RESUMO
This case report aims to delineate the clinical outcomes and technical considerations of hemi-hamate arthroplasty in the reconstruction of a delayed proximal interphalangeal (PIP) joint fracture-dislocation. It underscores the procedure's viability as a reconstructive option for complex finger injuries with delayed presentation. A 23-year-old male presented six weeks post-injury with a PIP joint fracture-dislocation of the left index finger. Traditional management options were limited due to the delayed presentation and the nature of the injury. A surgical intervention was performed using an autologous osteochondral hemi-hamate graft to reconstruct the articular surface. Herein, we describe the detailed surgical steps, postoperative care, and rehabilitation protocols. Over a five-month follow-up period, the patient demonstrated significant functional improvement. The range of motion in the PIP joint increased substantially, with a notable reduction in pain levels. Radiographic assessments showed successful graft incorporation and joint alignment. The patient reported satisfaction with the aesthetic and functional outcome, highlighting an enhanced quality of life post-surgery. Hemi-hamate arthroplasty emerges as a favorable surgical option for delayed PIP joint fracture-dislocations, offering improved articular congruity, joint stability, and functional outcomes. This case contributes to the growing body of evidence supporting the procedure's effectiveness and underscores the importance of considering innovative approaches in complex hand injuries.
RESUMO
Background: Starting the Foundation Programme can be challenging for many medical graduates, as medical school alone may not adequately prepare them for complex tasks like managing comorbidities or emergencies. Growing evidence supports the role of transition interventions to meet this knowledge gap, however data on the utility of situation-based learning are limited. This pilot study aimed to assess the efficacy of a near-peer case-based course in improving knowledge and preparedness for foundation training in recent medical graduates. Methods: Recent Imperial College graduates who attended a "Junior Doctor on Call" course were eligible for inclusion. This transition intervention, designed and delivered by a Foundation Year 1 doctor, covered six patient cases that integrated high-yield clinical concepts and practical tips. An online questionnaire was distributed one week before and after the course to assess perceptions of knowledge, confidence, and preparedness for training. Participants were also invited to attend an online semi-structured after the course. Results: Out of 19 attendees, 17 (89.5% response rate) completed the pre-course questionnaire, 14 (73.7% response rate) completed the post-course questionnaire, and 3 completed the interview. 68.75% (n=11) had not previously attended a preparatory course for foundation training. Results demonstrated that 85.7% of participants felt more knowledgeable than before in the key topics covered. Participants also demonstrated an increase in self-rated confidence in commencing work as a junior doctor following the course, with 92.9% of participants stating that they felt more confident. Conclusion: This study offers support for short-term situation-based courses in enhancing medical students' knowledge and confidence for foundation training. These findings add to the growing evidence-base encouraging implementation of short-term courses in preparing for practice. However, further research on the utility of such transition interventions is critical to inform the development of evidence-based recommendations for recent medical graduates, educators, and programme directors.
RESUMO
We study of the appearance and evolution of several anomalous (i.e., G < G(0) D 2e(2)/h) conductance plateaus in an In(0.52)Al(0.48)As/InAs quantum point contact (QPC). This work was performed at T = 4:2 K as a function of the offset bias ΔV(G) between the two in-plane gates of the QPC. The number and location of the anomalous conductance plateaus strongly depend on the polarity of the offset bias. The anomalous plateaus appear only over an intermediate range of offset bias of several volts. They are quite robust, being observed over a maximum range of nearly 1 V for the common sweep voltage applied to the two gates. These results are interpreted as evidence for the sensitivity of the QPC spin polarization to defects (surface roughness and impurity (dangling bond) scattering) generated during the etching process that forms the QPC side walls. This assertion is supported by non-equilibrium Green function simulations of the conductance of a single QPC in the presence of dangling bonds on its walls. Our simulations show that a spin conductance polarization as high as 98% can be achieved despite the presence of dangling bonds. The maximum in is not necessarily reached where the conductance of the channel is equal to 0:5G(0).
