***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Sore nipples in breast-feeding mothers are a common cause of premature weaning , and are difficult to treat owing to recurrent trauma and exposure to the infant 's oral flora . OBJECTIVE To compare the safety and efficacy of a hydrogel moist wound dressing ( Elasto-gel , Southwest Technologies Inc , Baltimore , Md ) with the use of breast shells and lanolin cream in the treatment of maternal sore nipples associated with breast-feeding . DESIGN R and omized controlled trial comparing the above treatments for sore nipples . Patients were seen for a maximum of 3 follow-up visits within 10 days , or until the resolution of symptoms . SETTING The Maternal-Infant Lactation Center at the Mercy Hospital of Pittsburgh , Pittsburgh , Pa , a tertiary care teaching hospital in inner-city Pittsburgh . PATIENTS A referred sample of 42 breast-feeding women who presented to the Maternal-Infant Lactation Center for the treatment of sore nipples . All patients with breast infection or chronic unrelated pain conditions were excluded from the study . INTERVENTION After informed consent , patients were r and omized to receive either a hydrogel wound dressing or breast shells and lanolin .  All patients underwent a history , physical examination of the infant and the mother 's breasts , assessment of breast-feeding technique , and breast-feeding instruction . MAIN OUTCOME MEASURES The degree of pain on self-report question naires and the change in scores for physical examination , breast-feeding technique , and pain behaviors during breast-feeding . RESULTS Although both treatments , in association with instruction in breast-feeding technique , were effective , greater improvement was seen in the group using breast shells and lanolin . This reached statistical significance for physician-rated healing ( P<.01 ) and self-reported pain ( P<.05 ) . There were significantly more infections in the dressing group ( P<.05 ) , which result ed in early discontinuation of the study . CONCLUSIONS Prevention of sore nipples by teaching proper technique on the initiation of breast-feeding should be instituted . For those cases in which sore nipples do develop , breast shells and lanolin in association with instruction in breast-feeding technique are more effective than moist wound dressings . Lanolin and shells should remain first-line therapy BACKGROUND Nipple soreness is one reason why breastfeeding women wean their infants . This study examined the effectiveness of three topical agents -- USP-modified lanolin , warm water compresses , and expressed breast milk with air drying -- in alleviating nipple pain , and if early predictors of breastfeeding at six weeks could be determined . METHODS One hundred seventy-seven breastfeeding , primiparous women were r and omly assigned to one of four groups . All women received education about breastfeeding technique . Numeric rating scales were used to discriminate levels of pain intensity , pain affect , and strength of sucking on day 1 . Participants were interviewed by telephone on postpartum days 4 , 7 , and 14 , and during week 6 using the same scales . RESULTS No significant differences were found among groups for pain intensity , pain affect , or duration of breastfeeding . Results of a logistic regression indicated that older mothers and those who were exclusively breastfeeding ( no supplemental feeding ) were most likely to be breastfeeding six weeks postpartum . Raw scores supported the use of warm compresses . CONCLUSION Further investigation is required into ways of supporting young mothers and how caregivers provide support to breastfeeding mothers in the early weeks after childbirth OBJECTIVE To evaluate effectiveness of water versus tea bag compresses in treatment of  sore nipples during breastfeeding .  DESIGN Prospect i ve , r and omized trial . SETTING Mother-infant care wards in a tertiary care teaching hospital . PARTICIPANTS Sixty-five primiparae with sore nipples who were breastfeeding after a vaginal delivery at 37 or more weeks gestation , who were 36 hours or less postpartum , and had combined mother-infant care . INTERVENTIONS Participants were assigned r and omly to one of six treatment groups with one of three regimens ( tea bag compress , water compress , or no compress ) r and omly assigned to right or left sides . Participants applied the treatments at least four times a day , from Days 1 to 5 postpartum . MAIN OUTCOME MEASURE Reduction of nipple pain . RESULTS Tea bag and water compresses were more effective than no treatment , with no statistically significant difference between the two types of compresses . CONCLUSION Warm water or tea bag compresses are an inexpensive , equally effective treatment for sore nipples during the early postpartum period OBJECTIVE To examine various comfort measures and evaluate their effects in alleviating nipple soreness . DESIGN Prospect ively r and omized , experimental study . SETTING Postpartum unit of a community teaching hospital . PATIENTS Seventy-three primiparous , postpartum , breastfeeding women . INTERVENTIONS Subjects were r and omly assigned to four groups , with all women receiving instruction about breastfeeding and using one of the following treatments : warm moist tea bag compress , warm water compress , expressed milk massaged into the nipple and areola and air dried , instruction only ( control group ) . The subjects completed a question naire each morning for 7 days regarding nipple soreness . MAIN OUTCOME MEASURE Effect of treatments on postpartum nipple pain . RESULTS Subjects in the warm water compress group demonstrated significantly less pain on Day 3 than did the tea or breast milk group . CONCLUSIONS Anticipatory guidance by obstetric nurses may assist breastfeeding women in treating their pain nonpharmacologically This study was design ed to evaluate whether maintenance of a moist environment on the nipple skin during the first week of breast-feeding would improve damaged nipple skin condition , as indicated by the presence of eschar , erythema , and fissures , and reduce pain . Fifty White women applied a polyethylene film dressing with a perimeter adhesive system to a r and omly determined nipple . The dressing was present at all times except during feeding . Subjects were assessed every 48 hours ( four times ) over 7 days . Serial photographic slides were obtained and assessed for skin characteristics . Nipple pain was self-rated with a verbal descriptor scale . Use of an occlusive film dressing on nipple skin during the first week of breast-feeding appeared to have limited influence on improvement in damaged skin condition . Summary scores indicated significant reduction in the amount of eschar on the surface of the nipple . There were no differences in erythema intensity or fissure severity . Use of a dressing significantly reduced nipple pain during the study period Sore and cracked nipples are common and may represent an obstacle to successful breastfeeding . In Italy , it is customary for health professionals to prescribe some type of ointment to prevent or treat sore and cracked nipples . The efficacy of these ointments is insufficiently documented . The incidence of sore and cracked nipples was compared between mothers given routine nipple care , including an  ointment  ( control group ) , and mothers  instructed to avoid the use of nipple creams and other products ( intervention group ) . Breastfeeding duration was also compared between the two groups . Eligible mothers were r and omly assigned , after informed consent , to one of the two groups . No difference was found between the control ( n=96 ) and the intervention group ( n=123 ) in the incidence of sore and cracked nipples and in breastfeeding duration . However , several factors were associated with sore nipples and with breastfeeding duration . The use of a pacifier and of a feeding bottle in the hospital were both associated with sore nipples at discharge ( p=0.02 and p=0.03 , respectively ) . Full breastfeeding up to 4 months postpartum was significantly associated with the following early practice s : breastfeeding on dem and , rooming-in at least 20 hours/day , non-use of formula and pacifier , no test-weighing at each breastfeed . The incidence of sore and cracked nipples and the duration of breastfeeding were not influenced by the use of a nipple ointment . Other interventions , such as providing the mother with guidance and support on positioning and latching , and modifications of hospital practice s may be more effective in reducing nipple problems OBJECTIVE To assess whether an antenatal teaching session on position and attachment of the baby on the breast had an effect on postnatal nipple pain , nipple trauma and breast feeding duration . The study was planned as a pilot study to allow an adequate sample size to be calculated for a larger study . DESIGN An observer blind experimental design was used . Women were r and omly assigned to either the experimental group teaching session or the control group . SETTING One public hospital in Western Australia . PARTICIPANTS 70 primiparae who intended to breast feed their baby were recruited from the antenatal clinic of the study hospital at 36 weeks ' gestation . INTERVENTION Antenatal group sessions on position and attachment of the baby on the breast were conducted by a lactation consultant . MEASUREMENTS AND FINDINGS During the first four postnatal days , position and attachment was measured by LATCH ( Latch on , Audible swallow , Type of nipple , Comfort and Help ) ( Jensen et al 1994 ) , nipple pain was measured by the Visual Analogue Scale ( VAS ) and nipple trauma was measured by the Nipple Trauma Index ( NTI ) . The analysis of variance ( ANOVA ) results indicated that the women in the experimental group were better able to attach the baby on the breast and had significantly less nipple pain and trauma than the control group . At six weeks postnatally , 31 of the 35 women in the experimental group were breast feeding compared to 10 of the 35 in the control group . CONCLUSIONS AND IMPLICATION S These initial findings suggest that midwives can make the best use of decreasing re sources by using practical ' h and s on ' antenatal group teaching as an effective strategy to increase breast feeding rates BACKGROUND Although lactation experts suggest that a correct positioning and attachment technique reduces breastfeeding problems and enhances long-term breastfeeding , evidence from r and omized trials is lacking . The objective of this study was to evaluate the effect of postpartum positioning and attachment education on breastfeeding outcomes in first-time mothers . METHOD A r and omized trial was performed in a public hospital in Adelaide , South Australia , where 160 first-time mothers were r and omly allocated to receive either structured one-to-one education ( experimental group ) or usual postpartum care ( control group ) within 24 hours of birth . The primary outcome was breastfeeding at 6 weeks and 3 and 6 months postpartum ; other outcomes were nipple pain and trauma in hospital and at 6 weeks and 3 and 6 months , and satisfaction with breastfeeding . RESULTS No significant differences occurred in breastfeeding rates between the groups at each endpoint , although a trend in the direction of lower rates was seen at each endpoint in the experimental group . This group reported less nipple pain on days 2 ( p = 0.004 ) and 3 ( p = 0.04 ) , but this was not sustained on follow-up . No differences were observed in nipple trauma in hospital or in self-reported nipple pain and /or trauma at the three endpoints . Experimental group women were less satisfied with breastfeeding at 3 and 6 months postpartum when using a one-item measure ; however , a multiple-item measure showed no significant differences at the three endpoints . CONCLUSIONS The intervention did not increase breastfeeding duration at any assessment time or demonstrate any differences between the groups on secondary outcomes . The trend toward lower breastfeeding rates in the experimental group suggests a need for a larger trial to evaluate whether or nor postpartum positioning and attachment education may negatively affect breastfeeding 
    Output:
    
The authors of this review recommend full consideration be given to the sample size and study setting prior to implementation of the review recommendations in order to determine applicability to varied clinical setting s. The results section highlights sample size issues for each included study .With this limited evidence , no single intervention was identified that offers a dramatic effect in terms of treating pain and or trauma in breast-feeding women .
However , there is potential for some benefits for reducing pain and increasing comfort and thereby maximising breast-feeding duration .
CONCLUSIONS In terms of prevention , warm water compresses are recommended for the prevention of nipple pain , and simply keeping the nipples clean and dry is recommended for the prevention of cracked nipples .
In terms of treatment , warm water compresses are recommended for the reduction of nipple pain , and expressed breast-milk reduces the duration of cracked nipples .
Hydrogel dressings were associated with a high incidence of infections and their use can not be recommended .