NISAN - Current Projects

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Current Projects

Our current projects are:

  • Auckland Regional Community Stroke Study (ARCOS IV)
  • Global Burden of Disease Stroke Project
  • Primary Prevention of Stroke in the Community (PRESCO)
  • Prevalence of Neuromuscular Conditions in New Zealand
  • Auckland Transient Ischemic Attack Study (ATIAS)
  • European Union Center-TBI Collaboration
  • Long-term impact of initial and recurrent TBI in the NZ community
  • Stroke self-management rehabilitation trial (SMART)
  • Teen online problem solving - New Zealand
  • Traumatic brain injury - infant genetics study
  • Geomagnetic weather triggers of acute stroke:  manmade or heaven sent?
  • Can an online cognitive behavioural programme improve outcomes for people following TBI
  • Case classification of mild-TBI
  • Sleep and napping behaviour in fibromyalgia syndrome
  • NeuroAid (BRAINS)

Listed below are details of all the research projects that are currently hosted by the NISAN. If you require any further details, please contact the Institute Administrator Helen McDonald directly on +64 (0)9 921 9174 or via email at helen.mcdonald@aut.ac.nz 

AUCKLAND REGIONAL COMMUNITY STROKE STUDY (ARCOS IV) 

Contact:


Timeline: The study commenced in March 2010 and will  run for five years.

The Auckland Regional Community Stroke (ARCOS) IV; Measuring and Reducing the stroke burden in New Zealand, is a five year programme (2010-15) with five inter-linked objectives and three distinct study designs, providing a multi-perspective evidence-base to assess and reduce stroke burden in New Zealand.

The study has been awarded funding by the Health Research Council, and is led by Professor Valery Feigin as the Principle Investigator, and Professor Kathryn McPherson and Dr Suzanne Barker-Collo as Co-Principle Investigators.

Stroke is the second most common cause of death worldwide and a frequent cause of adult disability in developed countries. The aim of the ARCOS study is to measure and reduce stroke burden in New Zealand. This unique population-based approach will allow examination of trends in stroke incidence, prevalence and outcomes for a fourth decade (flowing on from previous ARCOS I, II and III studies); examination of effectiveness of primary and secondary prevention strategies adopted over the last 30 years.

A second component of the study, Motivational Interviewing Stroke Trial (MIST), is to evaluate a novel, potentially widely applicable behavioural intervention to reduce stroke recurrence.  The goal of this intervention is to prevent a second stroke with clients.  We aim to do this by giving clients a forum in which to discuss their physicians' recommendations (such as medications, physical activity and diet) as well as their overall health.  All topics are open for discussion because we understand that many areas of life connect to health and happiness.

In addition, a third, qualitative component of the study lead by Professor Kathryn McPherson, will examine the long-term impact of stroke.

ARCOS IV Research Assistants


GLOBAL BURDEN OF DISEASE STROKE PROJECT

Contact:

The Global Burden of Disease (GBD) stroke study aims to generate comparable information on disease burden in 21 regions of the world. The new round of the GBD stroke study will conduct systemic reviews of studies from 1990 to 2010 to estimate incidence, prevalence, case fatality and cause specific mortality for stroke risk factors. NISAN is the international headquarters for the stroke project and contributes to the GBD study.  The project aims to collate the most comprehensive database of all epidemiological data on stroke. We invite researchers to submit relevant data on stroke incidence, prevalence and outcome.


MEMBERS OF THE STROKE EXPERT PANEL:
Andrew Moran, USA; Myles Connor, UK; Carlene Lawes, NZ; Ralph L Sacco, USA; Derrick Bennett, UK; Rita Krishnamurthi, NZ; Emma Witt, NZ; Suzanne Barker-Collo, NZ; George Mensah, USA; Thomas Truelsen, Denmark; Hannah Gardener, USA; Valery Feigin, NZ (Chairman); Jeyaraj D. Pandian, India; Varsha Parag, NZ; Laurie Anderson, Australia; Wenzhi wang, China; Majid Ezzati, USA; Yukito Shinohara, Japan; Martin O’Donnell, Ireland


PRIMARY PREVENTION OF STROKE IN THE COMMUNITY (PRESCO)

Contact:


Stroke is a major cause of death and disability worldwide, yet 90% of strokes can be prevented by adequate control of modifiable risk factors (e.g. high blood pressure, diabetes, smoking) through lifestyle modifications and medications. Individuals at a high risk of stroke can be identified by their family doctor through a cardiovascular disease risk calculator (PREDICT).

Those at a high 5-year risk should be prescribed medications and/or given recommendations to lifestyle changes to reduce cardiovascular risk. However, adherence to these recommendations is low, resulting in preventable strokes. Health/Wellness Coaching is a psychological intervention that may enhance adherence to doctor’s recommendations, and reduce stroke risk.

This study aims to determine the feasibility of a planned randomised clinical trial to test the effectiveness of health/wellness coaching for the primary prevention of stroke and cardiovascular disease in the community. 

Aims
The aim of the study is to help identify any issues that need to be addressed before commencing a full scale randomised clinical trial to test the effectiveness of Health and Wellness Coaching (HWC) in reducing the risk of stroke and cardiovascular disease in the community.

Design
This study is a phase II, open label, single centre randomised control trial (n=24) addressing feasibility issues of HWC coaching for primary stroke prevention in high stroke and CVD risk subjects to inform the design and methodology of statistically powered phase III randomised controlled trial.

Outcome Measures
The main outcome of the study will be feasibility of screening for eligible participants at primary healthcare practices in Auckland, rate of recruitment, rate of retention in the study and level of completion of case record forms and feedback from study participants. Relevant information to be collected in the full trial such as demographic information and other relevant medical information will be recorded for each study participant. To assess behaviour modification, each study participant will complete questions on general health and lifestyle information such as smoking status, diet, exercise, and medications during the phone interview at baseline and 3 months after the randomisation.


PREVALENCE OF NEUROMUSCULAR CONDITIONS IN NEW ZEALAND

Contact: 

Neuromuscular conditions can have a significant impact on people’s ability to participate in everyday life, however we currently have no data as to how many people are living with a neuromuscular conditions in New Zealand.

This study will include a review of the international literature on the prevalence (frequency) of neuromuscular conditions in other countries. Figures from the literature will be combined with data of known cases in New Zealand (NZ) to provide estimates of the frequency of different types of neuromuscular conditions in our country.

The study is being funded by the Neuromuscular Research Foundation Trust and the Richdale Charitable Trust.


AUCKLAND TRANSIENT ISCHEMIC ATTACK STUDY (ATIAS)

Contact:


Principle Investigator:
Professor Alan Barber

Named Investigators:
Prof Valery L Feigin
Dr Neil E Anderson
Dr Dean K Kilfoyle
Dr Edward Wong
Dr Rita V Krishnamurthi

Hypothesis:

  1. That the incidence of transient ischemic attack (TIA) in Auckland is higher than other developed countries.

  2. That the risk of stroke and cardiovascular disease following TIA in Auckland is greater than other developed countries.

  3. That the ABCD2 stroke risk stratification score is less accurate at predicting adverse outcomes than originally reported.


Aim:

  1. To determine the community-based incidence, outcome and risk factor profile of TIA in an ethnically mixed population.

  2. To determine the accuracy of the ABCD2 stroke risk stratification score in a general practice, emergency department and specialist TIA clinic, and whether it requires modification.


Abstract of Research:

TIA can be simply defined as stroke-like symptoms and signs that resolve within 24 hours. About 25% of people with ischemic stroke have a preceding or warning TIA. Recent evidence highlights that the risk of stroke following TIA is greatest in the first 48 hours but may still be as high as 10% at 30 days and 20% at 90 days. Studies have shown that this risk of stroke can be reduced by up to 80% by rapid assessment, investigation and commencement of secondary prevention measures.

There have been few population based studies of the incidence and outcome of TIA. Most of these studies were performed over 10 years ago before there was widespread use of medications to lower cholesterol levels and blood pressure low and surgical intervention in patients with internal carotid artery stenosis. Even fewer TIA studies have looked at the effect of ethnicity on incidence and outcome.

We will test the hypotheses that the incidence of TIA is higher, and the outcome is worse, in Auckland than in other developed countries, and this may be explained by differences in our ethnically diverse population. We will also examine the accuracy of the ABCD2 stroke risk stratification score and determine if it should still be recommended in national and international stroke and TIA guidelines, or if (and how) it should be modified.

We will identify all patients with TIA between 1st March 2011 and 28th February 2012 who are aged 15 years or older and resident in Auckland, including those patients presenting to hospital or who are managed in the community. The patient identification processes of the fourth Auckland Regional Community Stroke study (ARCOS IV) will be utilised. All participants will be assessed at day 90 and 12 months.

Crude and age, ethnic, and sex standardized TIA incidence (first-ever events) and attack (all events) rates of stroke per 100 000 people will be determined. The incidence of stroke and other adverse cardiovascular events at 48 hours, 7 days, 90 days and 12 months will be determined. The ability of the ABCD2 score to discriminate between those who go on to have a stroke and those who do not, will also be determined.

This study has a high potential to play a central role in the planning of services and development of health policy in relation to TIA and stroke, within New Zealand and internationally, and be used to inform evidence-based recommendations for health care.

ATIAS will conclude in September 2013.

Funded by:

  • The Auckland Medical Research Fund, and The New Zealand Neurological Foundation



EUROPEAN UNION CENTER-TBI COLLABORATION

Contact:


Traumatic brain injury (TBI) represents one of the greatest unmet needs in medicine and public health worldwide. To help impact on the treatment and prevention of brain injury at an international level, NISAN is part of the European Union CENTER-TBI collaboration.

The collaboration includes researchers from over 40 centres from across 19 countries with expertise in brain injury. The collaboration aims improve characterization and classification of TBI, and to improve health care delivery and treatment by identifying the most effective clinical interventions to inform treatment recommendations and guidelines. This is the largest in the world TBI epidemiological project.

The collaboration is being funded by the European Union Commission. Through the sharing of anonymised data (to enable more intricate analyses which larger patient numbers), resources and expertise, this landmark project aims to greatly enhance knowledge and improve outcomes for people following a brain injury.


LONG-TERM IMPACT OF INITIAL AND RECURRENT TBI IN THE NZ COMMUNITY

Contact:


Timeline:

  • October 2013 to September 2016


In the BIONIC study we revealed that rates of brain injury were far higher than we had previously thought. We also revealed that the short term burden of brain injury had been grossly underestimated with many people experiencing moderate to severe levels of cognitive impairment, emotional disturbance and post concussive symptoms one year following injury even including those who had experienced a ‘so called’ mild injury.  The Long-term impact of initial and recurrent TBI in the NZ Community study aims to follow up that cohort of patients 4 years post-injury to see how they are doing.

Funded by:

  • The Health Research Council of New Zealand.


STROKE SELF-MANAGEMENT REHABILITATION TRIAL (SMART)

Contact:

Stroke is a leading cause of death in the world and a major cause of long-term adult disability. The emotional and socioeconomic impact of stroke on patients, families, and health services is enormous. However, the availability of community rehabilitation after hospital discharge is limited. Given the increasing number of stroke survivors, there is an urgent need to develop alternatives to costly face-to-face therapist rehabilitation to support stroke survivors and their families.

One strategy is to maximise the benefits of new technologies, such as instructional DVDs.  Prof. Valery Feigin and colleagues have developed a novel, role model observational learning tool for stroke recovery and coping (in DVD format). 

We are now undertaking a prospective pilot clinical trial and recruiting stroke survivors and their families to help explore the effectiveness of the DVD-based learning tool.  We aim to recruit 700 stroke survivors and their families worldwide. Current study sites are located in Australia, New Zealand, Canada, Singapore, UK, USA, and India. 

The pilot study will allow us to explore the feasibility of recruitment and likely level of support required for individuals to benefit from the DVD-based intervention. We also aim to identify those stroke survivors who may be most likely to benefit from the intervention and in what ways they benefit from participation in the study.  Identifying barriers to fully participating in the trial will also be important.

Together, information from this pilot trial will be vital for informing the design of a full-scale randomised controlled trial.  If proven to be effective, this unique DVD observational learning tool may have a vital and positive impact on reducing stroke burden within our communities, as well as worldwide. Findings will be relevant to clinicians, rehabilitation specialists, stroke researchers and policy makers involved in maximizing the recovery of stroke survivors and reducing burden for family caregivers.

COLLABORATORS:

  • National Institute for Stroke and Applied Neurosciences, AUT University, Auckland, NZ – Prof. Valery Feigin, Dr R Krishnamurthi, Dr A Theadom, A/Prof. S Barker-Collo, Dr K Jones
  • North Shore Hospital, NZ – Dr Yogini Ratnasabapathy
  • University of Otago, Palmerston North, NZ – Dr Anna Ranta
  • Griffith Health Institute, Griffith University, Queensland, Australia – Prof. E. Kendall, Dr A. Maujean, Dr C. Ehrlich
  • Monash University, Melbourne, Australia – Prof. A. Thrift, A/Prof. D. Cadilhac
  • Emory University, Atlanta, USA – Prof. S. Wolf, Assistant Prof. S. Blanton
  • School of Physiotherapy, Dalhousie University, Halifax, Nova Scotia, Canada – Prof. M. MacKay-Lyons
  • Govind Ballabh (G B) Pant Hospital, New Delhi, India – Prof. M. M. Mehndiratta
  • Christian Medical College, Ludhiana, India – Prof. J. Pandian
  • University of Melbourne, Melbourne, Australia – A/Prof. F. Khan


Funded by:

  • NISAN with support from the New Zealand Stroke Education Charitable Trust.



TEEN ONLINE PROBLEM SOLVING – NEW ZEALAND (TOPS-NZ)

Contact:


Traumatic brain injury (TBI) is a leading cause of disability for young people in New Zealand, frequently resulting in long term difficulties with problem-solving, planning, organisation and maintaining social relationships. This study will evaluate an innovative internet-based problem-solving treatment program developed specifically for adolescents’ after a head injury and their families (Teen Online Problem Solving Intervention: TOPS).

Developed by Professor Shari Wade, a US-based international expert on paediatric TBI, this intervention aims to reduce the long-term consequences of head injury throughout adulthood and help people to achieve at school and in employment. This study will include focus group discussions and measures to capture feedback about the website content of the TOPS program, potential suitability for use in New Zealand, and recommendations for future development. 

Longer-term, if participation in TOPS is found to be effective in reducing the long term effects of head injury, and it is more affordable to provide, and more accessible than traditional health services, this will mean more teens throughout New Zealand can access high quality treatment to improve the recovery following a head injury.

COLLABORATORS:

Lead:  Dr Kelly Jones.

Co-investigators include:
Assoc. Prof. Suzanne Barker-Collo (University of Auckland)
Professor Shari Wade (Cincinatti Children's Hospital)
Ms Priya Parmar (AUT University)
Dr Alice Theadom (AUT University)
Prof. Valery Feigin (AUT University)

Funded by:

  • AUT University Faculty of Health and Environmental Sciences Contestable Dean’s Café Funding with support from NISAN.


TRAUMATIC BRAIN INJURY - INFANT GENETICS STUDY

Contact:


Traumatic brain injury (TBI) is the single most common cause of death and disability in children worldwide, with enormous risks for subsequent cognitive deficits and behavioural problems associated with life-long implications, even after a mild injury. 

Compared to older children, infants may be especially vulnerable to developmental impairment or delay after TBI due to increased physical and neurological vulnerability. However, the long-term effects of TBI in infants and factors that influence recovery are not well understood.  In particular, almost nothing is known about the role of specific genetic contributions to recovery, as well as possible gene-gene and gene-environment interactions influencing children’s development after TBI. 

Before undertaking such a study, it is necessary to see whether it is possible to collect samples of saliva from infants aged less than 3-years-old that can be used for the examination of genetic makeup.  We would also like to check that the saliva collection processes we use in this study are culturally appropriate for Maori and non-Maori.  We aim to collect saliva sample/s from 20 infants aged 0-2.11 years.  The results from this study will guide future research involving the collection of saliva from infants and young children.

COLLABORATORS:

Lead:
Dr Kelly Jones, NISAN, AUT University. 

Co-Collaborators:
Professor Rob Kydd, University of Auckland
Professor Valery Feigin, Director, NISAN, AUT University
Assoc. Prof. Suzanne Barker-Collo, University of Auckland
Dr Alice Theadom, NISAN, AUT University
Professor Shari Wade, Cincinnati Children’s Hospital

Funded by:

  • AUT University Faculty of Health and Environmental Sciences Contestable Dean’s Café Funding with support from NISAN, and co-funding by the University of Auckland, courtesy of Professor Rob Kydd.


GEOMAGNETIC WEATHER TRIGGERS OF ACUTE STROKE:  MANMADE OR HEAVEN SENT?

Contact:


This study is a collaborative international project involving individual participant, stroke, and environmental data to determine if environmental factors such as weather, air pollution and geomagnetic activity can trigger the occurrence of stroke.

Evidence is being assessed from individual participant data meta-analysis of 11,157 patients from population-based stroke incidence studies in New Zealand, Australia (two centres), United Kingdom, France, and Sweden.

The International Stroke Incidence Studies Data Pooling Project collaborators are:

  • Baker Heart Research Institute, National Stroke Research Institute, and Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
  • Neurological & Mental Health Division, George Institute for International Health, University of Sydney, Australia
  • Service de Neurologie, Centre Hospitalo-Universitaire, Dijon, France
  • The National Institute for Stroke and Applied Neurosciences, AUT University, Auckland, New Zealand
  • The Clinical Trials Research Unit and Department of Statistics, University of Auckland, New Zealand
  • Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
  • University Department of Clinical Neurology, University of Oxford, Oxford, United Kingdom



CAN AN ONLINE COGNITIVE BEHAVIOURAL PROGRAMME IMPROVE OUTCOMES FOR PEOPLE FOLLOWING TBI?

Contact:


This qualitative consultation/pilot study aims to adapt an online programme to improve sleep for people with traumatic brain injury (TBI) and to ensure it is culturally appropriate for New Zealand.

The study will interview 12 people about the programme and incorporate changes into the design.

Funded by:

  • AUT Dean's Café



CASE CLASSIFICATION OF MILD TBI

Contact:

Classification of mild traumatic brain injury (TBI) is currently problematic.  This study aims to review a TBI cohort classified using different classification symptoms to explore the most effective system, or to develop a revised system.

Funded by:

  • AUT Dean's Café



SLEEP AND NAPPING BEHAVIOUR IN FIBROMYALGIA SYNDROME

Contact:


A cohort of over 1000 people diagnosed with fibromyalgie syndrome will be followed up one year later to explore the use of sleep and napping and its relationship to the symptom experience.

DOES NEUROAID IMPROVE COGNITIVE ABILITY FOLLOWING MILD TO MODERATE BRAIN INJURY (BRAINS)

Contact:

Timeline:

  • July 2013 to January 2016


This pilot study aims to test the safety and feasibility of using NeuroAid supplementation in 100 people following mild to moderate brain injury.

Funded by:

  • Moleac Pte Ltd





 


 


Last updated: 10 Mar 2014 11:45am

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