After the article in the JHL (sorry don't have the issue at home to give data), and the ILCA conf presentation, I have used it on many clients. I usually recommend it for cracked nipples and have moms try lanolin on sore, intact nipples. I have used it on 20-30 cases and only 2 were not satisfied with the results. The first comment they make when it is applied to the nipple is "how soothing" with some instant relief. I will have moms use the shells if the nipples are so irritated that they cannot tolerate anything touching, but shells are not that comfortable to wear long term. I would question that part of the study. As practitioners we have to make decisions biased on what we observe and the feedback we receive, not on studies alone (especially when there are flaws in studies). I will cont to use hydrogel drsg for sore/cracked nipples. Ann Perry RN IBCLC Boston, Mass