Stripping out pus in lactational mastitis: a means of preventing breast abscess.

OBJECTIVE: To determine whether manual stripping of pus from the breasts of women with lactational mastitis is effective in preventing the formation of breast abscesses. DESIGN: Case series (chart review). SETTING: Family practice in Montreal. PATIENTS: All (475) charts of patients with lactational mastitis were reviewed; 61 women were excluded because they already had a breast abscess. Most of the patients had been referred. OUTCOME MEASURES: Abscess formation, length of illness after treatment, rate of recurrence of mastitis, illness in the mother or infant within the 6 weeks after the mastitis and continuance of breast-feeding. MAIN RESULTS: The duration of symptoms before treatment was 1 to 56 (mean 5.3) days. In 9% of the cases both breasts were affected, and in 23% at least one episode of mastitis had previously occurred. The stripping technique was applied to all the patients. Pus was removed in 210 women; the remaining women were considered to have cellulitis. Only four patients (less than 1%) had breast abscesses. The mean length of illness after treatment was 7.2 days. The rate of recurrence was 14%. In all, 6% of the mothers and 9% of the infants became ill in the 6 weeks after the mastitis. Most (92%) of the patients continued to breast-feed. CONCLUSIONS: The rate of abscess formation was considerably lower than the rates reported in the literature. Therefore, manual stripping of pus from the infected breasts of lactating women appears to be effective in preventing breast abscesses.

Methodological considerations in the use of attribute variables in neuropsychological research.

This paper examines the conceptual and statistical difficulties created when neuropsychological research uses attribute variables in traditional orthogonal experimental designs. It is argued that attribute variables, as a result of their statistical and theoretical nonindependence, break the underlying assumptions of these traditional designs, and may lead to incorrect inferences being drawn. These difficulties are illustrated in a consideration of the typical use of analysis of variance designs, matched groups designs, and the analysis of covariance. Finally, a plea is made for the explicit consideration of the assumptions underlying the design models used in neuropsychological research, and a suggestion is made regarding the more appropriate use of correlational techniques in neuropsychology.