Editorial

This, the third issue of the journal this year marks its half-way point – the year is indeed going rapidly.

I am happy to say the journal is now receiving an increasing number of submissions, and so competition for space is increasing. I am afraid this particularly affects case reports, always a contentious area for editors of journals. They are not particularly attractive as they are by definition anecdotal so no great insights can be drawn; they are infrequently cited so that they are unattractive to those who believe in the importance of impact factors, and whatever you feel about the merits of this system it cannot be ignored – certainly not by the publishers and the editorial unit. On the other hand many tell me – both readers and reviewers that often there is interest in such articles. Not infrequently reviewers will comment that a literature search has confirmed the case report is not unique – what strikes me here is that the reviewer had had to do the literature search to know this, so at least the case was novel to the reviewer up to that point!!! Another benefit from case reports is that they often represent the start of a publishing career for those starting their training, and this is not inherently a bad thing, and an area I would like to encourage. I will be looking into ways into which we may continue to accommodate case reports, though this may have to be on-line. Also – note that this does not anticipate that I expect the standard of case reports to fall, or that I am asking reviewers to be less stringent!

This issue contains some items to which I should like to draw attention. Primarily the issue contains articles on head injury and neurovascular topics, though there is as usual a broad range of topics that I hope will interest all readers.

Please note the correspondence regarding trials – two important areas – head injury and intracerebral haemorrhage. I do not think the practical difficulties faced by investigators are always fully appreciated, but these items will I think bring these out.

First is the considered response of the Rescue ICP investigators to the recently publish DECRA trial on decompressive craniectomy. We are not privy to the full results to date from the Rescue ICP trial (only available to its data monitoring committee) but in the absence of a pronouncement from this committee, for the reasons outlined in their letter I fully concur with their stance and support the continuance of the trial. There are many unknowns in respect of the trial of decompressive craniectomy – and both trials are to be commended for addressing such issues. So that this procedure is not taken lightly I have assembled for this issue a number of articles detailing some of the complications of decompressive craniectomy – beneficial the procedure may be, but it is not without risks or complications and must not be undertaken lightly in my estimation.

Next is an article, with some responses, addressing the difficulties of running a trial particularly when there is poor recruitment, and compounded by the plethora of forms, and hurdles to be overcome. These articles concern themselves with the STICH II trial, and there is reference to an article about this in a previous issue concerning the very real difficulties of recruitment of patients to such trials.

Neither of these articles deals with a further issue regarding trials or indeed any studies, which is the seemingly unending difficulties imposed by the bureaucracy – such that arrangements have to be made – perhaps liaison research individuals or units put in place to help potential investigators get through these hurdles. I have no quarrel with the excellence and commitment from these sources, but would it not be more efficient to improve the bureaucracy? If clinical practice can always be made more efficient (delivered more cheaply, without prejudice to the outcome) then why should this area be exempt – what is the research bureaucracy equivalent of day case surgery – or minimally invasive surgery – or early discharge?

I hope as ever the issue provides stimulation – I am encouraged to see correspondence concerning articles and topics, which continues to be welcome.