Protocol for a randomized, placebo-controlled, double-blind clinical trial investigating sacral neuromodulation for neurogenic lower urinary tract dysfunction

BACKGROUND Sacral neuromodulation has become a well-established and widely accepted treatment for refractory non-neurogenic lower urinary tract dysfunction, but its value in patients with a neurological cause is unclear. Although there is evidence indicating that sacral neuromodulation may be effective and safe for treating neurogenic lower urinary tract dysfunction, the number of investigated patients is low and there is a lack of randomized controlled trials. METHODS AND DESIGN This study is a prospective, randomized, placebo-controlled, double-blind multicenter trial including 4 sacral neuromodulation referral centers in Switzerland. Patients with refractory neurogenic lower urinary tract dysfunction are enrolled. After minimally invasive bilateral tined lead placement into the sacral foramina S3 and/or S4, patients undergo prolonged sacral neuromodulation testing for 3-6 weeks. In case of successful (defined as improvement of at least 50% in key bladder diary variables (i.e. number of voids and/or number of leakages, post void residual) compared to baseline values) prolonged sacral neuromodulation testing, the neuromodulator is implanted in the upper buttock. After a 2 months post-implantation phase when the neuromodulator is turned ON to optimize the effectiveness of neuromodulation using sub-sensory threshold stimulation, the patients are randomized in a 1:1 allocation in sacral neuromodulation ON or OFF. At the end of the 2 months double-blind sacral neuromodulation phase, the patients have a neuro-urological re-evaluation, unblinding takes place, and the neuromodulator is turned ON in all patients. The primary outcome measure is success of sacral neuromodulation, secondary outcome measures are adverse events, urodynamic parameters, questionnaires, and costs of sacral neuromodulation. DISCUSSION It is of utmost importance to know whether the minimally invasive and completely reversible sacral neuromodulation would be a valuable treatment option for patients with refractory neurogenic lower urinary tract dysfunction. If this type of treatment is effective in the neurological population, it would revolutionize the management of neurogenic lower urinary tract dysfunction. TRIAL REGISTRATION TRIAL REGISTRATION NUMBER http://www.clinicaltrials.gov; Identifier: NCT02165774.

Dexmedetomidine versus standard care sedation with propofol or midazolam in intensive care: an economic evaluation.

INTRODUCTION Dexmedetomidine was shown in two European randomized double-blind double-dummy trials (PRODEX and MIDEX) to be non-inferior to propofol and midazolam in maintaining target sedation levels in mechanically ventilated intensive care unit (ICU) patients. Additionally, dexmedetomidine shortened the time to extubation versus both standard sedatives, suggesting that it may reduce ICU resource needs and thus lower ICU costs. Considering resource utilization data from these two trials, we performed a secondary, cost-minimization analysis assessing the economics of dexmedetomidine versus standard care sedation. METHODS The total ICU costs associated with each study sedative were calculated on the basis of total study sedative consumption and the number of days patients remained intubated, required non-invasive ventilation, or required ICU care without mechanical ventilation. The daily unit costs for these three consecutive ICU periods were set to decline toward discharge, reflecting the observed reduction in mean daily Therapeutic Intervention Scoring System (TISS) points between the periods. A number of additional sensitivity analyses were performed, including one in which the total ICU costs were based on the cumulative sum of daily TISS points over the ICU period, and two further scenarios, with declining direct variable daily costs only. RESULTS Based on pooled data from both trials, sedation with dexmedetomidine resulted in lower total ICU costs than using the standard sedatives, with a difference of €2,656 in the median (interquartile range) total ICU costs-€11,864 (€7,070 to €23,457) versus €14,520 (€7,871 to €26,254)-and €1,649 in the mean total ICU costs. The median (mean) total ICU costs with dexmedetomidine compared with those of propofol or midazolam were €1,292 (€747) and €3,573 (€2,536) lower, respectively. The result was robust, indicating lower costs with dexmedetomidine in all sensitivity analyses, including those in which only direct variable ICU costs were considered. The likelihood of dexmedetomidine resulting in lower total ICU costs compared with pooled standard care was 91.0% (72.4% versus propofol and 98.0% versus midazolam). CONCLUSIONS From an economic point of view, dexmedetomidine appears to be a preferable option compared with standard sedatives for providing light to moderate ICU sedation exceeding 24 hours. The savings potential results primarily from shorter time to extubation. TRIAL REGISTRATION ClinicalTrials.gov NCT00479661 (PRODEX), NCT00481312 (MIDEX).

Effect of chin-cup treatment on the temporomandibular joint: a systematic review

AIM To systematically search the literature and assess the available evidence for the influence of chin-cup therapy on the temporomandibular joint regarding morphological adaptations and appearance of temporomandibular disorders (TMD). MATERIALS AND METHODS Electronic database searches of published and unpublished literature were performed. The following electronic databases with no language and publication date restrictions were searched: MEDLINE (via Ovid and PubMed), EMBASE (via Ovid), the Cochrane Oral Health Group's Trials Register, and CENTRAL. Unpublished literature was searched on ClinicalTrials.gov, the National Research Register, and Pro-Quest Dissertation Abstracts and Thesis database. The reference lists of all eligible studies were checked for additional studies. Two review authors performed data extraction independently and in duplicate using data collection forms. Disagreements were resolved by discussion or the involvement of an arbiter. RESULTS From the 209 articles identified, 55 papers were considered eligible for inclusion in the review. Following the full text reading stage, 12 studies qualified for the final review analysis. No randomized clinical trial was identified. Eight of the included studies were of prospective and four of retrospective design. All studies were assessed for their quality and graded eventually from low to medium level of evidence. Based on the reported evidence, chin-cup therapy affects the condylar growth pattern, even though two studies reported no significance changes in disc position and arthrosis configuration. Concerning the incidence of TMD, it can be concluded from the available evidence that chin-cup therapy constitutes no risk factor for TMD. CONCLUSION Based on the available evidence, chin-cup therapy for Class III orthodontic anomaly seems to induce craniofacial adaptations. Nevertheless, there are insufficient or low-quality data in the orthodontic literature to allow the formulation of clear statements regarding the influence of chin-cup treatment on the temporomandibular joint.

Primary prophylaxis for venous thromboembolism in patients undergoing cardiac or thoracic surgery.

BACKGROUND Cardiac and thoracic surgery are associated with an increased risk of venous thromboembolism (VTE). The safety and efficacy of primary thromboprophylaxis in patients undergoing these types of surgery is uncertain. OBJECTIVES To assess the effects of primary thromboprophylaxis on the incidence of symptomatic VTE and major bleeding in patients undergoing cardiac or thoracic surgery. SEARCH METHODS The Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator searched the Specialised Register (last searched May 2014) and CENTRAL (2014, Issue 4). The authors searched the reference lists of relevant studies, conference proceedings, and clinical trial registries. SELECTION CRITERIA Randomised controlled trials (RCTs) and quasi-RCTs comparing any oral or parenteral anticoagulant or mechanical intervention to no intervention or placebo, or comparing two different anticoagulants. DATA COLLECTION AND ANALYSIS We extracted data on methodological quality, participant characteristics, interventions, and outcomes including symptomatic VTE and major bleeding as the primary effectiveness and safety outcomes, respectively. MAIN RESULTS We identified 12 RCTs and one quasi-RCT (6923 participants), six for cardiac surgery (3359 participants) and seven for thoracic surgery (3564 participants). No study evaluated fondaparinux, the new oral direct thrombin, direct factor Xa inhibitors, or caval filters. All studies had major study design flaws and most lacked a placebo or no treatment control group. We typically graded the quality of the overall body of evidence for the various outcomes and comparisons as low, due to imprecise estimates of effect and risk of bias. We could not pool data because of the different comparisons and the lack of data. In cardiac surgery, 71 symptomatic VTEs occurred in 3040 participants from four studies. In a study of 2551 participants, representing 85% of the review population in cardiac surgery, the combination of unfractionated heparin with pneumatic compression stockings was associated with a 61% reduction of symptomatic VTE compared to unfractionated heparin alone (1.5% versus 4.0%; risk ratio (RR) 0.39; 95% confidence interval (CI) 0.23 to 0.64). Major bleeding was only reported in one study, which found a higher incidence with vitamin K antagonists compared to platelet inhibitors (11.3% versus 1.6%, RR 7.06; 95% CI 1.64 to 30.40). In thoracic surgery, 15 symptomatic VTEs occurred in 2890 participants from six studies. In the largest study evaluating unfractionated heparin versus an inactive control the rates of symptomatic VTE were 0.7% versus 0%, respectively, giving a RR of 6.71 (95% CI 0.40 to 112.65). There was insufficient evidence to determine if there was a difference in the risk of major bleeding from two studies evaluating fixed-dose versus weight-adjusted low molecular weight heparin (2.7% versus 8.1%, RR 0.33; 95% CI 0.07 to 1.60) and unfractionated heparin versus low molecular weight heparin (6% and 4%, RR 1.50; 95% CI 0.26 to 8.60). AUTHORS' CONCLUSIONS The evidence regarding the efficacy and safety of thromboprophylaxis in cardiac and thoracic surgery is limited. Data for important outcomes such as pulmonary embolism or major bleeding were often lacking. Given the uncertainties around the benefit-to-risk balance, no conclusions can be drawn and a case-by-case risk evaluation of VTE and bleeding remains preferable.

Estudio de redes WSN y su aplicación a la ingeniería civil

Las redes inalámbricas están experimentando un gran crecimiento en el campo de la instrumentación electrónica. En concreto las redes de sensores inalámbricas (WSN de Wireless Sensor Network) suponen la opción más ventajosa para su empleo en la instrumentación electrónica ya que sus principales características se acoplan perfectamente a las necesidades. Las WSN permiten la utilización de un número relativamente alto de nodos, están orientadas a sistemas de bajo consumo y funcionamiento con baterías y poseen un ancho de banda adecuado para las necesidades de la instrumentación electrónica. En este proyecto fin de carrera se ha realizado un estudio de las tecnologías inalámbricas disponibles, se han comparado y se ha elegido la tecnología ZigBeeTM por considerarse la más adecuada y la que más se ajusta a las necesidades descritas. En el desarrollo de mi vida profesional se han conectado dos campos teóricamente distantes como son la instrumentación electrónica y la ingeniería civil. En este proyecto se hace una descripción de la instrumentación que se utiliza para controlar estructuras como presas, túneles y puentes y se proponen casos prácticos en los que las redes WSN aportan valor añadido a instrumentación actual y a los sistemas de comunicaciones utilizados. Se definen tanto los sistemas de comunicaciones utilizados actualmente como una serie de sensores utilizados para medir los principales parámetros a controlar en una obra civil. Por último se ha desarrollado una aplicación de prueba de una red ZigBeeTM basada en equipos comerciales del fabricante Digi. consiste en una aplicación desarrollada en entorno web que maneja de forma remota, a través de Internet, las entradas y salidas digitales y analógicas de los nodos que forman la red. Se forma una red ZigBeeTM con un coordinador, un router y un dispositivo final. El Coordinador está integrado en un Gateway que permite acceder a la red ZigBeeTM a través de internet y conocer el estado de los nodos que forman la red. Con los comandos adecuados se puede leer el estado de las entradas y salidas analógicas y digitales y cambiar el estado de una salida digital. ABSTRACT. Wireless networks are experiencing tremendous growth in the field of electronic instrumentation. In particular wireless sensor networks represent the most advantageous for use in electronic instrumentation since its main characteristics fit perfectly to the needs. The WSN allow the use of a relatively large number of nodes, are aimed at low-power systems and battery operation and have an adequate bandwidth for the needs of electronic instrumentation. In this project has made a study of available wireless technologies have been compared and chosen ZigBeeTM technology was considered the most appropriate to the needs described. In the course of my professional life have connected two fields are theoretically distant as electronic instrumentation and civil engineering. In this project, there is a description of the instrumentation used to control structures such as dams, tunnels and bridges and proposes practical cases in which WSN networks add value to current instrumentation and communications systems used. There are defined as communications systems now being used as a set of sensors used to measure the main parameters to be controlled in a civil structure. Finally, I have developed a test application based ZigBeeTM networking equipment maker Digi trading. It consists of a Web-based application developed to manage remotely, via the Internet, the digital and analog inputs and outputs nodes forming the network. ZigBeeTM It forms a network with a coordinator, router and end device. The Coordinator is built into a gateway that allows access to the ZigBeeTM network through internet and know the status of the nodes forming the network. With the appropriate command can read the status of the digital inputs and outputs and change the state of a digital output.

Variable impedance LED matrix control system for lamps in PV applications

The interest in LED lighting has been growing recently due to the high efficacy, lifelime and ruggedness that this technology offers. However the key element to guarantee those parameters with these new electronic devices is to keep under control the working temperature of the semiconductor crystal. This paper propases a LED lamp design that fulfils the requ irements of a PV lighting systems, whose main quality criteria is reliability. It uses directly as a power supply a non·stabilized constant voltage source, as batteries. An electronic control architecture is used to regulate the current applied to the LEO matri)( according to their temperature and the voltage output value of the batteries with two pulse modulation signals (PWM) signals. The first one connects and disconnects the LEOs to the power supply and the second one connects and disconnects several emitters to the electric circuit changing its overall impedance. A prototype of the LEO lamp has been implemented and tested at different temperaturas and battery voltages.

Mission profile based optimization of a wearable power system

A Wearable Power System (WPS) is a portable power source utilized primarily to power the modern soldier’s electronic equipment. Such a system has to satisfy output power demands in the range of 20 W...200 W, specified as a 4-day mission profile and has a weight limit of 4 kg. To meet these demands, an optimization of a WPS, comprising an internal combustion (IC) engine, permanent magnetic three-phase electrical motor/generator, inverter, Li-batteries, DC-DC converters, and controller, is performed in this paper. The mechanical energy extracted from the fuel by IC engine is transferred to the generator that is used to recharge the battery and provide the power to the electrical output load. The main objectives are to select the engine, fuel and battery type, to match the weight of fuel and the number of battery cells, to find the optimal working point of engine and to minimize the system weight. To provide the second output voltage level of 14 VDC, a separate DC-DC converter is connected between the battery and the load, and optimized for the specified mission profile. A prototype of the WPS based on the optimization presented in the paper results in a total system weight of 3.9 kg and fulfils the mission profile.

Metodología para la evaluación de productos innovadores de construcción : (preassessment-preevaluación DIT)

The specific research described in this dissertation is based on the author’s work over the years as head of the Eduardo Torroja Institute for Construction Science’s4 Technical Unit for the Assessment of Innovative Construction Products. The hypothesis proposed is the feasibility of developing methodology able to deliver a preliminary estimate (in just 1‐3 months’ time) of the technical suitability of certain innovative construction products for their intended use. The product families studied are the object of technical assessment guides or guidelines authored by two European organisations, the Union Européenne pour l'agrément technique dans la construction (UEAtc) and the European Organization for Technical Assessment (EOTA). Such families are eligible for or have been awarded technical approvals (TAs, also referred to in English under the French term “agréments”) or European Technical Approvals (ETAs), which is presently an 11‐month process. The proposed methodology would consist of a pre‐assessment procedure referred to hereunder as DIT PREASSESSMENT/PREEVALUACIÓN (Spanish initials, PPD). Based on the experience obtained from trials, calculations and studies undertaken in the framework of this research, the proposed procedure would identify the performance factors (primarily identification and fitness for use, although also durability where ascertainable via shortterm testing) that predict construction product or system suitability in a more immediate time frame.

Sistema para integrar automáticamente datos públicos del NCBI en la plataforma de medicina personalizada p-medicine

En los últimos años ha habido un gran aumento de fuentes de datos biomédicos. La aparición de nuevas técnicas de extracción de datos genómicos y generación de bases de datos que contienen esta información ha creado la necesidad de guardarla para poder acceder a ella y trabajar con los datos que esta contiene. La información contenida en las investigaciones del campo biomédico se guarda en bases de datos. Esto se debe a que las bases de datos permiten almacenar y manejar datos de una manera simple y rápida. Dentro de las bases de datos existen una gran variedad de formatos, como pueden ser bases de datos en Excel, CSV o RDF entre otros. Actualmente, estas investigaciones se basan en el análisis de datos, para a partir de ellos, buscar correlaciones que permitan inferir, por ejemplo, tratamientos nuevos o terapias más efectivas para una determinada enfermedad o dolencia. El volumen de datos que se maneja en ellas es muy grande y dispar, lo que hace que sea necesario el desarrollo de métodos automáticos de integración y homogeneización de los datos heterogéneos. El proyecto europeo p-medicine (FP7-ICT-2009-270089) tiene como objetivo asistir a los investigadores médicos, en este caso de investigaciones relacionadas con el cáncer, proveyéndoles con nuevas herramientas para el manejo de datos y generación de nuevo conocimiento a partir del análisis de los datos gestionados. La ingestión de datos en la plataforma de p-medicine, y el procesamiento de los mismos con los métodos proporcionados, buscan generar nuevos modelos para la toma de decisiones clínicas. Dentro de este proyecto existen diversas herramientas para integración de datos heterogéneos, diseño y gestión de ensayos clínicos, simulación y visualización de tumores y análisis estadístico de datos. Precisamente en el ámbito de la integración de datos heterogéneos surge la necesidad de añadir información externa al sistema proveniente de bases de datos públicas, así como relacionarla con la ya existente mediante técnicas de integración semántica. Para resolver esta necesidad se ha creado una herramienta, llamada Term Searcher, que permite hacer este proceso de una manera semiautomática. En el trabajo aquí expuesto se describe el desarrollo y los algoritmos creados para su correcto funcionamiento. Esta herramienta ofrece nuevas funcionalidades que no existían dentro del proyecto para la adición de nuevos datos provenientes de fuentes públicas y su integración semántica con datos privados.---ABSTRACT---Over the last few years, there has been a huge growth of biomedical data sources. The emergence of new techniques of genomic data generation and data base generation that contain this information, has created the need of storing it in order to access and work with its data. The information employed in the biomedical research field is stored in databases. This is due to the capability of databases to allow storing and managing data in a quick and simple way. Within databases there is a variety of formats, such as Excel, CSV or RDF. Currently, these biomedical investigations are based on data analysis, which lead to the discovery of correlations that allow inferring, for example, new treatments or more effective therapies for a specific disease or ailment. The volume of data handled in them is very large and dissimilar, which leads to the need of developing new methods for automatically integrating and homogenizing the heterogeneous data. The p-medicine (FP7-ICT-2009-270089) European project aims to assist medical researchers, in this case related to cancer research, providing them with new tools for managing and creating new knowledge from the analysis of the managed data. The ingestion of data into the platform and its subsequent processing with the provided tools aims to enable the generation of new models to assist in clinical decision support processes. Inside this project, there exist different tools related to areas such as the integration of heterogeneous data, the design and management of clinical trials, simulation and visualization of tumors and statistical data analysis. Particularly in the field of heterogeneous data integration, there is a need to add external information from public databases, and relate it to the existing ones through semantic integration methods. To solve this need a tool has been created: the term Searcher. This tool aims to make this process in a semiautomatic way. This work describes the development of this tool and the algorithms employed in its operation. This new tool provides new functionalities that did not exist inside the p-medicine project for adding new data from public databases and semantically integrate them with private data.

Cultural violence /

Cover title.

Towards definition of the global biotechnology value chain using cases from Australian biotechnology SMEs

The generic pharmaceutical value chain model has been employed to describe both the global pharmaceutical and biotechnology industries till now. This research investigates the organisational value chain in Australian biotechnology companies in order to assess the appropriateness of the pharmaceutical value chain to small-and medium-sized biotechnology companies. The main theme of the research is: Can a generic model of the organisational value chain be defined for the biotechnology industry? Emanating from the literature, two research propositions were developed. RP1: there are eight major definable elements/activities of the organisational value chain for the biotechnology industry. RP2: Coverage of the elements in the biotechnology value chain ranges from focused to broad. A multiple case study methodology was used to explore these propositions. To develop a number of case studies, data was collected from senior managers of small and medium Australian biotechnology companies using an interview instrument, as well as from publicly available documentation and through observation. The results were analysed using cross-case comparisons. The results showed that an aggregation of the value chains of each organisation can be reduced to these eight definable elements that constitute the biotechnology value chain: basic research, applied research, development, verification and validation, prototype development, clinical trials, manufacturing and marketing. However, the findings also indicate that these major elements of the value chain need to be further reduced into sub-activities or sub-tasks to cater for the unique differences between biotechnology companies. Generally, the findings were consistent with the literature. However, a wider sampling, including international biotechnology organisations should be studied. The major contribution of this research is in the development of a value chain model, including general sub-tasks, for the Australian biotechnology industry.

Viscosupplementation for the treatment of osteoarthritis of the knee (Review)

Background Osteoarthritis (OA) is the most prevalent chronic joint disorder worldwide and is associated with significant pain and disability. Objectives To assess the effects of viscosupplementation in the treatment of OA of the knee. The products were hyaluronan and hylan derivatives (Adant, Arthrum H, Artz (Artzal, Supartz), BioHy (Arthrease, Euflexxa, Nuflexxa), Durolane, Fermathron, Go-On, Hyalgan, Hylan G-F 20 (Synvisc Hylan G-F 20), Hyruan, NRD-101 (Suvenyl), Orthovisc, Ostenil, Replasyn, SLM-10, Suplasyn, Synject and Zeel compositum). Search strategy MEDLINE (up to January (week 1) 2006 for update), EMBASE, PREMEDLINE, Current Contents up to July 2003, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched. Specialised journals and reference lists of identified randomised controlled trials (RCTs) and pertinent review articles up to December 2005 were handsearched. Selection criteria RCTs of viscosupplementation for the treatment of people with a diagnosis of OA of the knee were eligible. Single and double-blinded studies, placebo-based and comparative studies were eligible. At least one of the four OMERACT III core set outcome measures had to be reported (Bellamy 1997). Data collection and analysis Each trial was assessed independently by two reviewers for its methodological quality using a validated tool. All data were extracted by one reviewer and verified by a second reviewer. Continuous outcome measures were analysed as weighted mean differences (WMD) with 95% confidence intervals (CI). However, where different scales were used to measure the same outcome, standardized mean differences (SMD) were used. Dichotomous outcomes were analyzed by relative risk (RR). Main results Seventy-six trials with a median quality score of 3 (range 1 to 5) were identified. Follow-up periods varied between day of last injection and eighteen months. Forty trials included comparisons of hyaluronan/hylan and placebo (saline or arthrocentesis), ten trials included comparisons of intra-articular (IA) corticosteroids, six trials included comparisons of nonsteroidal anti-inflammatory drugs (NSAIDs), three trials included comparisons of physical therapy, two trials included comparisons of exercise, two trials included comparisons of arthroscopy, two trials included comparisons of conventional treatment, and fifteen trials included comparisons of other hyaluronans/hylan. The pooled analyses of the effects of viscosupplements against 'placebo' controls generally supported the efficacy of this class of intervention. In these same analyses, differential efficacy effects were observed for different products on different variables and at different timepoints. Of note is the 5 to 13 week post injection period which showed a percent improvement from baseline of 28 to 54% for pain and 9 to 32% for function. In general, comparable efficacy was noted against NSAIDs and longer-term benefits were noted in comparisons against IA corticosteroids. In general, few adverse events were reported in the hyaluronan/hylan trials included in these analyses. Authors' conclusions Based on the aforementioned analyses, viscosupplementation is an effective treatment for OA of the knee with beneficial effects: on pain, function and patient global assessment; and at different post injection periods but especially at the 5 to 13 week post injection period. It is of note that the magnitude of the clinical effect, as expressed by the WMD and standardised mean difference (SMD) from the RevMan 4.2 output, is different for different products, comparisons, timepoints, variables and trial designs. However, there are few randomised head-to-head comparisons of different viscosupplements and readers should be cautious, therefore, in drawing conclusions regarding the relative value of different products. The clinical effect for some products, against placebo, on some variables at some timepoints is in the moderate to large effect-size range. Readers should refer to relevant tables to review specific detail given the heterogeneity in effects across the product class and some discrepancies observed between the RevMan 4.2 analyses and the original publications. Overall, the analyses performed are positive for the HA class and particularly positive for some products with respect to certain variables and timepoints, such as pain on weight bearing at 5 to 13 weeks postinjection. In general, sample-size restrictions preclude any definitive comment on the safety of the HA class of products; however, within the constraints of the trial designs employed no major safety issues were detected. In some analyses viscosupplements were comparable in efficacy to systemic forms of active intervention, with more local reactions but fewer systemic adverse events. In other analyses HA products had more prolonged effects than IA corticosteroids. Overall, the aforementioned analyses support the use of the HA class of products in the treatment of knee OA.

Was an increase in cocaine use among injecting drug users in New South Wales, Australia, accompanied by an increase in violent crime?

Background: A sharp reduction in heroin supply in Australia in 2001 was followed by a large but transient increase in cocaine use among injecting drug users (IDU) in Sydney. This paper assesses whether the increase in cocaine use among IDU was accompanied by increased rates of violent crime as occurred in the United States in the 1980s. Specifically, the paper aims to examine the impact of increased cocaine use among Sydney IDU upon police incidents of robbery with a weapon, assault and homicide. Methods: Data on cocaine use among IDU was obtained from the Illicit Drug Reporting System (IDRS). Monthly NSW Police incident data on arrests for cocaine possession/ use, robbery offences, homicides, and assaults, were obtained from the Bureau of Crime Statistics and Research. Time series analysis was conducted on the police data series where possible. Semi-structured interviews were conducted with representatives from law enforcement and health agencies about the impacts of cocaine use on crime and policing. Results: There was a significant increase in cocaine use and cocaine possession offences in the months immediately following the reduction in heroin supply. There was also a significant increase in incidents of robbery where weapons were involved. There were no increases in offences involving firearms, homicides or reported assaults. Conclusion: The increased use of cocaine among injecting drug users following the heroin shortage led to increases in violent crime. Other States and territories that also experienced a heroin shortage but did not show any increases in cocaine use did not report any increase in violent crimes. The violent crimes committed did not involve guns, most likely because of its stringent gun laws, in contrast to the experience of American cities that have experienced high rates of cocaine use and violent crime.

Is Lactobacillus rhamnosus GG effective in preventing the onset of antibiotic-associated diarrhoea: A systematic review

Objective: To evaluate the efficacy of Lactobacillus rhamnosus GG in the prevention of antibiotic-associated diarrhoea. Data Sources: A computer-based search of MED-LINE, CINAHL, AMED, the Cochrane Controlled Trials Register and the Cochrane Database of Systematic Reviews was conducted. A hand-search of the bibliographies of relevant papers and previous meta-analyses was undertaken. Review Methods: Trials were included in the review if they compared the effects of L. rhamnosus GG and placebo and listed diarrhoea as a primary end-point. Studies were excluded if they were not placebo-controlled or utilised other probiotic strains. Results:Six trials were found that met all eligibility requirements. Significant statistical heterogeneity of the trials precluded meta-analysis. Four of the six trials found a significant reduction in the risk of antibiotic-associated diarrhoea with co-administration of Lactobacillus GG. One of the trials found a reduced number of days with antibiotic-induced diarrhoea with Lactobacillus GG administration, whilst the final trial found no benefit of Lactobacillus GG supplementation. Conclusion: Additional research is needed to further clarify the effectiveness of Lactobacillus GG in the prevention of antibiotic-associated diarrhoea. Copyright (c) 2005 S. Karger AG, Basel.

Effectiveness of topical skin care provided in aged care facilities

Background The 2001 Australian census revealed that adults aged 65 years and over constituted 12.6% of the population, up from 12.1% in 1996. It is projected that this figure will rise to 21% or 5.1 million Australians by 2031. In 1998, 6% (134 000) of adults in Australia aged 65 years and over were residing in nursing homes or hostels and this number is also expected to rise. As skin ages, there is a decreased turnover and replacement of epidermal skin cells, a thinning subcutaneous fat layer and a reduced production of protective oils. These changes can affect the normal functions of the skin such as its role as a barrier to irritants and pathogens, temperature and water regulation. Generally, placement in a long-term care facility indicates an inability of the older person to perform all of the activities of daily living such as skin care. Therefore, skin care management protocols should be available to reduce the likelihood of skin irritation and breakdown and ultimately promote comfort of the older person. Objectives The objective of this review was to determine the best available evidence for the effectiveness and safety of topical skin care regimens for older adults residing in long-term aged care facilities. The primary outcome was the incidence of adverse skin conditions with patient satisfaction considered as a secondary outcome. Search strategy A literature search was performed using the following databases: PubMed (NLM) (1966–4/2003), Embase (1966–4/2003), CINAHL (1966–4/2003), Current Contents (1993–4/2003), Cochrane Library (1966–2/2003), Web of Science (1995–12/2002), Science Citation Index Expanded and ProceedingsFirst (1993–12/2002). Health Technology Assessment websites were also searched. No language restrictions were applied. Selection criteria Systematic reviews of randomised controlled trials, randomised and non-randomised controlled trials evaluating any non-medical intervention or program that aimed to maintain or improve the integrity of skin in older adults were considered for inclusion. Participants were 65 years of age or over and residing in an aged care facility, hospital or long-term care in the community. Studies were excluded if they evaluated pressure-relieving techniques for the prevention of skin breakdown. Data collection and analysis Two independent reviewers assessed study eligibility for inclusion. Study design and quality were tabulated and relative risks, odds ratios, mean differences and associated 95% confidence intervals were calculated from individual comparative studies containing count data. Results The resulting evidence of the effectiveness of topical skin care interventions was variable and dependent upon the skin condition outcome being assessed. The strongest evidence for maintenance of skin condition in incontinent patients found that disposable bodyworn incontinence protection reduced the odds of deterioration of skin condition compared with non-disposable bodyworns. The best evidence for non-pressure relieving topical skin care interventions on pressure sore formation found the no-rinse cleanser Clinisan to be more effective than soap and water at maintaining healthy skin (no ulcers) in elderly incontinent patients in long-term care. The quality of studies examining the effectiveness of topical skin care interventions on the incidence of skin tears was very poor and inconclusive. Topical skin care for prevention of dermatitis found that Sudocrem could reduce the redness of skin compared with zinc cream if applied regularly after each pad change, but not the number of lesions. Topical skin care on dry skin found the Bag Bath/Travel Bath no-rinse skin care cleanser to be more effective at preventing overall skin dryness and most specifically flaking and scaling when compared with the traditional soap and water washing method in residents of a long-term care facility. Information on the safety of topical skin care interventions is lacking. Therefore, because of the lack of evidence, no recommendation on the safety on any intervention included in this review can be made.