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Carers should provide informed, cohesivek approach

BMJ 1995; 310 doi: (Published 14 January 1995) Cite this as: BMJ 1995;310:126
  1. H P Henderson
  1. Consultant plastic and hand surgeon Leicester Royal Infirmary NHS Trust, Leicester LE1 5WW

    EDITOR,—I hope that R K Vohra and C N McCollum's review on pressure sores will be read by the people who chair curriculum committees of medical schools.1 Pressure sores are seldom included as a specific topic for instruction to medical students. This accounts for widespread ignorance on the subject among doctors both in hospitals and in the community. It has always struck me as extraordinary that a condition that affects between 5% and 10% of all patients in hospital should not be a matter of top priority for teaching of medical students.

    One point that the review fails to emphasise is the need to establish satisfactory preventive measures in the community before patients are discharged from hospital. One of the commonest causes of the high rate of recurrence of pressure sores is the failure of communication between carers in hospital and carers in the community.

    As a surgeon with an interest in pressure sores, I seldom agree to close a pressure sore until I know that future prevention of the same sore is assured. This often means that special equipment has to be purchased and so proves expensive, but, in the long term, prevention of sores is much cheaper than treatment and the cost of providing the equipment for prevention is equivalent to that of only a two or three week stay in hospital. Demarcation disputes often delay the decision on who should fund the equipment: the hospital believes that the community should do so and the community believes that the hospital should. It would be in everybody's interest if each health authority set aside money for the provision of equipment for patients with pressure sores that could be called on by both hospitals and the community.

    Finally, I agree with the authors that a wide range of topical dressings and applications is marketed with, usually, little evidence of efficacy. This can be summarised in the aphorism “it matters far more what you put a pressure sore on than what you put on a pressure sore.”


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