1. MICROARRAY GENE EXPRESSION ANALYSIS OF FATTY ACID SYNTHASE (FAS) Palliative Care Service ICO-L’Hospitalet Hospital Duran i Reynals March 2011

2. MICROARRAY GENE EXPRESSION ANALYSIS OF FATTY ACID SYNTHASE (FAS) Home Support Teams ( PADES) District Hospitals Primary Care Health network

3. MICROARRAY GENE EXPRESSION ANALYSIS OF FATTY ACID SYNTHASE (FAS) Start & Evolution Programme “Vida als Anys” WHO Demonstration Programme on Palliative Care 1991 – Hospital Support Team (UFISS) 1995 – PCU + Clinic 1 doctor 3 nurses 1 secretary Model I.C.O. Comprehensive Oncological Care Epidemiology Prevention Research Teaching & Training Medical Oncology Raditherapeutic Oncology Clinical Haematology Palliative Care

4. 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 Service Teaching Dept. QUALY 19912011

5. MICROARRAY GENE EXPRESSION ANALYSIS OF FATTY ACID SYNTHASE (FAS) Functional Structure Hospital Support Team Palliative Care Unit Out-patients Clinic HEALTHNETWORKHEALTHNETWORK Research

6. MICROARRAY GENE EXPRESSION ANALYSIS OF FATTY ACID SYNTHASE (FAS) Structure Head of Service Head of Nursing Secretary 1 doctor [HUB + Haematology] + 1 doctor [Oncology] 1 nurse 2 doctors 9 nurses + 7 auxiliary nurses 2 doctors 1 nurse 16 beds 3/4 doctor 3/4 nurse PSOSWPhysioNutrVol Specialties Pain Clinical Trials Pain Clinic

7. 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: ICO67% Oncology48% Haematology19% HUB33% Discharge to: Home38 % Mortality30 % Social-Health C.20 % PCU10 % Data up-date 12.2010 Activity & outcomes

8. 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. - PPS40% -PaP-group A+B84% -ESS II+III74% -ChT33% - Cognitive failure (at admission)31% - CAGE16% - Psychiatric disorder28% - Social Worker44% - Psychologist32% - Physiotherapy24% - Nutritionist 7.5% - Pain clinic11% - Mean Stay:10.9 days - Mortality49.3% - Discharge at home37% - Social-Health C.14% Activity & outcomes 24 beds Data up-date 12.2010

9. MICROARRAY GENE EXPRESSION ANALYSIS OF FATTY ACID SYNTHASE (FAS) Out-patients Clinic Age:64 a. PPS:70 ESS II-III:50% ChT40% - Follow-up (median):110 days - Phone calls (average)15xd - Social Worker16% - 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 Activity & outcomes Data up-date 12.2010

10. MICROARRAY GENE EXPRESSION ANALYSIS OF FATTY ACID SYNTHASE (FAS) Anti-tumour treatment Palliative Care Bereavement 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

11. 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 Coverage Need & complexity driven Cooperation

12. MICROARRAY GENE EXPRESSION ANALYSIS OF FATTY ACID SYNTHASE (FAS) Research Activity & outcomes Lines: 1.- Opioids/ Cancer Pain 2.- Digestive symptoms 3.- Uncommon problems 4.- Ethics at the End of Life 5.- Clinical Haematology Shared studies with Qualy [ Epi Cancer Pain & HST ] 2010 Papers in national journal: 13 Papers in international journals: 6

13. 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

14. 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)

15. MICROARRAY GENE EXPRESSION ANALYSIS OF FATTY ACID SYNTHASE (FAS) Gran Via, s/n km 2,7 08907 L'Hospitalet - Barcelona Tels. 93 335 70 11 / 90 11 Fax 93 260 77 83 http://www.iconcologia.catsalut.net