Day case stapled haemorrhoidopexy for prolapsing haemorrhoids

Objective Conventional surgical management of prolapsing haemorrhoids is by excisional haemorrhoidectomy. Postoperative pain has restricted the application of such procedures in the day case setting. These operations remain associated with a period of restricted activity. The use of circular stapling devices as an alternative to the excisional approach in the management of haemorrhoids has been described. This study reports our experience of stapled haemorrhoidopexy as a day case procedure.

Methods Patients with third or fourth degree haemorrhoids were eligible for the procedure. Patients were considered suitable candidates for day case surgery based on conventional parameters. Symptoms were assessed using a previously validated symptom severity rating score. Stapled haemorrhoiclopexy was carried out using a circular stapling device. Pain scores were obtained prior to discharge. Patients were admitted if pain was uncontrolled despite oral analgesia. Symptoms were re-scored at six-week follow-up.

Results Over a 70-month period 168 consecutive stapled haemorrhoidopexies were performed or directly supervised by one consultant colorectal surgeon. One hundred and ten (65%) patients were considered appropriate candidates for day case surgery by conventional criteria. Ninety-six (87.3%) patients successfully underwent stapled haemorrhoidopexyon a day case basis. Fourteen (12.7%) patients required admission on the day of surgery (5 for early Postoperative bleeding, 4 for pain necessitating continuing opiate analgesia, two for urinary retention and three for surgery performed late in the day). Six (5%) patients were re-admitted postoperatively; four for pain relief and two because of urinary retention. Of the day case patients, 91 (82.7%) and 56 (50.9%) had been seen for 6 week and 6 month review, respectively, at the time of analysis. Symptom scores were 6 (pre-operatively) vs 0 (postoperatively) (P <0.01). 76/91 (83.5%) patients reviewed at 6/52 were asymptomatic.

Conclusion Stapled haemorrhoidopexy is a safe and effective procedure that can be carried out on selected patients on a day case basis. Complications are of a similar nature to excisional haemorrhoidectomy.

Out of the Shadows: A one day investigation of the politics of architecture explored through the lens of post-conflict, Belfast

This booklet covers the itinerary and some of the findings of a day-long visit to Belfast on the 7th November 2014 by Peter Oborn; Vice President International of the Royal Institute of British Architects. His visit was in response to a motion submitted to the RIBA council (19.05.2014) calling for the suspension of the Israeli Association of United Architects from the International Union of Architects. Despite members of council speaking against the motion it was carried; 23 members voting for, 16 against, and 10 abstentions. Subsequently the RIBA came under considerable pressure to consider its position in such critical contexts. This visit to Belfast was part of a wider fact-finding mission and evidence taking. At its heart was the question: 'Is it appropriate for the institute (RIBA) to engage with communities facing civil conflict and/or natural disaster and, if so, how it can do so most effectively.' The visit was facilitated by Ruth Morrow, Professor of Architecture, School of Planning, Architecture & Civil Engineering, Queen's University Belfast, and Martin Hare, Royal Society of Ulster Architects (RSUA) president.

'Something That Unites Us All': Understandings of St. Patrick's Day Parades as Representing the Irish National Group

The present study investigates how attendees at national celebratory crowd events-specifically St. Patrick's Day parades-understand the role of such events in representing and uniting the national community. We conducted semi-structured interviews with people who attended St. Patrick's Day parades in either Dublin or Belfast. In year 1, full-length interviews were conducted before and after the events (N=17), and in years 1 and 2, shorter interviews were conducted during the events (year 1 N=170; year 2 N=142). Interview data were analysed using thematic analysis, allowing the identification of three broad themes. Participants reported that (i) the events extend the boundary of the national group, using participation to define who counts as Irish; (ii) the events strategically represent the nature of the national group, maximising positive images and managing stereotypical representations; and (iii) symbolism serves to unify the group but can also disrupt already fragile unity and so must be managed. Overall, this points to a strategic identity dimension to these crowd events. We discuss the implications of these findings for future research in terms of the role of large-scale celebratory events in the strategic representation of everyday social identities.

The Day After Tomorrow: Transition Management, Spatial Planning & the Low Carbon Economy

Many of the societal challenges that current spatial planning practice claims to be addressing (climate change, peak oil, obesity, aging society etc) encompass issues and timescales that lie beyond the traditional scope planning policy (Campbell 2006). The example of achieving a low carbon economy typifies this in that it demands a process of society-wide transition, involving steering a wide range of factors (markets, infrastructure, governance, individual behaviour etc). Such a process offers a challenge to traditional approaches to planning as they cannot be guided by a fixed blueprint, given the timescales involved (up to 50 years) and an enhanced level of uncertainty, social resistance, lack of control over implementation and a danger of ‘policy lock in’ (Kemp et al 2007). One approach to responding to these challenges is the concept of transition management which has emerged from studies of science, technology and innovation (Geels 2002, Markard et al 2012). Although not without criticism, this perspective attempts to uncertainty and complexity encompassing long term visions that integrates multi-level, multi-actor and multi-domain perspectives (Rotmans et al 2001).
 
Given its origins, research on transition management has tended to neglect spatial contexts (Coenen et al 2012) and, related to this, it’s relationship with spatial planning is poorly understood. Using the example of the low carbon transition, this paper will review the relationships between the concepts, methodologies and goals of transition management and spatial planning to explore whether a closer integration of the two fields offers benefits to achieving the long term challenges facing society.
 

[review] Ulrich LEISINGER (ED.), Bach: Messe in h-Moll BWV 232 (Stuttgart: Carus, [2014]), 312 pp + 1 DVD-ROM, ISMN: 9790007142599, €199

This latest edition of J. S. Bach’s B-minor Mass, by Ulrich Leisinger, described by the publisher as a ‘hybrid edition’, aptly addresses the needs of present-day performers and at the same time fulfils the scholarly expectations of new critical editions to conform to the current study environment

Logic Brightens My Day: Evidence for Implicit Sensitivity to Logical Validity.

A key assumption of dual process theory is that reasoning is an explicit, effortful, deliberative process. The present study offers evidence for an implicit, possibly intuitive component of reasoning. Participants were shown sentences embedded in logically valid or invalid arguments. Participants were not asked to reason but instead rated the sentences for liking (Experiment 1) and physical brightness (Experiments 2-3). Sentences that followed logically from preceding sentences were judged to be more likable and brighter. Two other factors thought to be linked to implicit processing-sentence believability and facial expression-had similar effects on liking and brightness ratings. The authors conclude that sensitivity to logical structure was implicit, occurring potentially automatically and outside of awareness. They discuss the results within a fluency misattribution framework and make reference to the literature on discourse comprehension.