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Abstract

Objective: The Androgen Excess Society (AES) charged a task force to review all available data and recommend an evidence-based definition for polycystic ovary syndrome (PCOS), whether already in use or not, to guide clinical diagnosis and future research.

Objective:

Participants: Participants included expert investigators in the field.

Participants:

Evidence: Based on a systematic review of the published peer-reviewed medical literature, by querying MEDLINE databases, we tried to identify studies evaluating the epidemiology or phenotypic aspects of PCOS.

Evidence:

Consensus Process: The task force drafted the initial report, following a consensus process via electronic communication, which was then reviewed and critiqued by the AES Board of Directors. No section was finalized until all members were satisfied with the contents and minority opinions noted. Statements that were not supported by peer-reviewed evidence were not included.

Consensus Process:

Conclusions: Based on the available data, it is the view of the AES Task Force on the Phenotype of PCOS that there should be acceptance of the original 1990 National Institutes of Health criteria with some modifications, taking into consideration the concerns expressed in the proceedings of the 2003 Rotterdam conference. A principal conclusion was that PCOS should be first considered a disorder of androgen excess or hyperandrogenism, although a minority considered the possibility that there may be forms of PCOS without overt evidence of hyperandrogenism but recognized that more data are required before validating this supposition. Finally, the task force recognized, and fully expects, that the definition of this syndrome will evolve over time to incorporate new research findings.

Conclusions:
Issue Section:

THE DISORDER THAT eventually would be known as the polycystic ovary syndrome (PCOS) was initially described by Stein and Leventhal in 1935 ( 1 ). There is little disagreement that PCOS should be considered a syndrome, i.e. a collection of signs and features, in which no single test is diagnostic. In essence, the whole (or global assessment) is greater than the sum of the individual features. However, establishing a clear, contemporaneous, and evidence-based definition for this syndrome has important clinical and investigational implications. Nonetheless, the definition of PCOS has continued to generate significant controversy ( 2 4 ).

Clinically, diagnosing a woman as having PCOS implies an increased risk for infertility, dysfunctional bleeding, endometrial carcinoma, obesity, type 2 diabetes mellitus, dyslipidemia, hypertension, and possibly cardiovascular disease ( 5 ). Furthermore, it has important familial implications, principally, but not exclusively, for her sisters and daughters ( 6 8 ). Finally, a diagnosis of PCOS may mandate life-long treatments, e.g. the use of insulin sensitizers, and may negatively affect her ability to access health care coverage, principally in capitalistic markets. Consequently, the diagnosis of PCOS should not be assigned lightly, and diagnostic criteria should be based on robust data.

Uncategorized What Separates World-Class Performers from Everybody Else
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Practice activities are worthless without useful feedback about the results.

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The best performers observe themselves closely. They are in effect able to step outside themselves, monitor what is happening in their own minds, and ask how it’s going. Researchers call this metacognition – knowledge about your own knowledge, thinking about your own thinking. Top performers do this much more systematically than others do; it’s an established part of their routine.

Metacognition is important because situations change as they play out. Apart from its role in finding opportunities for practice, it plays a valuable part in helping top performers adapt to changing conditions…[A]n excellent businessperson can pause mentally and observe his or her own mental processes as if from the outside:…Am I being hijacked by my emotions? Do I need a different strategy here? What should it be?

…Excellent performers judge themselves differently from the way other people do. They’re more specific, just as they are when they set goals and strategies. Average performers are content to tell themselves that they did great or poorly or okay. The best performers judge themselves against a standard that’s relevant for what they’re trying to achieve. Sometimes they compare their performance with their own personal best; sometimes they compare with the performance of competitors they’re facing or expect to face; sometimes they compare with the best known performance by anyone in the field…

…If you were pushing yourself appropriately and have evaluated yourself rigorously, then you will have identified errors that you made. A critical part of self-evaluation is deciding what caused those errors. Average performers believe their errors were caused by factors outside their control: My opponent got lucky; the task was too hard; I just don’t have the natural ability for this. Top performers, by contrast, believe they are responsible for their errors. Note that this is not just a difference of personality or attitude. Recall that the best performers have set highly specific, technique-based goals and strategies for themselves; they have thought through exactly how they intend to achieve what they want. So when something doesn’t work, they can relate the failure to specific elements of their performance that may have misfired…

Average performers believe their errors were caused by factors outside their control: My opponent got lucky; the task was too hard; I just don’t have the natural ability for this. Top performers, by contrast, believe they are responsible for their errors.

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