Objective To determine the most effective and cost effective type of catheter for patients performing intermittent self catheterisation in the community.Design Systematic review and meta-analysis. Results were incorporated into a probabilistic Markov model to compare lifetime costs and quality adjusted life years (QALYs). Data sourcesWe searched Medline, Embase, and Cochrane and Cinahl databases from 2002 to 18 April 2011 to identify studies comparing hydrophilic, gel reservoir, and non-coated intermittent catheters. Earlier guidelines were used to identify papers published before 2002. To capture studies comparing clean and sterile non-coated intermittent self catheterisation, each database was searched from its date of inception to 18 April 2011. Main outcome measuresClinical outcomes included symptomatic urinary tract infection (UTI), bacteraemia, mortality, patient preference or comfort, and number of catheters used. The economic model included downstream complications of UTI and cost effectiveness was calculated as incremental cost per QALY gained.Results Eight studies were included in the systematic review. Most were conducted in patients with spinal cord injuries, and most of the included patients were men. People using gel reservoir and hydrophilic catheters were significantly less likely to report one or more UTIs compared with sterile non-coated catheters (absolute effect for gel reservoir = 149 fewer per 1000 (95% confidence interval −7 to 198), P=0.04; absolute effect for hydrophilic = 153 fewer per 1000 (−8 to 268), P=0.04). However, there was no difference between hydrophilic and sterile non-coated catheters when outcomes were measured as mean monthly UTIs (mean difference = 0.01 (−0.11 to 0.09), P=0.84) or total UTIs at 1 year (mean difference = 0.18 (−0.50 to 0.86), P=0.60). There was little difference in the incidence of one or more UTIs for people using clean versus sterile non-coated catheters (absolute effect = 12 fewer per 1000 (−134 to 146), P=0.86). Although the most effective, gel reservoir catheters cost >£54 350 per QALY gained and are therefore not cost effective compared with clean non-coated self catheterisation. ConclusionThe type of catheter used for intermittent self catheterisation seems to make little difference to the risk of symptomatic UTI. Given large differences in resource use, clean non-coated catheters are most cost effective. However, because of limitations and gaps in the evidence base and the designation of non-coated catheters as single use devices, we recommend a precautionary principle should be adopted and that patients should be offered a choice between hydrophilic and gel reservoir catheters. IntroductionCatheter associated urinary tract infection is the most common healthcare acquired infection in the world, accounting for 20-45% of all nosocomial infections.1 While most urinary tract infections (UTIs) are mild and easily resolved with appropriate antibiotic treatment, more severe infections can be devastating, resulting in bacteraemia, sepsis, and deat...

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contains an error in figures 3 and 4 (algorithms for the selection of adults and children for imaging of the cervical spine). The final box in both of the algorithms should have said: "Perform CT cervical spine scan [not head scan] within 1 hour of risk factor being identified." The correct figures are supplied here.⇓⇓

An ongoing commitment to tackling anti-social behaviour was a central part of the New Labour policy agenda throughout their 13 years in government. Their policy and practice became increasingly enforcement-led with the anti-social behaviour order (ASBO) at the cornerstone of their agenda. Police and local authorities came under pressure to see the ASBO, along with a whole range of other enforcement powers, as almost a panacea for tackling anti-social behaviour and, in particular, youth disorder. This article draws upon the literature, the authors’ own evaluation experience and recently released statistics from the Ministry of Justice and the British Crime Survey to examine the legacy of New Labour in terms of tackling anti-social behaviour. These are discussed within the context of the Coalition Government’s emerging ideas about how best to tackle anti-social behaviour, including their plans to abandon the ASBO along with other enforcement measures introduced under New Labour. We suggest that rather than abandoning the ASBO altogether, there may be advantages to ‘rehabilitating’ the ASBO within the context of a range of more far-sighted and proactive community-based measures. We discuss the lessons to be learnt from New Labour’s legacy and discuss ways forward within the context of coalition government policy.

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Only 37 per cent of young people voted at the 2005 British General Election, seemingly confirming the oft-cited view that this generation is becoming increasingly disconnected from the political process. Results from a nationwide survey, however, indicate that their withdrawal from formal politics is more a result of their scepticism of the way the political system operates, than apathy. Furthermore, they are diverse in their political (dis)engagement. Results from an examination of the relative effects of socio-economic location and social capital are inconclusive, although the data indicate that government social policy aimed at mobilising social capital and addressing socio-economic issues may increase civic engagement.

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Despite the longstanding public and media fascination with the modern 'serial killer', the academic literature is relatively limited. The international field is dominated by individualistic biographical accounts, which offer a highly reductionist and distorted stereotype of the perpetrator, with little opportunity to learn from past cases, or place them within wider sociocultural contexts. Furthermore, there are a profusion of overlapping and confusing terms, confounded by the FBI's social construction of the 'serial killer problem', and perpetuating widespread misleading assumptions. After many years teaching in this area, we are often struck by how these media-driven misconceptions of the serial killer dominate students' knowledge and interest in the topic. This is despite a growing critique of the area in recent years, particularly from within our field of criminology. We seek to debate these issues by exploring some useful cases of serial killing, foregrounding some UK case examples, which are often underexplored. We argue for the need to facilitate scholarly, systematic research to counter the voyeuristic, essentialist narratives within popular media. We also advocate the alternative socio-cultural approach to the study of serial killing, which has emerged in recent years, although been relatively unacknowledged in the international literature to date.