Objectives: Competence in point-of-care ultrasound is recommended/mandated by several critical care specialties. Although doctors commonly attend point-of-care ultrasound short-courses for introductory training, there is little follow-up data on whether they eventually attain competence. This study was done to determine the impact of point-of-care ultrasound short-courses on point-of-care ultrasound competence. Design: Web-based survey. Setting: Follow-up after point-of-care ultrasound short-courses in the Asia-Pacific region. Subjects: Doctors who attended a point-of-care ultrasound short-course between December 2015 and February 2018. Interventions: Each subject was emailed a questionnaire on or after 6 months following their short-course. They were asked if they had performed at least 30 structured point-of-care ultrasound scans and/or reached point-of-care ultrasound competence and their perceived reasons/challenges/barriers. They were also asked if they used point-of-care ultrasound as a clinical diagnostic aid. Measurements and Main Results: The response rate was 74.9% (182/243). Among the 182 respondents, only 12 (6.6%) had attained competence in their chosen point-of-care ultrasound modality, attributing their success to self-motivation and time management. For the remaining doctors who did not attain competence (170/182, 93.4%), the common reasons were lack of time, change of priorities, and less commonly, difficulties in accessing an ultrasound machine/supervisor. Common suggestions to improve short-courses included requests for scanning practice on acutely ill ICU patients and prior information on the challenges regarding point-of-care ultrasound competence. Suggestions to improve competence pathways included regular supervision and protected learning time. All 12 credentialled doctors regularly used point-of-care ultrasound as a clinical diagnostic aid. Of the 170 noncredentialled doctors, 123 (72.4%) reported performing unsupervised point-of-care ultrasound for clinical management, either sporadically (42/170, 24.7%) or regularly (81/170, 47.7%). Conclusions: In this survey of doctors attending point-of-care ultrasound short-courses in Australasia, the majority of doctors did not attain competence. However, the practice of unsupervised point-of-care ultrasound use by noncredentialled doctors was common. Further research into effective strategies to improve point-of-care ultrasound competence is required.

Research on the nocebo effect has shown that some words can hurt. Pain is defined as ‘unpleasant’ and ‘associated with actual or potential tissue damage’. So, a sensation described as ‘pain’ may function as a negative suggestion or nocebo communication. This can lead to pain being experienced or exacerbated where it would not have been otherwise. The nocebo effect has also been implicated as adversely affecting the pain experience during the assessment of pain postoperatively. Words that avoid this potential nocebo effect such as ‘comfort’ may represent a more satisfactory alternative. We therefore aimed to determine whether ‘comfort’ and ‘pain’ scores correlate when assessing patients postoperatively at the same timepoint. Patients were questioned before routine post-anaesthesia rounds to rate their pain and comfort levels, with the sequence of questions randomised. Patients were asked to rate pain and comfort on a 0–10 verbal numerical rating scale, where 0 represents ‘no pain’ or ‘no comfort’ and 10 ‘worst pain’ or ‘most comfort’ imaginable, respectively. To provide a clinically relevant correlation of approximately 0.7 between pain and inverted comfort scores, a sample size of 100 would provide adequate precision (95% confidence interval (CI) 0.58–0.79). A P-value of <0.05 was considered significant. We recruited 100 patients. A positive correlation of 0.62 was found between pain and inverted comfort scores (95% CI 0.47–0.72; P<0.0001). The question sequence of asking about pain or comfort did not affect either score. Comfort and pain scores are moderately correlated. This finding represents a first step in validating comfort scores and suggests that they could be considered a suitable alternative to pain scores when assessing patients postoperatively. As comfort is not an exact antonym to pain, caution is required when using these measures interchangeably.

INTRODUCTION This study aimed to identify the way information is described and presented by childbirth educators during antenatal classes for expectant parents, and analyse the language structures used when discussing labour and birth. METHODS This cross-sectional study of antenatal education was conducted at a single tertiary referral centre for Maternity Care in Western Sydney, Australia. All childbirth educators (n=3) were recorded whilst providing information to parents during antenatal classes. Audio data were subsequently transcribed and then analysed by two researchers, independently categorising the various language structures and types of information provided. This is the second study in a series of antenatal education topics. RESULTS During the labour and birth class, information statements were the predominant language structure that was spoken with 241 of 655 statements; negative statements were the next most frequent at 119 while there were 79 positive statements. The second stage of labour had a greater proportion of negative statements for two educators, followed by information and positive statements combined. Misinformation statements were minimal for this topic however, and there was an absence of any statements discussing the rest period between contractions. CONCLUSIONS The findings further emphasise the need to examine the language used by health professionals when educating parents. Negative statements during antenatal education are still common despite research in other contexts suggesting that these are potentially unhelpful. Further research into the language and suggestions used during antenatal education is required to determine whether improved outcomes seen in other contexts are confirmed in the childbirth setting.

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