Hamstring strains, particularly involving the long head of biceps femoris (BFlh) at the proximal musculotendinous junction (MTJ), are commonly experienced by athletes. With the use of diagnostic ultrasound increasing, an in‐depth knowledge of normal ultrasonographic anatomy is fundamental to better understanding hamstring strain. The aim of this study was to describe the architecture of BFlh, using ultrasonography, in young men and cadaver specimens. BFlh morphology was examined in 19 healthy male participants (mean age 21.6 years) using ultrasound. Muscle, tendon and MTJ lengths were recorded and architectural parameters assessed at four standardised points along the muscle. Measurement accuracy was validated by ultrasound and dissection of BFlh in six male cadaver lower limbs (mean age 76 years). Intra‐rater reliability of architectural parameters was examined for repeat scans, image analysis and dissection measurements. Distally the BFlh muscle had significantly (P < 0.05) shorter fascicles and larger pennation angles than proximal sites. Agreement between ultrasound and dissection (cadaver study) was excellent for all architectural parameters, except pennation angle (PA), and MTJ length. All other measures demonstrated good‐excellent repeatability. BFlh is not uniform in architecture when imaged using ultrasound. It is likely that its distal‐most segment is better suited for force production in comparison to the more proximal segments, which show excursive potential, traits which possibly contribute to the high rate of injury at the proximal MTJ. The data presented in this study provide specific knowledge of the normal ultrasonographic anatomy of BFlh, which should be of assistance in analysing BFlh injury via imaging. Clin. Anat. 29:738–745, 2016. © 2016 Wiley Periodicals, Inc.

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.

ObjectiveTo evaluate the safety, quality and impact of point‐of‐care ultrasound on patient management when performed by rural generalist doctors.DesignCross‐sectional descriptive study.SettingSix rural small hospitals serving a range of communities in rural New Zealand.ParticipantsAll generalist doctors practising ultrasound in the study hospitals.Main outcome measuresTechnical quality, accuracy, impact on diagnostic certainty, patient disposition and overall patient care.ResultParticipants 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.ConclusionRural 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.

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/m(2) ), 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.

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 Rural and Remote Health rrh.org.au