An empirical investigation of information retrieval (IR) using the MEDLINE1 database was carried out to study user behaviour, performance and to investigate the reasons for suboptimal searches. The experimental subjects were drawn from two groups of final year medical students who differed in their knowledge of the search system (i.e., novice and expert users). The subjects carried out four search tasks and their recall and precision performance was recorded. Data was captured on the search strategies used, duration, and logs of submitted queries. Differences were found between the groups for the performance measure of recall in only one of the four experimental tasks. Overall performance was poor. Analysis of strategies, timing data, and query logs showed that there were many different causes for search failure or success. Poor searchers either gave up too quickly, employed few search terms, used only simple queries, or used the wrong search terms. Good searchers persisted longer, used a larger, richer set of terms, constructed more complex queries, and were more diligent in evaluating the retrieved results. However, individual performances were not correlated with all of these factors. Poor performers frequently exhibited several factors of good searcher behaviour and failed for just one reason. Overall end‐user searching behaviour is complex and it seems that just one factor can cause poor performance, whereas good performance can result from suboptimal strategies that compensate for some difficulties. The implications of the results for the design of IR interfaces are discussed.

Please cite this paper as: Dexter SC, Windsor S, Watkinson SJ. Meeting the challenge of maternal choice in mode of delivery with vaginal birth after caesarean section: a medical, legal and ethical commentary. BJOG 2014;121:133-140. IntroductionBirths by caesarean section constitute about 25% of our births in the UK.1 Therefore a substantial number of our obstetric patients will have this risk factor in their future pregnancies. Every labour and delivery carries risks to both the mother and baby, and obstetric care is centred on identifying risks, counselling women on the relative risks of various options, and seeking to adopt the choice that carries a favourable risk-benefit profile. Evidence shows that vaginal birth after caesarean section (VBAC) is sufficiently safe for the majority of women with one previous lower segment incision, and is supported by the Royal College of Obstetricians (RCOG). It is advised that VBAC labours are undertaken in hospitals with facilities for emergency surgery and advanced neonatal resuscitation, with continuous electronic fetal monitoring and intravenous access. 2In most VBAC cases, women will follow medical advice on labour and delivery. However, there are a small number of women who wish to consider VBAC in circumstances other than those recommended. Such nonconventional circumstances are perceived to bring maternal autonomy into conflict with a reasonable degree of maternal and fetal safety, which can be distressing and challenging to healthcare professionals.Patient-centred practice is the current UK standard of care, and is actively promoted by the UK Government and the National Institute for Health and Clinical Excellence. The NHS Constitution 4 sets out patients' rights within the NHS, fundamentally placing patients at the centre of the decision-making process about the care they receive. The days when paternalistic doctors would dictate patient treatment should be gone.With a rising caesarean section rate across the world, 5VBAC labours are relatively commonplace and so we are more likely to come across nonconventional birth plans. In this article, we discuss some of the factors that influence decisions regarding mode of delivery following a previous caesarean section, and briefly cover the English legal background to these discussions and decisions. We recognise that the legal framework in regard to women's rights, fetal rights and the age of majority, vary between individual countries and as such it would be impossible to discuss all permutations. We encourage readers to ensure that they know the legal requirements in their country of practice, but believe that the general ethical principles and approach to challenging cases are similar.In the hope of avoiding alienating women from standard obstetric and midwifery care, we also suggest ways to optimally manage these insistent women in the antenatal period to achieve a balance between empowering a woman to maintain maternal choice and autonomy, and promoting reasonable safety for both mother and baby in the current and ...

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