LEARNING FROM PARENTS’ BELIEFS

Most of our contributions reflect the ideas and opinions of clinicians. This month we publish two papers looking at the attitudes of parents. (Relatively) high technology is represented by Polnay and colleagues from Nottingham, England, who studied how parents of children with cystic fibrosis viewed subsequent reproductive decisions, given the opportunity of antenatal screening. Their findings can be contrasted with information collected by Hazir and others from Islamabad, Pakistan on the beliefs of parents in a developing country regarding their children’s asthma.

Some of Polnay’s findings were disappointing: less than three quarters of respondents recalled being offered genetic counselling after the diagnosis was made and a third of those to whom it was offered did not take it up. Perhaps the most interesting finding, however, was that only half of those offered antenatal diagnosis accepted. The authors summarise the reasons and conclude that the variety of opinions held by families reinforce their conviction that professionals should be non-judgemental in this situation.

In Pakistan, likewise, there is a spectrum of parental understanding and opinion, this time about a more common disease. Two hundred carers of children with asthma were interviewed. Numerous misconceptions were encountered, including the widespread belief that rice and oily foods aggravated asthma with 67% using food abstinence as treatment, an intervention regarded by the authors as potentially harmful.

More than one third thought asthma was communicable to contacts, which the authors are concerned might stigmatise patients. Apart from the lessons to be learned in the country of origin, there are two important messages for Western readers: one is that if you treat patients from another culture, make yourself aware of family beliefs about the condition you are treating so as not to misinterpret perceptions for facts.¹ The other is that when you conduct a questionnaire survey of parents in Pakistan, two thirds of the respondents will be men.

See pages 284 and 287

EMPYEMA—SURGEON OR PAEDIATRICIAN?

For many years, parapneumonic empyema was treated by open thoracotomy² but there is convincing evidence to prefer thoracocentesis with instillation of a fibrinolytic agent.³

The arguments may not be over yet—as surgeons seek to have the last word using video assisted thoracoscopic surgery—a technique which also produces rapid resolution and hospital discharge⁴ and which some consider best for advanced disease.⁵

This month, a short report from Wales details the value of using pigtail catheters, inserted under ultrasound guidance, followed by urokinase. Compared with a stiff drain, pigtails resulted in more rapid defervescence, quicker recovery, and less time in hospital. So, perhaps the answer to the question posed above is: “neither—leave it to the radiologist”.

See page 331

HEART MURMURS—LEAVE THEM TO TELEMEDICINE

We have previously agonised about the problem of false negatives in the diagnosis of congenital heart disease by non-cardiologists.⁶ A Norwegian group suggests a solution—namely recording murmurs with a sensor based stethoscope and emailing the result to the computer of a distant cardiologist. The stimulus for the study was the discovery that 99 of 103 children referred to a tertiary hospital for murmur evaluation had an innocent murmur—but families waited an average of 60 days to find this out.

The authors recorded onto a compact disc a variety of heart sounds—either without a murmur or with those that had been confirmed as either innocent or structural. After calculating sensitivities, specificity, and inter and intraobserver variability, Dr Dahl and colleagues conclude that telemedical consultation may develop into a safe, quick, and cheap method of assessing murmurs.

We append a commentary by our paediatric cardiologist associate editor, Christopher Wren. He suggests that the next logical step might be to replace the cardiologist receiving the CDs by a computer?

See page 297

WHAT SHALL I BE WHEN I GROW UP?

Paediatricians are often embarrassed by not knowing what might happen to their patients when they reach an age beyond the limit of our growth charts. In their short report, Drs Bateman and Finlay sent questionnaires to various major employing institutions asking how they would deal with applicants with asthma, epilepsy, attention deficit hyperactive disorder, and diabetes. The authors advise us to discuss career prospects with our patients and lobby employers and legislators to ensure that restrictions are based on evidence.

See page 291