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By far the single best goal you can achieve before you leave is to organise a post for your return in advance generic benicar 40mg online arteria hepatica propia. This will successfully continue your path to further training and specialisa- tion cheap benicar 10 mg on line coenzyme q10 high blood pressure medication. This is again notoriously difficult and I was laughed at heavily when I suggested to my peers that this was my intention. However,when I achieved this both my bosses and peers were not only surprised but also proud of what I had achieved. In their eyes I had achieved the impossible – obtaining a post in one of the most competitive units 95 96 What They Didn’t Teach You at Medical School in London before taking a year off to travel the world. I managed to do this by setting myself a list of goals approximately two years before leaving, the aim of which was to be at the same academic level as my peers when I returned instead of six or 12 months behind them. This meant that my curriculum vitae (CV) shone brightly before an inter- view and my skills of persuasion were employed at the interview. Collegiate Examinations Depending on which stage of training you are at it is important to be completely up to date if not ahead of your peers with regard to postgraduate examinations, that is if you are a new senior house officer (SHO) you should sit parts 1 & 2 as soon as pos- sible and make sure you pass first time. This may mean spending more money on revi- sion courses and books than your peers,but it is well worth it. Course Examinations Make sure you have taken and passed the relevant obligatory course examinations for your stage in training, for example advanced trauma life support, advanced life sup- port, care of the critically ill surgical patient and basic surgical skills. Research By year 2 of SHO training most will probably have written up a case report, but are unlikely to have done any further research work. If you can discuss research possibil- ities with your consultant at the start of your SHO training then it may be possible to assist in the production of abstracts and occasionally even papers. If you can get any of your work published it will add its weight in gold to your CV. Audit is part of clinical govern- ance and as such must be undertaken by every SHO at some stage in their training. Getting some audit experience early will give you a better understanding of clinical governance and allow you to converse at a more mature level in an interview. Practice makes perfect, but specialist registrars (SpRs) usually make the best tutors as they are up to date with modern technology and are used to presenting under pressure. Try to present at as many departmental and inter-departmental meetings as possible, whether it be a simple case report or research material. For each presentation for which you have compiled A Break from the Norm… 97 the material yourself (that is a short research piece, not a patient presentation) you may add this into your CV. TakingTime Off:Applying for Deferred Entry Once you have achieved all or some of the above you will need to apply for posts for your return. Keep your options open by having a number of jobs at different hos- pitals in mind. However, human resources are notoriously bad at passing these letters on to individual consultants, as I have learnt from my own experience. My advice would be to send your covering let- ter and a copy of your CV directly to each consultant involved as well as your com- pleted application pack to human resources. This way when you attend for an interview the fact that you are applying for deferred entry is not a complete surprise to everyone in the room except you and the human resources person. TakingTime Off: BeforeYou Go While you are away you will need to perform certain tasks to ensure a smooth tran- sition back into your training programme upon your return. Confirm the Post Take the e-mail address of the human resources person in charge of your contract with you. E-mail them at least twice while you are away to confirm that you have accepted the position and give your return date. E-mail them again one month before your return with the same information. This will prevent human resources conveni- ently forgetting about you and employing another SHO in your place. Courses Note down details of the courses you wish to attend on your return. You need to apply for most courses at least three to six months in advance in my experience.

He began investigating the pathology and etiology of osteochondritis of the hip in children generic 10mg benicar overnight delivery blood pressure medication migraines. While Adjunct 10mg benicar with mastercard blood pressure chart low, then Associate Orthopedic Surgeon, and finally Chief of the Orthopedic Clinic at Mount Sinai Hospital, Dr. Lippmann also served as Adjunct Orthopedic Surgeon and Associate Orthopedic Surgeon at Montefiore Hospital. At Montefiore he became Chief of Service in 1938, but resigned in 1942, 3 years after he became Director of the Department of Orthopedic Surgery and Orthopedic Surgeon-in- Chief at Mount Sinai Hospital. Lippmann served as Orthopedic Surgeon-in-Chief for almost 30 years at Blythedale, a long-term children’s care hospital in Valhalla, New York, and at the 196 Who’s Who in Orthopedics time of his death was Director Emeritus of Ortho- his scientific inquiry and teaching, his sense of pedics, and Emeritus Professor of the Department humanity and the ethical code manifest in his of Orthopedics of Mount Sinai School of practice and in his approach to patients formed Medicine. Lippmann was a superb craftsman, capable great influence on the growth of the hospital as a of translating his mechanical concepts into reality. In his office was a workshop with power tools and Until his untimely and sudden death on June 9, a lathe to work out the designs of devices that 1969, at the age of 70, Dr. Robert Korn Lippmann were later fabricated, or new instruments to was actively engaged in orthopedic practice. Among his many original Lippmann was survived by his wife, his daugh- contributions were the first compression bolt for ter, Mrs. Lippmann Orthopedic Research Laboratory at Mount Sinai was established in 1965 in his honor. Lippmann participated in community, national, and interna- tional orthopedics. He was a Fellow of the New York Academy of Medicine, serving as secretary (1949–1950) and chairman (1950–1951) of the orthopedic section, and as a member of the advi- sory committee (1951–1956). He was a Fellow of the American College of Surgeons (1932), serving as a member of its New York and Brooklyn Regional Fracture Committee (1949). He was a Fellow of the American Academy of Orthopedic Surgeons (1932) and a member of the American Orthopedic Association (1954), the Orthopedic Research Society (1959), and the Joseph LISTER Société Internationale de Chirurgie Orthopédique et de Traumatologie (SICOT) (1957). Lippmann developed a spirit of cooperation and dedication on the Mount Sinai Orthopedic Joseph Lister was born at Upton House, Essex, on Service. For generations his family had agreements, and thorough exploration of clinical belonged to the Society of Friends and the early problems. These were his basic techniques in influence of this body continued to govern his resident-training. He had considerable success in back of his mind was always the idea that he business in the city and somehow managed in his would some day describe the principles of con- leisure to acquire a worldwide reputation for his servative orthopedics that he taught—a task that researches in optics, which led to the perfection must be completed by his students. He also collab- many contacts with the residents and staff, orated with Thomas Hodgkin in the publication particularly at the monthly evening journal club of papers on microscopic observations of meetings at their home in New York and at their blood and animal tissues. Lippmann’s it may be gathered that the young Lister was born service and leadership over a period of 43 years, into an environment highly favorable for the 197 Who’s Who in Orthopedics pursuit of science; and in his great quest he was less ridicule. Morton, whom destined to gaze at the amazing new world of Wells taught, succeeded in inducing anesthesia microorganisms through an apparatus perfected while J. On December 21 of the same year, Robert he showed an early taste for natural science and Liston at University College Hospital carried out which led to his choice of medicine as a career. Hospital, London, where he took his BA degree This was a memorable time—the birth of a new before proceeding to professional training. He epoch in surgery—days to which men would look proved himself a brilliant student, occupied a back. No longer need a patient be terrified at the leading place in his own school, and took honors whisper of an operation, nor a surgeon be called at the university examinations. Anes- Sharpey were inspiring teachers, who at that time thesia promoted adventure; but sometimes sadly were laying the foundations upon which a disastrous adventure; the patient survived the succession of great investigators built a school of operation but risked death from later gangrene or physiology at University College, which became sepsis. Both these men taught him the might be, he was, in the words of Volkmann, scientific method of research. Wharton Jones, a “Like a husbandman, who having sown his field prolific worker, was interested in the mechanism waits with resignation for what the harvest might of the circulatory system and the stages of inflam- bring, and reaps it fully conscious of his own mation; for his investigations he used the frog’s impotence against the elemental powers which web and the bat’s wing. Lister undoubtedly owed may pour down on him rain, hurricane, and much to this master of research; he copied his hailstorm. Sharpey was both friend and At the proper time Lister qualified with the MB teacher to Lister and it was he who commended (London) and was appointed house physician and him to Syme. In 1852 he gained the FRCS Inspired by these two men, Lister, while yet an (England) and the next year went to Edinburgh undergraduate, carried out original work on the with an introduction to Syme. Kölliker surgeon received him cordially and there began a had discovered that the iris consisted of involun- friendship between them that the years increased.

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Layout ideas can be gleaned by looking through newspapers and magazines or cheap 40mg benicar mastercard arteria obstruida en el corazon, better still buy benicar 20 mg without a prescription heart attack chest pain, from graphic design books and journals. The layout should be clear, logical and suitable for the material being presented. Try a number of different rough layouts first and seek the opinion of a colleague to determine the best. Plan to mount components onto panels of coloured card cut to sizes convenient to transport. An alternative is to get the whole poster photographically enlarged to full size. Text should be large enough to be read at the viewing distance, which is likely to be about one metre. In this case, we suggest that the smallest letters be at least 5 mm high and preferably larger. Good quality titles and text can be produced with a word-processor and a high-resolution printer. These can be enlarged, as required, photo- 65 graphically or on a photocopier. For example, consider dividing the text into an abstract, an introduction, a statement of method, results and conclusion each with its own clear heading. A short list of references or of publications arising out of your work might also be appropriate. Remember, that in preparing your poster you are really trying to achieve many of the same things you would wish to achieve with a talk or lecture: attract interest and generally communicate effectively. CHAIRING A CONFERENCE SESSION Much of the success of a conference will depend on the quality of the chairing of individual sessions. Should this task fall to you, there are many responsibilities to fulfil. There are three categories of tasks – responsibilities to the organisers, to the speaker and to the audience. Responsibilities to the organisers The organisers of the conference will have approached you several months before the event. If you are lucky, they will also have given you detailed guidelines to follow but if not you must, at a minimum, find out: The time and length of the session. A copy of the instructions given to speakers with particular reference to the time allocated for the presentation and the time allocated for discussion. Ideally you will contact the speakers in advance of the conference to ensure they have indeed received instruc- tions and understand their implication, particularly with regard to time. You may find that some are inexperienced and nervous about the prospect of their presentation and your advice will be appreciated. Referring the speaker to the earliest parts of this chapter might be valuable. You must clarify the format of the session and reinforce your intention to stick rigidly to the allocated time. You should explain the method to be used to indicate when there is one minute to go, when time is up and what steps you will take should the speaker continue for longer. Prior to the session, you must also familiarise yourself with the layout of the venue, the audio-visual facilities and the lighting. In the absence of a technician, you may be called on to operate the equipment and lighting or to instruct the speakers in their use, At the start of the session, announce that you intend to keep to time and do so. Finally, you must be certain that the session and individual presentations commence and finish at the programmed time. Responsibilities to the speakers Speakers invariably fall into one of three types. The well-organised speakers: they will tell you exactly what they are going to do and what they require. If you ask them how long they are going to speak, they will tell you in minutes and seconds! You will need to have little concern for these speakers, but they will expect you be as well prepared and organised as themselves. The apprehensive speakers: they will generally be the younger and less experienced.

Femoral component durability has been more of a challenge because of failure to provide intimate fixation with good-quality bone cheap benicar 40mg on line blood pressure 160100, but this problem now appears to be solved with the second- generation surgical technique and cementing of the stem in patients with risk factors purchase benicar 40mg without a prescription heart attack types. The technical difficulty of resurfacing patients with LCP disease or SCFE is also related to the anatomical characteristics of these hips. The femoral head is generally flattened, the neck–shaft angle is lower than average, the neck is wide and short, and range of motion is consequently reduced (Fig. Notching of the thicker medial cortex of the femoral neck was sometimes necessary to fit the femoral component when the head–neck ratio approached 1 and the standard-thickness sockets were utilized. However, no femoral neck fractures have been recorded in our series with Metal-on-Metal Resurfacing 201 A B Fig. A Anteroposterior radiograph of a 32-year-old man with osteoarthritis (OA) of the left hip secondary to Legg–Calve–Perthes (LCP) disease. Inserts show the Johnson lateral radio- graph and the femoral head (above) after preparation. Note the flattening of the head, cystic defects, incongruity with the acetabulum, wide neck with low head–neck ratio, and increased anteversion, which are typical features of LCP with secondary OA. B At 2 years after metal-on- metal Conserve Plus resurfacing using the 3. This component allows a gain of 3mm in femoral head diameter without any extra reaming on the acetabular side as compared to the standard 5-mm shell. There was no need to notch the neck to conserve acetabu- lar bone stock. The component was positioned in a slight posterior-to-anterior position this etiology. Notching has not been necessary in more-recent cases utilizing the thin (3. In DDH, LCP, and SCFE, 1mm of leg equalization is generally possible when necessary. Leg lengthening should only be performed by bringing the socket to a more anatomical location and not by leaving the femoral component proud. Patients with osteonecrosis of the hip present challenges of a different nature. The femoral head often presents with extensive yellowish, friable necrotic bone, which must be completely removed down to the underlying white hard reparative bone to ensure proper component fixation. The residual defects are often large, and these should not be grafted, and the stem should be cemented to maximize the fixation area. Our results highlight that the etiology of osteonecrosis itself does not constitute a contraindication for resurfacing and that the risk factors for the procedure are similar to that of primary OA. Etiologies other than primary OA do not present challenges only to hip resurfacing: numerous reports have shown inferior results when treated with total hip arthroplasty (THA) [38–42] because poor bone quality and hip anatomy also affect conventional reconstructions. In that respect, a prosthetic solution that preserves bone stock on both the acetabular and the femoral sides is particularly indicated for a population of young patients likely to undergo revision surgery within their lifetime. From this perspective, hip resurfacing not only conserves bone at surgery but also preserves bone mineral density of the proximal femur [44–46], another advantage over conven- tional hip replacement where proximal femoral stress shielding [47,48] can frequently be observed with a decrease in bone mineral density [49–51]. Finally, for hip resurfacing to take its place in the array of conservative solutions for young and active patients, specific training for new surgeons needs to be made available because the procedure is technically more difficult than a conventional THR. Our experience has led to a significant reduction of the complication rate, and mini- mizing this learning curve for other surgeons is essential for the future success of the procedure, in particular with the most challenging cases. Grigoris P, Roberts P, Panousis K, et al (2005) The evolution of hip resurfacing arthro- plasty. Amstutz HC, Grigoris P, Dorey FJ (1998) Evolution and future of surface replacement of the hip. Smith-Petersen MN (1948) Evolution of mould arthroplasty of the hip joint. Nishio A, Eguchi M, Kaibara N (1978) Socket and cup surface replacement of the hip.

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