Conceptual and ethical problems underpinning calls to abandon vaginal breech birth.

The view that vaginal breech birth is unjustifiable due to neonatal safety concerns has resulted in continued calls for breech pregnancies to be managed via a policy of planned caesarean birth. Vaginal breech birth has of course always occurred, but women with term breech pregnancies who seek to have a vaginal birth often face coercive pressures to have a caesarean birth instead. In this paper I argue that even if there is population level evidence that vaginal birth is relatively riskier for the breech presenting fetus, implementing a policy of planned caesarean birth would essentially be an unjustified attempt at forced medical intervention upon women. Advocates of a policy of planned caesarean birth often conflate the acceptability of allocating participants to a treatment group (policy) within the context of a randomized controlled trial with the justifiability of doing that as part of individual health care. Calls for obstetricians to "abandon vaginal breech birth" mistakenly position vaginal breech birth itself as a form of medical intervention that can simply be removed as an option for women by obstetricians. In reality, abandoning vaginal breech birth would entail abandoning women by denying them access to healthcare options that are otherwise available to any woman having a vaginal birth.

Attitudes towards breech management among a team of maternity clinicians in Australia undertaking breech training.

BACKGROUND: Australian women seeking a vaginal breech birth report limited access to this option due to resistance from clinicians and strict medical criteria. Limited evidence exists to determine the attitudes, knowledge, experience and perceived confidence of Australian maternity clinicians towards the management of a breech presentation at term. AIM: The aim of this study is to identify experience, knowledge and attitudes of birth suite clinicians' before and after training, toward term breech presentation and management practices. METHODS: A mixed methods research design was used that included a survey tool. A survey of 29 midwives and 11 medical professionals who attended an educational course in breech management ("BABE - Becoming a Breech Expert") was undertaken pre and post BABE training. RESULTS: While participants were experienced in providing maternity services, the results indicated most were inexperienced in facilitating a vaginal breech birth. Prior to training, most participants believed vaginal breech birth had a higher risk of neonatal morbidity and mortality compared to caesarean birth. The prospect of a woman choosing a breech birth outside of medical recommendations made many participants "nervous". Despite this, support to ensure there was informed decision-making and respect for a woman's choice was high. Following training, clinician knowledge of assessment of risks for breech birth and intention to discuss breech management options with women increased. CONCLUSIONS: Participation in breech management training is beneficial to increasing clinician knowledge and assessment of risk and confidence towards discussing vaginal breech birth management, respect for women's choice and informed decision-making.

Non-medical prescription stimulant use to improve academic performance among Australian university students: prevalence and correlates of use.

BACKGROUND: Some university students consume pharmaceutical stimulants without a medical prescription with the goal of improving their academic performance. The prevalence of this practice has been well documented in the US, but less so in other countries. The potential harms of using prescription stimulants require a better understanding of the prevalence of this practice within Australian universities. METHODS: An internet survey of 1136 Australian students was conducted in 2015 in three large Australian universities. Students were asked about their personal use of prescription stimulants, attitudes and experiences with prescription stimulants. They were also asked about their use of caffeine, energy drinks and illicit drugs to enhance their academic performance. RESULTS: Lifetime self-reported use of stimulant medication to improve academic performance was 6.5, and 4.4% in the past year. Students were far more likely to report using coffee and energy drinks (41.4 and 23.6% respectively, lifetime use) than prescription stimulants to help them study and complete university assessments. Non-medical use of prescription stimulants was strongly associated with a history of illicit drug use. CONCLUSION: The prevalence of nonmedical prescription stimulant use to improve academic performance is low among university students in Australia, especially when compared with their use of coffee and energy drinks.

Predicting aggressive patient behaviour in a hospital emergency department: An empirical study of security officers using the Brøset Violence Checklist.

INTRODUCTION: The Brøset Violence Checklist (BVC) is a six item checklist that rates patients according to their risk of violence in the subsequent 24h - a score of ?3 indicates a "high risk" of violence. This study is the first to evaluate the statistical utility of the BVC when administered by a security officer in a hospital emergency department (ED). METHOD: A healthcare security officer conducted BVC assessments on patients who presented to the ED of a public hospital in metropolitan South East Queensland, Australia, over a two month period. Violent/aggressive acts requiring security intervention were registered in a database. RESULTS: 2064 ED patients were assessed on the BVC and 35 patients committed a violent/aggressive act (1.7%). BVC sensitivity was 45.7% and specificity 99.4%. At a cut-off score of BVC3, the positive predictive value was 55.2%. Violent patients were around 71 times more likely to score BVC?3 than non-violent patients. CONCLUSIONS: The BVC has good sensitivity, specificity, and predictive value in this setting. Using the BVC may help to implement measures that mitigate the impact of violent patients in the ED, or ideally, implement procedures that prevent violence towards ED workers in the first place.

Verbal abuse and physical assault in the emergency department: Rates of violence, perceptions of safety, and attitudes towards security.

INTRODUCTION: Emergency Department (ED) workers are prone to occupational violence, however the extent and impact of this may not be evenly felt across all roles in the ED. AIMS: Explore: 1) the rate of verbal abuse and physical assaults experienced by ED staff, 2) perceptions of safety, 3) attitudes towards security officers, and 4) formal reporting of incidents. METHODS: 330 ED workers were surveyed at four public hospitals in one metropolitan health service district in Queensland, Australia, including 179 nurses, 83 medical staff, 44 administration staff, 14 allied health, and 9 operational. RESULTS: Nurses were more likely to have been physically assaulted in the last six months and were less likely to feel safe. Most ED staff across all roles experienced verbal abuse. Nurses were better than medical staff at reporting instances of occupational violence although overall reporting across all roles was low. Staff who thought that security officers respond to incidents quickly and are a visible presence in the ED were more likely to feel safe in the ED. CONCLUSIONS: Workers in the ED, particularly nurses, experience high rates of verbal abuse and physical aggression and there may be a case for having designated security guards in the ED.

Concussion Ethics and Sports Medicine.

Despite considerable scientific dispute the science of concussion, there has been a proliferation of position statements and professional guidelines published on sports concussion management over the last 15 years. A number of ethical and clinical problems associated with concussion management protocols remain concerning, (i) diagnosis and management; (ii) conflicts of interest and coercion; (iii) same day return to play; and (iv) reporting, auditing and confidentiality. These issues are critically discussed in the light of recent Consensus Statements. It is argued that the use of independent match day doctors may ameliorate some of these concerns.

Smart drugs "as common as coffee": media hype about neuroenhancement.

BACKGROUND: The use of prescription drugs to improve cognitive functioning in normal persons--neuroenhancement"--has gained recent attention from bioethicists and neuroscientists. Enthusiasts claim that the practice is widespread and increasing, and has many potential benefits; however recent evidence provides weak support for these claims. In this study we explored how the newsprint media portrays neuroenhancement. AIMS: We conducted an empirical study of media reporting of neuroenhancement to explore: media portrayals of the prevalence of neuroenhancement; the types of evidence used by the media to support claims about its prevalence; and, the possible benefits and risks of neuroenhancement mentioned in these media articles. METHODS: Using the Factiva database, we found 142 newspaper articles about the non-medical use prescription drugs for neuroenhancement for the period 2008-2010. We conducted a thematic content analysis of how articles portrayed the prevalence of neuroenhancement; what type of evidence they used in support; and, the potential benefits and risks/side-effects of neuroenhancement that were mentioned. RESULTS: 87% of media articles mentioned the prevalence of neuroenhancement, and 94% portrayed it as common, increasing or both. 66% referred to the academic literature to support these claims and 44% either named an author or a journal. 95% of articles mentioned at least one possible benefit of using prescription drugs for neuroenhancement, but only 58% mentioned any risks/side effects. 15% questioned the evidence for efficacy of prescription drugs to produce benefits to users. CONCLUSIONS: News media articles mentioned the possible benefits of using drugs for neuroenhancement more than the potential risks/side effects, and the main source for media claims that neuroenhancement is common and increasingly widespread has been reports from the academic literature that provide weak support for this claim. We urge journalists and researchers to be cautious in their portrayal of the non-medical use of drugs for neuroenhancement.