The ten essential “T's” imparting impetus to research in anaesthesiology

摘要

Anaesthesiology encompasses knowledge of probably all sub disciplines of modern medicine especially with the inclusion of critical care and pain. Despite the available avenues for research in our country, sadly, the output has not been so encouraging. It is not that the will is lacking, but probably there is a lack in the direction to research. The need of the hour is to delve into these challenges and to provide an outline to improve the research in anaesthesiology as medical science is ever-evolving. If, it were the 'six honest serving men' that taught Kipling 'all he knew' (What, Why, When, How, Where and Who), there can be ten essential 'T's' that impart impetus to research in anaesthesiology.[1] These include: Team, Timeliness, Therapeutic necessity, Technology, Techniques, Tenor, Tabulation of data, Tests, Transparency and Teaching and Training. These ten 'T's' form the very basic foundation of a good research activity. Team A lone soldier cannot win a war! The expanded meaning of 'TEAM' (together everyone achieves more) itself conveys everything and is one of the most important facets of any research activity. Right from the conception and design of the study, defining the intellectual content, literature search, forming the protocol to conducting clinical/experimental studies, acquisition and analysis of data requires time and aptitude. It is nearly impossible to do it alone; neither does one have all the expertise. This is followed by preparation of the manuscript, revision and final draft before it can be submitted to a journal. Apart from the core group of people actively involved in the research, help is invariably obtained from colleagues and ancillary workers who may not be direct contributors but provide an invaluable input without which the research would have been incomplete. It is therefore imperative to acknowledge all these contributors either as authors, order of which may be decided by the team itself or as indirect contributors in the acknowledgement section. This cannot be better exemplified than the formulation of the 'ISA Fasting and Feeding Guidelines' which are being published in this issue of the Indian Journal of Anaesthesia (IJA).[2] All the authors have collectively worked hard in formulating plans and policies, collecting the evidence, analysing the data and details as well as discussing numerous times about each and every minute detail of these guidelines so as to arrive at an appropriate evidence- based document. These guidelines have comprehensively covered everything based on the strength of evidence for each and every frequent query related to fasting and feeding instructions before surgery in various subsets of population.[2] Timeliness This is perhaps the second most important aspect of research. Nothing else can underlie the importance of being first. The classical example is that of Marconi and Jagdish Chandra Bose who discovered the radio almost simultaneously with the former taking credit because of an earlier patent. This also underlies another fact- the duration allotted for a particular research. Too long a duration may cause it to be redundant due to a change in technology or worse, nature of the disease, whereas, too short a duration may not result in a meaningful result. Though lesser in importance to timely prospective studies, occasionally retrospective studies can be very useful in delivering the message and help in formulating strategies and policies to counter the challenges enhancing morbidity and mortality. These studies can be completed in a very short time but they lack the evidence-based advantages of prospective and interventional studies. A retrospective study being published in the current issue of the IJA aims to predict the various factors responsible for maternal mortality by utilising the World Health Organisation (WHO) near-miss approach and maternal severity scores. The message delivered by the study is very clear as they found out that haemorrhage is the lea