Objectives Up to 10% of Bladder Cancers may arise following occupational exposure to carcinogens. We hypothesised that different cancer phenotypes reflected different patterns of occupational exposure. Methods Consecutive participants, with bladder cancer, self-completed a structured questionnaire detailing employment, tasks, exposures, smoking, lifestyle and family history. Our primary outcome was association between cancer phenotype and occupational details. Results We collected questionnaires from 536 patients, of whom 454 (85%) participants (352 men and 102 women) were included. Women were less likely to be smokers (68% vs. 81% Chi sq. p<0.001), but more likely than men to inhale environmental tobacco smoke at home (82% vs. 74% p = 0.08) and use hair dye (56% vs. 3%, p<0.001). Contact with potential carcinogens occurred in 282 (62%) participants (mean 3.1 per worker (range 0-14)). High-grade cancer was more common than low-grade disease in workers from the steel, foundry, metal, engineering and transport industries (p<0.05), and in workers exposed to crack detection dyes, chromium, coal/oil/gas by-products, diesel fumes/fuel/aircraft fuel and solvents (such as trichloroethylene). Higher staged cancers were frequent in workers exposed to Chromium, coal products and diesel exhaust fumes/fuel (p<0.05). Various workers (e.g. exposed to diesel fuels or fumes (Cox, HR 1.97 (95% CI 1.31-2.98) p = 0.001), employed in a garage (HR 2.19 (95% CI 1.31-3.63) p = 0.001), undertaking plumbing/gas fitting/ventilation (HR 2.15 (95% CI 1.15-4.01) p = 0.017), undertaking welding (HR 1.85 (95% CI 1.24-2.77) p = 0.003) and exposed to welding materials (HR 1.92 (95% CI 1.27-2.91) p = 0.002)) were more likely to

The GMC states that “Trainees in hospital posts must have well organised handover arrangements, ensuring continuity of patient care[1]”.In the Belfast City Hospital throughout the day there can be multiple new medical admissions. These can be via the GP Unit, transfers for tertiary care, and transfers due to bed shortages in other hospitals. Over the course of 24 hours there can be up to four medical SHOs and three registrars that fill in the take sheet. Due to the variety of admission routes and number of doctors looking after the medical take information can be lost during handover between SHOs.In the current format there is little room to write and key and relevant information on the medical take sheet about new and transferring patients. I felt that this handover sheet could be improved.An initial questionnaire demonstrated that 47% found the old proforma easy to use and 28.2% felt that it allowed them to identify sick patients. 100% of SHOs and Registrars surveyed felt that it could be improved from its current form.From feedback from my colleagues I created a new template and trialled it in the hospital. A repeat questionnaire demonstrated that 92.3% of responders felt the new format had improved medical handover and that 92.6% felt that it allowed safe handover most of the time/always.The success of this new proforma resulted in it being implemented on a permanent basis for new medical admissions and transfers to the hospital.

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Crohn's disease is a chronic inflammatory condition of the gastrointestinal tract which can result in luminal stenosis and up to 90% of patients requiring surgery during their lifetime. Medical management aims to reduce the inflammatory burden to prevent the development of inflammatory strictures, progression to fibro-stenosis and subsequent obstructive symptoms. Endoscopic balloon dilatation (EBD) is a well-established, safe technique in the management of short strictures to prevent patients having multiple surgical resections. In this review the evidence and safety of EBD for colonic and small bowel strictures will be discussed as well as adjuvant techniques (including endoscopic stenting and endoscopic intralesional therapy), current trials and new evidence on the medical management of stricturing disease.