BACKGROUND: Practice guidelines have been increasingly recognized as an important tool for improving the quality of medical care. However, few studies have evaluated the clinical effectiveness of practice guidelines.
PURPOSE: To gain an insight into the clinical impact of practice guidelines.
METHODS: MEDLINE was searched in order to review experimental or quasi-experimental studies on the clinical impact of therapeutic practice guideline developed by specialist organizations or national/regional agencies.
RESULTS: A total of 17 studies was found, 10 (59%) of which reported positive clinical impacts and seven did not. Among the seven negative studies, two reported poor adherence by providers to guideline recommendations and three did not mention adherence. It was thus not possible to determine whether negative results reflected poor adherence by the providers or ineffectiveness of the practice guidelines themselves. The studies varied so widely that a formal meta-analysis was impossible.
CONCLUSION: The use of practice guidelines tended to have a positive clinical impact. However, sub-optimal study design and/or lack of data on key items such as the extent of adherence to guideline recommendations at the provider's level made the interpretation of study findings difficult.

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OBJECTIVE: This is the first research known to compare residents' attitudes about training in two countries. The objective was to examine and compare Japanese and US family medicine residents' attitudes about their residency training.
METHODS: A cross-sectional survey was conducted at two Japanese sites and one US site in 1991, and repeated in 1995 at these sites, as well as two additional US sites. Family practice residents completed a self administered, Likert scale format questionnaire containing items on demographics, identity as a family physician, resident education, the doctor-patient relationship, personal life, economic and women's issues.
RESULTS: The response rates were Japan, 1991: 92% (12/13) ; US, 1991: 76% (13/17) ; Japan, 1995: 89% (34/38) ; and US, 1995: 91% (60/66) . Fewer Japanese residents reported feeling like an outsider, or discriminated against while on outside rotations. More US residents reported expectations for training were being met, and being satisfied with their education. More Japanese residents reported that outpatient training was inadequate. US residents responded more positively about the rewards of clinical decision making, patient management and the doctor-patient relationship. Japanese residents were less likely to report training as compromising their physical or mental health, or feeling overworked. Financial concerns were similar for both groups. Most female residents reported feeling that being a woman provider was an advantage.
CONCLUSIONS: Some aspects of family medicine training are transculturally similar, while others are influenced by the medical culture of the respective countries. Family medicine residents' perspectives on training may be valuable to educators planning curriculum development.

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This paper has two aims, to summarise recent domestic and international events related to medicoethical-legal decisions in the clinical setting and to discuss the ethical implications of these events. Domestic issues include brain death and organ transplantation, refusal of treatment for religious reasons, disclosure required for legitimate informed consent, surrogate motherhood, prenatal diagnosis and selective abortion, issues pertaining to HIV/AIDS, concealment of medical mistakes, truth telling, public trust in physicians and in health care, and medical research. International issues include voluntary euthanasia and assisted suicide, the imposed separation of conjoined twins, problems pertaining to wrongful life, fetal surgery, the Icelandic database, homosexuality, resource allocation and global justice, and the death of participants in medical research.
It is hoped that this review of recent events related to clinical ethics may serve as a basis for ethical considerations in daily practice.

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