Hi folks. I am again posting this to the list in hopes of getting some of
the 80+ of you to respond and join into a lively and interesting discussion.
We are very fortunate to have Danny Hirsch, MD, to help and faciliate these
journal discussions...but we need *you* to participate. If we do not have
success with the journal club discussions in the general group, we will
consider taking the journal/research discussion club to private email for
those who wish to be active participants.
There were *many * who responded and want to participate. Please do. I
believe that we can all benefit from learning to read and evaluate research.
It takes work and commitment to do this, but I believe it would benefit
everyone if the discussions could take place in the general Lactnet venue.
Thanks.
Kathleen
**********
LACTNET JOURNAL CLUB
Hello everybody. As I follow-up of the discussion of the Livingtone
et al. article ("Treatment of Staphlococcus aureus infected sore
nipples…"), the following article is being presented for discussion:
Amir, LH, H Harris, H, L Andirske. "An audit of mastitis in the
emergency department."
J Hum Lact 1999;15(3):221-4.
**ABSTRACT**
1.
PURPOSE: "The aim of this study was to investigate the characteristics
of women presenting with mastitis and its current management in the
emergency department of a tertiary-referral maternity hospital."
2.
METHODS: A retrospective review via medical audit of all cases, during
the calendar year of 1996, of mastitis seen in the emergency dept. of
Royal Women's Hospital in Melbourne, Australia. This institution is
one of three tertiary referral hospitals in Melbourne. All ED charts
with a diagnosis of 'mastitis' were audited by the first two authors.
The data which was collected included:
Demographic data pertaining to the mother and her child
Information "about the diagnosis of mastitis"
Investigations undertaken (e.g. milk culture or ultarsound)
Management plan
The data were then analyzed using "descriptive statistics."
3.
RESULTS: 111 charts had a diagnosis of mastitis. However, 4 cases
were incorrectly coded. Therefore, 107 charts were included in the
final analysis.
Mean (avg.) age of mothers: 30.4 ± 5.8 yrs
1st baby: 53% of women
Mean age of babies: 36 ± 55 days
Median age of babies: 14 days
% presenting on weekend: 40
% presenting between 10PM and 9AM: 11
% admitted to hospital: 23 (84% admitted for intravenous antibiotics)
% with no recorded temperature upon presentation to ED: 88
% with normal (<37.5 Celsius) temperature: 39%
% with no documentation of location of mastitis: 14
Mastitis symptoms recorded (%)-
Breast pain: 80%
Redness: 68
Hardness or lump: 65
No mention/documentation of constitutional symptoms: 54
Management plans recorded (%)-
Continue breastfeeding or expressing (?and feed to baby or not, DH?):
32
Discontinue breastfeeding or expressing: 0
Prescribed flucloxacillin: 85
Prescribed analgesics: 37
Diagnosis:
% milk cultures obtained: 14
% of milk cultures positive for Staph aureus: 33
4.
CONCLUSIONS: "… we are unable to conclude if the diagnosis was
accurate in every case."
"A very high rate of antibiotic usage was found in this study."
"More research is needed on the process of diagnosing mastitis and the
indications for the use of antibiotics."
****
After reading the objective summary of the Amir et al. article and
critically reading (or carefully dissecting) the entire article,
participants are invited to post (in a professional manner) their
thoughts, comments and reactions on Lactnet.
'Food for thought':
What is mastitis (clinical signs & symptoms, pathology, physical
findings and pathophysiology)?
How is the diagnosis of mastitis established?
Assess the strengths & weaknesses (if any) of the article, as well as
each of its sections (purpose, methods, results, discussion).
Consider alternative approaches to the study of mastitis. In other
words, what other methods can be used to investigate this area?
What does this piece add to our knowledge of and the approach to
lactation-associated mastitis?
What is the next step? Or, Where do we go from here?
I look forward to a lively and rewarding (for all of us) discussion.
Daniel Hirsch, MD, FAAP, CLC
Director, Lactation Institute of Westchester
Attending Neonatologist, Westchester and Sound Shore Medical Centers
Assistant Professor of Pediatrics
New York Medical College
Valhalla, NY, USA
Kathleen B. Bruce, BSN, IBCLC co-owner Lactnet, Indep. Consultant
Williston, Vermont, USA
mailto:[log in to unmask]
http://homepages.together.net/~kbruce/kbblact.html
http://homepages.together.net/~kbruce/kbblrv.html
LACTNET Archives http://peach.ease.lsoft.com/archives/lactnet.html
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