MICROARRAY GENE EXPRESSION ANALYSIS OF FATTY ACID SYNTHASE (FAS) Palliative Care Service...

MICROARRAY GENE EXPRESSION ANALYSIS OF FATTY ACID SYNTHASE (FAS)

Palliative Care ServicePalliative Care ServiceICO-L’HospitaletICO-L’Hospitalet

Hospital Duran i ReynalsHospital Duran i Reynals

March 2011


Home Support Teams ( PADES)District HospitalsPrimary Care

Health network


Start & Evolution

Programme “Vida als Anys”WHO Demonstration Programme on Palliative Care1991 – Hospital Support Team (UFISS)

1995 – PCU + Clinic 1 doctor3 nurses

1 secretary

Model I.C.O.Comprehensive Oncological CareEpidemiology PreventionResearch Teaching & Training

Medical Oncology Raditherapeutic Oncology Clinical HaematologyPalliative Care


Evolution & Development

Care of Patients & Families

Clinical Research

Teaching & Training

WHO collaborating Centre Research on Programmes &

Services

End of Life Observatory

Palliative Care ServicePalliative Care Service

Teaching Dept.Teaching Dept. QUALY QUALY

19911991 20112011


Functional Structure

Hospital Support Team

Palliative Care Unit

Out-patients Clinic

HEALTH

NETWORK

Research


Structure

Head of ServiceHead of Nursing

Secretary

1 doctor [HUB + Haematology] + 1 doctor [Oncology]1 nurse

2 doctors9 nurses + 7 auxiliary nurses

2 doctors1 nurse

16 beds

3/4 doctor3/4 nurse

PSO SW Physio Nutr Vol

Specialties

PainClinical Trials

Pain Clinic


Hospital Support Team (UFISS)

- proactive intervention - multidimensional assessment & advise - case management – liaison - 5 level of intervention

Consultation from:ICO 67%Oncology 48%Haematology 19%

HUB 33%

Discharge to:Home 38 %Mortality 30 %Social-Health C. 20 %PCU 10 %

284 278350 350 384

520586

378

512

653563

0

100

200

300

400

500

600

700

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

No

pat

ien

ts

1st visits Data up-date 12.2010

Activity & outcomes


Palliative Care Unit

- in- patient care based on complexity- comprehensive multidimensional care

-Mean Age: 64.6 y. - PPS 40%-PaP-group A+B 84%-ESS II+III 74%-ChT 33%- Cognitive failure (at admission) 31%- CAGE 16%- Psychiatric disorder 28%

- Social Worker 44%- Psychologist 32%- Physiotherapy 24%- Nutritionist 7.5%- Pain clinic 11%

- Mean Stay: 10.9 days- Mortality 49.3%- Discharge at home 37%- Social-Health C. 14%

Activity & outcomes

481540

610 628 628689 665

544

762 729689

0100200300400500600700800900

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

No

Discharges

24 beds

Data up-date 12.2010


Out-patients Clinic

Age: 64 a.PPS: 70ESS II-III: 50%ChT 40%

- Follow-up (median): 110 days- Phone calls (average) 15xd- Social Worker 16%- Psychologist 12.5%- Pain Clinic 17%

Porta-Sales et al. JPSM 2005;30:145-53

- preferential appointment by needs- multidimensional assessment and care - phone support (clinical nurse)- case management and liaison - available in place: psychologist social worker pain specialist

0100200300400500600700800

20002002

20042006

20082010

1st visits

Activity & outcomes

Data up-date 12.2010


Anti-tumour treatment

Palliative CareBereavement

death

Support Care

Phase I trials

Early intervention

Greater interface and cooperation with the other oncological services

www.who.int/cancer/palliative/en/

Meyers et al. JPSM 2004 ;28:548-56

Healthcare development


Continuous & Shared Care

EMEG

SUR

HMC

PAIN

ORL

PAL

RDT

MO

“ping-pong model”

“sharing model”

hosp

Phase I

ONC

hosp

RDT

HCL

community

PAL

USAC

Partner

Acute Hosp

CoverageNeed & complexity driven Cooperation


Research

Activity & outcomes

Lines:1.- Opioids/ Cancer Pain 2.- Digestive symptoms 3.- Uncommon problems4.- Ethics at the End of Life5.- Clinical HaematologyShared studies with Qualy [Epi Cancer Pain & HST]

2010Papers in national journal: 13Papers in international journals: 6


Teaching-Residents

- Medical oncology 3-4 per year (2 months)- Haematology 2 per year (1 month)- Anaesthesiology (cancer pain) 4 per year (1/2 month)- Family Medicine 5 per year (1 month)- Pschyconcology 6 per year (2 months)

-Nursing students 4 per year (average)-Foreign visitors and stays

Participation in:-Undergraduate and post graduate couses-Masters: ICO- Universitat de Barcelona [Palliative Care]- Universitat Autónoma de Barcelona [Bioethics]- Universidad Rey Juan Carlos ( Madrid) [Bioethics]

Universidad Pontificia Comillas ( Sevilla) [Palliative Care] Univesidad Autónoma de Madrid [Palliative Care] Universitat de Vic (Barcelona) [Ageing]

-

Activity & outcomes


Summary

-Service inserted into a Cancer Institute & a Tertiary

Teaching Hospital-Care based on complexity

- Early Intervention and in diverse fields

- Intense clinical activity

- Busy teaching

- Intense research activity

- Reference service in a wide healthcare network - Shared non healthcare activities with other in-house

palliative care resources (i.e. Qualy)


Gran Via, s/n km 2,708907 L'Hospitalet - BarcelonaTels. 93 335 70 11 / 90 11 Fax 93 260 77 83http://www.iconcologia.catsalut.net

MICROARRAY GENE EXPRESSION ANALYSIS OF FATTY ACID SYNTHASE (FAS) Palliative Care Service...

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