SECTION A
Looking Back
INTRODUCTION
Publishing a book in an age of computers, online resources, networking websites and electronic dissemination of information is a reckless idea. To persist with it for a full ten years is insane. To do it in an era where everyone's attention is short, interests are fleeting and liasons are brief, is simply preposterous.
Having survived the odds, it is time to reflect on past events and some of the motivations that kept the publication going. The Critical Care Update is ten years old and it is time to look back.
HISTORY
The idea of producing a book for all delegates attending the Seventh National Critical Care Congress of the ISCCM, took shape only in the last month before the conference. All faculty members for the meeting in Bangalore were requested to provide an extended summary of their topics much earlier. Most complied with this request and also with the deadline of sending in an overview of their topics by mid Dec 2000. With sufficient material in hand to produce a monograph, the race was on to print a book and make it available to all delegates in time for the meeting in the first week of January 2001. Publication was achieved in record time by Jaypee Brothers through their production unit in Delhi. Over a thousand books were air-freighted from Delhi to Bangalore and Critical Care Update became reality.
The enthusiasm with which a subsequent publication was received became the real driver for continuation of the series. All copies of Update 2002 were sold out at the ISCCM meeting in Jaipur leaving a few delegates disappointed. Ironically, this volume turned out to be the smallest one ever produced with only 140 printed pages of material. What it lacked in bulk, it made up in the quality of published material. The production of this volume also coincided with the advent of training program in Critical Care in India that saw many enthusiastic young doctors gravitate towards a career in ICU Medicine. At around the same time, the science of ICU Medicine advanced rapidly with a number of publications appearing in mainstream medical journals (NEJM and JAMA).
One of the original aims of the Update was to provide busy postgraduates and junior doctors with evidence based recommendations on the management of their patients. A secondary but equally important goal was to provide a comprehensive summary of new and emerging knowledge on topics relevant to the practice of ICU Medicine. An additional objective was to cover topics related to the organisation of ICU services that impacted on the delivery of healthcare in general. Thus began a section of the book that carried 3 to 4 articles every year and became widely regarded as the theme section for each subsequent edition. In years that followed, this section covered diverse topics ranging from Infrastructure, Communication, Manpower, Education, Research, Economics and 2Quality. None of these topics actually show up in standard textbooks. Few, if any relate to the actual provision of care to an individual patient. But collectively, they are vital in creating the right environment and systems that, in turn, benefit all ICU patients.
Just when the objectives and direction were set, the impossible happened. The editorial base shifted from Bangalore to Sydney in Australia—an abrupt change that brought with it numerous challenges. The first challenge was to keep a balance between what was relevant in India and what was available in the West. A conscious effort was made to keep the contents of the Update focussed on the practice in India. In time this allowed for inclusion of special sections on Tropical diseases, Toxicology and certain rare problems seen especially in Indian ICUs. A second challenge was to keep in close contact with the publisher especially towards the end of each calender year. M/s Jaypee Brothers provided extraordinary support to carry this through with exchange of emails containing proofs and clarifications. A final challenge was to deal with the storage and distribution of books. In spite of arrangements made at that time, this remains a problem even now.
Move of the editorial base to Sydney created new opportunities to contact a large number of new authors from around the world. Several contributors from Australia were enthusiastically roped in to write chapters. Critical Care Update 2004 carried only one article by authors based in Australia. By 2005, this number was up to five and peaked at nine in 2006 before settling down to an average of three chapters per issue. In essence, the Update virtually became a publication for India with content generated in Australia. A second opportunity arose out of availability of Indian trainees who were, by this stage, working in several large Australian ICUs. Finally, availability of time allowed each edition to be planned carefully. Not only did this improve the depth of coverage, it really enhanced the publication quality as well.
Although planned for earlier, membership of the editorial board was finally expanded in 2006 with induction of two young intensivists based in India. Both had spent some of their training time in Australia and were enthusiastic and scholarly. In addition, Dr Roop Kishen from Manchester (UK) also joined the editorial team to support the publication into the future. Editorial team members regularly helped with identification of topics, potential authors and final production of each volume. By the time the 2006 edition was released at the ISCCM meeting in Kochi, the Update monograph had grown in stature and matured. In particular, the range of topics included in each volume encompassed an impressive list with coverage of the most recent advances in the field of Critical Care.
It is one thing to strive to achieve a high standard, but quite another to maintain it once it has been reached. During the last few years, it has been a constant struggle to keep the standards at a high level. For one, it has been difficult to identify new topics and contributors for the Update. Secondly, the anomaly of editing in Australia, a book published and distributed in India has drained some of the energy with which the publication was first started. Finally, financial transactions required to keep the publication afloat have also taken their toll.
10 YEARS OF THE UPDATE
A list of all the topics that have appeared in the Update is included in this book (see Appendices). This list does not contain chapters published in the 2001 volume which, although produced as the first edition of the series, was more a collection of articles related to topics discussed at a Critical Care conference (Bangalore, 2001). This notwithstanding, the list is impressive for the simple reason that not a single topic has been repeated in nearly ten years of publication. Taken together, it constitutes a virtual textbook of Critical Care.3
Sections on Airway and Ventilation, Cardiovascular, Renal Problems, Sepsis/Infection Control and Trauma/Neuro-Critical Care have appeared every other year in the Update. More than 50% of all the chapters published so far have been included under these five core subheadings of Critical Care. The largest number of chapters (total 20) has been published under the heading of Sepsis and Infection Control, which all practicing Intensivists recognize as an important component of their daily practice. Apart from core topics, the Update has carried within its pages a number of articles related to the organisation and effective delivery of care. Two of the best chapters appear in sections of the book devoted to organizational aspects of healthcare. “Not negotiable—Error in Medicine” and “Shiftwork and its effect on staff performance”, are chapters that have ongoing relevance to work flow and work force issues in the ICU.
Of the 174 chapters published so far, majority (57.5%) have been written by a single author (Fig. 1.1). Most of the single or multi-author chapters have been written by authors either in India or in Australia (81.3%) (Fig. 1.2). Editorial board members, individually or in co-authorship, have contributed to a substantial 57 chapters. Instances of multi-author chapters co-authored by intensivists based in two or more countries have been infrequent. Irrespective of their location, nearly all authors have given up substantial amount of their time to deliver manuscripts on time.
A feature of the Update has been its release and availability at all ISCCM meetings in India over the last ten years. The logistics of handling a consignment of the latest book along with its previous two editions has been a challenging task. Displaying the Update and making it available to delegates at each venue has been assisted by a single person whose unstinted support to this venture has been no less than outstanding. The Update has been made available to all delegates at the ISCCM conference at Rs 400.00 per copy. This has remained unchanged during the time the consumer price index (CPI) in India has risen 178% compared to base value in Dec 2000. As a testament to its popularity and easy availability, all copies of the Update have sold out on the last two occasions.
WHERE TO NOW
Long years of labor have often preceded scientific breakthroughs in medicine. Although success does not follow any laws, it seems to follow the so-called 10-year rule. First identified by the psychologist John Hayes in 1989, the rule states that a person must persevere with learning and practicing a craft or discipline for about 10 years before he or she can make a breakthrough. The initial evidence for this rule came from studies in 1960s and 70s of chess players, who take 10 years or more to become masters of the game. Then it was found to apply equally to Olympic swimmers and concert pianists. Subsequent studies of scientists, painters, composers, mathematicians and poets—living or deceased—further supported the rule.
At the end of ten years, it is difficult to assess if the Update has been successful or not. It is, no doubt, popular with delegates at the ISCCM meeting and also with trainees in Critical Care programmes in India. It has certainly kept some people (authors and editorial board members) busy at a time of the year when most people have holidays, at least in Australia. Whether all this effort involved in editing and publishing this monograph has been a useful exercise, time alone will tell.
Inevitably, considerations of time, effort, resources, demand and opportunities, drive decisions in any venture. A digital revolution is sweeping India and the world. The year Critical Care Update was launched, India had only 3.6 million mobile phone users. Now it has 687.7 million and what is more, India is projected to overtake China to become the world's largest mobile telecommunications market by the year 2013. It is predicted that by then, the teledensity will shoot up to 75% and the total mobile subscriber base would be a staggering 1.159 billion.
In such an environment, the Update will, in all likelihood, bow to pressure from this increasingly digitized world and become available as online content for subscribers. Regardless of this change, quality of its content will continue to be high. If anything, accessibility will be enhanced, particularly for those who have online access and good download speeds. For those wishing to own a hard copy of the Update, this will be made available exclusively through the publisher's distribution network.