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A study aims to estimate the mean extension in life expectancy in very elderly versus younger persons using cross-sectional data collected from patients undergoing colorectal cancer screening with colonoscopy. Findings suggest that, even though prevalence of neoplasia increases with age, screening colonoscopy in very elderly patients results in only 15% of the expected gain in life expectancy in younger patients.

The article discusses supervisory leadership skills necessary for improving industrial safety performances. An overview is presented of several management tools for motivating safety behaviors in an organization, including setting team safety objectives and goals, using public scorekeeping of safety performance indicators, and including the supervisor in safety training programs. Also explored is the certification of supervisor for competency in specific leadership skills.

OBJECTIVE: Severe GI bleeding after hematopoietic cell transplantation is commonly due to lesions that are unusual in nontransplant patients. The frequency of GI bleeding appears to have decreased over the last decade, but the reasons have not been readily apparent. We sought to determine the incidence of severe bleeding during two time periods, to describe the causes and outcomes of bleeding, and to analyze the reasons behind an apparent decline in severe bleeding over the decade covered. METHODS: During 1986-1987 and 1996-1997, we followed all patients with and without severe bleeding at our institution, a marrow transplant center. RESULTS: Over this decade, the incidence of severe bleeding declined from 50/467 (10.7%) to 15/635 (2.4%) (p < 0.0001). Overall mortality from intestinal bleeding declined from 3.6% to 0.9% (p = 0.002), but mortality in those with bleeding remained high (34% vs 40%). The onset (day 42 vs 47) and platelet counts (35,994 vs 37,600/µl) were similar, but the sites and causes of bleeding were different. During 1986-1987, 27/50 patients bled from multiple GI sites, viral and fungal ulcers, or graft-versus-host disease (GVHD). Over the decade, bleeding from GVHD had decreased 80% (p < 0.0001), and bleeding from viral (p < 0.0001) and fungal (p = 0.023) ulcers almost disappeared. CONCLUSIONS: The incidence of severe GI bleeding has declined significantly over the last decade because of prevention of viral and fungal infections and severe acute GVHD. However, severe bleeding after transplant remains a highly morbid event, particularly among patients with GVHD. [ABSTRACT FROM AUTHOR]

Several letters to the editor in response to previous issues including "SH&E or Not SH&E," by David Heidorn, and "Global Harmonization of Safety Standards: Examining the European Influence on Safety," by Fred Manuele are presented.