Objective: To determine if COVID-19 State of Emergency (SOE) restrictions were associated with a reduction in presentations to two urban EDs in Melbourne, Victoria. Methods: This retrospective observational study included adult patients presenting to The Alfred and Sandringham Hospital EDs during the first month of stage 2 and 3 SOE restrictions (26 March-25 April 2020). Patients transferred from other hospitals or diagnosed with COVID-19 were excluded. The primary outcome was the average number of presentations per day. Secondary outcomes included the average daily number of presentations for pre-specified subgroups defined by triage category and diagnosis. The independent impact of SOE restrictions, adjusted for underlying trends in attendance, was determined using negative binomial regression and reported as an incident rate ratio (IRR) with a 95% confidence interval (CI). Results: Average daily attendance during the exposure period was 174.7. In the absence of SOE restrictions, 278.8 presentations per day were predicted, a reduction of 37.3% (IRR 0.63, 95% CI 0.59-0.67). Attendance was lower than anticipated for all triage categories (especially category 5 [IRR 0.51, 95% CI 0.44-0.59]) and diagnostic groups (including circulatory problems [IRR 0.62, 95% CI 0.50-0.76] and injury [IRR 0.58, 95% CI 0.53-0.63]). There were fewer than predicted presentations for several sentinel diagnoses, including gastroenteritis (IRR 0.27, 95% CI 0.17-0.42) and renal colic (IRR 0.55, 95% CI 0.33-0.92). Conclusions: SOE restrictions were associated with a significant reduction in ED presentations across a range of triage categories and diagnoses. Public health messaging should emphasise the importance of timely ED attendance for acute illness and injury.

The volume of time dedicated to anatomy teaching has steadily decreased in the context of increasingly dense undergraduate curricula. We examine the complex topic of anatomical education from the undergraduate perspective, with a focus on student perceptions, their origins and their potential solutions. A limited dataset suggests students perceive their tuition in anatomy may be suboptimal. Multiple factors (including the intensity of pre-clinical studies, academic criticism of modern courses, surgical culture and misinformation) may account for the unrest. It is difficult to objectively measure the impact of modified anatomy curriculum on clinical performance and patient safety. While there is a case (on the basis of student perception at least) for reinvigorating elements of undergraduate anatomy education, the modern medical educational framework is here to stay, and students and clinicians must learn to adapt. Anatomy must be linked with contemporary approaches to medical education and it should be integrated, continuous and guided. It is critical that clinicians engage in the teaching of anatomy in the clinical environment and they must be adequately resourced to do so. Graduates must emerge with a core understanding of anatomy, but not an encyclopaedic knowledge of the human form. Undergraduate programme should simply strive to equip their graduates with a foundation for lifelong learning and a platform for safe practice as interns.

In emergency departments (EDs), demand for care often exceeds the available resources. Triage addresses this problem by sorting patients into categories of urgency. The Interagency Integrated Triage Tool (IITT) is a novel triage system designed for resource-limited emergency care (EC) settings. The system was piloted by two EDs in Papua New Guinea as part of an EC capacity development program. Implementation involved a five-hour teaching program for all ED staff, complemented by training resources including flowcharts and reference guides. Clinical redesign helped optimise flow and infrastructure, and development of simple electronic registries enabled data collection. Local champions were identified, and experienced EC clinicians from Australia acted as mentors during system roll-out. Evaluation data suggests the IITT, and the associated change management process, have high levels of acceptance amongst staff. Subject to validation, the IITT may be relevant to other resource-limited EC settings.

Objective: To report the incidence of fever among patients who tested positive for SARS-CoV-2. Methods: Retrospective cohort study of patients who tested positive for SARS-CoV-2 at a single centre. Temperature at time of testing and on repeat testing within 24 h were collected. Results: At the time of testing, fever was detected (sensitivity) in 16 of 86 (19%; 95% confidence interval 11-28) episodes of positive tests for SARS-CoV-2. With repeat testing, fever was detected in 18 of 75 (24%; 95% confidence interval 15-35) episodes. Conclusions: In an Australian hospital, screening for fever lacked sensitivity for detection of patients with SARS-CoV-2.