The evolution of paediatric hospitals

Hand in hand with the dramatic evolution of physical environments, and of our attitudes towards children's family members (remember when they were referred to as "visitors"?) has been a remarkable trend towards minimising the number and duration of a paediatric hospital admissions without prejudicing children's health and rate of recovery-often with the conviction that children's health is better served through alternative approaches to paediatric care. A live tele-medicine consultation service has recently been shown to reduce dramatically the need to transfer critical care patients from a rural intensive care unit to a highly specialised central paediatric intensive care facility. 2 In another innovative study of alternatives to traditional care, heart sounds from 87 patients with and without murmurs in distant rural areas of Norway were recorded with a sensor based stethoscope, e-mailed to a remote computer, and randomly distributed to four cardiologists, who had to categorise them as "no murmur", "innocent murmur", or "pathological murmur".