The requirement to respect autonomy - The Royal New Zealand ...

continuing professional developmentpearlscochrane cornerString of PEARLSPractical Evidence About Real Life Situationsabout eczema and asthmaPEARLS are succinct summaries of Cochrane Systematic Reviewsfor primary care practitioners—developed by Prof. Brian McAvoyfor the Cochrane Primary Care Field (www.cochraneprimarycare.org), New Zealand Branch of the Australasian Cochrane Centre at theDepartment of General Practice and Primary Health Care, Universityof Auckland (www.auckland.ac.nz/uoa), funded by the New ZealandGuidelines Group (www.nzgg.org.nz) and published in NZ Doctor(www.nzdoctor.co.nz.).Topical pimecrolimus is less effective for treatingeczema than moderate and potent corticosteroidsand tacrolimusThere is no clear evidence of benefit for antimicrobialinterventions in atopic eczemaProbiotics are not effective for eczemaRegular inhaled corticosteroids reduces exerciseinducedasthmaHouse dust mite control measures do not reduceasthma symptomsHomemade spacers are effective in deliveringbronchodilator therapy to children with asthmaCulture-specific programmes for minority groups withasthma improve some outcomesDisclaimer: PEARLS are for educational use only and are not meantto guide clinical activity, nor are they a clinical guideline.Spironolactone (when allelse fails) in hypertensionBruce Arroll MBChB, PhD, FRNZCGP; Professor of General Practiceand Primary Health Care, The University of Auckland, PB 92019,Auckland, New Zealand; Email: b.arroll@auckland.ac.nzThe problem: Your patient is on four antihypertensives andtheir blood pressure is still 180/120.Clinical bottom line: Spironolactone has a place in hypertension,but as a last option before referral to secondary care(assuming underlying causes have been ruled out). I personallyhave found it much better than doxasosin in lowering bloodpressure in those who are really difficult to manage. It is not adrug that patients like and is associated with gastrointestinalsymptoms (sometimes serious), 1 gynecomastia in men and hyperkalemiaand death. 2 The Cochrane review found in a meta-analysisof five crossover studies a reduction in SBP of 20.09 mmHg(95%CI:16.58–23.06, p