The Effectiveness of the Digital Environment and Perfectionism on Anxiety and Depression in the Light of the COVID-19 Pandemic in Northern Iraq.

This investigation is intended to explore the effect of the digital environment as well as perfectionism during the COVID-19 pandemic on anxiety and depression. The study used a mixed-methods design; a mixed research methodology was used regarding explanatory design by using a qualitative sub-sample from quantitative sample data. The researcher conducted the study on a sample of 980 students and non-students smartphone and internet users using both qualitative (self-reported) and quantitative (questionnaires) approach. Three different questionnaires were used: The Multidimensional Perfectionism Scale, Beck Depression (BD), and Beck Anxiety Inventory (BA). On the other hand, the researcher designed a self-reported interview for the qualitative part that included 5 major questions and 10 sub-questions. The gathered data were investigated using SPSS version 22 to analyze the collected data for this study, and simple descriptive statistics and coding were used. The results denote that the digital environment is significantly correlated with multidimensional perfectionism in a low positive manner for students. However, the correlation effects for non-students are significantly high as evidenced by a significant positive correlation. Another finding suggests that there is a positive significant association between perfectionism and being depressed and anxious.

Standardizing bimanual vaginal examination using cognitive task analysis.

OBJECTIVE: To create a standardized universal list of procedural steps for bimanual vaginal examination (BVE) for teaching, assessment, and simulator development. METHODS: This observational study, conducted from June-July 2012 and July-December 2014, collected video data of 10 expert clinicians performing BVE in a nonclinical environment. Video data were analyzed to produce a cognitive task analysis (CTA) of the examination steps performed. The CTA was further refined through structured interviews to make it suitable for teaching or assessment. It was validated through its use as a procedural examination checklist to rate expert clinician performance. RESULTS: BVE was deconstructed into 88 detailed steps outlining the complete examination process. These initial 88 steps were reduced to 35 by focusing on the unseen internal examination, then further refined through interviews with five experts into 30 essential procedural steps, five of which are additional steps if pathology is suspected. Using the CTA as a procedural checklist, the mean number of steps performed and/or verbalized was 21.6 ± 3.12 (72% ± 10.4%; range, 15.9-27.9, 53%-93%). CONCLUSION: This approach identified 30 essential steps for performing BVE, producing a new technique and standardized tool for teaching, assessment, and simulator development.

Imaging in the post-partum period: clinical challenges, normal findings, and common imaging pitfalls.

Complex physiological and biochemical changes occur in women during the post-partum period, many of which are incompletely understood. There are limited descriptions within the medical literature about expected imaging findings during this period and this review aims to illustrate 'normal' appearances following vaginal delivery and Cesarean section. We will also discuss some of the pertinent clinical challenges and imaging pitfalls encountered in assessing the post-partum female.

Real-time visualisation and analysis of internal examinations--seeing the unseen.

Internal examinations such as Digital Rectal Examination (DRE) and bimanual Vaginal Examination (BVE) are routinely performed for early diagnosis of cancer and other diseases. Although they are recognised as core skills to be taught on a medical curriculum, they are difficult to learn and teach due to their unsighted nature. We present a framework that combines a visualisation and analysis tool with position and pressure sensors to enable the study of internal examinations and provision of real-time feedback. This approach is novel as it allows for real-time continuous trajectory and pressure data to be obtained for the complete examination, which may be used for teaching and assessment. Experiments were conducted performing DRE and BVE on benchtop models, and BVE on Gynaecological Teaching Assistants (GTA). The results obtained suggest that the proposed methodology may provide an insight into what constitutes an adequate DRE or BVE, provide real-time feedback tools for learning and assessment, and inform haptics-based simulator design.

Intraobserver and interobserver reliability of the three-dimensional ultrasound imaging of female urethral sphincter using a translabial technique.

INTRODUCTION AND HYPOTHESIS: The aim of the study was to assess the interobserver and intraobserver reliability of translabial 3D ultrasound imaging of the urethral sphincter in non-pregnant nulliparous asymptomatic women. METHODS: A study using a 3D translabial ultrasound on thirty-seven women was performed. Urethral sphincter parameters were measured by the same experienced clinician 2 weeks apart. Multiple axial cross-sectional areas at 1-mm distances were used to calculate urethral sphincter volumes. The same measurements were carried out by a second experienced clinician to assess the interobserver reliability. RESULTS: We found an excellent intraobserver reliability (interclass correlation coefficient, ICC >0.8) and good interobserver reliability (ICC >0.6). CONCLUSION: The described technique using multiple axial cross-sectional areas at set distances and a translabial approach is a reliable and accurate tool in the evaluation of the urethral sphincter. This should be used instead of mathematical formulas as the urethral sphincter is not a uniform geometrical sphere. The technique and values reported may help clinicians in the assessment of women with lower urinary tract disorders.

Racial differences in female urethral morphology and levator hiatal dimensions: an ultrasound study.

AIM: To compare the urethral sphincter morphology and levator hiatal dimensions between white and black premenopausal nulliparous asymptomatic women using 3D/4D translabial ultrasonography. METHODS: Nulliparous black and white women were recruited in a tertiary gynecological center. All women were completely asymptomatic for pelvic floor dysfunction. Women were assessed with 3D/4D translabial ultrasound scan of the pelvic floor, at rest. Measurements of the total urethral sphincter volume (TSV), rhabdosphincter volume, (RSV) and levator hiatal dimensions (LH) were taken at rest, after voiding. RESULTS: Twenty-three white and 14 black women (37 in total) were investigated. Subjects did not differ by age or body mass index (BMI). Black women were found to have significantly larger rhabdosphincters (RS) than their white counterparts (8.88 cm(3) ± 1.65 vs. 5.97 cm(3) ± 1.82, respectively, P = 0.000). With respect to levator hiatal dimensions at rest, black women had a significantly wider transverse diameter (LHt) than white women (mean difference of LHt = 0.43 cm, 95% CI 0.08-0.78, P < 0.05). CONCLUSIONS: Asymptomatic black nulliparous women have significantly larger rhabdosphincters than their white counterparts. Racial differences in the female urethral morphology could provide an insight on the pathophysiology of stress urinary incontinence.