The Medical journal of Australia
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In the evidence-based medicine stakes, obstetrics has risen from being the holder of the "wooden spoon" to being a world leader in the pursuit of best evidence and the use of formal systematic reviews. A prime example of evidence-based obstetric practice is the use of corticosteroids to reduce respiratory distress syndrome in preterm infants. ⋯ Researchers in Australia are now examining strategies to maximise dissemination of available best evidence into obstetric practice. Without reflective practice and effective dissemination of evidence, the present litigation phobia surrounding obstetric care could lead to evidence-based medicine being replaced by "nervousness-based medicine".
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Practice Guideline Guideline
Metformin and intervention in polycystic ovary syndrome. Endocrine Society of Australia, the Australian Diabetes Society and the Australian Paediatric Endocrine Group.
Polycystic ovary syndrome (PCOS) is classically characterised by ovarian dysfunction (oligomenorrhoea, anovulation and infertility), androgen excess (hirsutism and acne), obesity, and morphological abnormalities of the ovaries (cystic enlargement and stromal expansion). More recently, insulin resistance has been found to be common in PCOS, along with an increased prevalence of other features of the "metabolic syndrome", namely glucose intolerance, type 2 diabetes mellitus, and hyperlipidaemia. Hyperinsulinaemia is likely to contribute to the disordered ovarian function and androgen excess of PCOS. ⋯ Some studies suggest that metformin will reduce total body weight to a small extent, but with a predominant effect on visceral adipose reduction. The effects of metformin on lipid abnormalities, hypertension or premature vascular disease are unknown, but the relative safety, moderate cost, and efficacy in reducing insulin resistance suggest that metformin may prove to be of benefit in combating these components of the "metabolic" syndrome in PCOS. Further properly planned randomised controlled trials are required.