microarray gene expression analysis of fatty acid synthase (fas) palliative care service...
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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
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MICROARRAY GENE EXPRESSION ANALYSIS OF FATTY ACID SYNTHASE (FAS)
Home Support Teams ( PADES)District HospitalsPrimary Care
Health network
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MICROARRAY GENE EXPRESSION ANALYSIS OF FATTY ACID SYNTHASE (FAS)
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
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MICROARRAY GENE EXPRESSION ANALYSIS OF FATTY ACID SYNTHASE (FAS)
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
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MICROARRAY GENE EXPRESSION ANALYSIS OF FATTY ACID SYNTHASE (FAS)
Functional Structure
Hospital Support Team
Palliative Care Unit
Out-patients Clinic
HEALTH
NETWORK
Research
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MICROARRAY GENE EXPRESSION ANALYSIS OF FATTY ACID SYNTHASE (FAS)
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
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MICROARRAY GENE EXPRESSION ANALYSIS OF FATTY ACID SYNTHASE (FAS)
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
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MICROARRAY GENE EXPRESSION ANALYSIS OF FATTY ACID SYNTHASE (FAS)
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
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MICROARRAY GENE EXPRESSION ANALYSIS OF FATTY ACID SYNTHASE (FAS)
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
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MICROARRAY GENE EXPRESSION ANALYSIS OF FATTY ACID SYNTHASE (FAS)
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
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MICROARRAY GENE EXPRESSION ANALYSIS OF FATTY ACID SYNTHASE (FAS)
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
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MICROARRAY GENE EXPRESSION ANALYSIS OF FATTY ACID SYNTHASE (FAS)
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
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MICROARRAY GENE EXPRESSION ANALYSIS OF FATTY ACID SYNTHASE (FAS)
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
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MICROARRAY GENE EXPRESSION ANALYSIS OF FATTY ACID SYNTHASE (FAS)
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)
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MICROARRAY GENE EXPRESSION ANALYSIS OF FATTY ACID SYNTHASE (FAS)
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