Cheung

Asking the right questions is important in research, studying, learning, problem solving, decision making, and in fact in everyday life. Socrates said in Plato's Protagoras, "My way toward the truth is to ask the right questions". Einstein undoubtedly pursued a similar path on his quest for the origin of the universe when he endorsed that "The most important thing is not to stop questioning". "If I had an hour to solve a problem and my life depended on the solution, I would spend the first 55 minutes determining the proper question to ask for once I know the proper question, I could solve the problem in less than five minutes," Einstein said. In the 21st century, many of us have certainly asked, and probably constantly so, Siri and Alexa questions to seek 'their' advice on the right answers. But are we asking the right questions?

In this issue of the Journal, several original articles have posed interesting research questions on several paediatric conditions. Basturk asked the question on the efficacy of different duration of lansoprazole therapy in the treatment of reflux esophagitis in children. He compared the outcomes of 4-week treatment versus 8-week drug treatment regimen and concluded comparable efficacy between the two regimens.¹ This nonetheless was not a randomised controlled trial. In another study, Oztas and Deveci asked the question whether phosphate enema is effective in treating ileocolic intussusception. They found in a cohort of 41 patients diagnosed with ileocolic intussusception, the reduction rate with phosphate enema was 82.9% and concluded that phosphate enema can effectively reduce short segment intussusception in children with short-segment ileocolic intussusception having symptom duration of 24 hours or less and with no blood in the stools.² Hung et al in another study asked the question whether imaging before operation is necessary for undescended testes.³ Based on a total of 254 patients and 286 imaging studies of the testes, they found that an ultrasound examination could only correctly identify testicular position in 26%. Hence, the investigators concluded therefore that pre-referral imaging solely for the purpose of localisation of the testes is not recommended, although it might be useful for patients with suspicion of disorder of sexual development. In the fourth original article, Tezol et al asked whether sirolimus is useful for the treatment of benign vascular anomalies in children.⁴ They found an overall successful response rate of about 67% in a group of children with infantile haemangioma and vascular malformation and that sirolimus was well tolerated by the patients.

These studies are examples of works based on posing clinically relevant research questions with the aim of arriving at answers that may guide clinical management of paediatric conditions. There are other paediatric studies that pose questions on the predictive value of certain parameters or indices, the topic on predictive medicine has already been discussed in my previous editorial.⁵ As alluded to in the previous editorial,5 the non-linearity of the human body systems and the need to predicting outcomes in the distant future of our paediatric patients renders prediction difficult. Dukhovny in his editorial entitled "Does ______ predict neurodevelopmental impairment in former preterm infants? Is this the right question to be asked" similarly acknowledged the limitations of studies when trying to address this type of question and recognised the dynamic trajectory of a neonate through to adulthood.⁶

Asking the right questions extends beyond medical research to medical education. For undergraduate teachings during clinical ward rounds, Shields et al has described the need to ask not only the right questions but also a variety of questions to make the rounds more worthwhile and engaging.⁷ The type of questions varied from open-ended questions, diagnostic questions, challenging questions, extension questions, priority questions, action questions, prediction questions to generalising and summarising questions. In fact, the art of asking a variety type of questions is a key Harvard Business School and Harvard Law School teaching strategy.⁸

Perhaps the next right question for me to ask is "whether this is the right moment to bid farewell after completion of my two terms as a Chief Editor?" The answer to this is affirmative. Allow me to reflect by quoting Rabindranath Tagore, "I leave no trace of wings in the air, but I am glad I have had my flight. The fireflies, twinkling among leaves, makes the stars wonder". I look forward to passing on, or more accurately, handing over the baton to the next Editorial Board, which I strongly believe would lead the Journal to another new height.

References

1. Basturk A. Investigation of the efficacy of short-term use of Lansoprazole in the treatment of reflux esophagitis in children. HKJ Paediatr (New Series) 2023; 28:3-7.

2. Öztas T, Deveci G. Is phosphate enema treatment effective in ileocolic intussusception? HKJ Paediatr (New Series) 2023; 28: 8-12.

3. Hung JWS, Chung KLY, Yam FSD, et al. Imaging before operation for undescended testes: Is it necessary? HKJ Paediatr (New Series) 2023; 28: 12-9.

4. Tezol O, Alakaya M, Gundogan B, et al. Sirolimus for the treatment of benign vascular anomalies in children: a single centre experience. HKJ Paediatr (New Series) 2023; 28:20-6.

5. Cheung YF. Predictive medicine in paediatrics. HKJ Paediatr (New Series) 2022; 27:224-5.

6. Dukhovny D. 'Does _____ predict neurodevelopmental impairment in former preterm infants? Is this the right question to be asked? J Perinatol 2017; 37:467-8.

7. Shields HM, Pelletier SR, Roy CL, Honan JP. Asking a variety of questions on walk rounds: a pilot study. J Gen Intern Med 2018; 33;969-74.

8. Christensen CR. The discussion teacher in action: questioning, listening and response. In: CR Christensen, DA Garvin, Sweet A, eds. Education for Judgment: The artistry of discussion leadership. Boston: Harvard Business School Press; 1991: 193-213.