Baby feeding: the thoughts behind the statistics.

AIM: To investigate attitudes towards baby feeding and to identify reasons why women stop breast feeding. METHOD: A series of six focus groups were held with thirty eight mothers with babies aged between 3 and 18 months, who had been breast and/or bottle fed. RESULTS: The discussions identified a number of significant themes. Decisions on baby feeding were made before birth. Women felt under considerable pressure to breast feed and felt guilty about bottle feeding. Information available about baby feeding was generally inconsistent, unrealistic and incomplete although all women were well informed about the benefits of breast feeding. Most women found breast feeding more difficult than anticipated and needed more help with common problems. A number of difficulties were identified with bottle feeding. Those women who enjoyed breast feeding were most likely to continue. The best support for breast feeding came from other mothers and supportive partners. Ceasing breast feeding was difficult for some women. CONCLUSION: Exploring mothers' attitudes to breast feeding highlighted the need for non judgemental attitudes to baby feeding and consistent information and support on both breast and bottle feeding. Duration of breast feeding is likely to be improved if problems can be addressed. A larger, more detailed prospective study would more accurately identify problem areas and suggest ways of solving them.

Failed validation of a clinical decision rule for the use of radiography in acute ankle injury.

AIM: To validate the Ottawa clinical decision rule for the use of radiography in acute ankle injuries. METHOD: A prospective, multicentre trial of 350 adult patients presenting with acute ankle injuries consisting of correlation of the features of the Ottawa clinical decision rule with the results of x-rays. RESULTS: There were 75 fractures in 350 patients, five of which would have been missed by the clinical decision rule. The sensitivity of the rule was 93% with a specificity of 11%. The positive predictive value was 22%, the false negative rate 14%. Fractures that would have been missed by the clinical decision rule included one unstable fracture of the ankle, one fracture of the talus, one calcaneal fracture and one fracture each of the cuboid and navicular. CONCLUSION: The Ottawa clinical decision rule for the use of radiography in acute ankle injuries is unacceptable for application in emergency departments in New Zealand due to a high false negative rate.