invited speakers and workshop abstracts

Invited Speakers and WorkshopAbstracts

Plenary Session 1 – Wednesday,31 August 2013 10:30–12:30

Healing from the dilly bagB LeeFlinders University, NT, Australia

In this presentation I will share information to help you get abetter understanding of Australian Aboriginal people’s deep connec-tion to Mother Earth and their beliefs of health and wellbeing. I willshare wisdoms to help you achieve an increased empathy for theAboriginal psyche and how to help them overcome the burden ofdisease.I will share information on my spiritual healing practice and howI work in a holistic way, taking care of body, soul and spirit of eachperson and how I diagnose and treat the cause not the symptomof the illness or injury. I will explore with you the spiritualreasons around why people suffer stokes, especially in the Aborigi-nal communities.

Maori taking charge after stroke: promotingself-directed rehabilitation to improve quality of life.M Harwood,1 M Weatherall,2 A Talemaitoga,3 PA Barber,4

J Gommans,6 W Taylor,2 K McPherson,5 H McNaughton1

1Medical Research Institute of New Zealand, 2University ofOtago, 3Ministry of Health, Wellington, 4Centre for BrainResearch, University of Auckland, 5Health and RehabilitationResearch Institute, Auckland University of Technology,Auckland, 6Hawke’s Bay District Health Board, Hastings,New Zealand

Background and Aims: Qualitative research has shown that theability to direct aspects of one’s own recovery or ‘taking charge’ isvalued by Maori, the indigenous peoples of New Zealand, withstroke. However, few rehabilitation programmes support people to‘take charge’ of stroke recovery. We tested two novel communityinterventions designed to promote self-directed rehabilitation follow-ing stroke for Maori and Pacifica people.Methods: This was a randomized, controlled parallel group 2×2 trialundertaken in the community with Maori and Pacifica people, ran-domized within three months of a new stroke. Participants receivedeither a DVD of four inspirational stories by Maori and Pacific peoplewith stroke or a ‘Take Charge Session’ – a single structured assessment

designed to facilitate self-directed rehabilitation – or both or usualcare.Findings: One hundred and seventy-two people were randomizedwith 139 (80.8%) followed up at 12 months post randomization. Apositive effect of the Take Charge Session on SF-36 PCS at 12 monthswas significant (score improved by 6.0, 95% confidence interval (CI)2.0 to 10.0); there was a smaller effect of the DVD (score improved by0.9, 95% CI –3.1 to 4.9) that was not significant. Participants allo-cated to the Take Charge Session were less likely to be dependent onothers (based on modified Rankin score of >2) with odds ratio 0.42(95% CI 0.2 to 0.89) and their carers had lower (better) Carer StrainIndex scores (–1.5, 95% CI –2.8 to –0.1).Conclusions: A simple, low-cost intervention in the community phaseof recovery aiming to promote self-directed rehabilitation improvedoutcomes for Maori and Pacifica peoples with stroke.

Improving cardiovascular outcomes forIndigenous AustraliansA BrownSouth Australian Health and Medical Research Institute,Adelaide, SA, Australia

The poor health status of Aboriginal and Torres Strait Islander peopleis well known and frequently discussed. In a long list of contributorsto adverse health outcomes, cardiovascular diseases stand as theprimary cause of death, and the leading contributor to life expectancydifferentials. Such poor statistics are all too frequently met with ill-conceived policy responses, inadequate and short term resourcing andlack of evidence-based decision making. These responses have con-tributed to an imbalance between rhetoric and action in health careand broader social policy.Understanding the determinants of cardiovascular conditions, whilstcomplex, provides clear targets for reform, spanning from individualpractice, through to the manner in which health care is best deliveredto vulnerable people and disadvantaged communities. This plenarywill explore the findings of extensive work in CVD epidemiology,management and prevention in Aboriginal people with a view toidentifying better health care system responses for the future. Theselessons have importance for building systems better able to mitigatethe growing burden of chronic conditions in all Australians.

4 Abstracts

© 2013 The Authors.International Journal of Stroke © 2013 World Stroke Organization Vol 8 (Suppl. 1), August 2013, 4–10

Excellence in Stroke Oration –Thursday, 1 August 2013 16:00–17:00

Stroke – ‘yesterday, today and tomorrow’ – apersonal reflectionSM DavisRoyal Melbourne Hospital and the University of Melbourne,VIC, Australia

When I started Neurology training in 1978, stroke was managed ingeneral medical wards and there was no evidence-based acute therapy.There were arguments about the value of CT (introduced in Australiain 1976) for acute stroke. Heparin, Chlormethiazole and steroids wereoften used. Aspirin had just been proven as the first therapy forsecondary prevention. There were no guidelines, professional societyor NGO for stroke.We now have evidence-based acute therapies, stroke units, guidelines,the SSA and NSF. Our major challenge is to use tPA in many morepatients and at earlier time points, aiming to treat around 15-20%acute ischemic stroke. Re-engineering of stroke systems in Australia

and NZ is well underway, with cooperation between ambulance ser-vices, emergency departments and use of “code stroke”. Proof ofmechanical thrombectomy is urgently needed.Key future strategies are likely to include the development of ambu-lance based, pre-hospital therapy that can be widely applied and thenpersonalized medicine to select treatment responders in the emergencydepartment. Mismatch selection using MRI and CTP is increasinglyvalidated and allows individualization of the time window for IV andIA thrombolysis. Newer thrombolytic drugs and adjuvant therapiesare likely to be confirmed. Development of blood biomarkers has beena slow journey in stroke without a troponin equivalent, but this maychange. Early intensive rehabilitation and drugs to promote post-stroke recovery are both on the horizon.Finally, the future of the SSA should involve an even closer partnershipwith Asia, rapidly changing and with 60% of the world strokeburden. The opportunities are immense.

Plenary Session 3 – CognitiveRehabilitation – Friday, 2 August2013 14:30–15:30

Promoting adaptive neural plasticity in post-strokecognitive rehabilitationT CummingFlorey Institute of Neuroscience and Mental Health,Melbourne, Vic., Australia

Cognitive rehabilitation after stroke does not share the long and richhistory of post-stroke physical rehabilitation. Many of the first strat-egies trialled to improve cognition were based on paradigms derivedfrom the physical realm: rehearsal, repetition, task-specific training.These strategies tended to result in some short-term benefit on thetrained task, but questionable maintenance over time and minimalgeneralisation to other cognitive tasks. More recently, approaches topost-stroke cognitive rehabilitation have sought to take advantage ofthe principles of neural adaptation. Transcranial magnetic stimulationhas been used to inhibit neural activity in the right hemisphere ofstroke patients with chronic aphasia, thus improving language perfor-mance. For hemispatial neglect, prism glasses have been used to adaptthe brain to an optical shift in the visual field, increasing attention tothe neglected side of space. While promising, these studies have typi-cally been conducted in very small samples and the interventions areyet to cross over into clinical practice. Future work will reveal whetherother drivers of neural plasticity, including pharmacological agentsand physical activity, can improve cognition after stroke, either inisolation or as ‘primers’ for concurrent rehabilitation strategies.

The role of music in cognitive rehabilitationafter strokeDL Merrett1,2

1Melbourne School of Psychological Sciences, The Universityof Melbourne, 2The Florey Institute of Neuroscience andMental Health, Melbourne, Vic., Australia

Music is used to treat an ever-increasing variety of psychological andneurological conditions. In particular, music-based treatments for themotor and cognitive sequelae of stroke are garnering a great deal ofinterest from researchers, clinicians, and patients. Despite evidence forthe efficacy of some music interventions, a clear understanding of themechanisms involved in music-based rehabilitation strategies is stillemerging. Putative neurobiological mechanisms include forms ofmusic-induced neuroplasticity, such as promotion of functional reor-ganisation, structural changes in grey and white matter, and modifi-cation of functional connectivity. However, the potential for music tochange the brain may be mediated or moderated by the significantinfluence of music on behaviour and cognition. For example, the useof music has been linked to improvements in motivation, mood,well-being, arousal, and memory. This talk will briefly review theexisting music rehabilitation literature and will also present researchfrom our lab investigating neurobiological and cognitive mechanismsby which singing could lead to successful rehabilitation of post-strokelanguage impairments. The findings will provide insight into theextent of singing-induced neuroplasticity, elucidate other mechanismsby which singing training might facilitate language rehabilitation, andcontribute to the optimisation of cognitive rehabilitation strategiesafter stroke.

Abstracts 5


Neuroplasticity and the art of using the brain wiselythrough CogACTM Byrnes,1 DJ Blacker2,3

1Australian Neuromuscular Research Institute and 2School ofMedicine and Pharmacology, University of Western Australia,3Neurology, Sir Charles Gairdner Hospital, Perth, WesternAustralia, Australia

Background: Despite the urgency for cognitive and psychosocialrehabilitation services as a standard of care, there has been a paucityof efficacy studies designed to investigate these integrated therapeuticapproaches in Stroke Survivors with current clinical research high-lighting the drastic need for effective rehabilitation techniques withinthe field of Stroke.Aims: i) To evaluate the clinical effectiveness of a 12 week integratedCognitive Acceptance and Commitment Therapy (CogACT) programon aspects of cognitive and psychosocial functioning including atten-tion, memory, information processing, mood, quality of life, andvalues-directed living.Methods: Ten Stroke Survivors commenced and completed the 12week integrated CogACT program with cognitive and psychosocial

assessments completed at pre, post and 3 months follow-up timepoints.Results: Our pilot results indicates that prior to the commencementof the integrated CogACT program, participants reported symptomsof depression, anxiety, stress and cognitive difficulties and lowlevels of acceptance, mindfulness, quality of life and values-directedliving. At the completion of the CogACT program we observed clini-cally and statistically significant improvements in all cognitive andpsychosocial variables assessed with resulting large effect sizes rangingfrom 0.8 to 4.9. In addition, at 3 months follow-up, these clinicallyand statistically significant cognitive and psychosocial improvementswere maintained.Conclusions: To date, cognitive and psychosocial rehabilitation ser-vices for Stroke Survivors have been relatively neglected, and as aconsequence, cognitive and psychosocial strategies and therapeutictreatments are under developed. Overall, the results presented supportthe feasibility and effectiveness of our CogACT program for StrokeSurvivors and warrants further clinical program development imple-mentation and evaluation.

Workshop 1 – The Challenge ofStroke Prevention – Wednesday,31 July 2013 13:30–15:30

Setting the scene for stroke prevention.DA CadilhacMonash University, Melbourne, Victoria, Australia

Background: Similar to other countries, stroke is a leading cause ofdisease burden in Australia. The annual lifetime cost burden of first-ever strokes in Australia is estimated to be about AU$2 billion, witha large portion borne by individuals and families because of out-ofpocket expenses and an inability to work.Aims: To describe the potential opportunities to reduce the burden ofstroke through prevention programs.Methods: Narrative review of the literature related to stroke preven-tion and show-casing of relevant Australian studies.Results: Preventing stroke will provide the best opportunity to tacklethe burden of stroke. The majority of stroke risk factors are modifi-able and effective therapies exist to reduce the risk of stroke. However,implementing effective programs to detect and manage individuals atrisk of stroke is complex and the evidence on comprehensive strokeprevention programs is limited. In a recent modelling study, it wasfound that by treating more patients with hypertension and priorstroke with a combined ACE-inhibitor/diuretic therapy by just 10%,2,859 strokes could be prevented each year in Australia. In addition,recent analysis of data from the Australian Stroke Clinical Registrydata that was linked to hospital data in Victoria has provided evidencethat about 10% of first-ever strokes present to hospital in the monthbefore their full stroke event. This highlights potentially missed oppor-tunities for preventing stroke.Discussion: In this workshop we will describe both research evidenceand government activities related to improving the evidence-base forpolicy and practice of stroke prevention.

Maximising opportunities to prevent recurrent stroke:using unproven policyAG Thrift,1 VK Srikanth,1 MR Nelson,7 J Kim,1 SM Fitzgerald,2

RP Gerraty,3,4 CF Bladin,5 TG Phan,1 J Frayne,6 DA Cadilhac1

1Stroke and Ageing Research Centre, Department ofMedicine, Southern Clinical School, Monash Medical Centre,Monash University, 2Department of Epidemiology andPreventive Medicine, Monash University, 3Department ofMedicine, Central Clinical School, Monash University,4Department of Medicine, Epworth Healthcare, Richmond,5Department of Neurosciences, Box Hill Hospital, 6NeurologyDepartment, Alfred Hospital, Melbourne, Victoria, 7MenziesResearch Institute Tasmania, Hobart, Tasmania, Australia

Background: The use of organised care has been shown to improvecontrol of cardiovascular risk factors such as diabetes and bloodpressure. The Medicare Chronic Disease Management (CDM) itemsare organised care models. Despite the fact that Medicare providesextra payments to General Practitioners (GPs) to utilise these items,there is no evidence for their effectiveness in stroke.Aim: We aimed to determine the effectiveness of the CDM program inreducing ‘absolute stroke risk’ in patients with stroke or TIA whencompared to usual care (UC).Methods: Multicentre cluster randomised controlled trial. Partici-pants are randomised to receive a CDM plan or UC, with clusters bygeneral practice. The CDM group receive 1) specialist advice on theirown risk factors utilising a standardised template to communicateoptimal management with their GPs; and 2) additional education andsupport about risk factor management. CDM plans are reviewed at 3,6, 12 and 18 months after baseline. The primary outcome is a changein the Framingham cardiovascular risk score (using blinded outcomeassessors and ‘intention-to-treat’ analysis). Analysis of covariance willbe undertaken to adjust for baseline risk score and confoundingfactors.

6 Abstracts


Results: We have recruited 424/570 patients. The mean age of par-ticipants is 68 years and 63% are male. In total 25 have dropped outand four have died, giving a participation rate of 93%.Conclusion: Recruitment is expected to be complete by November2013. If effective this readily applicable program will enable GPs tomore effectively manage their patients with stroke or TIA.

Implementation of a chronic conditions model toreduce cardiovascular disease in the NorthernTerritory (NT)C Connors,1 E Kasteel,1 G Sinclair,1 J You1

Northern Territory Department of Health, Darwin, NT, Australia

Background: The prevalence and mortality of chronic conditionsamongst Aboriginal Territorians is much higher than Australian rates.Aims: Reduce the premature mortality and complications fromchronic conditions for Aboriginal Territorians.Methods: Over the past 15 years the Aboriginal primary health caresector has implemented a population systems approach to screening

and management of chronic conditions with a focus on reducingcardiovascular risk and managing multiple diseases. Joint initiativesacross the Aboriginal primary health care sector included develop-ment of a Chronic Conditions Strategy, local standard treatmentguidelines, expanded roles for nurses and Aboriginal health practitio-ners, implementation of electronic systems including a shared elec-tronic health record , and focus on quality improvement.Findings: Features of cardiovascular disease, including stroke, in theNT include: early age of onset, high rates of co-morbidity, highprevalence of classic risk factors and additional risk due to high ratesof rheumatic heart disease. There has been a significant reduction inmortality between 1998 to 2010 with an annual rate reduction of 45.9deaths per 100,000 (26% overall). Clinical audits have shown signifi-cant improvements in the delivery of chronic conditions care, withgood BP and lipid control (55% of people with diabetes haveBP < 130/80). Recent initiatives to reduce smoking prevalence arechanging community attitudes.Conclusions: Despite the challenging circumstances, a systemsapproach is showing positive improvements.

Workshop 2 – Basic Science –Wednesday, 31 July 2013 13:30–14:30

Found in translation: preclinical stroke researchpredicts human pathophysiology, clinical phenotypesand therapeutic outcomesU DirnaglCenter for Stroke Research, Berlin, Germany

“The outlook for stroke therapy is excellent. . . if you are a rat”(Lindsay Symon)Stroke presents a major global burden to patients, their relatives, andeconomies. Great progress has been made in understanding the cellu-lar and molecular mechanisms which lead to the demise or salvage ofbrain tissue after stroke. However, despite major research efforts overthe last decades, thrombolysis remains the only specific pharmacologi-cal treatment of acute ischemic stroke with proven efficacy. Much hasbeen speculated about the reasons underlying the translational road-block, and the term ‘Lost in translation’ has entered the titles ofnumerous biomedical publications. Despite the apparently dismaltranslational track record of stroke research, in my talk I will forwardthe hypothesis that preclinical stroke research can indeed predictclinical outcomes and phenotypes. While numerous drugs were lost intranslation, many pathophysiological principles are in fact found intranslation. It will become apparent that there is little reason fornihilism, but a concise list of potential improvements which may helpto reduce the current attrition rate of bench to bedside translation.

Using embryonic stem cells to provide humanneurons for drug screeningA Antonic,2 M Dottori,1 J Leung,1 GA Donnan,2 DW Howells2

1University of Melbourne, 2Florey Neuroscience Institutes,Melbourne, Victoria, Australia

Background: Despite most neuroprotectants working in animalmodels of stroke, none have been shown to be successful in the clinic.While stem cell based therapies could be of benefit, an alternative useof stem cells is to create an in vitro screening system in which humanembryonic stem cells (hESCs) differentiated into neurons are used totest candidate drugs.

Aims: to differentiate hESC lines into neurons, develop a model ofischaemic injury and test potential therapeutic agents.Methods: HESCs were differentiated into neurons in the presence ofbone morphogenic inhibitor protein, Noggin. Neurons were main-tained for 11 days prior to the induction of injury. Two injury modelswere used: Oxygen-glucose deprivation (OGD) and oxidative stress(H2O2) Two potential therapeutic agents (hypothermia and NXY-059)were tested at various concentrations and cell death was quantifiedusing a lactate dehydrogenase assay.Results: Hypothermia to 33oC reduced H2O2 and OGD induced celldeath by 53% and 45% respectively at 24h. When hypothermia wasinduced at different times after injury the neuroprotective effectdecreased with time however it was neuroprotective even whenadministered 6h after H2O2 induced cell death. This was not seen infollowing OGD induction. NXY-059 however had no effect on neu-ronal cell survival in either of the injury models.Conclusion: These results demonstrate that hESCs have the potentialto be a useful model for future drug screening. Identifying neuropro-tective agents that work in such human in vitro systems may bridgethe gap between animal studies and clinical trials.

The changing face of GABA and targetingstroke recoveryAN Clarkson1,2

Departments of 1Anatomy and 2Psychology, University ofOtago, Dunedin, New Zealand

Background: Functional recovery is aided by extrinsic manipulationof neuronal excitability. Stroke results in prolonged elevation in tonicinhibition and dampening this increase in tonic GABA re-awakenssilent connections and facilitates functional recovery [1]. The aim ofthe present set of experiments was to define the therapeutic windowfor treatment, using both GABAAα5 or δ and GABAC receptor nega-tive allosteric modulators.Methods: Photothrombotic stroke was induced in the mouse primarymotor cortex of young (3-month) and aged (24-month) mice. Behav-ioral measures were assessed 1-week prior to stroking and then

Abstracts 7


subsequently 1-, 2-, 4-, and 6-weeks post-stroke using both the cylin-der and grid-walking task. Treatment with either L-655,708 (5mM),a selective GABAAα5 negative allosteric modulator, or (S)- or (R)-ACPBPA, selective GABAC receptor (ρ-subunit) modulators (2.5-5mM) was via subcutaneously implanted osmotic minipumps.Results: Significant forelimb deficits (P < 0.001) were observed for atleast 6-weeks post-insult on both behavioral measures Treatment withL-655,708 resulted in improved functional recovery in both youngand aged mice. Further treatment with L-655,708 starting 3-, 7- and14-days post, but not 21-days post-stroke also affords significantgains in motor function. Assessment of motor functions followingadministration with either (S)- or (R)-ACPBPA results in markedfunctional improvements.Discussion: These results extend on our previous findings and dem-onstrate that delayed suppression of tonic inhibitory currents out to14-days post-stroke affords an early and sustained reversal of forelimbmotor deficits after experimental stroke. In addition, functionalimprovements are seen following modulation of both GABAA andGABAC receptors.[1] Clarkson et al., Nature 468: 305–9, (2010).The work is supported by a New Zealand Neurological RepatriationFellowship, a Sir Charles Hercus Fellowship from the HRC.

The collateral circulation: key to outcome in miceand menD Beard,1,2 D McLeod,1,2 N Spratt1,2,3

1University of Newcastle, 2Hunter Medical Research Institute,3Hunter New England Local Health District, Newcastle, NSW,Australia

Background: Adequacy of the collateral circulation is a major deter-minant of outcome in stroke patients. Development of collateral cir-

culation therapies would be enhanced by a method to quantifycollateral flow in vivo. Elevation of cerebral perfusion pressure (CPP)by blood pressure augmentation to enhance collateral flow has beentested, with mixed results. Our data suggests that intracranial pressure(ICP) changes are common after stroke. Therefore ICP manipulationis a promising method to improve CPP, collateral flow and penumbralperfusion.Hypothesis: We hypothesized that ICP manipulation may be aneffective way to modify collateral flow and penumbral perfusionpost-stroke.Methods: We developed and validated a method to quantify flowvelocity and vessel diameter of individual leptomeningeal collateral inrats during stroke using fluorescent microspheres. ICP was manipu-lated in post-stroke animals by fluid infusion into the lateral ventriclesand effects on collateral flow were determined.Results: In vitro validation indicated accurate flow quantification(R2 = 0.99). Collateral flow was seen to switch from bidirectional tounidirectional flow (toward occluded vessel) with dramatic increasesin flow velocity immediately upon vessel occlusion. ICP elevationcaused a reduction of cerebral perfusion pressure and a proportionalreduction of collateral flow.Discussion: Our method permits real time quantification of flowthrough individual collateral vessels during stroke. Intracranial pres-sure change modified collateral flow, proportional to its well-knowneffect on cerebral perfusion pressure. Coupled with our previousdata indicating ICP changes after even minor stroke, this suggestsa new potential therapeutic strategy for investigation in strokepatients.

Workshop 3 – Stroke and the Tyrannyof Distance (VRD) – Thursday,1 August 2013 13:30–15:30

Medical outreach in the top end:a registrar perspectiveZ WoodwardRoyal Darwin Hospital, Darwin, NT, Australia

More than half of the population of the Top End of the NorthernTerritory live outside Darwin, spread out over vast distances in com-munities ranging from a few families to communities of 3000 people.Access to medical services is limited, and even in the larger commu-nities there are many barriers to providing gold standard care. Thispresentation will showcase the experience of a Medical Registrartraining in the Top End and providing patient care at remote locationsvia Outreach clinics, highlighting the rewards (and challenges) offace-to-face consultation in this setting, and setting the context for theCase Study to follow.

A picture of stroke in the top endJ BurrowRoyal Darwin Hospital, NT, Australia

This presentation will give a hot off the press look at the demographyand epidemiology of stroke in the Top End in 2013.

TIA management in rural and provincialNew ZealandA RantaUniversity of Otago, Palmerston North, New Zealand

This presentation will examine obstacles to optimum TIA manage-ment in areas with limited specialist access. Potential solutions arediscussed including the evidence behind and our experience with aTIA/Stroke electronic decision support software developed for use ingeneral practice.

From VRD and backH FlavellRoyal Darwin Hospital, NT, Australia

This presentation will describe a patient journey from VRD and thereturn. There will be a discussion of the medical dilemmas involved.

8 Abstracts


An exploration of the Indigenous stroke experiencein the top endK Faehse, S Evans, E StevensRoyal Darwin Hospital, NT, Australia

This presentation aims to explore the unique challenges of providingmulti-disciplinary rehabilitation to stroke survivors in the Top End. Acomparative overview of the demographics of stroke in the top end

and throughout Australia will be covered as well as a look at thecurrent research in relation to outcomes for Indigenous patients poststroke. Stroke journey through the hospital and to community will beevaluated through the use of questionnaires and case studies demon-strating the viewpoints of medical staff, nurses, therapists and clients.Some of the challenges that will be discussed include the social andcultural implications for rehabilitation, and access to resources suchas equipment and ongoing follow up for many remote clients.

Workshop 4 – Acute Stroke Care – ANational Nursing Perspective –Thursday, 1 August 2013 13:30–15:30

Creation of a national acute stroke nurseeducation networkG Silver,1 S Middleton2

1Royal Melbourne Hospital, Melbourne, Victoria, 2AustralianCatholic University, Sydney, New South Wales, Australia

Background: Nurses play a vital role in the management of acutestroke units Australia wide. They are influential within their hospitalnetwork and are major drivers of the acute stroke message. There arecurrently two isolated state-based networks for stroke nurses;however a national network, able to facilitate the exchange of knowl-edge and experience, does not exist.Aim: To create and support educational opportunities while support-ing collaboration and networking among acute stroke nurses Austra-lia wide.Methods: An initial ASNEN workshop was conducted at STROKE2012 to gauge support and interest in the proposal. A subsequent10-member steering committee was created. Database of acute andliaison nurses was also created. Set up of a national teleconference andonline forum explored. Applications for workshops at Stroke Societyof Australasia (SSA) and SmartStrokes Annual Meetings submitted.Explored potential of subsidized NETSMART Junior programs forAustralian stroke nurses.Results: From the STROKE 2012 feedback, 84% of responders saidthe session was excellent, and 100% said they would attend again.Over 100 nurses entered into ASNEN database. Successfully appliedfor ASNEN Workshops during 2013 SSA and SmartStrokes AnnualMeetings. Quotes obtained for teleconference facilities and onlineforum. Successfully applied for funding from industry and the SSA.Conclusions: Advances have been made on the national teleconfer-ences, online forum, and subsidized NETSMART Junior programinitiatives. The provision of increased nursing content in SSA andSmartStrokes meetings is a positive development, while the ability toprovide subsidies for nurses attending the SSA scientific meetingmakes attendance more attainable.

Stroke unit creation and management: barriersand enablersP Groot,1 E Baker,3 G Silver2

1South West Healthcare, Warrnambool, 2Royal MelbourneHospital, Melbourne, Vic., 3Sir Charles Gairdner Hospital,Perth, WA, Australia

Background: Stroke unit care is the major evidence-based interven-tion for stroke management within the hospital system. There remain

significant numbers of stroke patients who do not receive stroke unitcare.Aim: To present a summary of the identified barriers and enablers tothe creation and running of stroke units in a variety of settings andengage workshop participants in discussion. An awareness of thepotential impediments to stroke unit implementation as well as suc-cessful outcomes in this regard may assist clinicians and health ser-vices in developing stroke units in their settings.Methods: Experiences of the authors as well as the results of a surveyof acute stroke nurses and other clinicians will assist in the identifi-cation of barriers and enablers in creating and managing stroke unitsin regional and metropolitan settings across Australia.Results: Survey results will be presented at the 2013 SSA ASM, withrespondents expected to identify barriers to stroke unit creationranging from issues of awareness, lack of local commitment andsupport, resource scarcity, geographic isolation and an inconsistentdirection at departmental level. Additionally, different settings arefaced with varying challenges associated with effective stroke unitmanagement including maintaining high access rates to stroke units,meeting targets for early assessments and access to rehabilitation, andsustaining staffing and skill levels of the stroke team.Conclusion: Collaborative efforts involving all stakeholders acrosshospitals, departments and organisations at a regional, state andnational level appear to offer the best opportunity for further strokeunit development and their effective management.

Thrombolysis times and barriers to treatment:a national snapshotS CooteEastern Health, Melbourne, Victoria, Australia

Background: Thrombolysis has been in use as an ischaemic stroketreatment option in Australia since the early 2000’s. However, evenhospitals which thrombolyse frequently report many and varied issuesassociated with achieving and maintaining efficient door-to-needle(DTN) times. Some hospitals have introduced a “Code Stroke” team,often headed by an Acute Stroke Nurse (ASN,) to help expeditepatient care, treatment and DTN times.Aim: To compare 2011-12 data from a number of hospitals spreadacross Australia. Hospital demographics, stroke nurse role, t-PA rates,t-PA DTN times and barriers to treatment shall be examined.Methods: A survey was completed by the ASN (or similar role) athospitals nationwide on stroke and t-PA data.Results: The hospitals varied in terms of location (rural vs. metro-politan,) size, and t-PA treatment rates and DTN times. Median

Abstracts 9


door-to-CT times ranged from 20-44 mins and DTN times46-100mins. Regardless of the efficiency of the stroke service andpresence of an ASN, the hospitals still reported similar issues withbarriers to treatment. Themes identified include after hour CT andmedical review delays, CT interpretation, number of team members atthe Code Stroke, and CT access delays.Conclusions: Hospitals with established Code Stroke teams and anASN still have many treatment barriers which can delay rapid accessto thrombolysis. By identifying these issues, educating staff and teamwork, these barriers can be addressed and Australia’s thrombolysistimes reduced.

Stroke nurse practitioner roles and modelsin AustraliaE MackeyWestern Health, Melbourne, Victoria, Australia

Currently roles for the Stroke Nurse Practitioner (SNP) are based inacute, sub-acute and outpatient hospital settings. The role also has thepotential to be a valuable asset in primary health care, with the SNPimpacting on vascular disease risk reduction by monitoring bloodpressure, cholesterol, cardiac rhythm, weight and physical activity.The extended scope of practice of the SNP enables the nurse to initiatetreatment using both pharmacological and non-pharmacologicalmethods for patients at risk of cerebrovascular events and followingstroke as well as refer to other healthcare professionals.The SNP uses advanced clinical knowledge, assessment and clinicalleadership skills to manage patients with stroke and transientischaemic attack throughout the continuum of care. The presentationwill explore the three main apsects of SNP models of care: strokeprevention, stroke patient management, and stroke patient care facili-tation, and provide insight into the underlying philosophy of holisticnursing care and the importance of the psycho-social, educational andcounselling aspects of the role.

T3 Trial protocol: A CRCT evaluating anorganisational intervention to improve triage,treatment and transfer of stroke patients in EDsS Middleton,1,2 CR Levi,4 C D’Este,5 J Grimshaw,10

DA Cadilhac,6 J Considine,7 W Cheung,3 L McInnes,1,2

S Dale,1,2 RP Gerraty,8 M Fitzgerald,9 on behalf of the T3 Trialists1National Centre for Clinical Outcomes Research, AustralianCatholic University, 2Nursing Research Institute, St Vincent’sHospital, 3Department of Diabetes and Endocrinology,Westmead Hospital, Sydney, 4Priority Centre for Brain andMental Health Research and 5University of Newcastle, NSW,Australia, 6National Stroke Research Institute, 7DeakinUniversity-Eastern Health, 8Epsworth Centre, 9The AlfredHospital, Melbourne, Vic., Australia, 10Ottawa Health ResearchInstitute, Ottawa, Canada

Background: The QASC trial showed significant benefits for patientscared for in stroke units who received assistance to implementevidence-based treatment protocols to manage fever, hyperglycaemiaand swallowing. Building on these results, this NHMRC-funded trialwill rigorously implement and evaluate initiatives to improve triage,treatment and transfer of stroke patients in Emergency Departments(EDs).Methods: Design: cluster randomised control trial.EDs at 26 hospitals in three Australian states will be randomised toreceive either usual care or the T3 intervention comprising: rapidTriage; Treatment with thrombolysis where appropriate, fever, hyper-glycaemia and swallowing management; rapid Transfer from ED tostroke units.The intervention will consist of: multidisciplinary team buildingworkshops; interactive education program; and sustained engagementof ED and stroke unit champions to embed collaborations. Ourprimary outcome is 90-day death and dependency (modified RankinScore). We also will measure functional dependency (Barthel Index);Health Status (SF-36) and undertake medical record audits to examinequality of care outcomes and implementation efficacy.Results: A between-group, intention-to-treat analysis will be con-ducted adjusting for clustering. A separate process analysis willexamine contextual factors that may influence successful interventionuptake.Conclusion: We will provide evidence for the effectiveness of a behav-iour change intervention in emergency departments to improve strokeoutcomes. Stroke is common and its costs large if not treated accord-ing to evidence-based guidelines during all phases of hospital admis-sion. To improve the ‘whole pathway’ in stroke, care between EDs andstroke units must be more collaborative and evidence-based.

Symposium 1 – Stroke and the Heart– Wednesday, 31 July 201313:30–14:30

Where do the NOACS fit in contemporarystroke prevention?CR LeviHunter New England Area Health, NSW, Australia

This symposium will discuss the role of oral anticoagulation in strokeprevention with a specific focus on the use of the new oral anticoagu-

lants. Discussion will include which patient groups the new oralanticoagulant in prevention of stroke related to atrial fibrillation. Thebenefits of the new oral anticoagulants in comparison to Warfarin willbe discussed and also the relative differences between the three agentsin terms of Atrial Fibrillation patients with particular high risk ofembolic event versus those at high risk of bleeding.

10 Abstracts


invited speakers and workshop abstracts

Documents