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To estimate the effect of speculum examination only versus digital cervical examination on maternal infectious morbidity in women with preterm prelabor rupture of membranes by performing a systematic review and meta-analysis.We explored MEDLINE, Scopus, Embase, CINAHL, ClinicalTrials.gov and Cochrane Central Register of Controlled Trials for studies comparing the rate of a composite maternal infectious morbidity (either chorioamnionitis, endometritis or both) in women with preterm prelabor rupture of membranes that underwent a speculum only versus digital cervical examination at the time of diagnosis. Two reviewers separately ascertained studies, obtained data, and gauged study quality. The rate of a composite maternal infectious morbidity (either chorioamnionitis, endometritis or both) were compared and odds ratios (ORs) with 95% confidence intervals (CIs) were estimated.Four cohort studies, reporting on 1213 women were identified. The median point prevalence of the composite maternal infectious morbidity was 26% (interquartile range 15-35%) in women who had a speculum examination only compared to 33% (interquartile range 22-42%) in women who underwent a digital examination. The overall maternal composite infectious morbidity rate in women that had a speculum examination only was less compared to women that had undergone a digital examination (pooled OR 0.75, 95% CI 0.58-0.98,Speculum examination only in women with preterm prelabor rupture of membranes is associated with less maternal infectious morbidity and longer latency periods.

INTRODUCTION Evaluation of the female pelvic floor muscles is commonly carried out with digital examination and assigning a modified Oxford scale score or vaginal manometry. Racial differences can influence the size of the levator hiatus (LH) with "black" or African nulliparous women having a significantly larger LH compared to Caucasian women. The aim of this study was to assess the impact of LH size on manometry readings of simulated pelvic floor muscle contractions (PFMCs) using a small and large model LH. METHODS Small and large LH models were created using published data for size. Inflation of a pressure cuff placed circumferentially in the LH model represented a simulated PFMC. The models were examined in a supine position by three examiners and a perineometer twice each at varying simulated PFMC strength. RESULTS Positive correlation was found between increasing simulated PFMC strength with a higher Oxford score following digital examination and manometry readings for both the small (rs = .87, rs = .98) and large (rs = .95, rs = .87) models. There was good to excellent inter and intraobserver correlation for digital assessment of both models. The manometry measurements showed a much larger incremental rise from baseline in the small model compared with the large model (P

Local recurrence (LR) of rectal cancer (RC) has a disease-free survival rate of up to 50% if diagnosed early. Endorectal ultrasound (ERUS) is an outpatient procedure that can be used together with rectal digital examination for patient follow-up. This is the first study to determine the diagnostic test accuracy of ERUS in the detection of LR after RC and whether it is a good follow-up method. Three authors independently searched MEDLINE and ClinicalTrials.gov databases and included relevant original studies based on strict inclusion/ exclusion criteria. 3220 articles were identified. After reading the abstracts, 50 articles were selected, out of which 22 were deemed suitable for study inclusion, comprising 3737 patients, which were followed for 59,72 -16,4 months. Based on the available data, sensitivity of ERUS was 88,3% (CI 84,6 - 91,3%), specificity was 94,3 % (CI 92,7 - 95,5%) and diagnostic odds ratio of ERUS was 271,88 (CI 76,998 - 960,04), with ERUS being the only diagnosis method to detect LR in 40 - 12%. Area under the curve for ERUS was 0,9723 - 0,0131. LR after curative treatment of RC in our study was 15 - 2,99%. Concluding, ERUS seems to be a good and efficient follow-up method for diagnosing RC LR.

Over the last two decades, extensive research had been done evaluating the role of ultrasonographic assessment of the cervix in various clinical settings. This chapter reviews the evidence behind the use of cervical length in various clinical scenarios encountered on labor and delivery unit.

Digital examination has always been the “gold standard” method to evaluate the foetal head descent, cervical ripening and dilatation and foetal head position before and during labour [1] and has led to the development of comprehensive partograms used on most delivery units [2].

Intrapartum ultrasound (US) is acknowledged to support clinicians dealing with prolonged labour [1] as well as in the case of malpositions and malpresentations [2], thus representing a valuable support to the conventional digital examination.

AIM Overtreatment is an actual problem in low risk localized prostate cancer (PC) management. Active surveillance (AS) is a solution to limit this problem, but eligibility criteria remained discussed. The aim was to assess possibilities of widening selection criteria for patient in AS, studying curative treatment free survival (CTFS) according to restricted or expanded eligibility criteria. METHODS We retrospectively studied patients beginning AS between 2008 and 2014, for Gleason 6 localized PC, PSA

The present study aimed to compare the diagnostic reliability of a pre-set, manufacturer-specific, low-dose mode against a standard-dose mode in the detection of four different osseous lesions in the mandible with cone-beam computed tomography (CBCT). Four types of lesions (periapical lesion, extended periodontal gap, recession of the buccal lamella, sequestrum/fracture) were prepared on 40 pig mandibles. CBCT images were obtained from each mandible, with both the low-dose and standard-dose modes using the Orthophos SL CBCT device (Dentsply-Sirona, Bensheim, Germany). Twelve assessors quantitatively (detection of lesions) and qualitatively (assessment of detectability) evaluated the CBCT images in SIDEXIS 4 (Dentsply-Sirona) using a study-specific digital examination tool. A correct diagnosis was achieved in almost 71% (LD: 70.8%, SD: 70.9%) of 1920 lesions, without a statistically significant difference between the low-dose and standard-dose mode. This finding was consistent across all four lesion types. In conclusion, while low-dose mode and standard-dose mode CBCT scans performed similarly in the detection of four prepared lesions of the mandible, the former may be a promising, user-friendly alternative method of obtaining radiation-optimized, three-dimensional images in accordance with the As Low As Diagnostically Acceptable (ALADA) principle.

Background: NCCN’s guidelines for the diagnosis and treatment of rectal cancer suggest that accurate preoperative clinical staging of rectal cancer is very important. Reliable preoperative evaluation is the key to the development of surgical protocols, in order to investigate the diagnostic value of digital rectal diagnosis for lymph node metastasis of middle and low rectal cancer. Methods: We prospectively performed digital rectal examination in 258 patients with mid-low rectal cancer before operation, to analyze the distance from the lower margin of the tumor to the margin of the anus, the diameter of the invasion of the intestinal wall of the tumor, the accuracy between the general type and depth of invasion of the tumor and the pathological results of the postoperative specimen, and the predictability of the lymph node metastasis rate of the rectal digital examination. Results: The results of the analysis showed that the above indicators and postoperative pathological findings have high accuracy. Conclusions: It is concluded that accurate and detailed digital rectal examination before operation can predict lymph node metastasis rate of mid-low rectal cancer at a higher level and accurately.

We propose herein a short synthesis of evidence leading to deny organized screening of prostate cancer using PSA plus or minus rectal digital examination. Nevertheless, many scientific societies support opportunistic screening on basis of shared decision. Today, numerous proposals had been made to reduce the overdiagnosis and overtreatreatment.

Background Intrapartum ultrasound has been proposed as a method of assessing labour progress but its acceptability has not been comprehensively assessed. Aims We evaluated the acceptability of intrapartum ultrasound in women having vaginal examination (VE) and ultrasound (US) assessment (transabdominal (TA) and transperineal (TP)) prior to delivery, with and without regional analgesia (RA). Materials and Methods Women at 24–42 weeks gestation were included in a prospective observational cohort study. The acceptability of digital VE and TP US were assessed pre‐ and post‐examination using the modified validated Wijma Delivery Experience Questionnaire. Acceptability scores ranged 6–36 (6 being most and 36 being least positive) in six domains: positive‐trust and relax, negative‐harmful to baby, worrying, painful, intrusive. Results Of 119 women recruited, 104 completed both pre‐ and post‐assessment questionnaires. Eighty‐nine per cent of women were nulliparous with median gestation 40 + 2 weeks (25–42+1). Thirty‐two per cent had RA before assessment, 91% in total. The combined acceptability scores of both negative and positive experiences (6 = most acceptable, 36 = least acceptable) for VE and US pre‐assessment were 15 and 7 respectively (P < 0.0001: Mann‐Whitney U‐test). VE was associated with less positive / more negative domain scoring post‐assessment 12 and 6, respectively (P < 0.0001). Although RA made no difference to the perceived experience pre‐VE (P = 0.9), post‐VE, women with RAs considered VEs more acceptable than those without RA (P = 0.0022). Conclusion(s) This is the first study to comprehensively assess the acceptability of VE and intrapartum US. US assessment prior to delivery is more acceptable than VE. RA ameliorated the negative experience of the VE post‐assessment.

Bruxism is a disease with a multifactorial etiology. Its clinical manifestations are most often an unaesthetic smile with abraded tooth surfaces, temporomandibular disorders and muscle hyperactivity. Here we present a case of bruxism where proper articulation of the occlusal splint was performed using the T-scan Novus system. A patient with bruxism underwent treatment with stabilization splint made by 3D printer technology. Intraoral scanning was performed using Trios Color (3Shape, 2014), and the digital design was achieved using the 3Shape Dental system design - splint studio. Formlabs Form 2 printer with biocompatible resin Dental LT Clear Resin was used for printing. The T-Scan Novus system with software attached to it, version 9.1, was used for digital examination of the occlusion. A 2.7 mm thick occlusal splint was developed, and the software adapted the occlusion with antagonists. After adjustment with T-Scan Novus, a reduction in disocclusion time of the patient was achieved, which is a desired result in the treatment of bruxism. The position of the joint components was proven radiologically. The treatment of bruxism with splint therapy continues to be the main method of treatment. Using digital technology allows for more accurate constructions and precise balancing of occlusal relationships.

Fetuses with malpresentation and malposition during labor represent important clinical challenges. Women with fetuses presenting with malpresentation or malposition are at risk of increased perinatal complications, such as cesarean delivery, failure of operative vaginal delivery, neonatal acidemia, and neonatal intensive care admission. Intrapartum ultrasound has been found to be more reliable than digital examination in assessing malpresentation and malposition. The use of intrapartum ultrasound to assess fetal position and presentation, in addition to fetal attitude, to predict and aid in decision making regarding delivery can help in improving management decision making. Cephalic malpresentation and malposition is a unique subset of fetal orientation and can benefit from intrapartum ultrasound identification and assessment for delivery.

What you need to know Approximately 100 000 people in the UK have an intestinal stoma,1 which are most commonly formed after surgery for cancer or inflammatory bowel disease (IBD). They can be described according to the part of the bowel (small or large) used to create the stoma and can be temporary (with potential for reversal at a later date) or permanent. Many different types of stoma exist (eg, nephrostomy, urostomy), but in this article we focus on common complaints associated with intestinal stomas that may lead patients to present to general practice. Imagine a patient presenting to you in general practice with concerns about discomfort in their stoma. After a thorough history, you might examine them as follows: Ask the patient whether the stoma has changed in appearance. Then, inspect the stoma looking specifically at whether it sits proud of the skin and if it is healthy, pink, and moist. Consider digital examination of the stoma if you have concerns about function. This is an intimate examination, so good communication is essential. Ensure your patient has a replacement stoma bag and ask them to …

Higher education institutions are in the early stages of replacing traditional pen-and-paper assessments by adopting bring-your-own-device (BYOD) digital assessments for high-stakes examinations. This is happening at the same time as learner analytics (LA), which are gaining increasing popularity within the higher education sector. This chapter considers how digital examinations can open up the black box of student work by enabling data analysis not just at the end of an assessment but also during the process of producing it. Information is available as to how the work developed character-by-character, line-by-line. The question raised is how can this data be analyzed, and how can it be useful in the improvement of education? This chapter is in two parts. The first outlines the adoption of BYOD digital examinations as an enabling technology, learning lessons from the successful adoption of a BYOD exam platform at Brunel University London, UK. The second describes early work analyzing the data available from the typical digital examination platform. Finally, this chapter concludes by outlining some future directions for continued research in this area.

Objective: To compare the reliability of digital occlusal contacts quantification and the validity of digital occlusal contacts quantification with traditional methods used for occlusal contact determination. Subjects and Methods: Thirty participants, all of whom were students at the Sahlgrenska Academy, University of Gothenburg in Gothenburg, Sweden, were included in the study. Three different methods were used to evaluate occlusal contacts: (I) a digital examination of the patients’ casts, using the Ortho 3D Models (O3DM) software and measuring the total occlusal contact area in square millimeters (DE), (II) an examination involving the measurement of the total number of occlusal contacts on stone casts mounted in an articulator (AE), and (III) a clinical examination with the measurement of the total number of occlusal contacts with 8 μm-thick articulating foil (CE). Results: The repeated digital measurements (same casts scanned multiple times) showed a significant correlation of 0.85 (p &lt, 0.01), which shows a diagnostic consistency. Furthermore, there was a significant correlation between the results obtained with the DE method and the AE of 0.41 (p &lt, 0.05), and between those acquired with the AE method and the CE of 0.37 (p &lt, 0.05). However, no significant correlation was found between the DE method and the CE method with a correlation coefficient of 0.10 (p &gt, 0.05). Conclusions: Digital casts can be used for quantification of the total occlusal contact area (in mm2) owing to the high reliability of repeated measurements and the strong validity of the method compared to traditionally employed stone cast measurements.

Importance Measurement of cervical dilation is one of the major indicators of labor progression. At present, the criterion standard for this evaluation is digital examination, which results are sometimes inaccurate and extremely dependent on the subject (ie, obstetrician or midwife) experience. Objective In this systematic and meta-analysis review, the authors have gathered the vast majority of the instruments used for measuring cervical dilation and their clinical application; main features, potentialities, and the most significant constraints are underlined for each device. Evidence acquisition Three of the most popular databases (ie, Web of Science, PubMed, and ClinicalTrials.gov) were used to identify all available cervimeters, by using single or combinations of the following keywords: "cervical," "dilation or dilatation," "cervimetry," "cervix," "uterine," "measurement," "labour or labor," "birth," and "monitoring." Only articles describing the design or a specific clinical application of an instrument for cervical dilation measurement during labor were selected. Results Twenty-five articles were deeply investigated by classifying them in 4 different homogenous groups on the basis of the method proposed for measuring cervical dilation. Suitable devices have not been realized yet, and this is the reason why nowadays the gynecologist/obstetrician still evaluates labor progression by digital examination. Conclusions and relevance Based on a critical analysis of the selected devices, ultrasound seems to be the most promising technology for future cervimetry realization; ultrasound is accurate in distance measurement, and the behind technology can be miniaturized. However, additional studies are necessary for optimizing the technology and developing an optimal solution.

Ultrasonography has been extensively used in obstetrics and gynecology since 1980's. It found application in pediatric gynecology, procreation period, post-menopause, pregnancy monitoring and after delivery. Although the first reports on the use of ultrasonography in assessing delivery mechanism were published in 1990's, yet to date labor progress is evaluated by means of physical examination in most delivery units. Intrapartum sonography is not routinely performed despite the fact that numerous studies documented high error rates of conventional obstetrical examination. Even an experienced physician makes a mistake in every third case of the fetal head descent and fontanelle position assessment. Nowadays, obstetrician's role is not to strain for vaginal delivery at all costs, but to provide the patient in labor and her newborn with maximal safety. To achieve this objective, an obstetrician should distinguish between women who will deliver spontaneously and whose who require Cesarean section. Proper decision should be made on the basis of objective and valid evaluation of obstetric setting, which cannot be achieved solely with physical examination. Intrapartum sonography was shown to be far more accurate than digital examination. Moreover, it is not technically demanding, provides high reproducibility and neither increases the rate of ascending infection or causes discomfort to the patient. Current research suggests that if used routinely, intrapartum sonography can increase the safety of labor and reduce cesarean section rate.Diagnostyka ultrasonograficzna jest powszechnie stosowana w położnictwie i ginekologii od lat 80. ubiegłego wieku. Badania ultrasonograficzne wykonuje się w ginekologii dziecięcej, w okresie prokreacyjnym, po menopauzie, w monitorowaniu przebiegu ciąży i po porodzie. Pierwsze doniesienia o wykorzystaniu ultrasonografii do oceny mechanizmu porodowego pojawiły się w latach 90., jednak do dziś w większości ośrodków postęp porodu oceniany jest wyłącznie w badaniu klinicznym. Nie wykonuje się śródporodowego badania ultrasonograficznego, mimo że w wielu pracach wykazano, że tradycyjne badanie położnicze cechuje się wysokim odsetkiem błędów. Nawet doświadczony lekarz, oceniając zaawansowanie głowy w kanale rodnym i lokalizację ciemiączek, myli się w tym badaniu przeciętnie w co trzecim przypadku. Obecnie rola położnika nie polega na dążeniu za wszelką cenę do ukończenia porodu drogami natury, lecz na zapewnieniu maksymalnego bezpieczeństwa rodzącej i jej dziecku. Aby je zapewnić, położnik powinien określić, które pacjentki mają szansę urodzić drogami natury, a u których lepszym rozwiązaniem będzie wykonanie cięcia cesarskiego. Właściwa decyzja może zostać podjęta jedynie na podstawie obiektywnej i prawidłowej oceny sytuacji położniczej, co nie jest możliwe jedynie na podstawie samego badania klinicznego. Wykazano, że badanie ultrasonograficzne w czasie porodu jest znacznie bardziej wiarygodne niż badanie palpacyjne. Ponadto jest proste technicznie, powtarzalne, nie zwiększa ryzyka infekcji wstępującej i nie powoduje dyskomfortu dla pacjentki. Dotychczasowe wnioski wynikające z prac naukowych oceniających zastosowanie ultrasonografii w trakcie porodu są bardzo optymistyczne i wskazują, że jej wprowadzenie może wpłynąć na zwiększenie bezpieczeństwa porodu, a nawet na zmniejszenie odsetka cięć cesarskich.

Digital examination during labour is a subjective and inaccurate method, with high inter-examiners variability. The objective of this study was to evaluate the clinical applicability of ultrasound during labour in order to determine if it can be used as a routine method in labour management. We conducted a literature review for representative articles that studied the use of abdominal and transperineal ultrasound during labour. Intrapartum ultrasound proved to be a reliable technique for labour management and outcome prediction. Abdominal ultrasound is able to precisely determine the position of the fetal spine and head. Transperineal ultrasound can be succesufully used in determining fetal head, perineum distance, angle of progression and cervical dilatation as three markers that could predict labour remaining time and delivery mode.

The transition from 2D imaging to 3D scanning in the discipline of firearms and toolmark analysis is likely to provide examiners an unprecedented view of microscopic surface topography. The digital examination of measured 3D surface topographies has been referred to as virtual microscopy (VM). The approach offers several potential advantages over traditional comparison microscopy. Like any new analytic method, VM must be validated prior to its use in a crime laboratory. This paper describes one of the first validation studies of virtual microscopy. Fifty-six participants at fifteen laboratories used virtual microscopic tools to complete two proficiency-style tests for cartridge case identification. All participating trained examiners correctly reported 100% of the identifications (known matches) while reporting no false positives. The VM tools also allowed examiners to annotate compared surfaces. These annotations provide insight into the types of marked utilized in comparative analysis. Overall, the results of the study demonstrate that trained examiners can successfully use virtual microscopy to conduct firearms toolmark examination and support the use of the technology in the crime laboratory.

Dry-mount fecal cytology (FC) is a component of the diagnostic evaluation of gastrointestinal diseases. There is limited information on the possible effect of the sampling method on the cytologic findings of healthy dogs or dogs admitted with diarrhea. We aimed to: (1) establish sampling method–specific expected values of selected cytologic parameters (isolated or clustered epithelial cells, neutrophils, lymphocytes, macrophages, spore-forming rods) in clinically healthy dogs; (2) investigate if the detection of cytologic abnormalities differs among methods in dogs admitted with diarrhea; and (3) investigate if there is any association between FC abnormalities and the anatomic origin (small- or large-bowel diarrhea) or the chronicity of diarrhea. Sampling with digital examination (DE), rectal scraping (RS), and rectal lavage (RL) was prospectively assessed in 37 healthy and 34 diarrheic dogs. The median numbers of isolated ( p = 0.000) or clustered ( p = 0.002) epithelial cells, and of lymphocytes ( p = 0.000), differed among the 3 methods in healthy dogs. In the diarrheic dogs, the RL method was the least sensitive in detecting neutrophils, and isolated or clustered epithelial cells. Cytologic abnormalities were not associated with the origin or the chronicity of diarrhea. Sampling methods differed in their sensitivity to detect abnormalities in FC; DE or RS may be of higher sensitivity compared to RL. Anatomic origin or chronicity of diarrhea do not seem to affect the detection of cytologic abnormalities.

The Objective of the Study. To evaluate and explain the consequences of different morphological abnormalities of anal sphincters including the sphincter damage and its extent using the 3-dimensional endosonography. Material and Methods. 56 patients suffering from fecal incontinence all were subjected to analysis of patient symptoms, scoring the severity of symptoms, digital examination, electromyography, and 3D endoanal ultrasonography. Results. 5 patients showed intact anal sphincters and puborectalis muscle. 4 patients found with thick IAS > 4 mm, 4 patients with thin IAS Conclusion. No significant relationship was observed between sphincter damage except for combined internal and external sphincter injury and the severity score of FI symptoms. Puborectalis muscle injury and abnormal sphincter thickness are unlikely causes of severe FI.

The objective of this study is to investigate the associated risk factors of haemorrhoids. Th e study was conducted in the Hospital of National Institute of Unani Medicine . It was a cross sectional study of 1 year duration. A total number of 311 pati ents were found to be suffering from haemorrhoids in which 236 were males and 75 were females . Patients were diagnosed on the basis of anorectal examination which includes inspection , digital examination and proctoscopy. Both modifiable and non - modifiable risk factors were recorded i n a pretested semi - structured schedule . In the present study out of 416 patients , 311 were found to be having haemorrhoids. Prevalence of haemorrhoids was found maximum in age group of ≥ 40 years, and in those who were not doing morning or evening walk or other extra physical activities ; in those whom family history of haemorrhoids was positive ; which clearly shows the association of haemorrhoids with the ad vancement in age , sedentary li festyle and heredity and genetic makeup.

To compare elastosonography and digital examination of cervix for consistency in the prediction of successful vaginal delivery.A total of 64 pregnant women with the indication of induction of labor (IOL) were enrolled to the study. The uterine cervix is evaluated before and after the IOL with elastosonography and digital examination for consistency and sonography for length. Methods were compared in regard to the prediction of successful vaginal delivery.The median of gestational age was 41.00 (IQR = 2.32). Out of 64 participants, 40 (62.5%) had vaginal delivery and 24 (37.5%) had cesarean delivery. The preinduction and postinduction elastosonographic indices were insignificant in delivery groups. The preinduction and postinduction evaluations of cervical consistency with digital examination were significant within vaginal delivery group (p = 0.046), whereas it was insignificant within cesarean delivery group and between the delivery groups. The preinduction and postinduction Bishop scores were significant within vaginal delivery group (p = 0.005), whereas it was insignificant within cesarean delivery group and between the delivery groups. Postinduction Bishop score was significant between the delivery groups.Evaluation of cervix for consistency with either elastosonography or digital examination was found to be insignificant in prediction of successful vaginal delivery after IOL with oxytocin.

Introduction: The aim of this study is to evaluate the utility of digital examination in addition to ultrasonic measurement of cervical length for predicting spontaneous preterm delivery in women with threatened preterm labor. Material and methods: This was a prospective cohort study in Strasbourg University Hospital, France, between January 2013 and January 2015 All the women with a singleton pregnancy hospitalized with threatened preterm labor between 23 to 34 weeks of gestation were included. Cases of iatrogenic preterm delivery were excluded. A multivariable logistic regression model to estimate the significant predictive parameters of spontaneous preterm delivery was performed. The primary endpoint of our study was a preterm birth before 34 weeks of gestation. Results: A total of 395 women were included in our study. The rate of preterm delivery before 34 weeks was 13%. In univariate analysis every single cervical parameter assessed by the digital examination and all the ultrasound parameters were significantly associated with preterm delivery. The final model included five variables predicting preterm birth: visualization of the membranes at the speculum examination (OR, 15.8; 95%CI, 2.43-146), ultrasound cervical length (OR, 0.82; 95%CI, 0.75-0.89), signs of inflammation (OR, 6.23; 95%CI, 2.07-22.9), gestational age on admission (OR, 0.84; 95%CI, 0.71-1.0), and presence of vaginal infection (OR, 4.28; 95%CI, 1.52-12.7). None of the cervical parameters assessed by the digital examination provided additional predictive value of preterm delivery. Conclusion: Our study suggests that digital examination does not add to the information given by vaginal ultrasound evaluation in predicting preterm labor. This article is protected by copyright. All rights reserved.

PurposeMany learners with disabilities and special educational needs have difficulty reading or accessing traditional paper examinations at school. The most common method of accommodating these candidates, in Scotland, is the use of reader and scribe. This paper aims to define a specification for digital examination papers for candidates with disabilities, identify a suitable electronic format, and report on trials of these digital assessments.Design/methodology/approachThe support needs of candidates with disabilities were investigated through interviews with teaching staff and students, analysis of the type of requests made for accommodations, and the reasons for the requests. Findings from this exercise, together with consideration of the requirements of the examination context, were used to construct a specification for digital examination papers. Pilot trials using digital papers were then undertaken.FindingsAdobe portable document format (PDF) was judged to match the specification most closely. Successful pilot trials in 2005, 2006 and 2007 led to the introduction of digital papers by the Scottish Qualifications Authority in 2008.Research limitations/implicationsThere is some evidence that digital papers provide a more independent and less costly alternative to reader/scribes; this requires further research.Practical implicationsBetween 2008 and 2011, the number of requests for digital papers increased fivefold, indicating that digital question papers in PDF offer a practical and cost effective method of accommodation in examinations.Originality/valueThis research is of interest to examination boards, assessment designers, educators and learners. It demonstrates that candidates with disabilities can successfully access assessments in digital format.

Objective: The primary goal of this study was to determine the ultrasonographic signs of asynclitic and transverse head positioning. In addition, we compared the performance of intrapartum ultrasound to vaginal digital examination. Material & Methods: 150 women were evaluated by 2D transabdominal and translabial ultrasound (US) to detect the asynclitic and deep transverse positions. Transvaginal sterile digital examinations were performed immediately after each intrapartum US assessments, the examinations were repeated at intervals of 45–90 minutes. Examiners were blinded to each other’s findings (clinical or sonographic). Data were reviewed and analyzed by an independent reviewer. Results: The efficacy of digital examination was significantly lower than US evaluation for the detection of either transverse position or asynclitism. The most frequent transverse position was the left one, while the most frequent asynclitism was the anterior one. Conclusions: Digital pelvic examination for detection of fetal head transverse position during labor is inferior to US, especially in the deep transverse positioning, where caput succedaneum occurs and reduces the diagnostic accuracy of vaginal digital examination. The US examination leads to early detection of persistent transverse position allowing for earlier timing and optimal technique for the operative vaginal delivery. We describe two signs for diagnosing asynclitism. The “squint sign” and the “sunset of thalamus and cerebellum signs” are two simple US signs allowing detection of anterior and posterior asynclitism.

Cervical length (by transvaginal sonography) was compared to Bishop's score (by digital examination of cervix) for prediction of pre-term birth in women with pre-term labour. The study group was 100 women with a singleton pregnancy with pre-term labour between 26-36 weeks' gestation. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of cervical length ≤2.5 cm ( by TVS) to predict delivery within 48 h and 7 days of admission were 62.5%, 89.5%, 65.2%, 88.3%, and, 60.0%, 96.9%, 91.3%, 81.8%, respectively. Similar values of Bishop's score ≥5 were 62.5%, 85.52%, 57.69%, 87.83%, and, 62.8%, 93.8%, 84.6%, 82.4%, respectively. To conclude, both Bishop's score ≥5 and reduced cervical length of ≤2.5 cm (by TVS) can predict the risk of pre-term delivery within 48 h or 7 days.

A Standardbred mare presented with a 3-year history of stranguria and pollakiuria. Urethral spasm was detected by transrectal and digital examination. Ancillary diagnostic tests revealed no abnormal findings. The mare recovered after a 1-month treatment with acepromazine. Similar cases and responses to treatment have not been reported before in horses.

The purpose of this study was to determine the accuracy and reproducibility of intrapartum translabial 3-dimensional (3D) ultrasonographic measurements of cervical dilatation during labor.A prospective observational study was conducted. Three-dimensional ultrasonographic volume data sets from 52 patients were collected during labor and stored. Later, all volumes were randomly reviewed twice offline by 2 examiners blinded to previous clinical and ultrasonographic measurements. The correlation with delivery room personnel digital vaginal examinations and interobserver and intraobserver agreement were determined.Twenty-four patients were examined during the latent phase (0- to 4-cm cervical dilatation), and 28 patients were examined during the active phase (5- to 10-cm cervical dilatation). Translabial 3D ultrasonographic measurements of the cervical mean and maximal diameters and inner cervical area showed a positive correlation with digital vaginal examinations (r(2) = 0.609, 0.587, and 0.469, respectively; all P.001). The interobserver mean differences +/- SD between paired measurements for the mean and maximal cervical dilatation and inner cervical area were 0.11 +/- 0.49 cm, 0.12 +/- 0.48 cm, and -0.22 +/- 5.69 cm(2), and the intraclass correlation coefficients (ICCs) were 0.82, 0.85, and 0.87. The intraobserver mean differences between paired measurements of the mean and maximal cervical dilatation and inner cervical area were 0.002 +/- 1.15 cm, 0.02 +/- 1.4 cm, and -0.41 +/- 1.15 cm(2), and the ICCs were 0.85, 0.79, and 0.75.Assessment of cervical dilatation using 3D ultrasonography during labor is feasible and reproducible.

TWIN and triplet births are common in sheep and goats, but multiple births occur less frequently in uniparous species such as cattle and horses. Twinning is an important non-infectious cause of pregnancy loss in mares and should not occur on well-managed breeding farms. The equine uterus is not well designed to carry twins, as the entire endometrial surface is required for the placental development of a single fetus. The membrane shared between two vesicles does not function as a nutrient supply and therefore cannot fulfill the nutritional requirements of both fetuses, which eventually causes abortion of one or both of them during mid- to late gestation. This can result in considerable economic loss to the equine breeding industry. Recently, the use of transrectal ultrasonography has significantly improved the ability of veterinarians to diagnose and manage twin pregnancies more accurately compared with digital examination of the uterus per rectum. This article describes how to diagnose twinning at an early stage and how it can be managed appropriately to ensure the birth of a single viable foal.

Objectives This study compared the accuracy of ultrasound cervical assessment (cervical length and cervical index) and digital examination (Bishop score and cervical score) in the prediction of spontaneous birth before 34 weeks in twin pregnancies. Methods In a prospective multicenter study, digital examination and transvaginal sonography were performed consecutively in twin pregnancies attending for routine sonography at either 22 weeks (175 women) or 27 weeks (153 women). The digital examination took place first, and the Bishop score and cervical score (cervical length minus cervical dilatation) were calculated. Ultrasound measurements were then made of cervical length and funnel length to yield the cervical index (1 + funnel length/cervical length). The association between each variable and delivery before 34 weeks was tested by the Mann–Whitney U-test. The receiver–operating characteristics (ROC) curves of the ultrasound and digital indicators were determined for both gestational age periods, and the areas under the ROC curves compared. The best cut-off values for each indicator were used to determine predictive values for delivery before 34 weeks. Results The median gestational age at delivery among the women included in the 22-week examination period was 36.0 (range, 21–40) weeks; 10.9% (19) gave birth spontaneously before 34 weeks. The median cervical length was 40 (range, 6–65) mm. All four parameters were predictors of delivery before 34 weeks. The areas under the ROC curves for cervical index, cervical length, Bishop score and cervical score did not differ significantly. The median gestational age at delivery among the women in the 27-week examination period was 36.0 (range, 27–40) weeks; 9.2% (14) gave birth spontaneously before 34 weeks. The median cervical length was 35 (range, 1–57) mm. All parameters except the Bishop score were predictors of delivery before 34 weeks. The likelihood ratio of the positive and negative tests for cervical length ≤ 25 mm was 5.4 (range, 3.2–9.0) and 0.3 (range, 0.1–0.7), respectively, compared with 2.3 (range, 1.3–4.2) and 0.6 (range, 0.3–1.1), respectively, for cervical score ≤ 1. The area under the curve for the cervical index was significantly larger than that for the Bishop score (P = 0.008) or cervical score (P = 0.02). Conclusion Transvaginal sonography predicted spontaneous delivery before 34 weeks better than digital examination at the 27-week but not the 22-week examination. Copyright © 2005 ISUOG. Published by John Wiley & Sons, Ltd.

To determine the correlation between visual assessment of the cervix and digital examination.Prospective study of patients presenting to Labor and Delivery. Exclusion criteria were preterm premature ruptured membranes (PPROM) and placenta previa. Visual and digital assessments of cervical dilation, effacement, position, and station of fetal presenting part were made. Correlation between visual and digital examinations was measured using Spearman rank correlation coefficient (COR). A p-value0.05 was considered significant.The study involved a total of 107 patients at a mean gestational age of 32.3 weeks (range 17-41). Seven patients had ruptured membranes, and 46 were nulliparous. Visual assessment correlated with digital examination for all parameters measured with Spearman rank correlation coefficients between 0.618 and 0.686 (all significant at p0.001). Correlations between visual and digital assessment of cervical dilation, effacement, station, and position were not as strong (0.291-0.699), but remained significant (p0.02) in a subgroup of 50 preterm patients34 weeks gestation.Visual assessment correlates with digital examination of the cervix. This correlation remained significant in a subset of preterm patients with intact membranes.

Vaginal stones are extremely rare and are classified as primary and secondary. A 45 year-old female presented with an unexplained dyspareunia and vaginal discomfort for 2 years unresponsive to traditional treatment. Vaginal examination revealed no prolapse or vaginal fistula. Digital examination revealed multiple small rounded firm to hard or tender masses varying in size from 0.5 to 1.5 cm anterior to the vagina. Patient was treated with midline anterior vaginal wall incision with the extraction of eight smooth surfaced stones with uneventful postoperative course. Stone analysis revealed that they were composed of pure ammonium acid urate (AU). We recommend that for any patient with unexplained dyspareunia or vaginal discomfort that has proved to be unresponsive to traditional treatment, the possibility of anterior vaginal wall stones should be kept in mind.

Sonographic evaluation of the uterine cervix can accurately assess cervical length and image other characteristics of the cervix and lower uterine segment, and it offers significant advantages over the digital examination. Although the cervix has been recognized as an important anatomic component of the spontaneous preterm birth syndrome, the relationship between cervical length and reproductive performance has been widely reported. These investigations confirm a significant, inverse relationship between cervical length and the risk for spontaneous preterm birth, although its predictive accuracy varies according to the population studied. At present, cervical ultrasound represents an important research tool with potential clinical applications in women at appreciable risk for spontaneous preterm birth.

Critics, unimpressed by the rigor of the forensic digital examination process, have taken the position that forensic digital analysis is, more rightly, simply little more than ad hoc data collection and analysis. The reality is that forensic digital analysis as a whole, in its relative infancy, is the unwilling victim of the rapid advancement of computer technology.

The management of fistula-in-ano has been based on digital examination and operative findings. MR imaging has shown significant limitations to this approach, particularly in the management of recurrent fistula. The most cost-effective approach may be using a combination of endosonography and MR imaging. Preoperative confirmation of fistula complexity facilitates surgery planning of sphincter saving techniques and prevents sepsis being missed, which has been shown to reduce recurrence. Imaging has a significant role to play in this condition to improve patient outcome.

Serious perineal birth damage may contribute to anal incontinence, but exactly what constitutes adequate repair is not agreed on. This study was designed to show whether digital examination immediately after repair of a third- or fourth-degree laceration is able to confirm reapproximation of the external anal sphincter and perineal body. Digital measurements were compared with transperineal ultrasonography in 34 randomly selected women who underwent end-to-end sphincteroplasty and perineal reconstruction for significant lacerating injuries but had no past history of perineal injury or episiotomy. There was no attempt to standardize the repair technique. Digital examination assessed the thickness of the external sphincter, the presence or absence of a gap in the sphincter, and perineal length from the introitus to the anus. The findings of two examining physicians were averaged. Ultrasound studies were done using a 5-MHz convex scanner by imaging in the sagittal and horizontal planes. A midline episiotomy had been created in 9 of 26 patients with third-degree lacerations and 7 of 8 with fourth-degree injuries. Only two third-degree injuries resulted from third-degree episiotomies for dystocia. There were no mediolateral episiotomies, and no vacuum extractions had been done. Digital examination and ultrasonography both identified an external sphincter more than 1 cm thick with no apparent gap in 29 patients. Four women whose sphincter was found on digital examination to be less than 1 cm thick had the same finding on transperineal ultrasonography. One patient had an impalpable anal gap that was noted on ultrasound study. The correlation coefficients comparing digital and ultrasound assessments of the external sphincter and perineum were 0.88 and 0.40, respectively. The internal anal sphincter was visualized in 69% of subjects having third-degree repair but in only 12% of those with fourth-degree repairs. The authors believe that simple digital evaluation of the external sphincter muscle and perineal body, done directly after repair of a laceration, can help to reduce long-term morbidity.

Intraocular pressure (IOP) assessment is a valuable skill for any physician working in the emergency room. Measuring the IOP digitally (when the examiner uses his fingers to evaluate a patient's IOP) or with a simple inexpensive tonometer can aid in the diagnosis of vision-threatening ocular conditions (figures 1 and 2). The following case illustrates the usefulness of this examination in the workup of a young patient presenting with severe headache. Figure 1 Measuring the intraocular pressure using digital examination. The aim of this technique is to assess the force required to indent the orbital wall. The patient is asked to shut his eyes and look down. Gentle pressure is applied alternately to the superior part of the lid by both index fingers.2 Figure 2 This rebound tonometer contains a lightweight disposable probe that measures the intraocular pressure (IOP) by a brief contact with the …

Question: A 43-year-old woman, with an unremarkable medical history, was admitted for chronic diarrhea. Colonoscopy was performed to evaluate the diarrhea. Perianal examination before the procedure revealed a 2.5 2 1.5-cm lesion extruding from the anus (Figure A) but reducible on digital examination. On top of the lesion was a 5-mm patch of a different appearing surface with a granular pattern (Figure B). Subsequent colonoscopy was otherwise normal, although the polyp was confirmed on retroflexion (Figure C). What is your diagnosis for this lesion? See the Gastroenterology web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI.

PURPOSE: We evaluated the usefulness of magnetic resonance imaging for the preoperative diagnosis of deep anorectal abscesses. METHODS: Subjects were 21 patients with deep anorectal abscesses. Deep anorectal abscesses were classified into two types, ischiorectal and pelvirectal, according to their location. Patients were also classified into a single abscess group, which showed either an ischiorectal or pelvirectal abscess, and a double abscess group, which showed both ischiorectal and pelvirectal abscesses. The final diagnosis was made from surgical findings, and the types of deep anorectal abscesses determined by digital examination and magnetic resonance imaging were compared. RESULTS: Sensitivity of ischiorectal abscesses (20 lesions) with digital examination and magnetic resonance imaging was 75 and 95 percent, respectively, and that of pelvirectal abscesses (10 lesions) with digital examination and magnetic resonance imaging was 60 and 70 percent, respectively. Sensitivity of the magnetic resonance imaging was significantly higher than that of digital examination in ischiorectal abscesses. Diagnostic accuracy of digital examination and magnetic resonance imaging were both 83 percent in the single abscess group (12 patients), whereas in the double abscess group (9 patients) it was 22 and 78 percent, respectively. The rate of accurate diagnosis of magnetic resonance imaging compared with digital examination in the double abscess group was significantly higher than that in the single abscess group. CONCLUSION: Magnetic resonance imaging was useful for diagnosing and differentiating ischiorectal and pelvirectal abscesses.

Fecal impactions occur in both sexes at any age but are particularly concentrated in children, in the institutionalized or impaired elderly, and in patients with certain psychiatric disorders or medical conditions that predispose to obstipation. The clinical consequences may be disabling and occasionally life threatening. Clinical manifestations include fecal incontinence, abdominal distention and pain, anorexia, weight loss, intestinal obstruction, and stercoral ulceration with bleeding or colonic perforation. Diagnosis begins with recognition of possible fecal impaction and confirmation by digital examination or abdominal radiography. Management consists of disimpaction, colon evacuation, and a maintenance bowel program to prevent recurrent impactions.