Reduction in the diagnostic interval after the introduction of cancer patient pathways for colorectal cancer in northern Sweden.

OBJECTIVE: To compare the diagnostic interval for patients with colorectal cancer before and after the introduction of cancer patient pathways in northern Sweden. DESIGN: A retrospective study comparing two cohorts (2012 and 2018) of patients diagnosed with colorectal cancer before and after the introduction of cancer patient pathways in 2016. SETTING: Three counties in northern Sweden with large sparsely populated areas and some cities (637143 residents ∼5.1 residents/km2). SUBJECTS: Patients were included from the Swedish Cancer Register. Electronic health records reviews were performed and linked to socioeconomic data from Statistics Sweden. MAIN OUTCOME MEASURES: Differences in the diagnostic intervals, the patient intervals and the characteristics associated with the longest diagnostic intervals and investigations starting at the emergency department. RESULTS: The two cohorts included 411 patients in 2012 and 445 patients in 2018. The median diagnostic interval was reduced from 47 days (IQI 18-99) to 29 days (IQI 9-74) (p < 0.001) after the introduction of cancer patient pathways in general. Though for the cases of cancer in the right-side (ascended) colon, the reduction of the diagnostic interval was not observed and it remained associated with investigations starting at the emergency department. CONCLUSION: Our results indicate that cancer patient pathways contributed to an improvement in the diagnostic interval for patients with colorectal cancer in general, yet not for patients with cancer in the right-side colon. IMPLICATION: In general, cancer patient pathways seem to reduce the diagnostic interval for colorectal cancer but it is not a sufficient solution for all colorectal cancer localisations.

Diagnostic interval for colorectal cancer reduced in general, particularly for patients seeking primary healthcare, after the introduction of cancer patient pathways.Patients with cancer in right-side colon still have long diagnostic intervals and mainly start their investigation through the emergency department.

Intrathecal sufentanil, fentanyl, or placebo added to bupivacaine for cesarean section.

UNLABELLED: We compared the effects of intrathecal sufentanil 2.5 and 5 microg, fentanyl 10 microg, and placebo when administered together with hyperbaric bupivacaine 0.5% 12.5 mg for cesarean section. The study was performed in a randomized, double-blind fashion in 80 (20 per group) healthy, full-term parturients presenting for elective cesarean section. Postoperative pain was assessed using the visual analog scale (VAS). Duration of complete analgesia was defined as the time from the intrathecal injection to VAS score > 0. Duration of effective analgesia was defined as the time to VAS score > or = 4. No patient experienced intraoperative pain. Complete analgesia was prolonged in all groups receiving opioids. Effective analgesia was prolonged and the 0- to 6-h intravenous opioid requirements were lower in the groups receiving sufentanil compared with those receiving fentanyl and placebo. The need for intraoperative antiemetic medication was greater in the placebo group. Pruritus was a frequent and dose-related side effect in the groups receiving sufentanil. There were no differences in umbilical cord blood gases or neonatal Apgar scores and neurological and adaptive capacity scores among the groups. In conclusion, the addition of sufentanil or fentanyl improved the quality of subarachnoid block compared with placebo. The duration of action was longer for sufentanil than fentanyl. IMPLICATIONS: Small doses of fentanyl or sufentanil (synthetic opioids) added to bupivacaine (local anesthetic) for spinal anesthesia for cesarean section reduce the need for intraoperative antiemetic medication and increase the duration of analgesia in the early postoperative period compared with placebo.