One of the key objectives of the NIHR Global Health Research Group on Neurotrauma is the establishment of a global neurotrauma registry. This will be implemented in collaboration with the World Federation of Neurosurgical Societies (WFNS).

Global neurotrauma is increasing across the globe, especially in low and middle income countries (LMICs).1-2 The public health consequences of this ‘silent epidemic’ cannot be ignored where these range from economic burden to individuals, families and governments, burden to healthcare systems, major psychological, psychiatric, social and community impact as well as demographic impact.3-4

In the last five years, two randomised trials assessing the effectiveness of decompressive craniectomy (DC) following traumatic brain injury (TBI) have been published (DECRA, RESCUEicp). The results have generated debate amongst clinicians and researchers working in the field of TBI. Even though, further randomised trials are ongoing (RESCUE‐ASDH and PRECIS), it is now felt necessary to provide general guidance on the use of DC following TBI and identify areas of ongoing uncertainty via a consensus‐based approach. Hence, the University of Cambridge (NIHR Global Health Research Group on Neurotrauma) together with the World Federation of Neurosurgical Societies and AONeuro are organising an international consensus meeting on the role of Decompressive Craniectomy in the management of Traumatic Brain Injury that was held at Robinson College, University of Cambridge, Cambridge, UK on 28-29 September 2017. Consensus from the meeting coming soon.

RESCUE-ASDH trial

RESCUE-ASDH is an ongoing multi-centre, randomised trial that aims to compare the clinical and cost-effectiveness of decompressive craniectomy versus craniotomy for the management of adult head-injured patients undergoing evacuation of an acute subdural haematoma (ASDH). Four institutions participating in the Group are actively enrolling participants in the RESCUE-ASDH trial (AIIMS, New Delhi; NIMHANS, Bangalore; PGIMER, Chandigarh; UMMC, Kuala Lumpur) and more are in the process of joining.

This project is set within Theme 2 of the NIHR Global Health Research Group on Neurotrauma’s (NIHR GHRGN) research portfolio. It seeks to use a systems approach to understand TBI care in Myanmar, as part of a partnership between: - The NIHR GHRGN - The Healthcare Design Group, University of Cambridge, UK - University of Medicine 1, Myanmar - Yangon General Hospital, Myanmar - Cambridge Global Heath Partnerships (CGHP), UK - Tropical Health Education Trust (THET), UK

The NIHR Global Health Research Group on Neurotrauma has partnered with the Department of Neurosurgery at the University Teaching Hospital (UTH), Lusaka, Zambia and the University of Zambia in Lusaka, Zambia to develop a National Neurosurgery Training Programme and provide teaching support on a 6 - 12 monthly basis based on the National Training Programme Curriculum. To date the population of Zambia was served by a single Neurosurgery Department based at UTH and a further Paediatric Neurosurgery Department based at the Cure Childrens' Hospital in Lusaka. Both hospitals provide a limited service in general and paediatric neurosurgery. There were 3 fully trained Neurosurgeons and no National Training Programme. Doctors and surgeons interested in a career in Neurosurgery were training abroad (currently 1 trainee in Kenya). Therefore there was a need to develop a National Training Programme in Neurosurgery to facilitate expansion of neurosurgery services.

This study contributes to Theme 4 of the NIHR Global Health Research Group on Neurotrauma ‘measuring and nurturing research capacity’. The aim of this study is to understand neurosurgeon’s experiences of, aspirations for and ability to, conduct and disseminate clinical research in low- and middle-income countries. Research Objectives 1. Explore the types of clinical research neurotrauma physicians from low- and middle-income countries are engaged in. 2. Understand the contextual challenges to conducting and disseminating clinical research in Low- and middle-income countries 3. Identify ways in which research and dissemination activities can be facilitated in low- and middle-income countries.