BMJ  2004;329:917-918 (16 October), doi:10.1136/bmj.329.7471.917-b

Letter

Feeding tubes in dementia: is there an effective UK strategy?

The first 150 words of the full text of this article appear below.

EDITOR—In their quality improvement report Monteleoni and Clark showed a reduction in the number of gastrostomy tubes inserted (in patients with dementia) after specific quality interventions had been implemented.¹ We would like to add two points to the debate.

Firstly, how applicable is this observation to the United Kingdom? We have previously reported a high mortality in patients with dementia who have a percutaneous endoscopic gastrostomy (PEG) tube inserted.² As a result of this observation we devised a pragmatic strategy to try to improve all aspects of our selection process for insertion of the tube. Our quality interventions are not dissimilar to Monteleoni and Clark but also incorporated a one week, waiting list policy before the tube was inserted (box). We found that this additional quality intervention further improved selection of patients as it provided an opportunity for all those involved in the decision making process to reflect . . . [Full text of this article]

d.s.sanders28@btopenworld.com Royal Hallamshire Hospital, Sheffield S10 2JF

Rotherham District General Hospital, Rotherham S60 2UD

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