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Introduction: Point-of-care ultrasound (POCUS) has the potential (FAST) and aortic aneurysm (AAA) - in the rural context. to improve access to diagnostic imaging for rural communities. Methods: This study is a subgroup analysis of a larger study into This article evaluates the sensitivity and specificity, impact on POCUS in rural New Zealand. Twenty-eight physicians in six New patient care, quality and safety of two common POCUS Zealand rural hospitals, with limited access to formal diagnostic examinations - focused assessment with sonography in trauma imaging, completed a questionnaire before and after POCUS scans to assess the extent to which it altered diagnostic certainty and patient disposition (discharge v admission to rural hospital v transfer to urban hospital). The investigators and a specialist panel reviewed images for technical quality and accuracy of interpretation, and patient clinical records, to determine accuracy of the POCUS findings and their impact on patient care. Results: For FAST and AAA scans respectively, sensitivities were 75% and 100%, and specificities 100% and 93%; rural doctors correctly interpreted their POCUS images for 97% and 91% of scans. The proportions of scans that had either a 'significant' or 'major' impact on patient care were 17% and 31%. POCUS resulted in the disposition being de-escalated for 15% and 10% of patients and escalated for 5% and 3% of patients. Conclusions: In the rural context, POCUS AAA is a reliable 'rule out' test for ruptured abdominal aortic aneurysm and FAST scan has a role as a 'rule in' test for solid organ injury. These findings are consistent with larger studies in the emergency medicine literature. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the safety, quality and impact of point‐of‐care ultrasound on patient management when performed by rural generalist doctors. Design: Cross‐sectional descriptive study. Setting: Six rural small hospitals serving a range of communities in rural New Zealand. Participants: All generalist doctors practising ultrasound in the study hospitals. Main outcome measures: Technical quality, accuracy, impact on diagnostic certainty, patient disposition and overall patient care. Result: Participants correctly interpreted 90% of images and a similar percentage of point‐of‐care ultrasound findings when compared with the results of formal imaging or the final diagnosis. In total, 87% of scans contributed to the diagnostic process, changing the diagnostic probability. There was a 4% overall reduction in the number of patients needing hospital admission or transfer to an urban base hospital. The overall impact on patient care was positive for 71% of point‐of‐care ultrasound scans. Three percent of scans had the potential for patient harm. Conclusion: Rural generalists' practise a broad scope of point‐of‐care ultrasound that, when used as a part of the full clinical assessment, has a positive impact on patient care, improving diagnostic certainty and reducing the need for hospital admission and inter‐hospital transfer. There are challenges in learning and maintaining the skills needed to practise a high standard of point‐of‐care ultrasound in this context. Further consideration needs to be given to the development safe scopes of practice, training, credentialing and quality assurance. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Point-of-care ultrasound (POCUS) is an increasingly common adjunct to the clinical assessment of patients in rural New Zealand. AIM: To describe the scope of POCUS being practiced by rural generalist hospital doctors and gain insights, from their perspective, into its effect. METHODS: This was a mixed-methods descriptive study. Main outcome measures were type and frequency of POCUS being undertaken. A questionnaire was given to POCUS-active rural hospital doctors to survey the effect of POCUS on clinical practice and assess issues of quality assurance. RESULTS: The most commonly performed scans were: cardiac (18%) and volume scans (inferior vena cava and jugular venous pressure) (14%), followed by gallbladder (13%), kidney (11%), Focused Assessment with Sonography in Trauma (FAST) (7%), bladder (6%), leg veins (6%) and lungs (5%). There was large variation in frequency of scan types between the study hospitals that could not be accounted for by differences in training. The participating doctors considered that POCUS had a positive and significant effect on their practice, largely by adding to diagnostic certainty. Challenges identified included maintenance of POCUS skills, lack of systems for POCUS set-up and the absence of quality assurance for POCUS in rural hospitals. DISCUSSION: Rural generalists consider the broad scope of POCUS they practise to be an important but challenging skill set. Clinical governance, including an agreed scope and standards, may increase the benefits and improve the safety of rural POCUS. [ABSTRACT FROM AUTHOR]

The head is positioned erect for an approximation; yet most facial soft tissue depths ( FSTD) used are measured from supine subjects. Depth difference might be significant, but there is a paucity of data to verify. This study compared erect and supine values for 17 landmarks from 30 healthy New Zealand (European population affinity) women (18-30 or 40-55 years) in erect then supine positions. Height, weight, and sonographic FSTD data, totaling 1020 measurements, were obtained. Three midline and seven averaged bilateral values were compared using ANOVA, p values, and Pearson's correlations. Correlative strength of age and body mass index, BMI (kg/m2), was determined by values. Results showed averaged erect and supine differences were significant for four of ten FSTDs. Between individuals, difference was various and not unidirectional. In conclusion, depth differences were observed but not all significant or unidirectional, BMI significantly influenced nine FSTD values, but age group did not. [ABSTRACT FROM AUTHOR]

Introduction: Point-of-care ultrasound (POCUS) has the potential to improve access to diagnostic imaging for rural communities. This article evaluates the sensitivity and specificity, impact on patient care, quality and safety of two common POCUS examinations - focused assessment with sonography in trauma (FAST) and aortic aneurysm (AAA) - in the rural context., Methods: This study is a subgroup analysis of a larger study into POCUS in rural New Zealand. Twenty-eight physicians in six New Zealand rural hospitals, with limited access to formal diagnostic imaging, completed a questionnaire before and after POCUS scans to assess the extent to which it altered diagnostic certainty and patient disposition (discharge v admission to rural hospital v transfer to urban hospital). The investigators and a specialist panel reviewed images for technical quality and accuracy of interpretation, and patient clinical records, to determine accuracy of the POCUS findings and their impact on patient care., Results: For FAST and AAA scans respectively, sensitivities were 75% and 100%, and specificities 100% and 93%; rural doctors correctly interpreted their POCUS images for 97% and 91% of scans. The proportions of scans that had either a 'significant' or 'major' impact on patient care were 17% and 31%. POCUS resulted in the disposition being de-escalated for 15% and 10% of patients and escalated for 5% and 3% of patients., Conclusions: In the rural context, POCUS AAA is a reliable 'rule out' test for ruptured abdominal aortic aneurysm and FAST scan has a role as a 'rule in' test for solid organ injury. These findings are consistent with larger studies in the emergency medicine literature.