A systematic review of treatments for atopic dermatitis

Atopic dermatitis is a very common inflammatory skin disease, particularly in children. A systematic review of randomised controlled trials of treatments for atopic dermatitis (AD) was carried out to assess how many trials exist, what they cover, what they do not cover, the research gaps, provide a 'blue print' for future Cochrane Reviews and assist those making treatment recommendations by summarising the available RCT evidence, using descriptive statistics. The Cochrane Collaboration systematic review process formed the basis of the methodology, from which over 4000 studies were located via electronic database searches and hand searching of journals. A total of 292 trials were finally included covering 9 treatment groups and over 48 individual treatments. There are lots of trials covering lots of interventions but gaps are evident. However, there is evidence of a benefit in the treatment of atopic dermatitis with topical corticosteroids, psychological approaches, UV light, ascomycin derivatives, topical tacrolimus and oral cyclosporin. Treatments that show limited evidence of a benefit include non-sedatory antihistamines, topical doxepin, the oral antibiotic Cefadroxil on clinically infected AD, the topical antibacterial Mupirocin on clinically uninfected AD, Chinese herbs, hypnotherapy and biofeedback, massage therapy, dietary manipulation, house dust mite reduction, patient education, emollients, allergen antibody complexes of house dust mite and thymic extracts. Treatments that show no evidence of benefit include sedatory antihistamines, oral sodium cromoglycate, oral antibiotics on clinically uninfected AD, topical antibacterials, topical antifungals, aromatherapy essential oils, borage oil, fish oil, evening primrose oil, enzyme-free clothes detergent, cotton clothing, house dust mite hyposensitisation, salt baths, topical coal tar, topical cyclosporin and platelet-activating-factor antagonist. When interpreting the conclusions of this thesis it is important to understand that lack of evidence does not equal lack of efficacy, particularly considering the interventions that are commonly in use today to treat atopic dermatitis that have not been subjected to RCTs, such as occlusive dressings, water softening devices and stress management among many others.

Some aspects of performance at a psychokinetic task

Psychokinetic phenomena are currently anomalous with respect to physics. They are not generally accepted as genuine nor are their possible physical mechanisms understood. It is argued here that a certain class of psychokinetic phenomena, termed "directly detectable" psychokinetic effects, are likely to yield possibly important insights into the physical mechanisms mediating psychokinetic phenomena generally. The current use within parapsychological research of randomly behaving psychokinetic target systems is criticised on several grounds. They are of limited scope for use in delineation of physical mechanisms involved in psychokinesis, and their intrinsic characteristics prevent subjects from utilising their possible capacity to learn to produce larger magnitude effects. It is argued that instrumented directly detectable psychokinetic tasks have characteristics which may allow subjects to treat their psychokinetic ability as akin to a normal skill which can be improved with continued practice, using an experimental paradigm similar to that used in the biofeedback training of physiological functions. The task used in this work was a microscopic form of psychokinetic metal-bending, whereby subjects produce pulse-like electrical outputs in a ceramic piezoelectric element used as psychokinetic target. Subjects were not allowed to touch the target and many effects were obtained under witnessed conditions with subjects situated several metres from it. One pilot and three principal longitudinal training studies were performed with a total of seventeen subjects. Six of the seventeen subjects showed significant improvement in their psychokinetic performance in the training studies, one showed a non-significant increase. The other ten failed to show any convincing signs of psychokinetic output. Three of the successful subjects did not show convincing signs of voluntary control over their effects, three did. Large individual differences were found including different rates of learning and levels of initial and final ability. This research was performed by Julian David Isaacs in preparation for the degree of Doctor of Philosophy and was submitted in 1984.