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Healthy Skepticism Library item: 5424

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.

 

Publication type: Journal Article

Lomas J, Enkin M, Anderson GM, Hannah WJ, Vayda E, Singer J.
Opinion leaders vs audit and feedback to implement practice guidelines Delivery after previous cesarean section.
JAMA 1991 May 1; 265:(17):2202-7


Abstract:

A randomized controlled trial with 76 physicians in 16 community hospitals evaluated audit and feedback and local opinion leader education as methods of encouraging compliance with a guideline for the management of women with a previous cesarean section. The guideline recommended clinical actions to increase trial of labor and vaginal birth rates. Charts for all 3552 cases in the study groups were audited. After 24 months the trial of labor and vaginal birth rates in the audit and feedback group were no different from those in the control group, but rates were 46% and 85% higher, respectively, among physicians educated by an opinion leader. Duration of hospital stay was lower in the opinion leader education group than in the other two groups. The overall cesarean section rate was reduced only in the opinion leader education group. There were no adverse clinical outcomes attributable to the interventions. The use of opinion leaders improved the quality of care.

Keywords:
Cesarean Section/utilization* Clinical Protocols Comparative Study Delivery, Obstetric/statistics & numerical data* Education, Medical, Continuing Feedback* Female Humans Leadership* Medical Audit* Obstetrics and Gynecology Department, Hospital/standards* Ontario Outcome and Process Assessment (Health Care)/statistics & numerical data* Physician's Practice Patterns/standards* Physician's Role Pregnancy Research Support, Non-U.S. Gov't Trial of Labor

 

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Far too large a section of the treatment of disease is to-day controlled by the big manufacturing pharmacists, who have enslaved us in a plausible pseudo-science...
The blind faith which some men have in medicines illustrates too often the greatest of all human capacities - the capacity for self deception...
Some one will say, Is this all your science has to tell us? Is this the outcome of decades of good clinical work, of patient study of the disease, of anxious trial in such good faith of so many drugs? Give us back the childlike trust of the fathers in antimony and in the lancet rather than this cold nihilism. Not at all! Let us accept the truth, however unpleasant it may be, and with the death rate staring us in the face, let us not be deceived with vain fancies...
we need a stern, iconoclastic spirit which leads, not to nihilism, but to an active skepticism - not the passive skepticism, born of despair, but the active skepticism born of a knowledge that recognizes its limitations and knows full well that only in this attitude of mind can true progress be made.
- William Osler 1909