[The right care in the right place].

Older patients who experience a fall may be admitted to hospital without a strict medical necessity. An unexplained fall incident requires thorough history taking and, if necessary, further investigation into the cause of the fall. Possible underlying multimorbidity must also be examined to prevent recurrence and complications.

Multidisciplinary decision-making and course of treatment in older patients with colorectal cancer: Effect of geriatrician input.

Introduction: We evaluated the effect of the inclusion of a geriatrician in the multidisciplinary cancer team (MDT) on decision-making for chemotherapy with curative intent in older patients with colorectal cancer.

Materials And Methods: We audited all patients aged 70 years and older with colorectal cancer discussed at MDT meetings between January 2010 and July 2018; selection was limited to those patients for whom guidelines recommended chemotherapy with curative intent as part of the primary treatment. We assessed how treatment decisions came about, and what the course of treatment was in the period before (2010-2013) and after (2014-2018) the geriatrician joined the MDT meetings.

[Supportive treatment and decision-making in a patient with severe anaemia when blood transfusion is not an option].

In severely anaemic patients, blood transfusions remain the standard of care when haemoglobin levels become dangerously low. However, in some situations blood transfusion is not an option. In this clinical lesson, we present a case of a young Jehovah's Witness who developed a life-threatening anaemia due to a gastro-intestinal bleeding.

Adherence to surveillance guidelines for colorectal adenomatous polyps in the elderly.

Objective: Determining adherence to recommended surveillance intervals after polypectomy in elderly patients.

Design: A retrospective cohort study including 531 patients aged above 70 years undergoing polypectomy between 2009-2011 in a large Dutch teaching hospital, identified using the hospital's pathology registry. Outcomes of the index colonoscopy were reviewed.

Malignant and Nonmalignant Complications of the Rectal Stump in Patients with Inflammatory Bowel Disease.

Background: Patients with refractory inflammatory bowel disease (IBD) might require a subtotal colectomy with construction of an ileostomy. Due to the risk of nerve damage and pelvic sepsis, the diverted rectum is often left in situ. Evidence on long-term complications of this rectal stump is limited, particularly in patients with Crohn's disease (CD).

How the concept of biochemical response influenced the management of primary biliary cholangitis over time.

Background: Criteria assessing biochemical response to ursodeoxycholic acid (UDCA) are established risk stratification tools in primary biliary cholangitis (PBC). We aimed to evaluate to what extent liver tests influenced patient management during a three decade period, and whether this changed over time.

Methods: 851 Dutch PBC patients diagnosed between 1988 and 2012 were reviewed to assess patient management in relation to liver test results during UDCA treatment.

Water, Water, Everywhere: Defining and Assessing Data Sharing in Academia.

Sharing of research data has begun to gain traction in many areas of the sciences in the past few years because of changing expectations from the scientific community, funding agencies, and academic journals. National Science Foundation (NSF) requirements for a data management plan (DMP) went into effect in 2011, with the intent of facilitating the dissemination and sharing of research results. Many projects that were funded during 2011 and 2012 should now have implemented the elements of the data management plans required for their grant proposals.

Multimodal treatment of perianal fistulas in Crohn's disease: seton versus anti-TNF versus advancement plasty (PISA): study protocol for a randomized controlled trial.

Background: Currently there is no guideline for the treatment of patients with Crohn's disease and high perianal fistulas. Most patients receive anti-TNF medication, but no long-term results of this expensive medication have been described, nor has its efficiency been compared to surgical strategies. With this study, we hope to provide treatment consensus for daily clinical practice with reduction in costs.

Late-onset inflammatory bowel disease in the very elderly.

Elderly-onset inflammatory bowel disease (IBD) will be seen more frequently with the ageing of the population and the increasing incidence of IBD. However, knowledge regarding the best approach to IBD in this population is scarce. Furthermore, differential diagnosis in elderly patients with diarrhoea, rectal blood loss or a changed defecation pattern is comprehensive and IBD is not always considered.

Long-term changes in physical capacity after colorectal cancer treatment.

Older patients with colorectal cancer are faced with the dilemma of choosing between the short-term risks of treatment and the long-term risks of insufficiently treated disease. In addition to treatment-related morbidity and mortality, patients may suffer from loss of physical capacity. The purpose of this review was to gather all available evidence regarding long-term changes in physical functioning and role functioning after colorectal cancer treatment, by performing a systematic Medline and Embase search.

Predicted effects of gypsy moth defoliation and climate change on forest carbon dynamics in the New Jersey pine barrens.

Disturbance regimes within temperate forests can significantly impact carbon cycling. Additionally, projected climate change in combination with multiple, interacting disturbance effects may disrupt the capacity of forests to act as carbon sinks at large spatial and temporal scales. We used a spatially explicit forest succession and disturbance model, LANDIS-II, to model the effects of climate change, gypsy moth (Lymantria dispar L.

[Domperidone and the risk of sudden cardiac death].

Domperidone is an antiemetic drug with relatively few side-effects. In the Netherlands, domperidone is available over the counter. Recently, discussion on the safety of domperidone has arisen because an association with sudden cardiac death has been suggested.

Diagnostic choices and clinical outcomes in octogenarians and nonagenarians with iron-deficiency anemia in the Netherlands.

Objectives: To evaluate current clinical practice for octogenarians with iron-deficiency anemia (IDA) by assessing referral patterns, diagnostic choices, clinical consequences of omission of endoscopy, and risks and benefits of IDA-related surgery.

Design: Chart review.

Setting: A regional hospital-based laboratory in the Netherlands between January 2008 and December 2010.

Optimal drug therapy after aspirin-induced upper gastrointestinal bleeding.

Upper gastrointestinal bleeding is a common adverse effect of chronic aspirin treatment. Traditionally, most physicians might tend to discontinue aspirin therapy after related gastrointestinal bleeding. However, recent studies have shown that continuation of aspirin is beneficial because of a decrease of cardiovascular complications and only a relatively small increase of recurrent peptic ulcer bleeding when combined with a proton pump inhibitor.

Optimal preparation for video capsule endoscopy: a prospective, randomized, single-blind study.

Background And Study Aim: Visualization of the small bowel by video capsule endoscopy (VCE) is frequently impaired by intestinal contents. Different bowel preparations have been studied with controversial results. The aim of this study was to determine a satisfactory and tolerable bowel preparation for VCE.

Clinical consequences of videocapsule endoscopy in GI bleeding and Crohn's disease.

Background: Videocapsule endoscopy (VCE) has a high diagnostic yield in the analysis of GI bleeding and Crohn's disease. Little information is available on the impact of VCE findings on clinical care.

Objective: Assess the impact of VCE findings on clinical management and outcome.

New endoscopic techniques for obscure gastrointestinal bleeding.

The case of a postmenopausal woman with a congenital aortic stenosis is presented. She presented with severe iron deficiency anemia. After negative extensive gastrointestinal analysis, she was treated with octreotide for six months.

Assessment of intestinal vascular malformations in patients with hereditary hemorrhagic teleangiectasia and anemia.

Introduction: Hereditary hemorrhagic teleangiectasia (HHT) is an autosomal dominant disorder with mucocutaneous teleangiectasia and visceral arteriovenous malformations. Mutations of endoglin and Activin A receptor like kinase-1 have different phenotypes, HHT1 and HHT2, respectively. The gastrointestinal tract is frequently affected, but limited information is available on the relationship with genotype.

Detection of small-bowel neuroendocrine tumors by video capsule endoscopy.

Objectives: Carcinoid tumors are the most common GI neuroendocrine tumors (NET). They often originate in the small intestine. The primary tumor is often difficult to locate, and resection in an early phase is recommended to prevent complications.

Results of videocapsule endoscopy in 250 patients with suspected small bowel pathology.

We aimed to assess technical feasibility, clinical applicability, and diagnostic yield of videocapsule endoscopy (VCE) in a large group of unselected patients. VCE was performed with the Given Imaging swallowable capsule. Findings were considered diagnostic if the observed finding could explain the symptomatology of the patient.

Video capsule endoscopy: procedure, indications and diagnostic yield.

Video capsule endoscopy (VCE) is a new noninvasive imaging technique for the complete small bowel. It provides good to excellent visualisation of the mucosa of the small bowel and has a high diagnostic yield in selected patients with gastrointestinal blood loss of suspected small bowel origin and in patients with Crohn's disease. In comparison with small bowel X-ray and push enteroscopy, diagnostic yield appears to be superior.

Monitoring forest carbon sequestration with remote sensing and carbon cycle modeling.

Sources and sinks of carbon associated with forests depend strongly on the management regime and spatial patterns in potential productivity. Satellite remote sensing can provide spatially explicit information on land cover, standage class, and harvesting. Carbon-cycle process models coupled to regional climate databases can provide information on potential rates of production and related rates of decomposition.