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Issues conveniently considered together as needle fixation are current among injecting drug users and may be relevant to the inability of some drug users to change from injecting drug use.

Aims.To establish the existence of needle fixation and provide a theoretical explanation for the phenomenon. Method. By searching published literature using electronic searches, consulting a National Drug Library (ISDD) and snowballing from reference lists in publications related to addiction. Findings. Needle fixation as a phenomenon has been mentioned in the literature since at least 1929 but there is only one published paper devoted to it. Needle fixation is a conditioned response but with a number of different secondary gains which maintain the practice. These include ritual, substitution of non psychoactive substances in the absence of drugs, pain, sexual pleasure and status. Conclusions. Needle fixation should be taken seriously because of the concern about blood borne viruses among injecting drug users and the need to reduce the practice of injecting. A greater understanding of the problem will help in treatment of injecting drug users.

ObjectivesTo determine the feasibility of a randomised controlled trial of ‘leave on’ emollients for children with eczema.DesignSingle-centre, pragmatic, 4-arm, observer-blinded, parallel, randomised feasibility trial.SettingGeneral practices in the UK.ParticipantsChildren with eczema aged 1 month to <5 years.Outcome measuresPrimary outcome—proportion of parents who reported use of the allocated study emollient every day for the duration of follow-up (12 weeks). Other feasibility outcomes—participant recruitment and retention, data collection and completeness and blinding of observers to allocation.InterventionsAveeno lotion, Diprobase cream, Doublebase gel, Hydromol ointment.Results197 children were recruited—107 by self-referral (mainly via practice mail-outs) and 90 by inconsultation (clinician consenting and randomising) pathways. Participants recruited inconsultation were younger, had more severe Patient-Oriented Eczema Measure scores and were more likely to withdraw than self-referrals. Parents of 20 (10%) of all the randomised participants reported using the allocated emollient daily for 84 days. The use of other non-study emollients was common. Completeness of data collected by parent-held daily diaries and at monthly study visits was good. Daily diaries were liked (81%) but mainly completed on paper rather than via electronic (‘app’) form. Major costs drivers were general practitioner consultations and eczema-related prescriptions. Observer unblinding was infrequent, and occurred at the baseline or first follow-up visit through accidental disclosure.ConclusionsIt is feasible in a primary care setting to recruit and randomise young children with eczema to emollients, follow them up and collect relevant trial data, while keeping observers blinded to their allocation. However, reported use of emollients (study and others) has design implications for future trials.Trial registration numberISRCTN21828118/EudraCT2013-003001-26.