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|NI FEATURE: THE EDITORIAL DEBATE II-- PROS AND CONS
|Year : 2017 | Volume
| Issue : 2 | Page : 261-262
Quantitative research on traumatic brain injury in India: The travails and the new optimism
Virendra Deo Sinha1, Amit Chakrabarty2
1 Member, World Federation of Neurosurgical Societies and Asian Australasian Society of Neurological Surgeons Neurotrauma Committee, President, Neurotrauma Society of India, Department of Neurosurgery, SMS Medical College and Hospital, Jaipur, Rajasthan, India
2 Department of Neurosurgery, Rukmini Birla Hospital, Jaipur, Rajasthan, India
|Date of Web Publication||10-Mar-2017|
Virendra Deo Sinha
Department of Neurosurgery, SMS Medical College, Jaipur, Rajasthan
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Sinha VD, Chakrabarty A. Quantitative research on traumatic brain injury in India: The travails and the new optimism. Neurol India 2017;65:261-2
Massenburg et al., have done an excellent work by reviewing quantitative research on traumatic brain injury (TBI) in India, pooling data from nearly 2000 patients, over 27 years, across 14 states, in 72 manuscripts. In India, the rapid urbanization, economic growth and changes in lifestyle have led to a tremendous increase in the incidence of TBI, so much so that it is being referred to as a 'silent epidemic.' It is an uphill task to obtain reliable information about TBI from India. There are several challenges in collating this epidemiological data of TBI from India. Inadequate case definition, lack of centralized reporting mechanisms, lack of population based studies, absence of standardized survey protocols and inadequate mortality statistics are some of the major obstacles.,,, Another problem in the epidemiological evaluation is that mortality statistics of India does not have information about the cause of death. Unless someone dies in a hospital that could provide information about the cause of death, it is not possible to identify the exact cause of death from the public mortality registers available in India.
Basic and clinical research in TBI has been focused on understanding the physics of injury, minimizing secondary brain injury and in improving treatment guidelines. Unfortunately, the evidence generated from neurotrauma studies carried out in high-income countries does not always translate to LMICs, where the health infrastructure (including the providers and the facilities available) is limited. Evidence-based recommendations established in high-income countries do not take into account the unique challenges that neurotrauma researchers may face in LMICs. Those recommendations are best applied in well-funded and well-equipped neurosurgical or neurotrauma centres.,,
Despite the increase in TBI burden, research, as evidenced by publications in scientific journals pertaining to TBI, is grossly inadequate in India. There are no studies in India that have evaluated the publishing strength of medical departments and institutes, the number of articles published by researchers from related disciplines, and the scientific impact of these articles. There is a dearth of research studies with a prospective design that could lead to better understanding of the etiology of brain injuries in the Indian context. In order to highlight the importance of TBI treatment and management among policy makers, more scientific evidence should be generated by the researchers.,, Restricted access to relevant scientific information could be a major hurdle while carrying out research in India. Literature search is followed by a careful screening of the searched titles, abstracts, and access to the shortlisted articles. Paid full text can be accessible to the individuals through individual subscriptions or through university and/or institutional subscriptions. Either method needs huge investments and can potentially restrict the access to important research articles. Political will and collaboration with research community of developed countries can reduce this financial burden.
There are several potentially promising areas for conducting research on TBI in India
- Improving the quality of epidemiological data on the burden of TBI in India
- Analysing the economic burden of TBI to the country
- Conducting trials for reducing TBI in LMIC and discovering novel ways to improve their management
- Studying the cost-effectiveness of interventions done for reducing the burden of TBI ,
- Conducting operations and systems research on the ways to integrate TBI-related interventions into the existing national health systems.
India has emerged as one of the foremost global destinations for clinical research. There is a phenomenal increase in the number of higher education institutions since 2009. India is ranked third in research output after China and Japan in Asia. Since 2006, there is a rapid increase in the number of publications on brain injury research that are often conducted with national as well as with international collaborations. At the current pace, it is expected that India will soon occupy a higher position at the global level in coming years related to the yearly output of scientific publications it produces. This communication is expected to motivate many neurosurgeons and allied specialists to pursue research in TBI, and share their scientific findings in high impact journals. Till date, there has been no evaluation of institutes conducting residency programs in Neurology and Neurosurgery on the basis of their publication performance and research output. This kind of study would also contribute in formulating yardsticks to measure the performance of neuroscience departments conducting residency in Neurology and Neurosurgery.
Hence, we propose a complete change in the way epidemiological data on TBI is collected, managed and utilized. Following a standard case definition, using the existing mechanisms such as telemedicine, to screen cases in rural areas and not just limiting studies to cities and urban areas, linking multiple hospital-based registries, initiating a state or nationwide population-based registry, conducting population-based studies that are methodologically robust, and introducing centralized and standard reporting mechanisms for TBI could be some of the strategies that will facilitate a thorough investigation into the epidemiology and understanding of TBI, which in turn will help to improve policies on management of acquired neurologic diseases. It may also help in facilitating mechanisms to understand and address other health conditions.,, Also Indian researchers need to publish in journals that are regarded as important journals by the research community in a field/subfield (high impact factor journals in a field/subfield is one indication of this aspect). This would lead to the higher visibility of the Indian research activity. Indian journals often have a low impact-factor. Peer review system, editorial policies, timeliness of journal publication are some of the key factors that need to be addressed for attracting high quality research papers.
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