CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne
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Multicenter Study
The association of cardiovascular disease risk factors with abdominal obesity in Canada. Canadian Heart Health Surveys Research Group.
To assess the degree of association of abdominal obesity with blood pressure and plasma lipid levels and to determine which anthropometric measures of obesity are most closely associated with these cardiovascular risk factors. ⋯ Considerable association was seen between measures of abdominal obesity and blood pressure and plasma lipid levels. WC is the measure of abdominal obesity most highly correlated with these cardiovascular disease risk factors.
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To assess the evidence for the effectiveness of clinical practice guidelines (CPGs) in improving patient outcomes in primary care. ⋯ There is very little evidence that the use of CPGs improves patient outcomes in primary medical care, but most studies published to date have used older guidelines and methods, which may have been insensitive to small changes in outcomes. Research is needed to determine whether the newer, evidence-based CPGs have an effect on patient outcomes.
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To assess Canadian physicians' confidence in, attitudes about and preferences regarding clinical practice guidelines. ⋯ Canadian physicians, although generally positive about guidelines and confident in those developed by clinicians, have not yet integrated the use of guidelines into their practices to a large extent. Our results suggest that respected organizations and opinion leaders should be involved in the development of guidelines and that the acceptability of any proposed format and medium for guidelines presentation should be pretested.
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When a pregnant woman makes a decision or acts in a manner that may be detrimental to the health and well-being of her fetus, her physician may be faced with an ethical dilemma. Is the physician's primary duty to respect the woman's autonomy, or to promote behaviour that may be in the best interest of the fetus? The controversial concept of "fetal rights" or the "fetus as a patient" contributes to the notion that the pregnant woman and her fetus are potential adversaries. ⋯ If a woman is competent and refuses medical advice, her decision must be respected even if the physician believes that her fetus will suffer as a result. Coercion of the woman is not permissible no matter what appears to be in the best interest of the fetus.