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PURPOSE: The implementation of enhanced recovery after surgery programs (ERPs) has significantly improved outcomes within various surgical specialties. However, the suitability of ERPs in trauma surgery remains unclear. This study aimed to (1) design and implement an ERP for trauma laparotomy patients; (2) assess its safety, feasibility, and efficacy; and (3) compare the outcomes of the proposed ERP with conventional practices. METHODS: This case-matched study prospectively enrolled hemodynamically stable patients undergoing emergency laparotomy after penetrating trauma. Patients receiving the proposed ERP were compared to historical controls who had received conventional treatment from two to eight years prior to protocol implementation. Cases were matched for age, sex, injury mechanism, extra-abdominal injuries, and trauma scores. Assessment of intervention effects were modelled using regression analysis for outcome measures, including length of hospital stay (LOS), postoperative complications, and functional recovery parameters. RESULTS: Thirty-six consecutive patients were enrolled in the proposed ERP and matched to their 36 historical counterparts, totaling 72 participants. A statistically significant decrease in LOS, representing a 39% improvement in average LOS was observed. There was no difference in the incidence of postoperative complications. Opioid consumption was considerably lower in the ERP group (p < 0.010). Time to resumption of oral liquid and solid intake, as well as to the removal of nasogastric tubes, urinary catheters, and abdominal drains was significantly earlier among ERP patients (p < 0.001). CONCLUSION: The implementation of a standardized ERP for the perioperative care of penetrating abdominal trauma patients yielded a significant reduction in LOS without increasing postoperative complications. These findings demonstrate that ERPs principles can be safely applied to selected trauma patients.

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PURPOSE: Trauma leagues (TLs) are extracurricular programs that offer medical students supervised exposure to trauma and acute care surgery, mentorship, and participation in other academic activities. TLs are fully approved medical schools, and currently, over 100 TLs exist in Brazil. We hypothesized that the performance/competence of medical students who participated in TLs was superior compared to non-participants. This study evaluated and compared the cognitive performance and technical skills of the two groups. METHODS: This retrospective cohort study evaluated the performance of TL medical students to non-TL alumni from 2005 to 2017, using the students' academic performance coefficient, Clinical Competence Assessment, and Progress Test results. SigmaPlot 12.0 software was used to perform statistical analyses, including Mann-Whitney comparison tests and the Kruskal-Wallis test to confirm the data. RESULTS: Of the 1366 medical students who graduated from a Brazilian university, 966 were included, with 17.9% having participated in TL. Compared to non-TL participants, TL students demonstrated better cognitive performance according to the performance coefficient (p = 0.017) and Progress Test result (p < 0.001), and higher achievement in the Clinical Competence Assessment (p < 0.001). CONCLUSION: The academic performance of TL students was superior to that of non-TL students at the University of Campinas (Unicamp), suggesting a positive impact of TL in the preparation of future doctors. The study findings suggest that participation in TL at Unicamp was beneficial in preparing better doctors and should be considered by medical schools worldwide. EVIDENCE LEVEL: II (Retrospective cohort).

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Hemostasis plays a critical and fundamental role in all surgical procedures. Its management has several key points that start with good operative technique and adequate anesthetic support. Certain situations, such as severe bleeding resulting from penetrating trauma, do not depend exclusively on the control of the surgical team and require the support of new solutions that decrease or control bleeding. Since ancient times, a hallmark of medicine has been to act in the control of hemorrhage, and more recently, in the facilitation of hemostasis by the application of topical agents by either manual compression or modern agents. In the last decade, the number of different topical hemostatic agents has grown dramatically. For the modern surgeon to choose the right agent at the right time, it is essential that he/she understands the mechanisms of action, the effectiveness and the possible adverse effects related to each agent. Thus, the great variety of topical hemostatics, coupled with the absence of a review article in the national literature on this topic, stimulated us to elaborate this manuscript. Here we report a detailed review of the topical hemostatic agents most commonly used in surgical specialties.

A hemostasia tem papel crítico e importância fundamental em todos os procedimentos cirúrgicos. Seu manejo possui diversos pontos chaves, que se iniciam por boa técnica operatória e adequado suporte anestésico. Determinadas situações, como hemorragias graves resultantes de trauma penetrante, por exemplo, não dependem exclusivamente do controle da equipe cirúrgica e necessitam do apoio de novas soluções que diminuam ou controlem a hemorragia. Desde os tempos antigos, um marco da medicina é atuar no controle da hemorragia e, mais recentemente, na facilitação da hemostasia pela aplicação de agentes tópicos, seja por compressão manual ou agentes modernos. Na última década, o número de diferentes agentes hemostáticos tópicos cresceu drasticamente. Para que o cirurgião moderno escolha o agente correto no momento correto, é essencial que conheça o mecanismo de ação, entenda a eficácia e os possíveis efeitos adversos relacionados a cada agente. Assim, a grande variedade de hemostáticos tópicos, somada à ausência de um artigo de revisão na literatura nacional sobre este tópico, nos estimulou a elaborar este manuscrito. Aqui relatamos uma revisão detalhada sobre os agentes hemostáticos tópicos mais comumente utilizados nas especialidades cirúrgicas.

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OBJECTIVE: to compare the students' performance in face-to-face and telemedicine courses for the training and necessary action in disasters, using telemedicine as an effective training tool. METHODS: online research conducted after the end of the course of preparation in disasters, carried out in-person, as well as by videoconference. We compared the performance of students in the in-person course and through telemedicine. RESULTS: in the comparison of the results obtained with the pre- and post-test data between the students who attended via telemedicine and in-person, we observed that in the two modalities there was an increase in knowledge (p<0.001). We also observed no statistically significant differences in the posterior evaluation between the in-person and telemedicine courses (p=1.0), however, there was a significant difference at the pre-test evaluative moment (p<0.001). CONCLUSION: videoconferencing can be effectively used to train health professionals in disaster management, being able to provide adequate knowledge and become an important tool to distance reaching in continuing education.

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BACKGROUND: In Brazil, most medical schools do not offer trauma surgery in their undergraduate curriculum. The Trauma Leagues arose in Brazil as an important promoter of trauma education and stimulated activities related to surgical skills and practices. In recent decades, studies have demonstrated that the number of surgical residency applicants has decreased worldwide. Strategies to motivate medical students to choose surgery are needed. OBJECTIVE: To evaluate the impact of participation in the Unicamp Trauma League (UTL) during a 20-year period in the choice for a surgical career. METHODS: The study included 276 students in a Brazilian university hospital who were part of the Trauma League. Research of records in universities and medical societies about the specialties chosen during residency were evaluated. A Likert questionnaire was sent to participants to evaluate the impact of participating in the Trauma League in the student's professional career. RESULTS: The questionnaire was answered by 76% of the participants. Of those, 38.4% chose general surgery. About 55.1% did not know what medical career to choose when joined the league. Participation in the league had an influence on specialty choice in 79.1% of the students. Of those choosing surgery, 93.2% believed that participating in the league had positively influenced their career choice. Overall, 93.1% believed that participating in the league provided knowledge and information that the medical school curriculum was not able to provide. CONCLUSION: Participation in Trauma League has been an effective strategy to encourage medical students to choose a career in general surgery in Campinas, Brazil.

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RESUMO A hemostasia tem papel crítico e importância fundamental em todos os procedimentos cirúrgicos. Seu manejo possui diversos pontos chaves, que se iniciam por boa técnica operatória e adequado suporte anestésico. Determinadas situações, como hemorragias graves resultantes de trauma penetrante, por exemplo, não dependem exclusivamente do controle da equipe cirúrgica e necessitam do apoio de novas soluções que diminuam ou controlem a hemorragia. Desde os tempos antigos, um marco da medicina é atuar no controle da hemorragia e, mais recentemente, na facilitação da hemostasia pela aplicação de agentes tópicos, seja por compressão manual ou agentes modernos. Na última década, o número de diferentes agentes hemostáticos tópicos cresceu drasticamente. Para que o cirurgião moderno escolha o agente correto no momento correto, é essencial que conheça o mecanismo de ação, entenda a eficácia e os possíveis efeitos adversos relacionados a cada agente. Assim, a grande variedade de hemostáticos tópicos, somada à ausência de um artigo de revisão na literatura nacional sobre este tópico, nos estimulou a elaborar este manuscrito. Aqui relatamos uma revisão detalhada sobre os agentes hemostáticos tópicos mais comumente utilizados nas especialidades cirúrgicas.

ABSTRACT Hemostasis plays a critical and fundamental role in all surgical procedures. Its management has several key points that start with good operative technique and adequate anesthetic support. Certain situations, such as severe bleeding resulting from penetrating trauma, do not depend exclusively on the control of the surgical team and require the support of new solutions that decrease or control bleeding. Since ancient times, a hallmark of medicine has been to act in the control of hemorrhage, and more recently, in the facilitation of hemostasis by the application of topical agents by either manual compression or modern agents. In the last decade, the number of different topical hemostatic agents has grown dramatically. For the modern surgeon to choose the right agent at the right time, it is essential that he/she understands the mechanisms of action, the effectiveness and the possible adverse effects related to each agent. Thus, the great variety of topical hemostatics, coupled with the absence of a review article in the national literature on this topic, stimulated us to elaborate this manuscript. Here we report a detailed review of the topical hemostatic agents most commonly used in surgical specialties.

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ABSTRACT Objective: to compare the students' performance in face-to-face and telemedicine courses for the training and necessary action in disasters, using telemedicine as an effective training tool. Methods: online research conducted after the end of the course of preparation in disasters, carried out in-person, as well as by videoconference. We compared the performance of students in the in-person course and through telemedicine. Results: in the comparison of the results obtained with the pre- and post-test data between the students who attended via telemedicine and in-person, we observed that in the two modalities there was an increase in knowledge (p<0.001). We also observed no statistically significant differences in the posterior evaluation between the in-person and telemedicine courses (p=1.0), however, there was a significant difference at the pre-test evaluative moment (p<0.001). Conclusion: videoconferencing can be effectively used to train health professionals in disaster management, being able to provide adequate knowledge and become an important tool to distance reaching in continuing education.

RESUMO Objetivo: comparar o desempenho dos alunos nos cursos presenciais e via telemedicina para a capacitação e atuação necessária em desastres, se valendo da telemedicina como uma ferramenta efetiva de treinamento. Métodos: pesquisa online realizada após o término do curso de preparação em desastres, realizado presencialmente, bem como, por videoconferência. Comparou-se o desempenho dos alunos do curso presencial e via telemedicina. Resultados: na comparação dos resultados obtidos com os dados pré e pós-teste entre os alunos que cursaram via telemedicina e presencialmente, observou-se que nas duas modalidades do curso houve aumento do conhecimento (p<0,001). Constatou-se ainda que não houve diferenças estatisticamente significativas na avaliação posterior entre os cursos presenciais e via telemedicina (p=1,0), no entanto, houve diferença com significância no momento avaliativo pré-teste (p<0,001). Conclusão: as videoconferências podem ser utilizadas de forma efetiva para a capacitação de profissionais da área de saúde na gestão de desastres, sendo capaz de prover o conhecimento de forma adequada e ser ferramenta importante para alcance à distância em educação continuada.

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OBJECTIVE: to describe the causes and severities of trauma in patients who met the criteria for alcohol abuse or dependence according to Mini International Neuropsychiatric Interview, and to display the pattern of alcohol consumption and subsequent changes one year after trauma. METHODS: a transversal and longitudinal quantitative study carried out between November 2012 and September 2013 in the ED. Medical and nursing students collected blood samples, applied the J section of the Mini International Neuropsychiatric Interview (MINI) and submitted alcohol abusers and dependents to BI. One year after admission, patients were contacted and asked about their patterns of alcohol use and their reasons for any changes. RESULTS: from a sample of 507 patients admitted to the ED for trauma, 348 responded to MINI, 90 (25.9%) being abusers and 36 (10.3%) dependent on alcohol. Among the abusers, the most frequent cause of injury was motorcycle accident (35.6%) and among the dependents it was predominantly interpersonal violence (22.2%). Positive blood samples for alcohol were identified in 31.7% of the abusers and 53.1% of the dependents. One year after trauma, 66 abusers and 31 dependents were contacted, and it was ascertained that 36.4% of the abusers and 19.4% of the dependents had decreased alcohol consumption. The main reported reason for the reduction was the experienced trauma. CONCLUSION: the motorcycle accident was the most common cause of injury. The detection of problematic alcohol use and implementation of BI are important strategies in the ED, however for alcohol abusers and dependents, BI was not the most reported reason for any changes in patterns of alcohol use.

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