Director and Chairman’s Reports

The burden of stroke remains one of the main disease issues facing us globally. As the second most common cause of death and major cause of disability there is a continuing need to develop strategies for prevention and treatment of stroke. Fortunately, over the last 30 years there have been enormous advances in both of these areas. It is extraordinary to think that as recently as the 1970’s, there were no proven forms of intervention for acute stroke or its secondary prevention.

We now know that the three interventions of proven benefit for patients with acute stroke are:

• the use of intravenous tissue plasminogen activator within 3 hours,
• oral aspirin within 48 hours and,
• management in a stroke unit.

For secondary prevention it is now well established that:

• the use of antiplatelet agents
• blood pressure lowering using such agents as perindopril and indapamide, or ramipril
• the use of warfarin for patients in atrial fibrillation,
• carotid endarterectomy for those with high grade symptomatic carotid stenosis, and
• lipid lowering with some statins reduce the probability of recurrent stroke.

Reassuringly, during this period national figures for stroke mortality have continued to fall but may now be levelling out. Unfortunately we are not really certain as to whether stroke incidence is also falling. In other words, there remains much to be done in spite of these significant advances.

To address the problem of stroke across its entire spectrum, the National Stroke Research Institute is structured in a “vertically integrated” fashion. This ranges from divisions of basic science, imaging, and ultrasound through to neurorehabilitation, clinical trials, epidemiology and public health. It is significant that members of NSRI and members of its Collaborating Centres have been involved in the advances made over the last 30 years in significant ways. Our current Collaborating Centres are:

• Dr. Romesh Markus at St. Vincent’s Hospital in Sydney,
• Associate Professor Neil Simms from Adelaide,
• Dr Jonathan Sturm from Gosford,
• Associate Professor Chris Levi from the John Hunter Hospital,
• Professor Graeme Hankey from the Royal Perth Hospital,
• Dr. Stephen Read and Associate Professor Jonathan Chalk from the University of Queensland and Royal Brisbane Hospital,
• Professor Stephen Davis from the Royal Melbourne Hospital and
• Dr. Mark Mackay and Anne Gordon from the Royal Children’s Hospital.

These collaborative links are strong and provide a strong network of stroke research across Australia.

Our Institute continues to grow. A new division has been added—Statistical and Decision Support, headed by Associate Professor Leonid Churilov. He comes very highly recommended with a strong background in research in the statistical aspects of decision making including the health care sector. This Division is one of the most important additions to NSRI since its inception as the need for statistical support at all levels of the biosciences is acute. Professor Churilov will not only provide a statistical support platform but also develop research programs of his own so that the Division will gradually grow in subsequent years.

We are delighted to announce that NSRI has become an affiliated Institute of La Trobe University, particularly associated with the Faculty of Health Science and School of Psychological Sciences.

On June 30th 2007, The National Stroke Research Institute amalgamated with the Brain Research Institute and the Howard Florey Institute in a federated model such that each institute will keep its identity but benefit from the enormous advantages of increased critical mass under the new Florey Neuroscience Institutes. The \Mental Health Research Institute will also participate by co-locating and integrating its research activities within the Florey Neuroscience Institutes. The Austin Hospital through Austin Health and the University of Melbourne are also participating in the creation of the Florey Neuroscience Institutes, which when complete is planned to rank as one of the leading neuroscience research institutes in the world, with new state of the art facilities based at both the Austin Hospital and the University of Melbourne's Parkville campus. The overall cost of the developments on both Austin and Parkville campuses is in the order of $200m.

There are many advantages for the NSRI, its dedicated researchers and partners in its Collaborating Centres in the new structure. Advantages flow from being able to participate in and contribute to a larger and richer agenda of cross disciplinary research that will contribute to better clinical outcomes for stroke patients, the capacity to attract greater amounts of research funding and, perhaps most importantly, the enhanced career opportunities available to researchers in a larger enterprise.

To protect the benefits that will flow to the NSRI and its research program there are safeguards built into the new arrangements intended to ensure the preservation and enhancement of the NSRI's research programs.

The Chairman and I thank all the dedicated researchers at NSRI and its Collaborating Centres for what has been another most successful year in which significant advances have been made in knowledge concerning the problem of stroke ranging from the basic sciences right through to public health issues.

We would also like to acknowledge the outstanding work and commitment from our Board Members, Graeme Bowker and John Lill, and we have no doubt that they will make an equally valuable contribution as members of the FNI Board of Governors. We wish to extend a warm welcome Mr Charles Allen who joined the NSRI Board of Directors and has become the Chairman of the FNI Board.

Geoffrey A. Donnan, Director
Robert Trenberth, Chairman