Indian Journal of Medicine 2011;1:31-33

Guidance document
DMRI Position Statements: an introduction
Emmanuel Bhaskar

Department of Medicine, Sri Ramachandra Medical College and Research Institute, Chennai, India

corresponding author email: drebhaskar@gmail.com

Published online on 17th Feb 2011

Copyright © 2011 Bhaskar E. This is an open-access article . The publisher and author permit unrestricted
use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract
Guidance on standards of care is an important prerequisite to facilitate good clinical practice. Database of
Medical Research in India (DMRI) position statements are guidance documents for practicing clinicians in
both resource adequate and resource poor settings in India. This document is an introduction to the series.

Keywords: guidance document, India, resource poor setting

Indian J Med 2011;1:31-33

Guidelines on standards of care is an important prerequisite to facilitate good clinical practice. Often
named as position statements by American societies (American Heart Association, American
Diabetes Association, etc) these are documents prepared by leading experts based on published
literature on the topic of interest and consensus among experts on critical management issues .
Though frequently discussed in teaching forums and clinical assessment, the validity of these
western guidelines in our settings is unclear. It may be argued that guidelines on non-infectious
diseases developed by international societies is expected to benefit most ethnic population since
the epidemiology of these disorders is more or less similar across the globe. The cost which goes
with implementation of international guidance policies is often high, a factor which makes these
recommendations a distant thought for clinicians practicing in resource poor settings which
contribute a major share to health management in India.

In addition to the selective inclusion of western studies in the guidelines which obviously may not
reflect our scenario, the volume of these guidelines is also a cause for concern. For instance the Joint
National Committee (JNC) 2003 guidelines runs through 13 pages and European Society of
Hypertension (ESH) guidelines occupy 75 pages. With the number of guidelines on the rise , which
are being frequently updated, it is difficult for primary care clinicians to peruse the elaborate
documents and keep informed about the frequent changes. To address some of these issues DMRI
(Database of Medical Research in India) has made an initiative to develop guidance documents
called position statements which will address key management issues in clinical practice. These
statements will be developed by a core group of medical professionals who have extensive
knowledge on the topic of interest.

The guidance documents are developed to appear small in volume ( 2 to 5 pages) , incorporate
salient recommendations of international documents, consider variations in recommendations when

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applied to resource poor settings and will attempt to address critical management issues. Each
guideline with follow a standard template of presentation as shown in Figure 1.

Figure 1: Template for DMRI position statements

The first component (problem statement) will highlight the disease burden in India and highlight
areas of high priority. The second component (critical management issues) will include a series of
questions relevant to the disease of interest which need evidence based or rationale based answers.
The third component (recommendations) include guidance statements on the issues raised, which
will be classified as S-strong evidence when based on meta-analysis or good quality randomized
controlled trials, M-moderate evidence when based on smaller RCT or observational studies and W-
weak when based on case reports or expert opinion. Each recommendation will consider relevance
in resource poor settings and a separate statement will be made whenever appropriate. The fourth
component ( areas of need ) highlights the areas related to the topic discussed which need more
research inputs in the near future .

Despite, India being a major contributor to global disease burden accounting for a proportion of
20%, very less is known about chronic disease nature in India. 1 The DMRI position statements will
attempt to simplify best practice guidelines so that the benefit reaches the population at large.
Constructive criticisms are welcome from the readers for the betterment of the guidance
statements.

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Conflict of Interest: Is a member of DMRI

References:

1. Balarajan Y, Selvaraj S, Subramanian SV. Health care and equity in India. Lancet 2011: 377; 505–15

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