Pat wrote:  Nurses don't read!

I find it frightening how many people rely on the abstracts or summaries (not
really reliable IMHO) of papers. And, even if they do read the papers, there is
a huge leap to incorporating the findings of research appropriately into
practice.

A classic example, is the work done by Mike Woolridge and Chloe Fisher (COLIC
"OVERFEEDING", AND SYMPTOMS OF LACTOSE MALABSORPTION IN THE BREASTFED BABY, A
POSSBLE ARTIFACT OF FEED MANAGEMENT?, Lancet 1988)  on the changes in fat
intake during one-breast and two-breast-per-feed feeding.  This work showed that
changing the management would benefit certain babies who suffered from a
distinct cluster of symptoms.  (Basically a difficulty in accessing enough
fat/hindmilk).

These  findings were widely disseminated and for years I have been speaking to
women who
have been told ON NO ACCOUNT  should they offer both breasts per feed.  A
subsequent paper
in the Lancet in 1990: DO CHANGES IN PATTERN OF BREAST USAGE ALTER THE BABY'S
NUTRIENT INTAKE?  was written by Woolridge, Ingham and Baum.  They state " Our
findings should be interpreted as encouragement for mothers not to adhere
strictly to either of the rigid patterns of breast usage imposed in the study
but to excercise flexibility and to be led by the baby, whose requirements may
fluctuate with time".

Indeed, the rigidity with which women are being told to feed one breast per
feed, to avoide colicy type symptoms is reducing, but I still come across this
ALL THE TIME.  (Sometimes this is causing the mother-baby pair difficulties --
iatrogenic pathology if ever I saw it).

The point being, it was a misundestanding of how to translate the findings of
the research into practice.

I think this is a super-hard skill to take on board and teach.  People tend to
see the academic papers, all laid out with stats and abstracts and not in
friendly English and assume they are beyond critiquing, and also to panic to
find the message and try to get hold of some part of the research to use, and
then not always in an appropriate way.

I don't know what training health professionals get in this area.  I know that
my training as an academic historian, where I had to take original documents,
later glosses and critiques and evaluate the whole lot, no one being considered
to be above revision or  reinterpretation, was very useful to me in this area.
I know that Evidence-Based Medicine is growing to be quite a discipline, but the
challenge is to get some of the concepts out into a wider community of workers
so that people not only read the papers, but they have the skills to evaluate
them (including knowing who to ask for help), and to derive appropriate actions
from them.

Magda Sachs
Breatfeeding Supporter
The Breastfeeding Network
Saddleworth, near Oldham, Greater Manchester, UK