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M0hi(F#C Մ\ϙ{fwv{wĢaә;o̜9sv-(U(e(EZilY ໙/#Q|q.~HB -6,WXǨ,vJΉa͌sCcqKrSnv$./gB(-WAiC w~de۶.-((s2mmU%FCۍ/WۙJPqﯿJGPQNIpDcZ{_ ǘ2m@ sSm1fe4",ݬ!g+)u6IRj{c}꦳k |&)~Jp3d&嶎N\a#FPvcIǭ n6Bkh|mov[C/lNۯ.a>aSbJ{]9O;2$2!bT:zn<;$ n `+}mVC?? lDAo@ۿڰ:mU 7χtv祉dمZZ^ smt2!a; oTdwzQ?j ' QWE9cod6wd G/\'Zg$0L Y(Vc;{kc]H{Lu3wĪ_b㟅Xmrt6 g.Dkw&wc>s|gP{K7B]zSN8k oRoyV6|qG.?ގ1Y9Dat2IM&hEi@Ƿ#zWSǃ2^qds0s8;*8t|̜T:ug:Oӎ؂9 AKٵ /?M~~3;jl 0r=8.Q~` =[T&_A:95}EQ[w㳫I ISMX1Hq <|GB5L+`bN}brʱ^D9r;*r9ٱ _( PX ݃QBx m%U]8r/b1O`I|h|ptPX>X.Zwq uoA%{VW1e;߭]o10xm~mLYu|dÕ!?y3Y/?__aԅ2ne]{ wN ۍ-?¿%*=_[+~278 )c= lsz7W;Ee>W1ںulY8f +s>)o#wHHڎ;F0Ga%}vލяwJˍ1ߝ(=qWa~w[W "K}sn짼|.%Zeme|x|\.G{}۝kRzY}ϝ10N(f@=z BT&dr|e 8G3xY}lTE}wڃr xZ5j@CWSHm^b4hф( 4LHL?LA-?04A51̾ٻ{G,2fvvwfv{6"G*B:)V#r!34x `ǀQH>8.YHH7S`Iȗ Y%RMLv R#8/JC%*Y=%HqHulCaePXX 2mog>JA)|/B)'YǪj7Rl*8V1zL?M׉Hhc ZI?ڨ;u0 &݌mHHVK!ҍ7+gH=H [@nIQ#m/q۶/htȲvRdIN6tLdlD4A@tld_y4|mڼu=XlxMmS0QTd&cM8^>U>;8O)Ujh|˰"le2P+od`4}Jʾ־l=6xUlμ 84#dtl}aqAZeX<+?6S(imC_mCJAv|GĔ0LMMVHtJ f^5s?l~i톾зzC_o>'E5Ad ^b6Fl2 }9(%v~n1PЊp}+;a+"d%[ꚜ{bvl/ B͊/#~twU\^k39W.LW &=Ty-mVM[!$1k|sy^o#_/jyD#c3#(,K_5DJG,14%!Ř#f [| !XV²q7ܺo&[T~2 EŋS)zm 3{/$S{\~:o燍Xd..گý'U]"-g{\Pm""0bz~xo gxdS3?nrg|} ڀ͹|A u73'sav a?ǍX]:X!{?DE'nÓbO3hu-؎|_(_GFĻ+ =3 t˺6w9l9qø \ll[/ Ds=2s:?8w_/:**R .A{`lss; s[f|F~Ք˷żV'59BVzL ^ՆJu>ZUKRZVΗ4wtH?o@ۛe|5~w 6g*]Х&q3 KnKosnV?IK LOP%]^_ ` abdghijklq rtuv x{z| hR$;S%- `9yb$vp*oz*?,2 h9y"$3ąJ䀂#"$r f >"$P뫠uy=4R&"$ps"{TNh%NSMx"$ӍO Ԩ="$Nʱdg}R$HO\ч~e19$ "$ovʸZ߇'Jt2"$-*l뮺8!G|38$"$r(0PϘL>"$z BT&drE 0AAp3}z@C ʚ;2Nʚ;g4OdOdP9 x: 0ppp@ <4!d!d@ 0t, <4dddd@ 0t,  <4dddd@ 0t&0___PPT10 pp___PPT9bZ5? %6)bPrograma pilot sobre l s teraputic del cannabis22( $< Barcelona, 9 d abril de 2008 2$ 6 Antecedents  2Iniciatives socials zAssociaci gata Pacients cncer Problemtica: nusees i vmits per quimioterpia Sensibilitzaci Societat Grups polticsnZAZZZZA {c*Iniciatives poltiques$  "Resolucions Parlament de Catalunya##6   45Actuacions del Departament de Salut de la Generalitat66( 6mbit informatiu Elaboraci i difusi d un BIT a metges i farmacutics de Catalunya (web) mbit de recerca Revisi sistemtica evidncia cientfica (FICF) mbit de disponibilitat Obtenci del producte Estocs en els hospitalsZIZZ0ZZ.ZI/. &H55Actuacions del Departament de Salut de la Generalitat66( 6Creaci del Comit de Direcci de l s teraputic del cannabis: Direcci General de Recursos Sanitaris Fundaci Institut Catal de Farmacologia Collegi Oficial de Metges de Barcelona Collegi Oficial de Farmacutics de Barcelona Institut Municipal d Investigaci Mdica2@-@D      1\Programa pilot de l s teraputic del cannabis//(&&\ ESTUDI SEGUIVEX: Estudi pilot de seguiment dels pacients que reben Sativex com a s compassiu o com a medicaci estrangera des de sis centres hospitalaris de l rea de Barcelona per al tractament del dolor neuroptic, l espasticitat secundria a esclerosi mltiple o la sndrome d anorxia-caquxia.vPP-x;P2G7 Medicament  89Sativex ( ( Canad: Dolor neuroptic en pacients amb esclerosi mltiple. s compassiu (evidncia cientfica): - espasticitat en esclerosi mltiple - sndrome d anorxia-caquxia - dolor neuroptic d altra etiologia - nusees i vmits en quimioterpia:d= (H           F:Objectius dels estudis6 IObjectiu principalRespondre a la demanda social d utilitzaci teraputica d un extracte estandarditzat de cannabisa" a$ OJAltres objectius Avaluaci dels possibles beneficis relacionats amb el seu s en condicions estrictament controlades obtenint dades sobre: les caracterstiques clniques i epidemiolgiques dels pacients tractats amb l extracte de cannabis la dosi diria que necessiten els pacients els possibles efectes beneficiosos seguretat del medicament qualitat de vida grau de satisfacci dels pacients i dels investigadorsV{ZZZy{         ~+ Participants 4Serveis de neurologia, oncologia, dolor, malalties infeccioses, cures palliatives i farmcia de 6 hospitals de l rea de Barcelona. Hospital de la Vall d Hebron Hospital de la Santa Creu i Sant Pau Hospital del Mar Hospital Clnic i Provincial Hospital de Bellvitge Hospital Germans Trias i Pujol 75 oficines de farmcia de la provncia de Barcelona Personal d infermeria Personal de coordinaci de l estudiJZ-ZoZo            `(5Equip multidisciplinar de seguiment: escalada de dosi66(: |Seguiment dels pacients de l estudi Seguivex: Multidisciplinar??(<$EResultats del programa pilot$ Z'Caracterstiques dels pacients   Es tracta de pacients greus, amb malalties crniques de llarga evoluci, polimedicats, amb mala resposta als tractaments habituals i baixa qualitat de vida 4((.J HM  Pacients per indicacions (n=207)!!( !DE;<=>?H0/Hdefhip q {} !"#$%&'()*+,-./012h  0` ` ̙33` 333MMM` ff3333f` f` f` 3>?" dd@,|?" dd@   " @ ` n?" dd@   @@``PR    @ ` ` p>> $(  P  C A"  6  P   k7Haga clic para modificar el estilo de ttulo del patrn8 8/  04     kHaga clic para modificar el estilo de texto del patrn Segundo nivel Tercer nivel Cuarto nivel Quinto nivel7    llB  6D3o"H  0޽h ? ̙33 *Diseo predeterminado 0 #(    0 9   P*    0Hѡ L h9  R*  d  c $ ?O  /  0L    kHaga clic para modificar el estilo de texto del patrn Segundo nivel Tercer nivel Cuarto nivel Quinto nivel7    l  6ڡ 3l   P*    6ߡ 3L hl  R*  H  0e ? 3380___PPT10. `O 0((    0\ 9   `*   0< L h9  b*   6  3l   `*   6 3L hl  b* H  0e ? 3380___PPT10.ҌD 0 0(  X  C 0AFons_senyalr  S   r  S *  Y  H  0޽h ? ̙33Y" 0 x(  X  C 0AFons_senyal/x  c $>"  H  0޽h ? ̙33y___PPT10Y+D=' = @B +f & 0  f(    B P     <( f  H  0޽h ? ̙3380___PPT10.M>b  0 8b(  8r 8 S P   r 8 S ám`  6 8 0  HResoluci 646/VI del Parlament de Catalunya, sobre les gestions per a l s teraputic del cnem indi (Cannabis sativa var. indica). (2001) Resoluci 1721/VI del Parlament de Catalunya, sobre l elaboraci d un projecte d investigaci de l s teraputic del cnem indi (Cannabis sativa) (2003)^Ht %H 8 0޽h ? ̙3380___PPT10. _ ' 0 @l(    H`C ,     <D <  H  0޽h ? ̙33___PPT10i.plW+D=' = @B +J ! 0 aYp(  x  c $Uf    s tV0e0e #" 0eP   ?  HW>t\ 'Elaboraci dels protocols dels estudis ((f  H  0޽h ? ̙33___PPT10i. 5+D=' = @B +&   0 =5(  x  c $@n     6xo Ii 1 Inici: Gener de 2006. Final: Desembre de 2007. "2 0 >   s u0e0e #" 0eP   H  0޽h ? ̙33___PPT10i. _+D=' = @B +%  % 0 < 4 p  (   X   0}z Yif   0"`Y     6䉬< % Perode: Maig 2007 - Desembre 2007.  & $>V   <` , Programa pilot de l s teraputic del cannabis: nusees i vmits A0((&&   <`7 ' ESTUDI SEGUIVEX-EMESI: Estudi pilot de seguiment dels pacients que reben Sativex com a s compassiu des de cinc centres hospitalaris de Barcelona per al tractament de les nusees i els vmits tardans induts per la quimioterpia antineoplstica. F:@4F   <, S, NASSAIG CLNIC SATEME: avaluar l eficcia preliminar i tolerabilitat de Sativex per a la prevenci de les nusees i els vmits tardans produts per la quimioterpia. ::Y.1Z   6ਬVv  # Perode: Gener 2006 - Abril 2007.  $ ",H   0޽h ? ̙33___PPT10i. _+D=' = @B +Y# 0 x(  X  C 0AFons_senyal/x  c $h\"  H  0޽h ? ̙33y___PPT10Y+D=' = @B +( 0 h(    <ҙ P hSativex" ( ( b  C :A "pot-spray-insidev  0֙ + T- Extracte estandarditzat de cannabis Polvoritzador sublingual o en la mucosa oral Cada 100 ml: 2,7 mg tetrahidrocannabinol 2,5 mg cannabidiol 5% altres cannabinoidesV'=-G-'8G  +  H  0޽h ? ̙33___PPT10i.J+D=' = @B + ) 0   (  r  S f    s \0e0e #" 0eP   H  0޽h ? ̙33___PPT10i. PM+D=' = @B +\* 0 P\(    <X P fSativex ( ( b  C :A "pot-spray-inside`'   <2-  t.La utilitzaci d aquest medicament t una certa complexitat donat que cal ajustar la pauta de tractament per cada pacient fins assolir la dosi ptima que permeti controlar els smptomes amb efectes indesitjats tolerables mitjanant una escalada de dosi lenta i individualitzada. H  0޽h ? ̙3380___PPT10.kB;Y$ 0 x@(  X  C 0AFons_senyal/x  c $X"  H  0޽h ? ̙33y___PPT10Y+D=' = @B +{  0 0 2(  r  S tɬP     S Ϭ9   "p`Pp  6<Ҭ  *Que els pacients que ho necessitin tinguin un accs fcil i controlat a l s teraputic del cannabise e &\X2  0 0 @ H  0޽h ? ̙33y___PPT10Y+D=' = @B +m  0 @ $(  r  S ܬP   r  S ݬf  H  0޽h ? ̙33y___PPT10Y+D=' = @B +}  0 H$(  Hr H S TP   r H S ,f  H H 0޽h ? ̙33___PPT10i. 5+D=' = @B +  0 +X(  x ( 0C"?" <)x ' 0C"?2Aq   B  ]      ` ??   MPACIENT    `@ ??I IMetge    ` ?? X  p,Farmcia de l hospital   T ??@ L ZDepartament de Salut   T4 ?? | Ministerio de Sanidad y Consumo  4     ` ??m  N Laboratori  B  3 rDo?? B @ 3 rDo??FFB  3 rDo??""B  3 rDo??K MB @ 3 rDo??s B  3 rDo?? @ @ B  3 rDo?? B  3 rDo?? Z!    `  ??| WOficina de farmcia B ! 3 rDo??Kz K "  `$ ?? / N Infermeria  B $ 3 rDo??=  {B %@ 3 rDo?? ` * 6)   4Monitors de l estudi: FICF0H  0޽h ? ̙33___PPT10i.p*k+D=' = @B +  0  $v(  $r $ S  4P    $0 ZA ? ?mw0    $ <5 B 100% seguits pel seu metgeTH $ 0޽h ? ̙33y___PPT10Y+D=' = @B +Y  0 x(  X  C 0AFons_senyal/x  c $B"  H  0޽h ? ̙33y___PPT10Y+D=' = @B +   0 N(    HG P   r  S G  H  0޽h ? ̙33y___PPT10Y+D=' = @B + 0 P <(  x  c $lM]    HA ? ,7 H  0޽h ? ̙33y___PPT10Y+D=' = @B ++ 0 (    6 Zq* mResultats: Objectiu principal ((   0:D< ". S ha complert l objectiu principal de l estudi donat que: S ha posat a l abast dels pacients una alternativa teraputica que permet una dosificaci controlada. 207 pacients han rebut aquest tractament per les 5 indicacions autoritzades. Desprs de l inici del Programa a Catalunya, altres hospitals de l Estat Espanyol han pogut accedir al tractament per la via d s compassiu o medicaci estrangera.4<\-<\            H  0޽h ? ̙3380___PPT10.j0, 0 >60(    6P( Z* ~.Resultats: Tolerabilitat i grau de satisfacci /.$$ /  0 .DI  JJ Ms de la meitat dels pacients presenten una bona tolerabilitat al tractament i bona part d aquests pacients presenten millores en la seva simptomatologia. La meitat dels pacients que han rebut tractament es mostren satisfets, donat que han percebut una millora en la seva simptomatologia.&&        H  0޽h ? ̙3380___PPT10.j0- 0 `6(    6 F Zq* HResultats: Dolor neuroptic percebut per pacients amb esclerosi mltiple IH(( Ix  <A ??m@  x  <A ??X  H  0޽h ? ̙33___PPT10i.L+D=' = @B +. 0 3(    6DP Z* EResultats: Espasticitat percebuda per pacients amb esclerosi mltiple FE(( Fx  <A ??9  x  <A ??9h j H  0޽h ? ̙33___PPT10i.W+D=' = @B +/ 0 =(    6tZ Z* OResultats: Dolor percebut pel pacient amb dolor neuroptic de diversa etiologia PO&& Px  <A ??I v x  <A ??I@ jv H  0޽h ? ̙33___PPT10i.L+D=' = @B +0 0 (  x  <A ??S  x  <A ??u < t  6|e Z* Resultats: Sensaci de gana percebuda pel pacient amb sndrome d anorxia-caquxia SR$$&?H  0޽h ? ̙33___PPT10i.W+D=' = @B +1 0  Q(      6o Z* 9Resultats: Nusees i vmits secundaris a la quimioterpia :9$$ :"   0x  z Una tercera part dels pacients no han tingut nusees en cicles successius de quimioterpia. El 67% restant ha disminut la durada i intensitat mitjana de les nusees al final del tractament. Un 21,7% dels pacients no han tingut vmits en cicles successius de quimioterpia. El 73,9% restant ha disminut la durada i intensitat mitjana dels vmits al final del tractament.{{               H   0޽h ? ̙33___PPT10i.W+D=' = @B +2 0 (=(  ( ( 6( Z* [ Conclusions $$ < ( 0ĔP0o  Calen ms estudis de recerca per definir amb precisi el paper d aquestes substncies en teraputica. Ara ja hi ha a l abast una nova alternativa teraputica per als pacients que ho necessiten.$  H ( 0޽h ? ̙33___PPT10i. E+D=' = @B + 0 (  X  C 0AFons_senyal/H  0޽h ? ̙33y___PPT10Y+D=' = @B + 0   (  X  C O     S     "H  0e ? 3380___PPT10. 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