Description

Evidence based medicine is a methodology for evaluating the validity of research in clinical medicine and applying the results for the care of individual patients. Evidence is gathered from critical appraisal after a systematic review of the literature. The results are then integrated with the decision making process about a patient. During the past few years there has been a lot of talk about evidence based medicine. Professor C.P Price in this issue of the CPD Bulletin in Clinical Biochemistry discusses the principles of evidence based medicine and how this can be applied to laboratory medicine. He emphasises the importance of identifying the clinical question behind the use of an investigation and illustrates how to generate the best quality of evidence, the best way to use the test and to identify the value of the test in the overall clinical context. Professor Price highlights how this type of information can be used to establish guidelines.

Polycystic ovarian syndrome (PCO) is one of the commonest endocrine abnormalities in women, affecting 5 to 10% of women. Investigation of suspected cases of PCO is an important part of the work of a clinical biochemistry laboratory. Patients with PCO may present with either hirsuitism, menstrual irregularities or infertility. Drs Bulusa and Hacihanefioglu discuss the pathogenesis and metabolic manifestations of PCO. They emphasise the fact that different diagnostic criteria are used in different countries and the features of this disorder vary. None of the features originally described are constant findings in all cases of PCO. They discuss the role of insulin resistance in the pathogenesis of PCO syndrome and the importance of treating cardiovascular risk factors in patients with PCO.

In this issue of the Bulletin we have 3 interesting cases. Drs Dixon, Singh and Gama discuss a case of hyperprolactinaemia and highlight the importance of accurate diagnosis before starting treatment. Dr Wijeratne presents a patient with schizophrenia who developed fever and neck stiffness of 14 days duration. Investigation showed that he had neuroleptic malignant syndrome due to the use of neuroleptic drugs. The clinical findings and the diagnosis of this condition are discussed. Patients treated with lithium may develop polyuria. One such patient is discussed by Drs Chetty and Labib. Diagnosis and management of polyuria induced by lithium is discussed.

Finally, we would like to invite readers to submit interesting case reports that have a particular educational message. The Bulletin will become more lively and interesting with more contribution from readers.