Correspondence to Geoffrey A. Donnan, MD, FRACP, Department of Neurology, National Stroke Foundation, 394-400 Little Bourke St, Melbourne 3000, Australia. E-mail donnan{at}austin.unimelb.edu.au
Summary of Report—The Melbourne Declaration on Stroke Management
of October 29, 1997, consisted of 9 key points made in the areas of
primary prevention, acute stroke, secondary prevention, organization of
stroke services, economic aspects, issues relating to developing
countries, remote and rural areas, evaluation of quality of care,
rehabilitation, and public health/education issues.
Conclusions—The consensus statement embodied in the Melbourne
Declaration provides a framework for countries to establish minimum
standards of stroke care and thus make a contribution toward reducing
the global burden of stroke.
The general aims of the conference were to produce a series of
statements with accompanying goals, specific interventions, and future
and research priorities in the following areas: (1) primary prevention,
(2) acute stroke, (3) secondary prevention, (4) organization of stroke
services, (5) economic aspects, (6) developing countries, remote and
rural issues, (7) evaluation of quality of care, (8) rehabilitation,
and (9) stroke, a public health and education issue.
The first part of the program consisted of a series of plenary sessions
in which experts in the field gave an overview of the topic that would
later be discussed in workshops. A poster session was also conducted in
which participants from various countries addressed aspects of stroke
management pertinent to their region.
In the second part of the forum, the workshops were conducted by
chairpersons and cochairpersons and assisted by rapporteurs. A draft of
a consensus statement was presented to the group after which
interactive discussion, modification of the statement, and/or complete
replacement with a new statement were undertaken.
The consensus statements were reviewed by a broadly based consensus
panel, the membership of which consisted of Professor Geoffrey Donnan
(Forum Chairman), Professor Stephen Davis (International Advisory
Committee), Dr Brian Chambers (Local Organizing Committee), Professor
Jean-Marc Orgogozo (Europe), Dr Tim Ingall (North America), Dr John
Orley (WHO), Dr David Dunbabin (geriatrics), Ms Louise Ada (allied
health), Dr Michael Fett (National Health and Medical Research
Council–Australia), Ms Barbara Lester (nursing), Dr Meng Wong
(Southeast Asia), Ms Franca Smarelli (nongovernment organizations), and
Dr Susanne Wright (consumers).
A final review of the statements was then undertaken at a session
involving all delegates. This version was presented and read as
the Melbourne Declaration on Stroke Management, October 29, 1997.
At the meeting, nine statements were made in response to this global
problem. (1) Primary prevention should form the cornerstone of a plan
to reduce the incidence of stroke. Both mass campaigns and those
focused on high risk groups should be used. (2) The general public and
healthcare professionals should be made more aware that stroke is a
medical emergency. Education needs to be provided concerning the signs
and symptoms of stroke and, wherever possible, specialized stroke units
or stroke teams need to be established to provide acute stroke care.
(3) Existing knowledge about methods to reduce the recurrence
of stroke following a first attack should be applied more broadly in
healthcare services and the community. (4) Concerning the organization
of stroke services, the views of patients, community groups, and
service providers need to be taken into account to ensure a seamless
service for patients as they move through the system. (5) The concept
of cost effectiveness needs to be embraced when developing management
plans for stroke prevention, acute treatment, rehabilitation, and
community integration. This should include the identification of
specific issues and items that determine the overall direct and
indirect costs of stroke. (6) It must be recognized that many countries
are unable to provide an ideal stroke service because of lack of
resources. However, in these countries it is still possible to
introduce or strengthen efforts that will reduce the incidence of
stroke, particularly by public health measures directed at risk factor
modification. It is also possible to identify or establish local teams
who would be clinically responsible for the delivery of stroke services
and provide training and education of other healthcare providers. (7)
Countries should establish systems for the collection of appropriate
data for measuring trends of incidence, prevalence, morbidity, and
mortality from stroke as well as data evaluating the quality of stroke
prevention and management at local, regional, and national levels. (8)
All stroke patients should have access to adequate rehabilitation
services directed toward achieving optimal function, independence, and
quality of life for patients through restorative care. (9) There is a
need to increase public and professional awareness of the massive
burden caused by stroke, to highlight its preventable nature by
recognition of modifiable risk factors and warning symptoms of stroke,
and to highlight the need for rapid response. This approach needs to be
underpinned by a strong research base.
Consensus Statement 1: Primary Prevention
Specific Interventions
Responsibilities
Consensus Statement 2: Acute Stroke
1. To make the public and healthcare providers more aware that stroke
is a medical emergency and provide education of the signs and symptoms
of stroke.
2. To provide access (including emergency transport) for all patients
with acute stroke to an acute care hospital and, wherever possible, to
specialized stroke units or stroke teams.
3. To introduce emerging acute stroke therapies using evidence-based
principles.
4. To establish the early diagnosis of cerebral infarction or
intracerebral hemorrhage, wherever possible
this should be by CT or other neuroimaging techniques.
5. To reduce the early mortality of acute stroke while improving the
proportion with minimal disability.
Specific Interventions
2. Evidence-based principles should be the basis for introduction of
new acute therapies; disproven treatments should not be used.
3. There is emerging evidence that thrombolysis may be
an effective form of therapy for ischemic stroke if
administered within 3 hours of stroke onset.
4. Modest elevation of blood pressure should not be treated in the
acute phase of ischemic stroke.
5. Aspirin given within 48 hours of acute ischemic stroke
slightly improves outcomes.
6. Early mobilization, early rehabilitation, attendance to potential
swallowing problems, and compressive stockings for paralyzed legs are
some factors likely to be of importance for good outcome.
7. Current evidence indicates that low- or intermediate-dose heparin
given subcutaneously does not improve stroke outcome, but may be
indicated for deep vein thrombosis prophylaxis. Low-molecular-weight
heparins are currently under investigation.
Research Priorities
2. Develop a better understanding of the pathophysiology of stroke
progression and early recurrence;
3. Develop new therapeutic strategies to improve the outcome of
intracerebral hemorrhage;
4. To identify factors (including hospital arrival time and emergency
room delay) that would increase the proportion of patients who would be
eligible for acute therapies;
5. Develop brain imaging techniques to facilitate early diagnosis of
stroke.
Consensus Statement 3: Secondary Prevention
2. To better define risk factors for recurrent stroke;
3. To introduce known means of reducing stroke recurrence more
broadly in the community eg, antiplatelet therapy.
Specific Interventions
2. Antiplatelet agents, such as aspirin, reduce the relative risk
of stroke or death by approximately 20% per year after transient
ischemic attack (TIA) or minor ischemic stroke. This
translates into an absolute benefit of 12 strokes (in 12 patients)
prevented per 1000 patients treated for 1 year, at a cost of
approximately 1 intracerebral hemorrhage.
Ticlopidine and clopidogrel are slightly more effective than aspirin.
The precise role of other antiplatelet strategies such as
dipyridamole and combination therapies remains under
surveillance.
3. In patients with TIA or minor stroke and nonvalvular atrial
fibrillation, warfarin reduces the relative risk of recurrent stroke by
about 70% and should be used in selected patients. In treating 1000
such patients, approximately 80 strokes will be prevented at a cost of
20 major hemorrhages per year. The use of anticoagulation is
associated with significant hazard and requires rigorous patient
selection and quality assurance. The therapeutic International
Normalized Ratio should be 2.0 to 3.0, based on the evidence from both
secondary and primary stroke prevention trials in patients with atrial
fibrillation.
4. In developing countries, rheumatic heart disease is also a major
cause of stroke. In these regions anticoagulant monitoring is a major
problem and should be made more accessible.
5. In appropriate patients with symptoms attributable to ipsilateral
carotid stenosis of 70% or more using North American
Symptomatic Carotid Endarterectomy
Trial (NASCET) criteria (equivalent to 80% European Carotid Surgery
Trial [ECST] criteria) carotid endarterectomy
reduces the relative risk of subsequent risk of stroke or death by
about 70% within 2 years. The benefits of surgery increase with
greater degree of stenosis and number of risk factors. Carotid
endarterectomy is associated with significant risk
and the combined angiographic and perioperative stroke
and death rate should be less than 6%. Therefore, surgical expertise
should be developed in selected centers. Extracranial carotid disease
is much less common in Asian populations.
Research Priorities
2. Trials of modification of risk factors for stroke recurrence
such as hypertension and elevated blood lipids
3. Development and testing of new antiplatelet agents to reduce the
incidence of stroke recurrence
4. Development and evaluation in controlled clinical trials of new
techniques such as angioplasty/stenting
5. Aspirin safety should be further assessed in Asian populations.
6. Alternative, safer, and cost-effective treatments for cardiogenic
embolism, particularly rheumatic heart disease, should be explored.
7. Monitoring and research in controlled clinical trials of the use of
new and alternative medical strategies, including vitamins,
acupuncture, and traditional medicines should be conducted.
8. Further research is needed into different types of cerebrovascular
disease and their prevalence in different geographical regions.
Consensus Statement 4: Organization of Stroke
Services
2. Strategies should be developed to promote education at both
community and professional levels to address stroke prevention, acute
stroke treatment, rehabilitation, and community services.
3. Strategies should be developed to focus resource allocation on the
following:
4. The views of patients, family, and caregiver have access to all
aspects of community stroke services available through the appointment
of a linkage coordinator.
5. The smooth coordination of services both locally and nationally
needs to occur among the different aspects of health care and delivery
of services.
Specific Interventions
2. To ensure comprehensive stroke care services the following should be
included:
3. The development of centers of excellence of stroke care
(ideally stroke units) that provide a model for the delivery of "best
practice" stroke care both nationally and locally.
Research Priorities
2. Monitor the effectiveness of the strategies to optimize
stroke-related health care.
Consensus Statement 5: Economic Aspects
2. To identify specific issues and items that determine the overall
(direct and indirect) costs of stroke.
3. To introduce the concept of cost effectiveness in stroke management
plans (primary prevention, acute management, rehabilitation, and
secondary prevention) appropriate to individual countries.
4. To introduce standard methodology for evaluating costs and
benefits.
5. To encourage a move from simple needs description to needs
prioritization (based on potential to benefit) and integration of needs
assessment with economic appraisal.
6. To educate clinicians, health planners, and the public about
economic issues related to stroke.
Specific Interventions
2. To recognize the need for increased study of cost effectiveness of
stroke management strategies including the evaluation of new
therapies
3. To establish priorities for the allocation of resources within
stroke management programs and between different disease processes to
optimize cost effectiveness and equity of resource allocation
Future Priorities
2. Set up a system for economic assessment (including clinical trials
and long-term follow-up studies) of new medical interventions in the
field of stroke and implement regular economic assessment of existing
interventions
3. Incorporate economic evidence in the development of best practice
guidelines
4. To determine the economic impact of alterations in stroke incidence,
prevalence, handicap, and mortality and priority setting of stroke
management in health service planning
Consensus Statement 6: Developing Countries, Remote and Rural
Issues
Eighty percent of these populations live in rural areas.
2. Stroke is a major health problem in developing countries. In the
next 30 years the burden of stroke will grow most in developing
countries rather than in developed countries.
3. Government and health planners in developing countries underestimate
the importance of stroke.
4. In rural areas and developing countries access to stroke services is
limited because of reasons such as geography, lack of resources, and
cultural practices.
5. It is recognized that there are special considerations regarding
risk factor management in developing countries, eg, antiplatelet
and anticoagulant therapy may be more hazardous. In addition, the
profile of risk factors not only includes recognized risk factors in
developed countries but also risk factors that are more common in
developing countries, eg, rheumatic heart disease and puerperal
stroke.
Goals
2. Establish priorities in terms of resource allocation for stroke
services—these should include stroke prevention as the most important
priority, in particular detection and management of hypertension,
prevention of smoking, and other lifestyle issues such as diet
3. To develop effective training programs for professional
caregivers
4. To develop effective public awareness and education programs for
stroke prevention, rehabilitation, and treatment
5. To collect accurate data on stroke
6. To develop ways of transferring rehabilitation knowledge and skills
to family members and other community workers as endorsed by the WHO
"Community Disability Services" initiative
Specific Interventions
2. Identify or establish key national institutions or organizations
that promote training and education of health professionals and
disseminate information
3. Establish a minimum data set to document and monitor key indicators
of stroke at national, regional, and local levels
4. Countries should demonstrate implementation of these strategies by
the year 2010.
Consensus Statement 7: Evaluation of Quality of Care
General Principles
2. Quality of care is concerned with the following:
3. Comparisons between services should not be made unless
variations in patient characteristics that may effect outcomes (eg,
age, stroke severity, socioeconomic, environment, culture, health, and
social sector resources) are taken into account. Ultimately, such
comparisons may prove impossible to be made reliably.
4. Priorities for evaluation must be set relevant to national,
regional, and local needs.
5. Special consideration should be given to views of patients, their
caregivers and the general public in defining the scope of
evaluation.
6. Evaluation for the purposes of monitoring public health and
standards of care should include indicators for the following:
7. The cost of data collection should be commensurate with the
value of obtaining the information.
8. The accuracy of existing mortality and hospital statistics should be
improved.
9. Evaluation of stroke services will require more detailed, accurate,
and timely information from primary care providers, hospitals, and
other service providers.
Research Priorities
2. Definition of what to measure, how to measure, and when to
measure
Consensus Statement 8: Rehabilitation
Rehabilitation comprises assessment, goal planning, intervention, and
evaluation. This should be delivered in the setting most appropriate to
the individual.
2. Financial, clinical, and community resources for rehabilitation must
be provided in proportion to the level of stroke disability in a
community.
Specific Interventions
2. Initial rehabilitation goals should be patient oriented and
involve the person, family, other caregivers, and rehabilitation team
members.
3. Effective rehabilitation interventions require collaboration
between all persons involved in the individual's care.
4. Ongoing evaluation is essential to ensure that the changing
recovery and care needs of stroke patients are monitored and met.
Research Priorities
2. Understanding of the interrelationship between pathology and the
mechanisms of change in impairment, disability, and handicap is
essential to the development of effective rehabilitation
strategies.
Consensus Statement 9: Stroke: A Public Health and Education
Issue
2. To implement preventative programs such as the "Brain Attack"
campaign.—the aim is to involve the community, professional bodies,
non-government organizations, and governments to increase public and
professional awareness, to bring about lifestyle changes, and to ensure
appropriate medical and rehabilitation management.
3. To increase awareness and knowledge among the community and
healthcare providers of the preventable nature of stroke
4. To highlight the modifiable risk factors of stroke
5. To educate the public and healthcare workers about the warning
symptoms for stroke and the need for a rapid response
6. To recognize the public health issues that arise in the post-stroke
phase
Specific Interventions
1. The mass approach to primary prevention—this should include public
education about lifestyle factors for all people.
2. The high risk approach to primary prevention by educating those
with existing risk factors for stroke.
3. The education of the public and healthcare providers concerning the
warning symptoms of stroke and that these are medical emergencies.
4. The emphasis on the importance of the continuum of care approach of
stroke management from the acute event through to long-term community
support. Secondary prevention of stroke must form an important element
of this.
5. To develop global, regional, and national guidelines for
rehabilitation.
6. To underpin the campaign with a strong and comprehensive research
base.
International Advisory Committee
Local Organizing Committee
Consensus Panel
Plenary Sessions—Chairs and Cochairs
Plenary Sessions—Discussants
Workshop Chairs
Workshop Rapporteurs
Received April 7, 1998;
revision received May 4, 1998;
accepted May 4, 1998.
© 1998 American Heart Association, Inc.
Special Report
Asia Pacific Consensus Forum on Stroke Management
Abstract
Top
Abstract
Introduction
Scope and Purpose
Methods
The Melbourne Declaration of...
Appendix
COMMITTEES
Background and Purpose—Because of
the enormity of the burden of stroke globally, there is a real need to
develop strategies to reduce its impact. With this in mind, the World
Health Organization (Division of Mental Health and Prevention of
Substance Abuse) together with the National Stroke Foundation
(Australia) sponsored the Asia Pacific Consensus Forum on Stroke
Management in Melbourne, Australia, in October 1997.
Representatives from the European Stroke Council,
American Heart Association, Canadian Heart Association, Stroke Society
of Australasia, and South-East Asian Stroke Association were involved,
together with other delegates from Southeast Asia, Asia, North America,
Europe, the Middle East, South Africa, and the subcontinent.
Contributions from delegates allowed a broad set of principles to be
put in place concerning stroke management that may be generalizable
globally and with specific emphasis on the Asia Pacific
region.
Key Words: stroke management • consensus document • guidelines
Introduction
Top
Abstract
Introduction
Scope and Purpose
Methods
The Melbourne Declaration of...
Appendix
COMMITTEES
Stroke is the second
most common cause of death globally, although, paradoxically, the
problem tends to receive less attention than many other disease
processes from healthcare providers. As the world population ages, the
burden due to stroke is likely to increase in regions such as Asia,
where an increase in risk factors such as smoking and the introduction
of western dietary patterns is also occurring. Other groups, such as
women, may also need attention because of their longer lifespan and
increase in smoking incidence. In order to contain the problem, minimum
standards concerning stroke management need to be set to provide a
framework within which governments may work. This document addresses
many of these issues.
Scope and Purpose
Top
Abstract
Introduction
Scope and Purpose
Methods
The Melbourne Declaration of...
Appendix
COMMITTEES
This consensus meeting was an initiative of the World Health
Organization (WHO, Division of Mental Health and Prevention of
Substance Abuse) and the National Stroke Foundation (Australia).
Representatives from the European Stroke Council,
American Heart Association, Canadian Heart Association, Stroke Society
of Australasia, and South-East Asian Stroke Association were also
involved. It was thought that since the first WHO-sponsored consensus
meeting in Helsingborg for the European population new issues had
arisen that could be addressed in a second consensus forum. Specific
issues related to the Asia Pacific Region also needed to be addressed.
To obtain a broad representation, delegates from Southeast
Asia, Asia, North America, Europe, the Middle East, South Africa, and
the subcontinent were invited to contribute so that a broad set of
principles could be put in place concerning stroke management. At the
same time, regional variations in available resources for healthcare
management in general could be taken into account.
Methods
Top
Abstract
Introduction
Scope and Purpose
Methods
The Melbourne Declaration of...
Appendix
COMMITTEES
The delegates were initially addressed by the following speakers
at the opening ceremony: Right Honorable Robert Knowles, Minister of
Health, Victoria, Australia; Dr John Orley, Program Manager, Program on
Mental Health, Division of Mental Health and Prevention of Substance
Abuse, World Health Organization, Geneva, Switzerland; and Professor
Geoffrey A Donnan, Director of Research, National Stroke Foundation,
Melbourne, Australia.
The Melbourne Declaration of the Asia Pacific Consensus Forum on
Stroke Management
Top
Abstract
Introduction
Scope and Purpose
Methods
The Melbourne Declaration of...
Appendix
COMMITTEES
Stroke is a public health problem that contributes significantly
to the global burden of disease, and is predicted to become an even
greater burden within the next 25 years, given the ageing of the
population and the increase in other risk factors.
Goal
To formulate and implement community specific programs for
reducing the incidence of stroke and vascular dementia.
In each community we should: (1) measure trends of incidence,
prevalence, morbidity, and mortality of stroke; (2) determine risk
factors for stroke; (3) devise specific targets through an
understanding of cost-effectiveness, equity, and resource allocation;
(4) introduce strategies targeted at the whole population to encourage
a healthy lifestyle, including smoking cessation, regular exercise, and
reduction of obesity, cholesterol, excessive intake of
salt, dietary fat, and alcohol, and other relevant risk factors. These
strategies should be integrated within a broad prevention health
promotion program targeted at all vascular diseases; (5) identify,
treat, and monitor those with hypertension, diabetes, atherosclerotic
vascular disease, and cardiac diseases that predispose to stroke (such
as atrial fibrillation, myocardial infarction, and rheumatic heart
disease); (6) Educate the community about stroke, its presenting
symptoms and the risk factors which predispose to stroke; (7) improve
compliance with lifestyle recommendations and medical treatments to
reduce stroke risk; (8) carotid endarterectomy for
asymptomatic carotid stenosis may be of benefit in
selected patients but the benefits of surgery do not warrant mass
screening programs.
The responsibility for primary prevention of stroke is shared. The
parties include the following:
Goals
The following guidelines can be adopted according to the extent of
resources in each region.
1. There is definite evidence that management in a specialized
stroke unit environment improves mortality and outcome in a
cost-effective way.
1. Development and testing in clinical settings of new therapeutic
principles that may also be effective during longer time windows after
the onset of acute ischemic stroke;
Goals
1. To reduce the incidence, disability, dependency and mortality
from recurrent stroke;
1. Modification of adverse lifestyle and major risk factors such
as hypertension, diabetes, lipids, smoking, and alcohol abuse is
desirable after stroke.
1. Identification of risk factors or predictors of stroke
recurrence
Goals
1. Organizational strategies should be developed in each country
to optimize stroke care. These strategies should take into account
local, national, and global needs, as well as the availability of
resources.
1. Organizational strategies should be developed at all levels
including the local level (urban, rural, and remote), taking into
consideration resource availability, cultural diversity, and
geographical constraints.
1. To develop information databases, which assess and
evaluate:
Goals
1. For each country to have an assessment of the economic impact
of stroke and to have a worldwide view to reducing the burden of
stroke.
1. To develop an increased knowledge of the frequency and types of
stroke together with costs of stroke in developing countries (both
monetary and resource based)
1. Assess the potential health gains and cost implications of
implementing best practice in stroke management
Issues
1. Two thirds of the world population lives in developing
countries.
1. To increase awareness of stroke among health planners and
government in developing countries
1. Identify local individuals or teams within a defined community
who are responsible for the implementation and delivery of stroke
services, eg, rural and community health workers or stroke teams
Goals
1. Countries should establish monitoring systems for routine
collection of appropriate basic data needed to evaluate the quality of
stroke prevention and management at local, regional, and national
levels.
1. For evaluation to be meaningful, the stroke services structure
(ie, staffing, buildings and organization), process (ie, the way
services are conducted), and outcome (ie, the effects of services) need
to be assessed.
1. Establishing the key indicators of process and outcome
Goals
1. All stroke patients should have access to rehabilitation aimed
at achieving optimal function, independence, and quality of life
through restorative care, including locally and culturally available
resources.
1. All stroke patients must be assessed as early as feasible to
establish the initial rehabilitation goals.
1. Evidence-based rehabilitation practice requires that a range of
scientifically valid studies be performed to evaluate potential
rehabilitation strategies, including clinical and pharmacological
treatments.
Goals
1. To have a vertically integrated approach to the burden of
stroke involving government at international, national and local
levels—programs put in place should have achievable goals and
practical strategies, involve all stakeholders, and emphasize the
importance of research.
To focus the "Brain Attack" prevention program on the
following areas:
Appendix
Top
Abstract
Introduction
Scope and Purpose
Methods
The Melbourne Declaration of...
Appendix
COMMITTEES
COMMITTEES
Top
Abstract
Introduction
Scope and Purpose
Methods
The Melbourne Declaration of...
Appendix
COMMITTEES
International Program Committee
G. Donnan (Chairman), Australia; H. Adams, USA; S. Ahmad,
Indonesia; N. Anderson, New Zealand; A. Aquino, Philippines; N.
Bharucha, India; S. Davis, Australia; D. Gunawan, Indonesia; R. Kay,
Hong Kong; L. Lisheng, People's Republic of China; W Ng, Malasia; J.
Norris, Canada; J. Orley, WHO, Switzerland; N. Ramani, Singapore; F.
Smarelli, Australia; T. Stewart-Wynne, Australia; M. Wong, Singpore; T.
Yamaguchi, Japan.
S. Davis (Chairman), Australia; K. Asplund, Sweden; H. Barnett,
Canada; J. Bogousslavsky, Switzerland; N. Bornstein, Israel; G. Boysen,
Denmark; P. Dalal, India; G. Donnan, Australia; J. Easton, United
States; S. Ebrahim, United Kingdom; V. Fritz, South Africa; T. Ingall,
United States; M. Kim, South Korea; J. McNeil, Australia; T. Ome,
Japan; J. Orgogozo, France; C. Silagy, Australia; C. Tan, Malaysia; C.
Warlow, United Kingdom; M. Wong, Singapore.
B. Chambers (Chairman), Australia; C. Anderson, Australia; C.
Bladin, Australia; D. Crimmins, Australia; C. deWytt, Australia; D.
Dunbabin, Australia; J. Frayne, Australia; P. Gates, Australia; G.
Hankey, Australia; D. Rosen, Australia; F. Smarrelli, Australia; M.
Vampatella, Australia; A. Iacuone (Conference Coordinator),
Australia.
G. Donnan, Forum Chairman; S. Davis, International Advisory
Committee; B. Chambers, Local Organizing Committee; J.
Orgogozo, Europe; T. Ingall, North America; J. Orley, World
Health Organization; D. Dunbabin, Geriatrics; L. Ada, Allied Health; M.
Fett, NHMRC, Australia; B. Lester, Nursing; M. Wong, SE Asia; F.
Smarelli, Non-Government Organizations; S. Wright, Consumers.
G. Donnan, Australia; A. Podger, Australia; S. Davis, Australia;
H. Barnett, Canada; T. Omae, Japan; B. Chambers, Australia; R. Eccles,
Australia; T. Stewart-Wynne, Australia; M. Fett, Australia; G. Hankey,
Australia; W. Ng, Malaysia; A. Terent, Sweden; C. Anderson,
New Zealand; J. Orgogozo, France; J. Easton, USA; T. Yamaguchi, Japan;
D. Wade, UK; P. Disler, Australia; S. Ebrahim, UK; R. Kay, Hong Kong;
J. Chopra, India; L. Lisheng, People's Republic of China; J.
Norris, Canada; M. Fisher, USA; J. Whitworth, Australia; R. Judd,
Australia.
N. Bharucha, Bombay India; V. McLoughlin, Australia; J. McNeil,
Australia; R. Walker, Australia; D. Dunbabin, Australia; R. Carter,
Australia; N. Ramani, Singapore; D. Cadilhac, Australia; G. Cooper,
Australia; D. Crimmins, Australia; J. Royle, Australia; A. Aquino,
Philipines; N. Anderson, New Zealand; J. Yeo, Malaysia; J.
McMeekan, Australia; J. Oliver, Australia; J. Douglas,
Australia; D. Wade, UK; G. Close, Australia; A. Reddy, Australia; D.
Gunawan, Indonesia; V. Fritz, South Africa; H. Flavell, Australia; C.
Williams, Victorian Aboriginal Health Service; D. Rosen, Australia; F.
Smarelli, Australia; M. Stanford, Australia; S. Ahmad,
Indonesia.
M. Wong, Singapore; G. Boysen, Denmark; S. Davis, Australia; L.
Caplan, United States; N. Bornstein Israel; D. Rosen, Australia; S.
Ebrahim, UK; T. Ingall, United States.
A. Thrift, Australia; C. Bladin, Australia; C. DeWytt,
Australia; D. Crimmins, Australia; D. Dunbabin, Australia; K. Wong,
Hong Kong; R. Gerraty, Australia; J. Frayne, Australia.
Acknowledgments
Educational grants were received from the following. Major
Supporter: Commonwealth Department of Health and Family Services,
Canberra. Contributing Partner: Department of Human
Services, Victoria. Sponsors: AusAID, Australian Tourism
Commission, Boehringer Ingelheim Pty Ltd, the City of
Melbourne, Faulding Pharmaceuticals, Janssen-Cilag Pty Ltd, Melbourne
Convention and Marketing Bureau, Qantas Airways Limited, Rhone-Poulenc
Rorer Australia Pty Ltd, Rhone-Poulenc Australia Holdings Pty Ltd, and
UCB Pharma Singapore Pty Ltd.
Footnotes
A list of the committees and key participants appears in the Appendix.
This article has been cited by other articles:
 |
|
 |
|
  L. Hilbrich and P. Sleight Progress and problems for randomized clinical trials: from streptomycin to the era of megatrials Eur. Heart J., September 2, 2006; 27(18): 2158 - 2164. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. G. Hart and R. D. Bailey An assessment of guidelines for prevention of ischemic stroke Neurology, October 8, 2002; 59(7): 977 - 982. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Anderson, S. Rubenach, C. N. Mhurchu, M. Clark, C. Spencer, and A. Winsor Home or Hospital for Stroke Rehabilitation? Results of a Randomized Controlled Trial : I: Health Outcomes at 6 Months Stroke, May 1, 2000; 31(5): 1024 - 1031. [Abstract] [Full Text] [PDF]
|
|
| |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||