive care. Patients who preferred single rooms tended to do so for privacy, and for reduced disturbances. By contrast, men, older adults, children, and adolescents were more likely to prefer shared accommodation to avoid loneliness. While shared accommodation seemed to be the most cost-effective approach for construction, greater costs associated with building single rooms were small and likely to be recouped over time by other efficiencies. Conclusions: The lack of difference between inpatient accommodation types in a large number of studies suggests that there would be little effect on clinical outcomes, particularly in routine care. Patients in intensive care areas are most likely to benefit from single rooms. Most patients preferred single rooms for privacy and some preferred shared accommodation for avoiding loneliness.