The following is a list of preliminary plenary sessions, workshops, and breakfast sessions. To view or download a full copy of the preliminary programme click here.
Wednesday 1 September
STROKE IN DISADVANTAGED POPULATIONS
George Howard (USA)
STROKE IN INDIGENOUS POPULATIONS AND DEVELOPING COUNTRIES
Intergenerational and Early Life Origins of Stroke and Related Conditions among Indigenous Australians – Hunter Gatherers as a Population in Transition Sandra Eades (Baker IDI, Melbourne)
Risk factors for Stroke in Indigenous Australians: Comparison with Hunter-Gatherer Lifestyle Kerin O'Dea (Sansom Institute, Adelaide)
Journey After Stroke, Caring for Indigenous Australians Tracey Symmons (Townsville Hospital, Townsville)
Organisation of Stroke Services – An Indian Experience Jeyaraj Pandian (India)
Thrombolysis in Vietnamese Tertiary Settings Thanh Huy Nguyen (Vietnam)
Current Clinical Research and Practice of Stroke in China Ming Liu (China)
WOMEN AND STROKE
Marie-Germaine Bousser (France)
Thursday 2 September
WILL TELEMEDICINE REVOLUTIONISE STROKE CARE IN AUSTRALIA?
First Australian Experience of Telestroke Systems, Infrastructure Needed for Telestroke, Medico-Legal Issues, Live Demonstration
Peter Gates, Bernard Yan, Chris Levi, Chris Bladin
BENEFITS OF DEVELOPING STROKE NETWORKS
Nicol Korner-Bitensky (Canada)
Discussion: Developing a Stroke Network in Australia: What Should it Look Like?
REHABILITATION FOR SEVERE STROKE: EQUAL ACCESS FOR ALL?
Coordinated by Kim Brock
Selection for Rehabilitation - Prognostic Indicators, Predictive Models and Variations in Practice: A Review of the Literature Soniia Denisenko
Geographic Distribution of Inpatient Stroke Rehabilitation Services – Should you Move House? Chris Price
Funding Models for Stroke Rehabilitation Jim Butler
Access to inpatient stroke rehabilitation: a survey of factors influencing decision making Genevieve Kennedy
Are There Variations in Practice in Severe Stroke Rehabilitation? The Victorian Experience Sonia Denisenko
This plenary session will explore the factors that can impact on provision of rehabilitation resources, including access to rehabilitation, for people with severe stroke. Rehabilitation episodes for those with severe stroke are characterized by longer hospital stays and may end in a discharge destination other than home. Factors that can impact on the ability of the rehabilitation provider to deliver rehabilitation to these patients include pressures on bed availability, pressures to maximise financial remuneration and fear of “bed blockage”, where there is difficulty accessing appropriate discharge destinations in a timely manner. In addition, clinicians assessing patients in the acute setting may hold different views regarding a patient’s potential to benefit from rehabilitation. These issues will be discussed and some data presented in a series of short presentations (each approximately 15 minutes), followed by an extensive panel discussion of Australian stroke experts with audience participation.
Debate: NEUROINTERVENTION: IS IT WORTH IT?
Topic 1: Neurointervention should be considered first line therapy (for intracranial stenosis).
Peter Mitchell (For) versus Richard Gerraty (Against)
Topic 2: Intra-arterial clot retrieval should be offered as first line therapy for acute ischaemic strokes.
Tim Harrington (For) versus Bernard Yan (Against)
The Claim: Neurointervention Techniques are the First choice for ALL Cerebrovascular Diseases.
Revascularisation therapy is based on the belief that progressive and irreversible ischaemic injury in the region of the penumbra could be attenuated by rapid recanalization (vessel opening) and reperfusion (restoration of blood flow). Although intravenous tissue plasminogen activator (iv tPA) has been shown to improve the likelihood of recanalization, there are disadvantages to this treatment. Some clots are much less likely to recanalize and patients with more severe strokes secondary to increased clot burden in proximal occlusions rarely benefit from iv tPA.
Neurointervention techniques such as intra-arterial thrombolysis, balloon angioplasty and clot retrieval are attractive in theory and produce higher recanalization rates than iv tPA. However, the enthusiasm for these techniques must be tampered by the awareness of tricks and pitfalls. This debate gathers two teams of highly regarded Neurointerventionists and Stroke Neurologists who will vigorously argue for and against neurointervention techniques as the first choice for ALL cerebrovascular diseases.
Wednesday 1 September
AUSTRALASIAN ACADEMIC TRIALS UPDATE
Coordinated by Australasian Stroke Trials Network
This workshop provides an update on current multicentre academic trials, their challenges and successes, in order to facilitate discussion and provide opportunities to enhance research activity in our region. Trials in this update include: IST-3, INTERACT 2, AVERT, START and CADISS.
GUIDELINES 2010: INTRODUCTION AND IMPLEMENTATION
Coordinated by Kelvin Hill
This interactive workshop will provide participants with an overview of the new NSF Stroke Management Guidelines (2010). The new guidelines combine and update the previous 2005 Rehabilitation and Recovery and 2007 Acute guidelines into one document. Initially the guidelines will be presented focusing on the areas that are new or that have changed. The workshop will then explore the application of the guidelines in the clinical setting by exploring issues to consider and providing strategies to assist participants change local practice.
Thursday 2 September
SMALL VESSEL DISEASE, Coordinated by Richard Gerraty, Velandai Srikanth
CADASIL Marie-Germaine Bousser
Small vessel disease – a basic science overview Simon Koblar
Surrogate markers of cerebral small vessel disease – lessons from the retina? Richard Lindley
Non-genetic phenotypes, effects and treatment Velandai Srikanth
The pathogenesis and treatment of cerebral small vessel disease still remains a relative mystery since the time of C. Miller Fisher. However, there have been several advances in scientific technology that has allowed a greater insight into its mechanisms with implications for treatment and prevention. This panel of internationally recognised experts in the field will speak on a range of topics from basic science to clinical detection and treatment of small vessel disease, promising to be of great value to researchers and clinicians alike.
SPASTICITY - THE CHALLENGE OF REACHING CONSENSUS ON ASSESSMENT AND MANAGEMENT. Coordinated by Debbie Kesper
Barby Singer, Debbie Kesper, Natasha Lannin
EARLY SUPPORTED DISCHARGE SERVICES: THEIR PLACE IN STROKE REHABILITATION, Coordinated by Andrew Granger
Geoff Green (NZ), Andrew Granger
Early Supported Discharge schemes provide a link between inpatient and community stroke recovery and rehabilitation. Their aim is to reduce inpatient length of stay whilst producing outcomes equivalent to inpatient care, within the patient’s home environment. The evidence for their effectiveness is strong, and this is reflected in the 2010 National Stroke Foundation Clinical Guidelines for Stroke Management, which state that where appropriate “… early supported discharge should be offered for all stroke patients with mild to moderate disability. (Grade A; Level I)”. Stroke specific Early Supported Discharge schemes are however relatively rare in Australasia.
This session will review the various models of Early Supported Discharge and the evidence base for their effectiveness. Clinicians in Australia and New Zealand will present their experience in establishing and running such Early Supported Discharge schemes, assessing outcomes, but also practical issues such as staffing and clinical governance. Barriers to their adoption and ways to overcome these will be discussed. The session is targeted at medical, nursing and allied health staff involved in the rehabilitation of stroke survivors.
Friday 3 September
PALLIATIVE CARE, Coordinated by Louise Weir, Peter Poon
In spite of significant advances in stroke management, active medical intervention remains futile for a proportion of patients with severe stroke and a palliative care approach assumes a more dominant role. There is currently a sea change in the philosophy of the palliation of stroke patients. Furthermore, advances in palliation strategies in other fields (e.g. Cancer medicine) could be added to the armamentarium of comprehensive stroke care. The aim of this session is to examine several important themes in stroke palliation which include:
1. The decision making process to palliation. What are the predictors of patients who will benefit from palliation?
2. Case discussion of common clinical end-of-life scenarios
3. A standardized and translatable Stroke Palliative Care Pathway
4. Advances in the management of common end-of-life symptoms
MISSING DATA, MINDING DATA, AND MESSING WITH DATA IN STROKE STUDIES
Handling Data in Clinical Trials George Howard (USA)
Data Management Janice Collier (Melbourne)
Data Analysis Leonid Churilov (Melbourne)
Coordinated by Leonid Churilov, Chris Levi
Breakfast Sessions (Thursday 2 September)
RISK-MANAGEMENT OF POST-STROKE STARVATION
Lin Perry
Nutritional depletion is a common complication of stroke, yet seldom recognised. It occurs both as an acute problem and superimposed on long-term chronic deficiencies; is equally a concern for acute management, for rehabilitation and stroke survivors in the community. Whilst it is recognised as predisposing to poor outcomes, it is seldom regarded as a care priority. This session will focus on metabolic, functional and psycho-social effects of nutritional depletion in acute and chronic stroke, and will discuss risk management strategies to prevent starvation.
NEUROSURGICAL PERSPECTIVES OF ACUTE STROKE MANAGEMENT
John Laidlaw, Richard Gerraty
Acute ischaemic stroke is not infrequently complicated by raised intracranial pressure which may precipitate catastrophic brain herniation. The timely recognition of this clinical syndrome (malignant infarction) is critical in that intervention may be futile beyond a time window. Mr. Laidlaw will discuss the traps to the recognition of the syndrome and the choices of neurosurgical intervention. The second topic involves the clinical presentation of Moya Moya disease and its mimics. It is now no longer tenable to restrict the diagnosis to a few select ethnic groups (e.g. young Japanese females). Increasingly, the clinical entity is identified in the Western world. There is also an increasing awareness of atypical Moya Moya disease and its mimics. These will be discussed with particular emphasis on therapy which includes neurosurgical arterial bypass and endovascular stenting.
THE INSULIN RESISTANCE INTERVENTION AFTER STROKE (IRIS) AUSTRALIAN INVESTIGATORS MEETING
Karen Furie, Chris Bladin, Peter Keller
The Insulin Resistance In Stroke trial is a major NIH-funded stroke prevention trial with recruitment across North America, Israel, Australia, and Europe. This is a meeting for local site investigators and coordinators involved in the study. Presenters include Professor Karen Furie, Director Stroke Service and Stroke Prevention Clinic, Massachusetts General Hospital, and Principal Neurologist for the IRIS study, Associate Professor Mark Parsons and Dr Peter Keller.
ASTN is a special interest group of the Stroke Society of Australasia (SSA)