The Journal of family practice
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The use of clinical guidelines is one strategy intended to improve health care quality, rein in costs, and standardize medical practice. Clinical guideline development has been prodigious, while less effort has been expended on the guidelines' dissemination and implementation. This study examines family physician attitudes toward and perceived uses of clinical guidelines in practice. ⋯ Family physicians found clinical guidelines to be valuable educational tools but were divided on their potential regulatory role. If clinical guidelines are to improve quality in practice, they must be more effectively disseminated and implemented. To broaden physicians' adoption of clinical guidelines, further research into dissemination and implementation methods is warranted, along with wider endorsement of guidelines by those whom family physicians trust.
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Cuba's accomplishments in primary care, while controversial, include several developments pertinent to family medicine. These accomplishments involve low-technology and organizational innovations such as neighborhood-based family medicine as the focus of primary care; regionalized systems of hospital services and professional training; innovative public health initiatives and epidemiologic surveillance; universal access to services without substantial barriers related to race, social class, gender, and age; and active programs in treatments such as "green medicine" and "thermalism." High-technology achievements include innovations in pharmacology and biotechnology, surgical procedures, and care of patients infected by the human immunodeficiency virus (HIV). Limited access to Cuban publications, impediments to presentations by Cuban health care professionals at professional meetings, and the prohibition on importing products of Cuban biotechnology to the United States inhibit a detached, scientific appraisal of Cuba's accomplishments. Cuba's isolation from the US clinical and research communities has prevented interchanges that would improve primary care services in both countries.
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Contraceptive use among women with an elevated risk of cardiovascular disease and stroke has generated little concern among primary care physicians. African Americans in the southeastern region of the United States are particularly vulnerable to hypertension but are often neglected in research studies of cardiovascular disease. The current study examines the effect of oral contraceptive use by African-American women on blood pressure response to orthostatic and mental challenges. ⋯ While absolute levels of systolic blood pressure never exceeded 126 mm Hg under either testing condition, the difference in blood pressure levels between the OC users and nonusers warrants concern about the long-term effects of oral contraceptive use among African-American women. Although all OC users in this study were taking low-dose formulations, OC use did not eliminate the risk of elevated blood pressure in this population. Our findings suggest that caution is warranted and that alternative birth control methods should be advised for African-American women who have additional risk factors for cardiovascular disease.