[Climate-smart and effective health care reduces green-house gas emissions]. / Klimatsmart och effektiv sjukvård minskar utsläppen av växthusgaser.

Health care is associated with a considerable climate impact and this short review describes approaches to reduce this impact. Reviews from WHO and World Bank Group end up with recommendations on low-carbon and resilient health care which is beneficial for health, economy and climate. The concept of climate-smart healthcare has been suggested as new way of describing this much needed work. In Skåne Region, Sweden a four-step method has been developed to reduce the climate impact of hospital care: to map and identify areas of greatest impact, to work with measures to reduce impact and evaluate the results. A test of this method showed a significant reduction in emission of CO2. In another project, fast-track access for patients with hematuria for diagnosis of bladder cancer showed that the median time from referral to diagnosis was reduced in comparison with conventional care with less costs and less use of resources associated with climate impact.

Fast-track access to urologic care for patients with macroscopic haematuria is efficient and cost-effective: results from a prospective intervention study.

BACKGROUND: The delay between onset of macroscopic haematuria and diagnosis of bladder cancer is often long. METHODS: We evaluated timely diagnosis and health-care costs for patients with macroscopic haematuria given fast-track access to diagnostics. During a 15-month period, a telephone hotline for fast-track diagnostics was provided in nine Swedish municipalities for patients aged ⩾50 years with macroscopic haematuria. The control group comprised 101 patients diagnosed with bladder cancer in the same catchment area with macroscopic haematuria who underwent regular diagnostic process. RESULTS: In all 275 patients who called 'the Red Phone' hotline were investigated, and 47 of them (17%) were diagnosed with cancer and 36 of those had bladder cancer. Median time from patient-reported haematuria to diagnosis was 29 (interquartile range (IQR) 14-104) days and 50 (IQR 27-165) days in the intervention and the control group, respectively (P=0.03). The median health-care costs were lower in the intervention group (655 (IQR 655-655) EUR) than in the control group (767 (IQR 490-1096) EUR) (P=0.002). CONCLUSIONS: Direct access to urologic expertise and fast-track diagnostics is motivated for patients with macroscopic haematuria to reduce diagnostic intervals and lower health-care expenditures.

Patient-reported outcome after radical cystectomy: translation and psychometric validation of the Swedish version of the Functional Assessment of Cancer Therapy Scale Vanderbilt Cystectomy Index.

OBJECTIVE: The aim of this study was to translate and validate the Swedish version of the Functional Assessment of Cancer Therapy Scale - Vanderbilt Cystectomy Index (FACT-VCI). MATERIALS AND METHODS: For adaptation into Swedish, a multiprofessional team was used for translation including cultural adjustment, followed by back-translation. Test and retest in 10 individuals was followed by assessing metric properties in 75 consecutive patients with bladder cancer treated with radical cystectomy. Reliability and internal consistency were measured by Cronbach's alpha. Face validity was tested with two laypersons and construct validity was tested by correlation to the dimensions in the Functional Assessment of Cancer Therapy Scale - General (FACT-G). RESULTS: The translated Swedish instrument showed validity and reliability similar to the original, and the results were comparable to published studies using FACT-VCI. The correlation between the VCI sum score and FACT-G dimensions was significant in all dimensions and the item-total correlation was over 0.3; therefore, the construct validity was acceptable. In addition, it was possible to detect differences in separate items in the translated version of FACT-VCI between age groups, type of diversion and those treated with chemotherapy, even though the samples were small. CONCLUSIONS: The Swedish version of FACT-VCI is a valid and reliable instrument for use in the follow-up of patients with bladder cancer treated with urinary diversion. To measure changes after surgery, preoperative assessment with the related FACT-G instrument is advisable.