Celebrating our. Achievements REPORT. Leaving a SOLID FOUNDATION. for the Future of Stroke Care in Canada

Transcription

1 Celebrating our Achievements REPORT Leaving a SOLID FOUNDATION for the Future of Stroke Care in Canada

2 p p p.10 OUR GOAL WAS TO REDUCE THE IMPACT OF STROKE IN CANADA p p p p.32

3 p p p p.16 TO IMPROVE THE LIVES OF CANADIANS p p p. 44

4 Design EarthLore Communications

5 Contents 2 3 Message from Management Our Story Membership Financials

6 MESSAGE FROM MANAGEMENT Antoine Hakim OC, MD, PhD CEO and SCIENTIFIC DIRECTOR Kevin Willis PhD EXECUTIVE DIRECTOR Pierre Boyle PhD CHAIR, BOARD of DIRECTORS In this report from the Canadian Stroke Network we are Celebrating our Achievements. Our term as one of Canada s Networks of Centres of Excellence (NCE) ended in March, 2013, and we began the concluding phase of the CSN with clear goals for completing programs and transitioning projects to partners. As this will be the final report we are taking this special opportunity to look back on our progress, not only over the course of this past year, but over 15 outstanding years in Our Story The credit for these achievements goes to our researchers and partners from across the country. They have worked together in a collaborative, coordinated, and networked effort to defy the challenges of stroke. Thank you for your dedication and for your willingness to see and to address the big picture. We extend our special thanks to our major partner the Heart and Stroke Foundation and to our host institution the University of Ottawa. There is much still to be accomplished during the final months as we move towards the dissolution of the Canadian Stroke Network as a corporation in September, It is hard to say goodbye but we hope you will share in our celebration and agree that the CSN will be Leaving a Solid Foundation for the Future of Stroke Care in Canada. 2

7 The story of the Canadian Stroke Network demonstrates how federal government funding for centres of excellence can catalyze research and have a major impact on society. In the case of stroke, the impact has been enormous. In fewer than 14 years, changes have been made to the way stroke care is delivered in Canada. As a result of the Canadian Stroke Strategy, a partnership between the Canadian Stroke Network and Heart and Stroke Foundation of Canada, paramedics ensure patients get to the right hospital faster and more people receive drugs to limit brain damage. More hospitals have stroke units and stroke programs that reduce disability and prevent death. Best practice recommenda tions have improved the delivery of stroke care across the country and have set the bar for international guidelines. Research has enhanced recovery and standardized rehabilitation therapy. Basic science has identified a potential new drug to protect brain cells from the effects of stroke. A new cardiac monitoring protocol has been developed and tested to better detect irregular heart rhythms that lead to stroke. An annual major international Congress has been organized to bring together more than 1,000 stroke clinicians to share the latest research knowledge. The list goes on. Our Story Thanks to funding from the Networks of Centres of Excellence program, a federal-government initiative to support areas of research excellence in Canada, stroke research, care and knowledge have improved substantially in a relatively short amount of time. The impact of the Canadian Stroke Network has been so great that Scientific Director Dr. Antoine Hakim was named to the Canadian Medical Hall of Fame in 2013, largely for leading the efforts of the CSN. In the following pages, we lay out the chronology of the network, the progression of research efforts, the evolution of network activities and the impressive outcomes. What is interesting to note is how, a few years into its mandate, the network transformed itself from a traditional NCE focused on grant dispersal, industrial partnerships and commer cia - lization. Realizing that the real demand in stroke was for improved delivery of research-proven practice and the reorganization of health systems, the CSN became a driver of targeted largescale interdisciplinary research and new policy initiatives and a partner for social change and knowledge mobili - zation. In this role, tremendous results were achieved for stroke. A strong community a truly national network developed and flourished. It is a credit to the flexibility of the NCE program that its networks have the support to identify gaps and respond in ways to make a difference. 3

8 CSN MISSION To reduce the impact of stroke on Canadians through collaborations that create valuable new knowledge; to ensure the best knowledge is applied; and to build Canadian capacity in stroke. The Canadian Stroke Network is one of Canada s Networks of Centres of Excellence WHO WE ARE The Canadian Stroke Network is an independent, not-for-profit corporation. It was established in 1999 to reduce the burden of stroke through leadership in research innovation. It is made up of stroke scientists, clinicians, rehabilitation specialists and knowledge-translation experts from universities and hospital-based research institutes across the country. Headquartered at the University of Ottawa, the Canadian Stroke Network brings together partners from government, industry and the non-profit sector.

9 1999 Late in the year, it was learned that the application to fund a Canadian Stroke Network had been successful and would receive the support of the federal government s Networks of Centres of Excellence program. The network, to be headquartered at the University of Ottawa, would pull together top researchers, industry partners and thought leaders in the field. Dr. Paul Morley Dr. Frank Silver Katie Lafferty Dr. Antoine Hakim David Scott Dr. Stephen Phillips 5

10 STROKE IS A HARSH REALITY

11 2000 In April, a news conference was held at host institution the University of Ottawa to celebrate formation of the Canadian Stroke Network and to introduce eminent Ottawa lawyer David W. Scott as board chair and respected stroke researcher-clinician Dr. Antoine Hakim as the scientific director with Dr. Paul Morley of the National Research Council (NRC) as the deputy scientific director. Among founding board members were former Governor General Ramon J. Hnatyshyn, NRC president Arthur J. Carty, stroke research luminary Dr. Henry J. Barnett, and others of international renown. In early 2000, the work of the CSN got under way and consulting services were used to determine short- and long-term needs of the network, to flesh out membership on boards and committees and to further engage partners. Partnerships included academic and clinical institutions, industry, non-profit organizations and government departments and agencies. Investigators within the four different research themes met to discuss their work and to plan collaborative efforts. Among exciting early initiatives was the development of the Registry of the Canadian Stroke Network under the leadership of Toronto neurologist Dr. Frank Silver and Halifax neurologist Dr. Stephen Phillips. The goal of the registry was to collect necessary information on stroke risk factors, symptoms, treatment and hospital management in order to inform research and to identify gaps in care. Registry coordinators were identified in 20 sites across Canada and data collection got under way. Investment in Ontario s first Telestroke system was another early effort of the CSN, recognizing the need to support new technology to enhance access to state-of-the-art stroke care in the province. Both of these early efforts would prove to be valuable investments for the CSN and lay the groundwork for further research and practice change. Also in 2000, efforts to recruit a permanent CSN manage ment team were in high gear. Time was invested in identifying the best possible people to support CSN researchers: individuals with the necessary skills and experience as well as personal commitment to stroke. A slow, thoughtful process to seek out people with experience in management, administration, communications, finance and partnerships paid off. (As this chronology will reveal, the CSN retained the original team throughout its NCE lifespan.) Stroke is a harsh reality. As Robert Browning wrote, a man s reach should exceed his grasp... With optimism fuelling our efforts, we are confident that the Canadian Stroke Network will achieve enviable results in aid of stroke victims now and in the future. The CSN is dedicating its research efforts to the areas of prevention and treatment of stroke; reduction of stroke damage; rehabilitation and recovery from the effects of stroke; and the influencing of policy in the care and treatment of stroke patients. 7

12 TURNING POINT FOR THE CSN Dr. Phil Barber University of Calgary

13 2001 In many ways, 2001 was a turning point for the CSN. A permanent management team was put in place, platforms were developed for stroke research, training, knowledge translation and partnerships. A strategic plan was developed and the first Annual General Meeting and scientific conference was held in the spring. On the research front, the Registry of the Canadian Stroke Network began collecting information and, within the first nine months, gathered data on more than 4,000 patients from 21 tertiary-care and community hospitals. The CSN leveraged more than $1.8 million in new training dollars through its Focus on Stroke program and supported more than 270 individuals through its research projects and training programs. It s clear that the CSN is poised to achieve its mission to reduce the effects of stroke on the lives of Canadians with determination and energy: an effective and focused team is in place; research and training goals are clear; the Board of Directors is engaged, supportive and effective; and, a number of serious partners are coming forward. Dr. Jeff Kleim The CSN partnered with the Canadian Stroke Consortium to develop the first-ever national stroke-training program for physicians. The network developed newsletters, news releases and an expanded website to raise public awareness about stroke research. The future is bright. 9

14 STROKE IS TREATABLE Dr. Dale Corbett with inset Dr. Phil Barber

15 2002 Collaborative research continued to grow among CSN researchers with the development of large-scale efforts, such as Stroke Canada Optimization of Rehabilitation through Evidence (SCORE), which brought together a diverse group of rehabilitation and knowledge-transfer experts to ensure that the best evidence was applied in practice. Multi-centre projects, such as FASTER a study of the impact of early intervention following TIA took hold. As well, there was increased focus on under-serviced communities. For example, research probed the early stroke risk indicators in a Canadian Aboriginal population. Large cross- Canada teams looked at strategies to help the brain recover and remap itself post-stroke; new tools such as virtual reality and driving simulators were tested; and quality of life and caregiver studies provided quantitative and qualitative data on life after stroke. Message from CSN Management Over the past year, the CSN has renewed its commitment to reducing the effects of stroke on Canadian society. In the autumn of 2002, an external panel reviewed the progress of the CSN, recommended approval of its mandate, and provided positive feedback. The panel encouraged the CSN to maintain its direction in the years ahead. The CSN, through a strategic planning exercise, recognized the need to focus its efforts on fewer, yet higher-impact projects and to make a concerted effort in knowledge translation moving the latest research to the bedside. Over the year, the CSN has made significant progress in achieving these goals. Stroke is treatable. In the past few years, major advances have been achieved in stroke treatment. The Canadian Stroke Network aims to optimize stroke care so that all patients have access to the full range of appropriate treatments. A unique characteristic of stroke, compared to other brain conditions, is that, within certain time con - straints, it is treatable. If a patient recognizes what is happening as a stroke, rapidly gets to an emergency room (ER), and this particular ER gives the patient priority access to a CT scan, and the scan does not show any hemorrhage in the brain, and the clot-busting drug t-pa is started within three hours from the onset of symptoms, the patient s deficit is much reduced, and sometimes totally eliminated. Stroke survivor Lew Crummey and Gladys Crummey 11

16 STROKE SUMMIT Dr. Moira Kapral left and Dr. Frank Silver, Co-leader, The Registry of the Canadian Stroke Network

17 2003 CSN organized a Stroke Summit in partnership with the Heart and Stroke Foundation to look at how to improve stroke practice by ensuring the best research knowledge was applied. As a result of this meeting of key stroke champions, the CSN and Heart and Stroke Foundation (HSF) began to develop a Canadian Stroke Strategy. The goal was to address the ever-increasing gap between research knowledge and clinical practice. A blueprint was deve loped, which included a framework for increasing public awareness, implementing best practice, strengthening professional development and coordinating research to support the development of regional and provincial stroke strategies. At the same time, large research efforts began to yield promising results, the pace and quality of scientific publications grew, and training programs continued to expand to draw more people into the field of stroke. The collaborative Stroke-Stem Cell project, which gathered valuable information about the stroke-damaged brain and the potential of stem cells as a therapeutic tool, and a project that enhanced understanding of brain cell death in stroke were among novel research efforts. Nowadays, we need more support for scientific efforts on behalf of stroke patients. The work of the Canadian Stroke Network makes me confident that this will happen. The CSN is an essential component of the international stroke effort. Dr. Gregory J. del Zoppo, Associate Professor, Department of Molecular and Experimental Medicine, The Scripps Research Institute, La Jolla, CA Network success stories were featured in monthly internal newsletters and a news magazine, mailed three times a year to 7,000 stakeholders and to the news media. The CSN built a presence as an authoritative source of information on stroke research for journalists and policymakers in all parts of the country. If you don t understand why something happens, you can t fix it. We believe that basic research to understand brain cell death is the way to prevent stroke damage. Dr. Michael Tymianski, Toronto Western Hospital 13

18 MEASURING PROGRESS RENEWING THE VISION

19 2004 Five years into its mandate, the CSN took time to measure its progress and renew its vision as it prepared to apply for funding renewal from the NCE program. Funding renewal is a highly competitive process in which existing networks vie for a second seven-year term. Enormous effort was expended at the CSN office to tell the network s story, to lay out its accomplishments, to rally partners behind the work ahead and fund innovative and impactful research efforts. Among research successes was the FASTER project, which brought together researchers in Canada and the UK. The work of the Registry of the Canadian Stroke Network was also proving highly valuable and actively used by researchers, industry and provincial health ministries to monitor quality of care. Investigators gathered in all parts of the country to consider new and big ideas and to plan strategic research efforts that would support the vision of the CSN. At the same time, a huge effort was made to build the Canadian Stroke Strategy. An experienced director was hired to oversee this CSN-HSF partnership. Administrative and program support were put in place and a secretariat was established at CSN headquarters. The Canadian Stroke Network has changed the landscape of stroke research in Canada and successfully set up world-class research initiatives. The CSN has been successful in linking rehabilitation researchers in larger scale projects than have ever been seen in Canada. This is increasing the pace of research, promoting improvements in care and should be a model for other countries. Dr. Geoff Fernie Vice-President, Research Toronto Rehabilitation Institute The Canadian Stroke Network is making a tangible difference in real people s day to day lives. 15

20 RESEARCH RESULTS

21 2005 The Canadian Stroke Strategy took shape with the formation of a provincial-territorial roundtable, involving represen ta - tives from every province and territory. National working groups were established to oversee the development of national tools, including best practices, training programs, evaluation and monitoring systems. This Annual Report focuses on results. Together we believe we can, and will, make lives better for those Canadians affected by stroke. On the CSN front, a bedside screening tool to assess swallowing disorders (dysphagia) in stroke patients was developed and a new Web-based tool, called Stroke Engine, was launched to help clinicians, patients and families investigate all available rehabilitation treatments and therapies for stroke. Among targeted clinical research were two CSN projects to study atherosclerosis in an Aboriginal community. A spinoff company, NoNO Inc., was established with the goal of developing therapies to prevent brain cell death. And, a core facility to construct viral vectors important tools used in basic gene research was established to support network research. In the area of recovery, an ongoing multi-disciplinary, multi-site project began to study how quality of life post-stroke is defined and measured. Training efforts continued to grow with expansion of Focus on Stroke, courses for physicians, a national stroke fellow ship program, summer studentships for undergraduates and a Summer Program in Neuroscience (SPIN) course that allowed CSN trainees first-hand experience with animal stroke models and interaction with stroke patients in rehabilitation care. The impact of the CSN, its research publications and vision for improved stroke care began to draw the attention of other countries. The coordinated and consensus-based approach to defining and implementing best practices was cited as a model for other countries and both the UK and European stroke networks sought advice as they modeled themselves after the CSN. The CSN was successfully reviewed by an expert external panel and its funding was renewed for another full sevenyear cycle with a budget increase of 36 per cent. A news conference was held at the University of Ottawa to announce the funding increase and continued research efforts in stroke. In 2005, founding board chair David W. Scott retired and was replaced by board member Ottawa lawyer Eric Elvidge. Strong leadership of the Network was key to its success. Through its highly focused research program and emphasis on training both stroke researchers and health professionals, the CSN is bringing the best possible stroke prevention, treatment and rehabilitation to Canadians. The Canadian Stroke Strategy will be a model for changing the way we deliver health care and it will offer benefits for the system as a whole. Debra Lynkowski, Director, Canadian Stroke Strategy 17

22 REACHING OUT TO REDUCE THE IMPACT OF STROKE

23 2006 With renewed funding and a strong mandate to push forward with plans to advance stroke care, the Canadian Stroke Network and Heart and Stroke Foundation came together for a public launch of the Canadian Stroke Strategy at the National Press Theatre in Ottawa. With the support and sponsorship of Senator Dr. Wilbert Keon, CSN and HSF explained the urgency behind the strategy, the need for governments to invest in and commit to the plan and the economic costs associated with failing to act. An economic analysis by the Canadian Stroke Network showed widespread access to organized stroke care could prevent 160,000 strokes, prevent disability in 60,000 Canadians and save $8 billion net in health-care costs over 20 years. The news conference made national TV, print and radio headlines and raised awareness about the strategy. Behind the scenes, provincial-territorial champions led the development and implementation of stroke strategies at provincial, regional and local levels. Two provinces Alberta and Nova Scotia committed financial resources to their efforts. Three consensus conferences, focusing on national platforms, sought consultation and consensus on a plan to promote best practices and standards, national measurement approaches and enhanced professional development and training. At the same time as the strategy gained momen - tum, CSN-funded research delivered fundamental new insights into stroke and discoveries were published in Stroke, Science, The New England Journal of Medicine and other high-impact journals. The number of CSN-funded publi cations appearing in high-impact journals increased by 30 per cent, illustrating that the network was delivering on its promise to generate new ideas, cutting-edge research and to further scientific discovery. For example, a gene was discovered that leads to the weakening of blood vessels in the brain, increasing the risk of stroke. The discovery paved the way for the development of new drugs to protect The evidence is overwhelming that controlling blood pressure is the way to dramatically lower stroke and cardiac disease. Dr. Larry Chambers, Cardiovascular Health Awareness Program (CHAP) study 19

24 2006 Celebrating our Achievements In terms of the economics of organized stroke care, a comprehensive program does something very unique in health care it actually saves money. blood vessels and the development of a potential genetic screening tool for hemorrhagic stroke and dementia. The CASES study, funded in part by CSN, showed that thrombolysis for acute ischemic stroke is safe and effective outside the clinical trial setting. Greater use of clot-busting drugs was urged to prevent disability from stroke. A study on transient ischemic attacks (TIAs) showed that the majority of people don t get adequate follow-up. A call was made for the establishment of secondary stroke prevention clinics to reduce the incidence of major strokes. Valuable clinical insights were gathered about stroke care using data from the Registry of the Canadian Stroke Network. As well, the Registry was approved by the Ontario Privacy Commissioner as one of eight entities with special rights to collect personal health information for research and health-care quality improvement purposes. And, the Ontario Ministry of Health and Long-Term Care provided $1 million in annual funding to the CSN to measure, monitor and evaluate its provincial stroke system. Dr. Mike Sharma, Deputy Director, Canadian Stroke Network 20

25 REPORT Stroke is a growing problem especially with the aging population and countries around the world are struggling to figure out what to do and how to organize themselves. Other countries see the Canadian Stroke Network as a model because we cover the complete translational spectrum from research to application, which is hard to find elsewhere. New research efforts included a pilot project that showed reductions in blood pressure could be achieved through community-based interventions and a study in six cities looked at more than 50 community-based stroke programs with the objective of creating greater opportunities for socialization, exercise, leisure, language stimulation and learning. Dr. Antoine Hakim, CEO and Scientific Director, Canadian Stroke Network A promising new stroke drug developed by CSN researchers and spinoff company NoNO Inc. entered Phase 1 clinical trials. The drug, called NA-1, was one of only a limited number of new pharmaceuticals to enter human trials in Canada in The CSN also helped to establish the National Stroke Nursing Council to connect all nurses across Canada interested in stroke. And, it released the first Canadian Best Practice Recommendations for Stroke Care, which were distributed through the Canadian Medical Association Journal and other channels. 21

26 RESEARCH MAKING IT REAL

27 2007 A six-page special supplement in the Globe and Mail newspaper made the case for the Canadian Stroke Strategy and described the potential for huge improvements in patient care and outcomes. A special supplement also appeared in Canadian Health magazine, distributed to medical offices across Canada. Tools to support the strategy, including a dynamic website and regular newsletters and media releases, rolled out. Across the country, stroke coordinators were funded and mobilized in every province to advance efforts. People are at the core of everything we do. The Network s profile increased on the national and international stage from the keynote address at the International Stroke Conference in California to key presentations at stroke meetings in the U.K., Europe, Russia and Korea. And, the Network took a strong stand on a population-level approach to stroke prevention by initiating efforts to increase awareness about the dangers of excessive sodium consumption and the related impact on blood pressure. CSN efforts helped draw the first media attention to this important issue and to push for changes to Canada s food guide. The CSN developed a campaign and a website called sodium101.ca and worked in partnership with groups such as Hypertension Canada to push the issue. A CSN-funded initiative called CHAP (Cardiovascular Health Awareness Program) screened more than 10,000 seniors for hypertension in 20 communities across Ontario and reported improvements in blood pressure, diet and exercise levels. And the CSN supported the establishment of two new stroke prevention clinics in Manitoba to study the impact of secondary prevention measures on patients who experienced a stroke or transient ischemic attack. The Stroke Rehabilitation Evidence-based Review (ebrsr.com), the most comprehensive and current review of the stroke rehabilitation research literature, formed the foundation for numerous Canadian and international stroke rehabilitation research initiatives aligned with the CSN and the Canadian Stroke Strategy. The CSN sponsored the First National Stroke Rehabilitation Conference, the World Stroke Congress, targeted workshops and courses and its annual public lecture on stroke to raise awareness about research in the field. Stroke is for life and persons with stroke need life-long programs. Professor Nancy Mayo of Montreal s McGill University, delivering the CSN s 2007 Ramon J. Hnatyshyn public lecture on stroke in Winnipeg, Sept. 13, 2007 In the largest European stroke research program ever undertaken, countries in the European Union have joined forces in a unique effort to structure, integrate, and advance stroke research. The European Stroke Network (ESN) is modelled after the Canadian Stroke Network. 23

28 WE RE GETTING THINGS DONE

29 2008 A dynamic new slate of projects was approved beginning in April Canadian Best Practice Recommendations for Stroke Care received a major update and re-release. The 2008 Canadian Best Practice Recommendations for Stroke Care were distributed as a special supplement through the Canadian Medical Association Journal to 72,000 physicians across Canada. A patient s guide to the best practices was created and the performance measurement manual was updated and expanded for use as a tool to help health-care providers and administrators measure how well they were delivering care. As well, the CSN was selected to chair the World Stroke Organization s panel on best practices with a view to creating global standards. Determination, focus and a sense of purpose. The CSN formed a partnership with Accreditation Canada to develop Canada s first disease-specific accreditation program based on the Best Practice Recommendations. The Canadian Stroke Strategy continued to transform stroke treatment by working with provincial and territorial governments to improve health-care systems. Governments in Nova Scotia, Alberta and British Columbia made funding commitments to provincial stroke strategies and Saskatchewan finalized and released to the public its plan for improved care. The CSN monitored and evaluated the well-established Ontario stroke system to help other provinces make the case for restructuring stroke care by providing them with economic data on potential savings in lives and health-care dollars. Work continued with partners on highlighting the link between excessive sodium in the food supply and the incidence of hyper tension, the No. 1 risk factor for stroke. The CSN success - fully brought the issue before the media and generated extensive news coverage. Because of its leadership on the issue, the Network was invited to join Health Canada s Sodium Working Group, I felt lost after my stroke. The Patient s Guide to Stroke Care helped me calm down and know what my caregivers were working on and what questions to ask. Victor Miniotas experienced a stroke in

30 2008 Celebrating our Achievements Ten years into our mandate, our vision is clear and our resolve has never been stronger. Without the support of the Canadian Stroke Network, there would be no Stroke Rehabilitation Evidence-Based Review. It has become not only a powerful research engine in its own right but a powerful knowledge translation tool across Canada and increasingly internationally. Dr. Robert Teasell Professor, University of Western Ontario which was formed in response to lobbying by the CSN and its partners. The Sodium Working Group was charged with developing a sodium reduction strategy for Canada. The Network began funding a major international study of risk factors for stroke in different countries and ethnic groups to determine racial and genetic differences. In addition to annual courses, workshops and scientific meetings, the CSN expanded training through a newlyestablished Canadian Stroke Network Trainee Association (CSNTA), working to strengthen visibility of trainees within the CSN through sponsoring learning events, encouraging collaboration and the development of core competencies. The Board of Directors of the CSN continued to enjoy strong leadership as Chair Eric Elvidge cycled off and was replaced by board member Michael Cloutier, who held the position until

31 REPORT These qualities characterize the efforts of the Canadian Stroke Network. We re making lists, checking things off and We re Getting Things Done to reduce the impact of stroke. Agreement reached with the Heart and Stroke Foundation of Canada and Canadian Stroke Consortium to organize a major national and international conference on stroke, called the Canadian Stroke Congress. The meeting is set for June 7 and 8 in Québec City in

32 SEEING THE BIG PICTURE

33 2009 Ten years into its mandate, the CSN realized success on all fronts: new research findings; improvements in health care; productive clinical trials; expanded training programs; increased networking nationally and internationally; and new influence on public health policy. A paper published in Science built on earlier work also published in Science on the role of hemichannels in neurons, linking these channels to stroke. Researchers established important new pre-clinical models of stroke to evaluate a neuroprotective agent developed in CSN labs. A multi- project research program in vascular cognitive impairment was launched in collaboration with partners. The EMBRACE trial enrolled patients to study the efficacy of long-term heart monitoring after unexplained strokes. INTERSTROKE, a study looking at risk factors for stroke in 30 countries, was busy gathering data. New research got under way into the effectiveness of secondary prevention of stroke. Publications from the Registry of the Canadian Stroke Network provided new insights into stroke treatment and organization. The Getting On with With the Rest of Your Life After Stroke study resulted in a workbook based on findings and distri buted across Canada. In June 2009, Ontario s Telestroke program reached a milestone with the treatment of its 1,000 th patient. The Canadian Stroke Strategy had major wins with the establishment of stroke prevention clinics in several provinces, a pilot project established in Saskatchewan, the first stroke unit in PEI, a stroke summit in Quebec and more. The CSN also reached agreement with the Heart and Stroke Foundation and the Canadian Stroke Consortium to organize a major conference on stroke, called the Canadian Stroke Congress. Planning got under way for the meeting the first major international stroke congress in Canada which was slated for In 2009, an international panel of stroke experts recognized the Canadian Stroke Network s big-picture thinking when it assigned high praise after a rigorous research review. The result was an additional four years of funding from the NCE program. The panel s final report declared that: The Network has positioned Canada as a world leader in stroke EMBRACE and its sub-studies will have immediate impact. We expect the study results to contribute to the first evidence-based practice guidelines for cardiac monitoring after stroke and TIA. Dr. David Gladstone, University of Toronto The panel s final report declared that: The Network has positioned Canada as a world leader in stroke research. It said that the CSN is bringing significant social, health and economic benefits to Canada and that it has achieved the highest excellence. 29

34 2009 Celebrating our Achievements research. It said that the CSN is bringing significant social, health and economic benefits to Canada and that it has achieved the highest excellence. Stroke Services Distinction gives health-care centres an opportunity to look at areas of strength and areas where they can improve stroke services. It makes institutions accountable for the stroke care they provide. The panel s report in October 2009 said: The Network has developed an impressive portfolio of basic, clinical and applied research. Bringing together basic scientists and clinicians, supporting trainees and allied health pro fes - sionals, the Network has facilitated new multi-disciplinary and high quality research that improves patient care. Dr. Patrice Lindsay, Director, Performance and Standards, Canadian Stroke Network The Calgary Stroke Team after winning their award Taking part in Getting On with the Rest of Your Life After Stroke has shown me that I am still able to contribute even though I suffered a major stroke. This has meant a great deal to me. Sherman Elliott, Winnipeg, Manitoba 30

35 REPORT Seeing the Big Picture The paths we take today will lead to success and renewed opportunity in the future. The CSN is bringing significant social, health and economic benefits to Canada. xxx xxx The Network has developed an impressive portfolio of basic, clinical and applied research. Bringing together basic scientists and clinicians, supporting trainees and allied health professionals, the Network has facilitated new multidisciplinary and high quality research that improves patient care. Expert panel review of the CSN, October

36 MAKING STROKE TOP OF MIND

37 2010 Two key achievements of the Canadian Stroke Network in 2010 were the first Canadian Stroke Congress, which attracted more than 1,000 dedicated stroke clinicians and researchers from all parts of Canada and beyond, and the first national audit of stroke services, which gathered valuable data on the quality of stroke care and gaps in services. The Congress, held in Quebec City in June 2010, exceeded attendance expectations, attracted the highest quality research and generated extensive media attention. More than 230 abstracts from the Congress were published in Stroke: Journal of the American Heart Association. The three-day event provided an opportunity to exchange views, collaborate and learn about innovative approaches to stroke research and clinical care. The stroke audit was a major undertaking involving people in all provinces. Stroke charts were reviewed to measure the quality of services and provide new benchmarks for care in all parts of the country. Innovation. Action. Impact. Results. The Canadian Stroke Network is focused on finding new solutions for stroke by advancing research innovation, moving discovery into action, making an impact on prevention, care and recovery, and achieving results. What drives our efforts? People living with stroke and their families are TOP OF MIND with those of us who are part of the Canadian Stroke Network. A thorough review of the Canadian Best Practice Recommendations for Stroke Care was released in part - ner ship with the Heart and Stroke Foundation of Canada and for the first time were made available on a searchable smart-phone friendly website. There were about 2.5 million hits to the strokebestpractices.ca website in the six months after its launch. CSN continued to be involved in advocacy around reducing sodium content in the food supply. The Network was part of the expert working group established by Health Canada to study the issue, which released a Sodium Reduction Strategy in At the same time, the CSN funded and distributed hundreds of thousands of fridge magnets to individuals, health fairs and clinics as part of a national effort to educate consumers to read food labels. In fall CSN partnered with the World Health Organization to host a meeting in Calgary on monitoring levels of dietary sodium in the food supply. The Canadian Best Practice Recommendations for Stroke Care 2010 have been developed with rigour, meet international standards for quality and deserve to be widely read and accepted. Dr. Anthony G. Rudd Royal College of Physicians, London, UK commentary published in the Canadian Medical Association Journal, Feb. 22,

38 2010 Celebrating our Achievements There were about 2.5 million hits to strokebestpractices.ca in the six months after its launch. For the first time the recom mendations are available on a searchable, smart-phone friendly website strokebestpractices.ca. The website includes resources to improve stroke and emergency services and to measure their effectiveness. It also includes a patient s guide to optimal stroke care. Given the size of Canada and the limited number of stroke experts, Telestroke is the only solution that can provide advice to stroke patients and their physicians at the point of care. For stroke care, Telestroke is the next best thing to being there. Dr. Frank L. Silver CSN Investigator Medical Director, Ontario Telestroke Program Also in 2010, the CSN-funded INTERSTROKE study published Phase 1 results in Lancet, identifying the major risk factors for stroke. The report, which received widespread media coverage, was the result of a study of 6,000 people in 22 countries in Asia, North and South America and Europe. The Network recognized the importance of demographic changes for stroke services by jointly funding with the Heart and Stroke Foundation of Canada four new projects into vascular cognitive impairment. Published in 2010 was the CSN s Burden of Ischemic Stroke (BURST) study that found the direct and indirect health-care costs for new stroke patients tally an average $50,000 in the six-month period following a new stroke. Training continued to ramp up with workshops and panel discussions organized by the CSN s Trainee Association and by the National Stroke Nursing Council and allied health professionals. A CSN lecture for medical students was delivered at McGill University, webcast and posted on YouTube. The Canadian Stroke Strategy released a Stroke Unit Guide, a new resource to direct the establishment of new stroke units and the enhancement of existing stroke units across Canada. The Strategy s Information and Evaluation Working Group released an updated set of Core Performance Indicators to measure key aspects of stroke care. A guide was 34 MAKING STROKE TOP OF MIND

39 REPORT produced for Emergency Medical Services on the management of suspected stroke patients. And a Stroke Prevention Best Practice Tool Kit was developed for the interprofessional health care-team. The first two centres in Canada to receive Stroke Services Distinction accreditation the Calgary Stroke Program and Toronto Rehabilitation Institute were announced at Congress and highlighted by news media in their respective regions. Dr. Pierre Boyle of the Université de Montréal replaced Michael Cloutier as board chair in There were 347 media clips from the first Canadian Stroke Congress. Attention was focused on new treatments, the cost of stroke care and issues faced by caregivers. Dr. Antoine Hakim, CEO and Scientific Director of the Canadian Stroke Network, serves as chair of the exter nal scientific review committee of the European stroke network. As a result of this inter na tional linkage, a delegation of European researchers will attend the Canadian Stroke Congress to exchange ideas and probe opportunities for collaboration. In 2011, Dr. Hakim highlighted the efforts of the Canadian Stroke Network and shared resources as part of a China-Canada partnership initiative and he spoke about the CSN during a plenary talk for the Singapore Stroke Society. Dr. Antoine Hakim, CEO and Scientific Director of the Canadian Stroke Network 35

40 FOCUSED ON WHAT MATTERS

41 2011 A major accomplishment in 2011 was the release of The Quality of Stroke Care in Canada, the first national report on the state of stroke services from coast to coast. It involved analysis of almost 10,000 patient charts at 295 hospitals across the country. The report received national attention after its launch at the National Press Theatre in June. Its findings would drive health systems change. As they had over several years, prevention and health promotion continued to be the focus of considerable energy at CSN Central. The sodium101.ca website was expanded, revamped and content was translated into Mandarin. An iphone app was created for tracking sodium content and later named one of the best health apps of the year by the CBC. The CSNTA delivered another SPIN course, this time in Vancouver. And international outreach linked researchers in Australia, Asia, Europe, the Caribbean and beyond. The second Canadian Stroke Congress was held in Ottawa, building on the momentum and success of the inaugural meeting. New educational resources were developed based on CSN research efforts. These included an expanded Getting On With the Rest of Your Life After Stroke (a highly popular workbook), and a Family Guide to Pediatric Stroke. CSN research focused on scientific innovation, enhanced prevention, optimal care and recovery. Among CSN projects: the development of relevant models to study covert stroke; the use of brain mapping technology to understand blood flow in small vessels; and the study of white matter changes in the brain in order to identify imaging biomarkers for vascular dementia. Research into transient ischemic attacks, or TIAs, included the development of a blueprint for the management of mild strokes; a large trial to look at non-pharmacological interventions, including exercise, to reduce vascular risk factors; and a study of the use of a TIA hotline to reduce stroke rates after TIA. On the policy front, the network continued to push for expansion of Telestroke to deliver optimal stroke services to people living in remote and rural areas. And, it worked to unite researches in the field of vascular health to try to push for a major, national coordinated approach. There s no question the Canadian Stroke Network has been a catalyst for change. Since 1999, the Network has been focused on what matters by investing time and resources on initiatives with the biggest potential gains. In the end, being focused on what matters means focusing on people and working tirelessly to reduce the impact of stroke. 37

42 2011 Celebrating our Achievements Recognizing the need to transition some of its large-scale tools and initiatives to partner organizations, the CSN began planning for the move of its Registry to the Institute of Clinical and Evaluative Sciences (ICES), a valued partner of the CSN. This was a natural evolution for the Registry and the CSN was pleased to see that this valuable data-collection system would remain under excellent stewardship. The Canadian Stroke Congress is your best chance this year to meet, interact and network with the best and brightest in stroke care in Canada and beyond. As the strategic plan of the Canadian Stroke Strategy (CSS), the CSS became formalized at the provincial level in mid-2011 and the centralized secretariat wound down operations. Attention shifted to provincial and regional efforts with ongoing support for initiatives to improve health systems, disseminate best practices, increase awareness of stroke and share national tools. Dr. Mark Bayley, Toronto Rehabilitation Institute, Congress Co-Chair The Congress has become an integral part of the annual academic stroke calendar a must-go-to meeting. Dr. Michael Hill, University of Calgary, Congress Co-Chair 38

43 REPORT The Canadian Stroke Network is an influential champion for the effective integration of world-leading stroke research with clinical practice. As the Network prepares to sunset in 2014, the long-standing and effective partnership with the Heart and Stroke Foundation of Canada will continue to evolve and will, no doubt, ensure a successful home and future for key components of the broader Canadian Stroke Strategy. Ian Joiner Director, Stroke Heart and Stroke Foundation of Canada 39

44 REFLECTION ON ACCOMPLISHMENTS, PROMISE FOR THE FUTURE Dr. Tim Watson providing Telestroke consultation

45 2012 Focused on the big picture and ensuring continued progress in strengthening Canada s stroke community, the network provided catalytic grants to help provincial stroke strategies develop business cases for improved stroke care. Funded initiatives included a stroke collaborative in B.C., a plan to develop a stroke unit in Saskatoon, an economic analysis in Manitoba to justify the need for improved stroke services, a case for the development of rehabilitation best practices in Ontario, a registry in Quebec to evaluate and improve stroke care, funding to evaluate the impact of organized stroke care in PEI and support of the development of a business case in Newfoundland and Labrador for the development of a provincial stroke strategy. The network fostered international cooperation by supporting collaborative basic research efforts between Canadian and European stroke networks. It finalized the transfer of the Registry of the Canadian Stroke Network (now known as the Ontario Stroke Registry) to ICES. Thanks to the support of the NCE program and CSN partners, the Network enters a new and final phase during which longstanding projects will be transitioned to the Heart and Stroke Foundation and other partners by fall Canadian Best Practice Recommendations for Stroke Care were updated with a new emphasis on improved practices around stroke prevention. In 2012, recommendations were updated to include growing evidence to demonstrate the role of sleep apnea as a risk factor for stroke and as a condition that may also results from stroke; identification and early management of patients who are candidates for hemicraniectomy; issues facing younger adults with stroke, especially around vocational rehabilitation, driving and community support; and more on the management of patients with atrial fibrillation and vascular cognitive impairment. The network commissioned a report to develop options and identify opportunities for the expansion of Telestroke services across the country. Training efforts for young researchers and stroke professionals were expanded. The network shared the results of the 2011 report on the Quality of Stroke Care by visiting provinces and regions to hand-deliver data, explain gaps and offer support. As a result of these visits, four new stroke units were established with educational and strategic support from CSN staff and 41

46 2012 Celebrating our Achievements expert volunteers; strong approaches to prevention were put in place and all provinces recognized the issues related to inadequate access to inpatient rehabilitation, with several planning early supported discharge programs. At the same time, the CSN produced a guide to establishing quality care, called This is What Quality Stroke Care Looks Like, by describing the hallmarks of the Calgary Stroke Program and lessons learned. A third Canadian Stroke Congress was organized in Calgary by far the biggest yet with 1,200 delegates, more science and an expanded exhibit hall floor. For the first time, the entire Congress was organized in-house in order to control costs and generate revenue for future efforts. It is anticipated that policy statements in the area of disease prevention relating to the marketing of junk food to children and healthy food procurement policies, will be effective catalysts for improvement of the diet of Canadians. Canadian Stroke Network 42

47 REPORT CSN-funded CHAP (Cardiovascular Health Awareness Program) study published in the British Medical Journal in Feb 2011 led by Dr. Larry Chambers, Dr. Lisa Dolovich, Dr. Janusz Kaczorowski, Michael Paterson and Dr. Lehana Thebane was named one of the top five health research achieve - ments in Canada in The award is given annually by the Canadian Institutes of Health Research and the Canadian Medical Association Journal to celebrate top achievements that have had a substantial impact on health. CHAP showed that pharmacy-based blood pressure monitor ing sessions led by volunteers and providing feedback to family physicians and pharmacists was a viable approach to mitigating under-detected hypertension. The highly successful Canadian Stroke Congress will be managed by the Heart and Stroke Foundation stroke team from 2014 onwards. From left: Laurie Cameron, Kathleen Manser and Ian Joiner Thanks to financial sup port from the Canadian Stroke Net work, we were able to involve the right people in conversation about how to improve stroke care in British Columbia. Pam Aikman Provincial Director, Stroke Services BC 43

48 CELEBRATING OUR ACHIEVEMENTS

49 2013 Results from the CSN-funded EMBRACE trial were presented as a late-breaking abstract at the International Stroke Conference and generated widespread attention from media and health professionals. The results were practice-changing: advocating for extended cardiac monitor - ing of patients with unexplained strokes in order to detect undiagnosed atrial fibrillation, a major stroke risk factor. CSN also released in partnership with HSF a set of new guidelines around treatment of mood and cognition post-stroke, as well as a new guide to establishment of stroke units. CSN involvement in supporting the development of the Vascular Network and planning for a Vascular 2013 Congress ramped up with leadership roles in all the major planning committees. Vascular 2013 signaled the first time five major medical conferences would come together to discuss com mon strategies for addressing chronic non-communicable disease. Strategic grants were awarded as part of the CSN partnership with the Centre for Stroke Recovery (CSR), expanding the work of the CSR and involving impactful and practice-changing recovery research at major universities across the country. Dr. Kevin Willis the CSN Director of Partnerships replaced Katie Lafferty as Executive Director in Katie moved to the CSR to take on the role of Executive Director. Practice-changing results. Advocating for extended cardiac monitor ing of patients with unexplained strokes in order to detect undiagnosed atrial fibril lation, a major stroke risk factor. Dr. Kevin Willis 45

50 2014 More than $250,000 in knowledge mobilization grants was provided to help Network Investigators ensure the results and insights generated from past CSN funded research is communicated fully to end users, including clinicians, researchers, policy makers, the public, and those living with the effects of stroke. A successful 4 th Canadian Stroke Congress was hosted that brought together over 900 experts from all sectors of stroke. The Congress was held in conjunction with other key medical conferences to form Vascular 2013 a one time event that was attended by more than 6,700 physicians, scientists, clinicians, nurses, educators, allied health professionals, and policy makers from the vascular health community. Delegates had access to the scientific programs of all four participating conferences, as well as one common day of special Vascular Day programming. The CSN supported the development of a telestroke toolkit intended to assist regions or provinces considering telestroke implementation. This toolkit, which will continue to be updated, included information on developing a telestroke program, as well as contact details of telestroke leaders and telehealth supporting organizations. Recognizing that catalytic funding may be required to implement telestroke services, the CSN contributed $675,000 to encourage the adoption, expansion, and evaluation of telestroke across the country. The seven projects that received this funding were highlighted in a publication, Implementing Telestroke in Canada. Transition of the leadership for Stoke Best Practice Recommendations and for monitoring the quality of stroke care to the Heart and Stroke Foundation was completed. The CSN also provided funding support for a major report 2014 Stroke Report released in June. Training and continuing education were a major focus. The CSN invested $300,000 in the Focus on Stroke training program. The program developed in 2001 in partnership with the Heart and Stroke Foundation builds stroke research capacity and supports research training for health professionals. Training opportunities were also provided for young researchers 46

51 through summer studentships, and through specialized courses for stroke professionals. CSN announced the release of accredited online learning modules for stroke profes sionals with courses on Rehabilitation, Secondary Prevention, and on Vascular Cognitive Impairment. It also partnered with Hypertension Canada and provided funding to develop and launch an online health professional training program in hypertension management. Underscoring the excellence of CSN research the Network celebrated the publication in the New England Journal of Medicine of the results of a CSN funded trial that will change clinical practice and significantly improve the prevention of recurrent strokes. The Network also took pride in the news that a neuro protectant drug discovered and developed through 15 years of continuous support from the CSN had been accepted for a pivotal Phase III trial to be conducted in Canada. If successful it will represent a scientific and medical breakthrough of historic significance. But more importantly the drug will dramatically Reduce the Impact of Stroke in Canada. It is wonderful to see that every province is now looking into implementing some form of telestroke. The work of the Canadian Stroke Network has really been catalytic in spreading this innovation across Canada. Dr. Mark Bisby author of the Expanding Telestroke in Canada Report It is hard to believe that the technology we discovered in the research lab during the early days of the Canadian Stroke Network 15 years ago has now made it to a pivotal trial, and that we will finally get an answer Dr. Michael Tymianski Canadian research chair in translational stroke research and head of neurosurgery at the University Health Network 47

52 Membership Board of Directors Pierre Boyle, (Chair), Université de Montreal Henry J.M. Barnett, Director Emeritus Pierre Chartrand, Consultant Eric Elvidge, Director Emeritus Watson Gale, Canadian Blood Services Luc Gauthier, University of Ottawa Antoine Hakim, (ex-officio), CSN Marilyn MacKay-Lyons, Dalhousie University Paul Morley, Consultant Roxanne Nadeau, Stroke Recovery Representative Rick Schwartzburg, Networks of Centres of Excellence David Scott, Director Emeritus Ruth Slack, University of Ottawa Bobbe Wood, Heart and Stroke Foundation of Canada Kevin Willis, (ex-officio), CSN Planning and Priorities Committee Antoine Hakim, (Chair) Canadian Stroke Network Norm Campbell, (Primary Prevention Representative) University of Calgary Ashfaq Shuaib, (Theme 1 Leader) University of Alberta Moira Kapral, (Theme 2 Leader) Institute for Clinical and Evaluative Sciences John MacDonald, (Theme 3 Leader) Robarts Research Institute Mark Bayley, (Theme 4 Co-leader) Toronto Rehabilitation Institute Dale Corbett, (Theme 4 Co-leader) University of Ottawa Kevin Willis, Canadian Stroke Network Rick Schwartzburg, Networks of Centres of Excellence Investigators Michelle Aarts, University of Toronto Theresa Ambrose, University of British Columbia David Andrews, Sunnybrook Research Institute Ruth Barclay-Goddard, University of Manitoba Mark Bayley, Toronto Rehab Sandra Black, Sunnybrook Health Sciences Centre John Blakely, Sunnybrook Hospital Steffen-Sebastian Bolz, University of Toronto Lara Boyd, University of British Columbia 48

53 Brian Buck, University of Alberta Norm Campbell, University of Calgary Leanne Casaubon, University Health Network Richard Chan, London Health Sciences Centre Frederick Colbourne, University of Alberta Dale Corbett, University of Ottawa Robert Côté, McGill University Shelagh Coutts, University of Calgary Stella S. Daskalopoulou, McGill University Andrew Demchuk, University of Calgary Johanne Desrosiers, Université de Sherbrooke Andre Douen, Trillium Health Centre Dar Dowlatshahi, University of Ottawa Janice Eng, University of British Columbia Gail Eskes, Dalhousie University Richard Frayne, University of Calgary David Gladstone, Sunnybrook Research Institute Brad Goodyear, University of Calgary Teri Green, University of Calgary Edith Hamel, McGill University Vladmir Hachinski, London Health Sciences Centre Daniel Hackam, Robarts Research Institute Michael Hill, University of Calgary David Howse, Thunder Bay Regional Health Sciences Centre Albert Jin, Queen s University Janusz Kaczorowski, Université de Montréal Aura Kagan, Aphasia Institute Moira Kapral, University Health Network Jiming Kong, University of Manitoba Nicol Korner-Bitensky, McGill University Jasna Kriz, Université Laval Mary L Abbe, University of Toronto Ting-Yim Lee, Robarts Research Institute John MacDonald, Robarts Research Institute R. Loch MacDonald, St. Michael s Hospital Marilyn MacKay-Lyons, Dalhousie University Brian MacVicar, University of British Columbia Rosemary Martino, University of Toronto Nancy Mayo, McGill University David Mikulis, University Health Network Edward Mills, University of Ottawa Cindi Morshead, University of Toronto 49

54 Tim Murphy, University of British Columbia Christian Naus, University of British Columbia Martin O Donnell, McMaster University Jennifer O Loughlin, Université de Montréal Guillaume Paré, McMaster University David Park, University of Ottawa Jim Peeling, University of Manitoba Andrew Penn, University of Victoria Marc Poulin, University of Calgary Carol Richards, Université de Laval Serge Rivest, Université de Laval Annie Rochette, Université de Montréal Fabio Rossi, University of British Columbia Demetrios Sahlas, McMaster University Michael Salter, University of Toronto Lyanne Schlichter, University of Toronto Dan Selchen, St. Michael s Hospital Mike Sharma, McMaster University Molly Shoichet, University of Toronto Ashfaq Shuaib, University of Alberta Frank Silver, University Health Network Ruth Slack, University of Ottawa Eric Smith, University of Calgary David Spence, Robarts Research Institute Danica Stanimirovic, National Research Council Peter Stys, University of Calgary Hong-Shuo Sun, University of Toronto Robert Teasell, St. Joseph s Health Care Roger Thompson, University of Calgary Michael Tymianski, University Health Network Steve Verreault, Université de Laval Yu-Tian Wang, University of British Columbia Samuel Yip, University of British Columbia Salim Yusuf, McMaster University 50

55 financial Report 51