Scenario-based teaching within an authentic clinical environment is feasible and perceived by participants to be educationally useful. This approach blurs traditional boundaries between skills laboratory teaching and clinical practice and may offer considerable advantages in training for clinical procedures.

Abstract-Blood flow and perfusion monitoring are critical appraisal to ensure survival of tissue flap after reconstructive surgery. Many techniques have been developed over the years: from optical to chemical, invasive or not, they all have limitations in their price, risks and adaptiveness to the patient. A wireless wearable self-calibrated device, based on near infrared spectroscopy (NIRS) was developed for blood flow and perfusion monitoring contingent on tissue oxygen saturation (StO 2 ). The use of such device is particularly relevant in the case of free flap myocutaneous reconstructive surgery; postoperative monitoring of the flap is crucial for a prompt intervention in case of thrombosis. Although failure rate is low, the rate of additional surgery following anastomosis problem is about 50%. NIRS has shown promising results for the monitoring of free flap, however lack of adaptation to its environment (ambient light) and users (body mass index (BMI), skin tone, alcohol and smoking habits or physical activity level) hinders the practical use of this technique. To overcome those limitations, a self-calibrated approach is introduced. Tested with ischaemia and cold water experiments on healthy subjects of different skin tones, its ability to personalize its calibration is demonstrated. Furthermore, using a vascular phantom, it is also able to detect pulses, differentiate venous and arterial colouredlike fluids with distinct clusters and detect significant changes in simulated partial venous occlusion. Placed in the trained classifier, partial occlusion data showed similar results between predicted and true classification. Further analysis from partial occlusion data showed that distinct clusters for 75% and 100% occlusion emerged.

Background The role of a tailored surgical approach for hypertrophic cardiomyopathy (HCM) on regional ventricular remodelling remains unknown. The aims of this study were to evaluate the pattern, extent and functional impact of regional ventricular remodelling after a tailored surgical approach. Methods From 2005 to 2008, 44 patients with obstructive HCM underwent tailored surgical intervention. Of those, 14 were ineligible for cardiac magnetic resonance (CMR) studies. From the remainder, 14 unselected patients (42±12 years) underwent pre- and post-operative CMR studies at a median 12 months post-operatively (range 4–37 months). Regional changes in left ventricular (LV) thickness as well as global LV function following surgery were assessed using CMR Tools (London, UK). Results Pre-operative mean echocardiographic septal thickness was 21±4 mm and mean LV outflow gradient was 69±32 mmHg. Following surgery, there was a significant degree of regional regression of LV thickness in all segments of the LV, ranging from 16% in the antero-lateral midventricular segment to 41% in the anterior basal segment. Wall thickening was significantly increased in basal segments but showed no significant change in the midventricular or apical segments. Globally, mean indexed LV mass decreased significantly after surgery (120±29nbspnormalg/m2 versus 154±36nbspnormalg/m2; p<0.001). There was a trend for increased indexed LV end-diastolic volume (70±13 mL versus 65±11 mL; p=0.16) with a normalization of LV ejection fraction (68±7% versus 75±9%; p<0.01). Conclusion Following a tailored surgical relief of outflow obstruction for HCM, there is a marked regional reverse LV remodelling. These changes could have a significant impact on overall ventricular dynamics and function.

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