Peer assisted learning: a meta-ethnographic synthesis of qualitative studies and recommendations for cardiovascular training, practice, and research.

INTRODUCTION: Peer assisted learning (PAL) is a common method to complement more traditional teaching. Several systematic reviews and meta-analyses described the most used ways of implementation and showed that it is effective in fostering learning. A synthesis of qualitative data is missing, to highlight the perceived value by the students and to drive a successful implementation. EVIDENCE ACQUISITION: The search was performed in Pubmed, Scopus and ERIC databases, with a combination of the search strings. The quality of the retrieved articles was assessed through the Critical Appraisal Skills Checklist. The analysis was performed according to the meta-ethnographic method. Fifteen articles were considered for the analysis, saturation was reached after 12 articles. EVIDENCE SYNTHESIS: Three main themes emerged from the analysis: PAL is effective when implemented in a safe environment, PAL is a driver of development of students' abilities and identity, and the "dark side" of PAL. Nine sub-themes emerged as components of the themes. The final line of argument highlighted the ambivalence of PAL, as an expression of the ambivalence of the still developing professional identity of students. CONCLUSIONS: This meta-ethnographic synthesis summarizes the elements of success and the threats of PAL, a method that is particularly suitable for the cardiovascular domain. It must be implemented according to some precautions, such as organization and protected time, tutor selection, training and support, a clear integration and endorsement in the framework of the medical curriculum.

Total necrotizing colitis proximal to obstructive left colon cancer: case report and literature review.

BACKGROUND: Necrotizing colitis (NC) is a rare complication of the obstructive cancer of the left colon and it is the result of intramural ischemia due to impairment of blood supply secondary to increased endoluminal pressure. CASE PRESENTATION: A 70 years old patient with significant comorbidities (ASA 4) was admitted for intestinal obstruction.The extensive necrosis of the entire proximal colon secondary to an obstructive sigmoid colon cancer has been diagnosed intraoperatively. Total colectomy and terminal ileostomy have been performed. The postoperative course was uneventful and the ileostomy closure with ileo-rectal anastomosis was performed 7 months later. A review of the literature discussing the epidemiology, pathogenesis, diagnosis and therapeutic approach of this type of colitis, was performed. CONCLUSIONS: NC implies diagnosis and therapeutic difficulties,especially from point of view of surgical strategy. We advocate of large colic resections, beyond the macroscopic limits of the necrosis in order to avoid the postoperative complications. We also consider seriate surgical procedures as a good choice for the high risk patients.

[Value of temporoparietal fasciocutaneous flaps in reconstruction of cutaneous defects at the OMF region]. / Valoarea lambourilor fasciocutanate temporo-parietale în reconstructia defectelor cutanate din teritoriul OMF.

AIMS: The authors propose the temporoparietal fasciocutaneous flaps for covering the surface skin defects from oro-maxillo-facial region. MATERIAL AND METHOD: Between 2000 and 2006 we performed 8 of this kind of flaps: 5 insular temporoparietal fasciocutaneous flaps, 2 fasciocutaneous flaps and one rotated flap. These flaps were used for reconstruction of the defects of the mouth's commissures, genian region in 1/2 superior, parotid region, upper lip and nasogenian sulcus. RESULTS: We recorded a singular case with necrosis of the insular fasciocutaneous flap; the rest of 7 were entirely survived. The cosmetic appearance was acceptable for all patients and the symmetry of the reconstructed area versus contralateral area was satisfactory. One case has cicatriceal alopecia at the donor site and in two cases, alopecia because of use of the skin graft for covering the donor defect. CONCLUSION: The fasciocutaneous temporoparietal flap is a value technique for repairing the facial skin defect.