Atopic eczema is important because it now affects around 15% of UK schoolchildren. It can cause misery for both child and family due to the constant itching, sleep disturbance, and the social stigma associated with a visible skin disease.

The purpose of the review was twofold:
To produce a "map" of all randomised controlled trials (RCTs) for atopic eczema in order to identify what has been done and what needs to be done in terms of research ·

To try and summarise the available RCT evidence using quantitative and qualitative methods in order to guide clinical practice

The final 272 RCTs of atopic eczema covered at least 47 different interventions which could be broadly categorised into ten groups.

The main findings were:
The quality of trial reporting was generally poor, regardless of who sponsored it.

There was reasonable RCT evidence to support the use of oral cyclosporin, topical corticosteroids, psychological approaches and ultraviolet light therapy.

There was simply not enough high-quality RCT evidence to come down either way on maternal allergen avoidance for preventing disease, oral antihistamines, Chinese herbs, dietary manipulation for established eczema, homeopathy, house dust mite reduction, massage therapy, hypnotherapy, evening primrose oil, emollients, topical coal tar and topical doxepin.

The following categories had been subject to RCTs, but their results did not suggest any clear clinical benefit: avoidance of enzyme-containing washing powders, cotton clothing as opposed to soft-weave synthetics, biofeedback, twice-daily as opposed to once-daily topical steroids, topical antibiotic/steroid combinations versus steroid alone and antiseptic bath additives.

There was a complete absence of RCT evidence for wet-wrap bandages, water softeners, salt baths, impregnated bandages, allergy testing, dilution of topical steroids, and oral prednisolone or azathioprine.

Although 97% of atopic eczema patients are treated in primary care in the UK, only one of the 272 RCTs was conducted in primary care.

None of the eczema trials had been sponsored by the MRC.

With the exception of a notable few, most drug companies completely ignored a request for unpublished studies.

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Systems of national hospital statistics in England were designed in the 1960s and redesigned in the mid 1980s. Hospital statistics are not linked to death certificate data nationally, although this has long been feasible. Even the National Confidential Enquiry into Perioperative Deaths, a meticulous ongoing national study with local clinical reporting and case note review of deaths, identifies only deaths in the hospital admissions in which the operations were done.

By using hospital data linked to death certificate data, the study examined the extent to which in-hospital deaths accounted for all deaths within 30 days of hospital admissions during which operations were done.

During 1963-98, 41,200 people died within 30 days after an admission in which they had surgery. Deaths in the admission in which surgery occurred (in-hospital deaths) represented 79.3% of all deaths within 30 days in 1963-74, 71.2% in 1974-86 and 61.2% in 1987-98 .

Most deaths that occurred within a few days of surgery were in-hospital deaths. With increasing time from admission, increasing numbers of deaths within 30 days occurred elsewhere and would have been missed by analysis of in-hospital mortality alone. The percentage of deaths that occurred after discharge or transfer increased substantially in the later years.

The percentage of deaths within 30 days of an admission for surgery that are in-hospital deaths has fallen substantially since routine hospital statistics were first collected in the 1960s and 1970s.

This reflects decreases in length of hospital stays and an increase in the transfer of acutely ill patients between hospitals for specialist care.

In-hospital mortality alone is now an incomplete measure of mortality even within 30 days of care. To identify the missing deaths, hospital statistical records need to be linked to data from death certificates. This is now feasible nationally in England.

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This was a recent review of the effectiveness of primary prevention strategies aimed at delaying sexual intercourse, improving use of birth control, and reducing incidence of unintended pregnancy in adolescents.

The review looked at 12 electronic bibliographic databases, 10 key journals, citations of relevant articles, and made contact with authors who had published in the field for unpublished data.

In total 27 trials were described in 22 published and unpublished reports that randomised adolescents to an intervention or a control group (alternate intervention or nothing).

Two independent reviewers assessed the methodological quality of the work and abstracted the data.

The interventions did not delay initiation of sexual intercourse in young women or young men; did not improve use of birth control by young women at every intercourse or at last intercourse or by young men at every intercourse or at last intercourse; and did not reduce pregnancy rates in young women.

Four abstinence programmes and one school based sex education programme were associated with an increase in number of pregnancies among partners of young male participants. There were significantly fewer pregnancies in young women who received a multifaceted programme, though baseline differences in this study favoured the intervention.

Overall this review showed that primary prevention strategies evaluated to date do not delay the initiation of sexual intercourse, improve use of birth control among young men and women, or reduce the number of pregnancies in young women.

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