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The incidence of colorectal cancer (CRC) is high, and 50–60% of colorectal cancer patients will progress with distant metastases. The liver is the most common site for CRC and the diagnosis can be made preoperatively, during the initial presentation of the disease, intraoperatively, or during the follow-up after the treatment of the primary. This diagnosis is based in clinical, laboratory, and radiological studies. This chapter will address the different circumstances of the diagnosis and the role of each of the present diagnostic tools.

Objective To evaluate the perception of doctors, residents, and medical students of smartphone use on daily medical practice. Materials and methods Cross-sectional study with data collected online by questionnaire on Google Docs®, with closed multiple-choice questions regarding smartphones use in medical practice and its impact on decision-making and patients' privacy. Results There were 118 questionnaires, mostly from students (61%), followed by medical residents (31%) and medical preceptors (8%). All preceptors confirmed eventual use of smartphones on clinical cases discussions, 77.8% of whom use it in less than half of the time. Among the residents, 94.6% use theirs smartphones, 77% of them in more than half of the time. On the contrary, 12.5% of the students do not use this kind of resource, and among those that do use it, 50% do so more than half of the time. All preceptors, 94.6% residents and 80.6% of the students believe its use does not expose the patients' privacy. Conclusion Preceptors and residents use smartphones more often than medical students. Most agree its use helps on daily decision-making and does not jeopardize the patients' privacy. How to cite this article Abreu-Reis P, Bassani T, Collaco IA, Pereira GD, Faggion HZ, Sawczyn GV, Uchida EP, Nasr A, Tomasich FS, Lopes JA. Telemedicine inside the Pocket: The Impact of Smartphones on Daily Patients' Evaluations. Panam J Trauma Crit Care Emerg Surg 2016;5(2):88-92.

Objective To evaluate the stress level in physicians of different levels of formation and to compare it between different medical specialties and the general population. Methods This was a cross-sectional study, using a questionnaire validated in Brazil in 2010, the Perceived Stress Scale (PSS-10). Results The stress level was higher among surgical doctors in comparison with clinical doctors, regardless of the stage of formation. There was a difference between the sex of the professionals, men showing lower results. None of these was statistically significant. Comparing to the American population or South Brazilian teachers, the medical preceptors presented a significant lower level of stress. Conclusion The medical specialty as well as gender and level of medical formation influence in the professional stress level, being elevated in fields of higher working hours and constant pressure. Descriptors Stress, surgery, residents, medical students. How to cite this article Abreu-Reis P, Nasr A, Tomasich FS, Collaco IA, Bassani T, Clivatti GM, Fontanella AP, Ito JM, Manfrinato MFM, Hammerschmidt I. At the Razor's Edge: Surgeons have Lower Stress Levels than the General Population. Panam J Trauma Crit Care Emerg Surg 2016;5(1):26-30.

Background It is not always that prehospital trauma life support (PHTLS) principles are applied to daily practice. Lack of training to health care providers and a high amount of patients overwhelming the system capacity may let malpractice behavior to happen. It is the aim of this study to assess injuries misdiagnosed by prehospital trauma care in a capital city in southern Brazil. Study design A prospective observational non-controlled study with 174 random trauma cases that were brought to a level 1 trauma center in the city of Curitiba, between May 28th and June 10th 2006. We analyzed data registered in the prehospital rescue team form. The including criteria were all patients delivered to the trauma center by ambulances. The excluding criteria were patients not transported by ambulances and those without the proper form filled out. Statistical analysis was performed using the Chi-square for discrete, and the students’ t-test for continuous variables. Results Of the 174 patients who met the including criteria, 75% were men with a mean age of 27-year-old. Of the 11 injuries to the neck identified in the Hospital evaluation, eight were missed by the prehospital care (OR 0.26 CI 95% 0.07-0.94). Also, only 7/20 injuries to the back were identified by the PHTLS team (OR 0.32 CI 95% 0.13-0.78). Similarly, only 6/26 injuries to the chest (OR 0.20 CI 95% 0.08-0.50), 4/15 to the abdomen (OR 0.24 CI 95% 0.08-0.76), 4/16 to the pelvis (OR 0.23 CI 95% 0.07-0.70), 13/33 to the upper body (OR 0.34 CI 95% 0.17- 0.68),7/39 to the lower body (OR 0.14 CI 95% 0.06-0.33) and 17/55 (OR 0.23 CI 95% 0.12-0.42) were correctly identified in the prehospital scenario. Conclusion Although it is known PHTLS principles, which save lives when applied in practice, further training and remarks to its importance is needed to fully implement efficient trauma systems. Electronic data collection shall make checklists consistently filled out, so that patient care will be improved. How to cite this article Abreu-Reis P, Nasr A, Tomasich FS, Collaco I. Misdiagnosed Injuries in the Prehospital Trauma Care: Better Training needs to be Implemented. Panam J Trauma Crit Care Emerg Surg 2014;3(3):93-96.

BackgroundTrauma registry remains a great problem to most countries that are implementing trauma systems. Nondigital data assessment and storage may lead to information deterioration along the process. In order to verify the missing registry in prehospital trauma rescuers’ form, we ran this study.Study designA prospective observational noncontrolled study with 288 random trauma cases brought to a Level 1 Trauma Center in Curitiba, between May 28th and June 10th 2006. We analyzed data registered in the prehospital rescue team form. The including criteria were all patients delivered to the trauma center by ambulances. The excluding criteria were patients not transported by ambulances and those without the proper form filled out. Statistical analysis was performed using the Chi-square for discrete, and the student's t-test for continuous variables.ResultsTwo hundred and eighty-eight trauma cases were observed. Twelve patients were excluded. Of the 276 patients who met the including criteria, 75% were men with a mean age of 27-year-old. In only 8.34% of times patients were brought by doctors, while in 91.66% by paramedics. 63.4% of patients were traffic injuries victims, followed by 12.31% falls, 6.52% falls from the high, 5.79% gunshot wounds, 5.34% assaults, 3.62% stab wounds, 2.89% others. Impressively, 16 patients (5.89%) had no records of respiratory rate from the prehospital care assessment, 20 (7.24%) had no data of systolic blood pressure and 13(4.71%)had no pulse registry. Furthermore, 31.25% of the RR not registered were abnormal in the hospital admission evaluation, as well as 15% of the SBPs, and 23% of HR. None of the cases had information regarding time from the scene to the hospital.ConclusionElectronic data collection shall make checklists consistently filled out. It is not well understood the importance of registering data for most of healthcare providers working in the field, especially when they do not follow the in-hospital care of trauma patients.How to cite this articleAbreu-Reis P, Tomasich FS, Nasr A, Collaco I. Prehospital Trauma Care Registry Problems in South Brazil. Panam J Trauma Crit Care Emerg Surg 2014;3(3):97-100.

Background Traffic injuries are among the main causes of death worldwide. Even with the advances in technology, there are still 50% of deaths that cannot be reduced by medical care improvement. These important injuries can though be reduced by prevention of trauma. One of the best ways to address this issue is through incorporating preventive measures to the daily routine of schools. It is the aim of this study to assess children's perception on traumatic events and to introduce a cost-effective peer-education preventive action. Study design A prospective interventional comparative study with children from a basic school in South Brazil. A questionnaire with 9 decision-making questions about traffic scenarios was applied by volunteer medical students from May to June 2012, before and after a peer-educational lecture on prevention of traffic injuries. There were 20 epidemiological questions as well. Data collected was compared between the pre and the posttests of the same students. Statistical analysis was performed using the Chi-square for discrete, and the students’ t-test for continuous variables. Results Among 246 students answered the questionnaires. The mean age was 10.19 years old. 21% reported that always crosses the street alone, while 47% only cross with an adult. Most of the students said they always cross-streets in the zebra-crossing and look to both sides before crossing (60.71 and 84.9% respectively). Impressively, 12.55% said they often/ sometimes drive a car or a motorcycle. Also, 30.76% ride a bike in between the cars. Furthermore, 77.48% of the students use the front seat of the car. Regarding safety issues, only one-third have a horn in their bikes, and less than half use helmet when playing. When comparing their assessments, there was a higher number of correct answers in the decision-making section in the post-test (5.21 vs 3.93, p = 0.000001161). The estimated overall cost was 45 dollars. Conclusion Preventive measures urge to be incorporated to schools curricula. Peer-educational actions are a cost-effective for spreading medical knowledge among children and youth. How to cite this article Abreu-Reis P, Tomasich F, Pinto BES, Manfrinato MFM, Oliveira LB, Nasr A, Slongo H, Cruz JB, Collaço I. Preventive Peer-educational Activities: What can Medical Students do to Potentially Save Lives? Panam J Trauma Critical Care Emerg Surg 2012;1(3):182-185.

Introduction The benefits of telepresence in trauma and acute surgical care exist, yet its use in a live, operating room (OR) setting with real surgical cases remains limited. Methods We tested the use of a robotic telepresence system in the OR of a busy, level 1 trauma center. After each case, both the local and remote physicians completed questionnaires regarding the use of the system using a five point Likert scale. For trauma cases, physicians were asked to grade injury severity according to the American Association for the Surgery of Trauma (AAST) Scaling System. Results We collected prospective, observational data on 50 emergent and elective cases. 64% of cases were emergency surgery on trauma patients, almost evenly distributed between penetrating (49%) and blunt injuries (51%). 40% of non-trauma cases were hernia-related. A varied distribution of injuries was observed to the abdomen, chest, extremities, small bowel, kidneys, spleen, and colon. Physicians gave the system high ratings for its audio and visual capabilities, but identified internet connectivity and crowding in the operating room as potential challenges. The loccal clinician classified injuries according to the AAST injury grading system in 63% (n=22) of trauma cases, compared to 54% (n=19) of cases by the remote physicians. The remote physician cited obstruction of view as the main reason for the discrepancy. 94% of remote physicians and 74% of local physicians felt comfortable communicating via the telepresence system. For 90% of cases, both the remote and local physicians strongly agreed that a telepresence system for consultations in the OR is more effective than a telephone conversation. Conclusions A telepresence system was tested on a variety of surgical cases and demonstrated that it can be an appropriate solution for use in the operating room. Future research should determine its impact on processes of care and surgical outcomes.

Advances in information and communication technologies are changing the delivery of trauma care and education. Telemedicine is a tool that can be used to deliver expert trauma care and education anywhere in the world. Trauma is a rapidly-evolving field requiring access to readily available sources of information. Through videoconferencing, physicians can participate in continuing education activities such as Grand Rounds, seminars, conferences and journal clubs. Exemplary programs have shown promising outcomes of teleconferences such as enhanced learning, professional collaborations, and networking. This review introduces the concept of telemedicine for trauma education, and highlights efforts of programs that are utilizing telemedicine to unite institutions across the world.

Domestic accidents yearly account for an important amount of morbidity related to trauma worldwide, mainly amongst children and youth. One of the best ways to address this issue is through incorporating preventive measures to the daily routine of schools. It is the aim of this study to introduce a cost-effective peer-education preventive action.

Traffic injuries are amongst the main causes of death worldwide. Even with the advances in technology, there are still 50% of deaths that cannot be reduced by medical care improvement. These important injuries can though be reduced by prevention of trauma. One of the best ways to address this issue is through incorporating preventive measures to the daily routine of schools. It is the aim of this study to assess children’s perception on traumatic events and to introduce a cost-effective peer-education preventive action.