• Clinical guidelines are being increasingly produced to improve quality of care, but are vulnerable to bias. • Only 15% of guidelines on the National Health and Medical Research Council portal from the most prolific developers have published conflict of interest statements, and fewer detail the processes used to manage conflicts. • Comprehensive disclosure of conflicts is needed to safeguard the integrity of clinical guidelines and the medical profession. • Peak bodies and clinicians should seek to promote an improvement to current poor practice.
Neurological diseases are a major cause of morbidity and mortality in pregnancy. The management of multiple sclerosis, epilepsy, myasthenia gravis, certain neuropathies and headache in pregnancy is described; the potentially life-threatening conditions of stroke and eclampsia are also discussed. Management of most neurological conditions is similar to outside of pregnancy, but special consideration should be given to delivery plans and the safety of medications antenatally and during breastfeeding. Pre-pregnancy counselling, regular review and effective communication among a multi-disciplinary team are key to optimising management and outcomes.
An increasing weight of evidence is demonstrating that sleep deprivation and circadian rhythm disruption in doctors are associated with human error and harm to both patients and doctors. The increasing junior doctor workforce entering the hospital system in Australia provides a rare opportunity for workplace and roster reforms. There are cultural, educational and industrial challenges to reforming working hours. Any changes should be evidence-based and monitored to ensure that training for junior doctors and patient care are not compromised.
Internship selection is becoming more competitive due to substantial increases in numbers of medical graduates. Australian states operate a "priority system" for medical internship selection which discriminates against Australian interstate applicants. This discrimination arguably infringes section 117 of the Australian Constitution, which seeks to ensure that all citizens are treated equally and promotes national unity. The priority system should be reformed. It is inequitable and inconsistent with other aspects of medical training and regulation.
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