POCUS for volume assessment

Tuesday, September 24th, 2019 | Rory | No Comments

POCUS influences clinical management – part 394.

Nixon G, Blattner K, Finnie W, Lawrenson R, Kerse N. Use of point‐of‐care ultrasound for the assessment of intravascular volume in five rural New Zealand hospitals. Can J Rural Med 2019;24:109‐14.

Another of Garry’s papers on POCUS, again showing it alters clinical decisions, this time for assessing intravascular volume.


Introduction: Measuring the diameter of the inferior vena cava (IVC) or the height of the jugular venous pressure (JVP) with point‐of‐care ultrasound (POCUS) is a practical alternative method for estimating a patient’s intravascular volume in the rural setting. This study aims to determine whether or not POCUS of the IVC or JVP generates additional useful clinical information over and above routine physical examination in this context.

Methods: Twenty generalist physicians, working in five New Zealand rural hospitals, recorded their estimation of a patient’s intravascular volume based on physical examination and then again after performing POCUS of the IVC or JVP, using a visual scale from 1 to 11.

Results: Data were available for 150 assessments. There was an only moderate agreement between the pre‐ and post‐test findings (Spearman’s correlation coefficient = 0.46). In 28% (42/150) of cases, the difference was four or more points on the scale, and therefore, had the potential to be clinically significant.

Conclusion: In the rural context, POCUS provides new information that frequently alters the clinician’s estimation of a patient’s intravascular volume.

Rural youth in distress

Monday, July 29th, 2019 | Rory | No Comments

Ferguson Isobel, Moor Stephanie, Frampton Chris, Withington Steve (2019) Rural youth in distress? Youth self-harm presentations to a rural hospital over 10 years. Journal of Primary Health Care 11, 109–116.

Open Access

A very interesting, but concerning, paper from Ashburton showing significant and rising rates of self-harm in young Ashburtonians/Ashburtonites especially in Māori. We all know that mental health services need bolstering in NZ, especially rurally. Open access paper that is worth a read in full!


Introduction: Despite growing awareness of increasing rates of youth suicide and self-harm in New Zealand, there is still little known about self-harm among rural youth.

Aim: This study compared: (1) rates of youth self-harm presentations between a rural emergency department (ED) and nationally available rates; and (2) local and national youth suicide rates over the decade from January 2008 to December 2017.

Methods: Data were requested on all presentations to Ashburton Hospital ED coded for ‘self-harm’ for patients aged 15–24 years. Comparative data were obtained from the coroner, Ministry of Health and the 2013 census. Analyses were conducted of the effects of age, time, repetition, method, ethnicity and contact with mental health services on corresponding suicide rates.

Results: Self-harm rates in Ashburton rose in the post-earthquake period (2013–17). During the peri-earthquake period (2008–12), non-Māori rates of self-harm were higher than for Māori (527 vs 116 per 100 000 youth respectively), reflecting the national trend. In the post-earthquake period, although non-Māori rates of self-harm stayed stable (595 per 100 000), there was a significant increase in Māori rates of self-harm to 1106 per 100 000 (Chi-squared = 14.0, P < 0.001). Youth living within the Ashburton township showed higher rates than youth living more rurally.

Discussion: Youth self-harm behaviours, especially self-poisoning, have increased since the Canterbury earthquakes in the Ashburton rural community. Of most concern was the almost ninefold increase in Māori self-harm presentations in recent years, along with the increasing prevalence among teenagers and females. Possible explanations and further exploratory investigation strategies are discussed.

Good rural hospital 2017

Thursday, June 13th, 2019 | Rory | No Comments

The Qualities of a good rural hospital. A NZ 2017 perspective.

“A rural hospital can be compared to a ketei – whereby like the flax strands, culture, ideology and values are interwoven with systems, workforce, facilities, social and geographical context to become a purposeful provider of rural health care.”

The rural hospital kete: Ruth Upsdell 2017

In 2002 students and faculty of Otago University’s postgraduate rural programme, (then in the Department of General Practice and Rural Health, Dunedin School of Medicine), wrote a document titled ‘The Good Rural Hospital’ which has since been core reading for the paper GENA724: ‘The Context of Rural Hospital Medicine’. The intent in writing this 2017 document was to update the original document given the intervening period of 15 years.

This document was written by the 2017 students and faculty of GENA724 ‘The Context of Rural Hospital Medicine’ paper (now part of the post-graduate rural programme, Department of the Dean, Dunedin School of Medicine) with input from the wider post graduate rural programme faculty.

This is an aspirational document describing the specific role of the hospital as one part of wider rural health services. While recognising that there is and needs to be a wide variation of rural hospitals in New Zealand the document’s focus is on commonalities that define rural hospital practice.

The document (like the 2002 version) is written by doctors and as such represents a significant bias towards the views of the medical team. We acknowledge that other members of the rural hospital team and the community may have a significantly different, but equally important, view of the place of the rural hospital.

Students and faculty of Rural Postgraduate Programme, University of Otago. The Good Rural Hospital: New Zealand 2017 Edition 1. 2017 accessed from: https://blogs.otago.ac.nz/rural/2019/06/13/good-rural-hospital-2017/

Link to The Good Rural Hospital 2017 e1 full text document


Contributions by:

Sue Todd

Ruth Upsdell

Justin Venable

Rory Kennelly

Arwen Bakker

Amanda van Zyl

Jack Haywood

Christina Jenkins

Katherine Orme

Chloe Horner

Rory Miller

Navin Sivalingam

Mafi Vakaola

Isaac Campbell

Katie Smith

Gillian Twinem

Simeon Intal

Garry Nixon

Katharina Blattner

Yan Wong

Mark Smith

Marc Gutenstein

Sampsa Kiuru

Peter Kyriadkoudis

Nina Stupple

Emma Davey

Steve Withington

Trevor Lloyd

Jeremy Webber

Martyn Williamson

Joel Pirini


Nigel Cane