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Surveillance schemes vital

I would urge caution in following Professor Francesco Capuccio's advice to 'go electronic' (News, October 18). In my experience electronic sphygmomanometers, especially the fully automatic type, are unsuitable for surgery use.

The readings can vary quite a lot when repeated over a few minutes and are very subject to interference from small arm movements or clothing.

I like to hear the sounds. This helps to decide if a reading is likely to be reliable or not and thus supports clinical judgment as to what weight to put on any single reading.

The spurious illusion of precision created by electronic measurement devices encourages us to forget that most biological measurements are subject to considerable variation.

While controversy remains over the significance of point values, the importance of systolic versus diastolic blood pressure, the relationship of Korotkoff-based measurements and direct intra-arterial pressure and even over what exactly is achieved for any individual patient (as opposed to the benefit to the doctor in achieving an extra Q&O point), we should be cautious about relying too much on methods of measurement that make the doctor progressively more remote from the variable they are measuring.

Dr Michael Blackmore



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