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Peptide bond The bond joining amino acids in a polypeptide Phagocytosis The uptake of large particles such as bacteria by a cell trusted rogaine 5 60 ml. Protein phosphatase An enzyme that reverses the action of protein kinases by removing phosphate groups 60 ml rogaine 5. Proteins Polypeptides with a unique amino acid sequence Proteoglycan A protein linked to glycosaminoglycans Proteolysis Degradation of polypeptide chains Quaternary structure The interaction between polypeptide chains in proteins consisting of more than one polypeptide Receptor mediated endocytosis The selective uptake of macromolecules that bind to cell surface receptors generic rogaine 5 60 ml amex. We have a full staff of Inside Sales Representatives calling on hospitals and surgery centers around the country. By avoiding Professional Anesthesia Handbook the expense of having a 1-800-325-3671 salesman in a suit calling on hospitals, we are able to pass on significant savings directly to you. Disclaimer The material included in the handbook is from a variety of sources, as cited in the various sections. The information is advisory only and is not to be used to establish protocols or prescribe patient care. The information is not to be construed as offcial nor is it endorsed by any of the manufacturers of any of the products mentioned. These recommendations may be adopted, with face mask ventilation of the upper airway, modified, or rejected according to clinical needs difficulty with tracheal intubation, or both. Recommendations: The use of practice guidelines cannot guarantee At least one portable storage unit that contains any specific outcome. Practice guidelines are specialized equipment for difficult airway subject to revision as warranted by the evolution management should be readily available. They provide basic recommendations that are supported by analysis of the current literature and by a synthesis of expert opinion, open forum commentary, and clinical feasibility data. Rigid laryngoscope blades of alternate design and size from those routinely used; this may include a rigid fiberoptic laryngoscope 2. Examples include (but are not limited to) semirigid stylets, ventilating tube changer, light wands, and forceps designed to manipulate the distal portion of the tracheal tube 4. Examples include (but are not limited to) an esophageal tracheal Combitube (Kendall-Sheridan Catheter Corp. The contents of the portable storage unit should be customized to meet the specifc needs, preferences, and skills of the practitioner and healthcare facility. The intent of this communication is to provide the patient (or responsible person) with a role in guiding and facilitating the delivery of future care. The information conveyed may include (but is not limited to) the presence of a difficult airway, the apparent reasons for difficulty, how the intubation was accomplished, and the implications for future care. Notification systems, such as a written report or letter to the patient, a written report in the medical chart, communication with the patient’s surgeon or primary caregiver, a notification bracelet or equivalent identification device, or chart flags, may be considered. The anesthesiologist should evaluate and follow up with the patient for potential complications of difficult airway management. These complications include (but are not limited to) edema, bleeding, tracheal and esophageal perforation, pneumothorax, and aspiration. The patient should be advised of the potential clinical signs and symptoms associated with life-threatening complications of difficult airway management. These signs and symptoms include (but are not limited to) sore throat, pain or swelling of the face and neck, chest pain, subcutaneous emphysema, and difficulty swallowing. This curve is molded directly into the tube so correct insertion is easy without abrading the upper airway. The Aura-i is pre-formed to follow the anatomy of the human airway with a soft rounded curve that ensures fast and easy placement and guarantees long-term performance with minimal patient trauma. The curve is molded directly into as single unitwith built-in, and rigid at the connector for easy, the tube so that insertion is easy, without anatomically correct curve atraumatic insertion and removal abrading the upper airway. Moreover, the Practical clear “window” curve ensures that the patient’s head re- to view condensation mains in a natural, supine position when the Reinforced tip will resist bending mask is in use. Verify bulb stays fully collapsed for at least to current and relevant standards and includes 10 seconds. Open one vaporizer at a time and repeat ‘c’ following monitors: capnograph, pulse oximeter, and ‘d’ as above. Turn On Machine Master Switch and all to modify to accommodate differences in other necessary electrical equipment. Adjust flow of all gases through their full operator’s manual for the manufacturer’s specific range, checking for smooth operation of procedures and precautions, especially the floats and undamaged flowtubes. Breathing system ready to use Manual and Automatic Ventilation Systems * If an anesthesia provider uses the same machine in successive cases, these steps need 12. Test Ventilation Systems and not be repeated or may be abbreviated after the Unidirectional Valves initial checkout. Verify that during inspiration bellows delivers appropriate tidal volume and that during expiration bellows fills completely. Verify that the ventilator bellows and simulated lungs fill and empty appropriately without sustained pressure at end expiration. Ventilate manually and assure inflation and deflation of artificial lungs and appropriate feel of system resistance and compliance. A adults, 66 million obese adults, and 9 million decreased respiratory rate and ultimately periods morbidly obese adults in the U. Body Mass of apnea occur frequently, with resultant self- Index is the commonly accepted formula for limited periods of severe hypoxia. A morbidly obese patient’s heart is frequently stressed by the strain of supplying oxygenated Underweight <20 blood to all the tissues. Obese 30 – 40 Approximately 3 ml of blood volume are needed Morbidly obese 40+ per 100 g of adipose tissue. Increased The Center for Disease Control and Prevention blood volume increases preload, stroke volume, predict that the number of obese adults will cardiac output and myocardial work. Elevated more than double in the next five years in the circulating concentrations of catecholamines, U. Hyperkinesia, myocardial in the world although the numbers of obese are hypertrophy, decreased compliance, diastolic increasing in other industrialized nations as well. With this increase in obesity, health care providers are more and more frequently faced The diastolic disfunction characteristic of obesity with planning care for larger, heavier patients. A pulmonary This special population can predispose artery catheter may be useful in obese patients caregivers to injury. Therefore, an in-dwelling Obesity affects every organ of the body arterial catheter should be employed when and is associated with an increased risk for hemodynamic stability is in question. Patient positioning is a key component of surgical Lungs and other organs do not increase in procedures and, if not executed correctly, there size as the patient becomes obese. Proper patient positioning can reduce respiratory load and further increase the work the risk of unwanted conditions such as ulcers, of breathing. This results in decreased vital pressure sores, nerve damage, excess bleeding, capacity and tidal volume which compromises breathing difficulties and skin breakdown. Wheelchairs, beds, and bathroom facilities need heavy duty equipment to accommodate the obese patient. Pressure-induced rhabdomyolysis is a rare but well- described postoperative complication that results from prolonged, unrelieved pressure to muscle during surgery. Prevention of rhabdomyolysis and related complications includes attention to padding and positioning on the operating table, minimization of operative time, and maintenance of a high index of suspicion postoperatively. The open end of the U-shape can be pointed in a left or right direction, for convenient positioning of anesthesia equipment. Oxygen is supplied from inspired and expired gas streams diverge (the cylinders at around 2000 psi (regulated to Y-connector). It cleanses carbon dioxide from the tracheal heat and humidity, and economize patient’s exhalations chemically, which allows on volatile agents. Ventilate by hand rather than with the pressure 50 psi) rather than your oxygen mechanical ventilator (which uses cylinder cylinder source (down-regulated to oxygen for the driving gas if the pipeline is 45 psi). Custom Circuit Kits Gas Size Gas Bacterial Latex Parallel Sample Case Qty/ Available, (exp = Sample / Viral Mask Free Wye Line Price* Cs Ask for a quote! Thus, if apnea occurs, no gas will what percent of the hemoglobin binding sites are be exhaled, and the monitor will show a flat line. However, pulse oximetry cannot determine You’ll get a much earlier warning of severe hy- which molecules are occupying those binding poventilation or apnea – in seconds -- than you sites.

The testes contain many seminiferous tubules order 60 ml rogaine 5 with visa, which are lined by a germinal epithelium consisting of germinal elements (spermatogonia buy rogaine 5 60 ml overnight delivery, spermatocytes generic rogaine 5 60 ml mastercard, and spermatids) and Sertoli cells. Lying between the seminiferous tubules are the interstitial cells of Leydig, which produce the male sex hormones (androgens). When sperm leave the seminiferous tubules they pass through the following series of ducts: Ducts Characteristics 1. The male sex accessory glands are the paired seminal vesicles, the prostate gland, and the paired bulbourethral glands. The duct of each seminal vesicle unites with the ampulla of a ductus deferens to form a common ejaculatory duct. The prostate gland surrounds the ejaculatory duct and the prostatic urethra, and secretes into the latter. The mediastinum (not visible on this slide) is the mass of acidophilic connective tissue at one 67 pole through which the major vessels enter and leave the testis. At higher magnification identify the germinal elements (spermatogonia, spermatocytes and spermatids) and Sertoli cells in the seminiferous tubules. Only the Sertoli cells and spermatogonia (usually with interphase nuclei) rest on the basement membrane. The larger primary spermatocytes lie on the luminal side of the Sertoli cells and are frequently in some stage of the prolonged prophase of the first meiotic division. Beneath the basement membrane of the tubules note the myoid cells (myoepithelium) with their pale- staining elongated nuclei. In the interstitium (between the seminiferous tubules) identify Leydig cells, which are large eosinophilic cells. It is a coiled tube lined by pseudostratified epithelium with long microvilli (non-motile stereocilia). Note: For the histological characteristics of the efferent ductules see examples in textbooks or online. Note that there are no discrete secretory alveoli in the seminal vesicle; instead the entire lining membrane of the saccular gland is thrown into a series of complex, high, thin folds. The lining epithelium is generally simple columnar or pseudostratified, and basal cells 68 are frequently seen, as in the epididymis and ductus deferens. The seminal vesicle is embryologically derived from the ductus deferens, and like the latter, it has a prominent muscularis. The acidophilic secretory material in the lumen of the gland is rich in fructose, thought to serve as an energy source for spermatozoa following ejaculation. Also evident are the elongate tubules forming the parenchyma of the gland and the dense fibrous connective tissue capsule. Compare its transitional epithelium with the epithelium lining the ducts and glands of the prostate, which can be cuboidal, columnar or pseudostratified. The tubulo-alveolar glands of the prostate are embedded in an abundant stroma of fibro-elastic connective tissue, which is interlaced with strands of smooth muscle. Fixation is much better in the H & E sections, and it should be studied for the structure of the lining epithelium of the glands. Examine the central penile urethra and the surrounding blood-filled vascular sinuses that comprise the erectile tissue of the corpus spongiosum. Note that the lining epithelium of the penile urethra has a stratified columnar or stratified cuboidal appearance. Study the erectile tissue surrounding the urethra and observe that the trabeculae between blood sinuses contain smooth muscle and connective tissue fibers. The connective tissue capsule surrounding the corpus spongiosum is not as thick as that surrounding the corpora cavernosa. At low power note the general division of the ovary into an outer cortex containing follicles in various stages of development and an inner medulla containing numerous blood vessels and dense fibrous connective tissue. Identify; Lining epithelium (classically called “germinal epithelium”) - a simple cuboidal covering the ovary, continuous with the mesothelium of the peritoneum. These are growing follicles Secondary (antral) follicles - 1 oocyte surrounded by granulosa cells among which fluid-filledo spaces are coalescing into a single space, or antrum. Outside the basal lamina of the granulosa layer, the theca has differentiated into a theca interna and a theca externa. Atresia is often first recognized in the granulosa cells as the nuclei become apoptotic and there is a loosening of the cells. Corpus luteum – Following ovulation follicular cells (both granulosa and luteal) fold into the empty follicle and undergo luteinization. Identify the two primary cellular components of the corpus luteum, the granulosa lutein and theca lutein cells. Notice the relationships of these two cell types to each other and to the vascularization of the developing corpus luteum. Granulosa lutein left, theca lutein right #64 Ovary, Corpus Luteum of Pregnancy Compare the development of this corpus luteum of pregnancy (probably from the first trimester) with that of the recently formed corpus luteum of slide #63. Note particularly the increase in thickness of the granulosa luteal layer as compared to the thin, peripheral zone of theca luteal cells. The extensive vacuolization of the granulosa luteal cells is due to the extraction of its abundant lipid droplets. This reflects the importance of the corpus luteum (particularly the granulosa lutein cells) as the primary ovarian source of the steroid hormone progesterone. Be certain that you understand the changes that occur within the follicle during follicular development. These folds decrease progressively from the ovarian (infundibular) end of the tube to the uterine (isthmus) portion. The uterine tubes are a common site of occlusion after pelvic inflammatory disease, resulting in sterility. It is important to understand the interrelationships among the pituitary, ovary, and uterus during different stages of the menstrual cycle. The proliferative stage follows menstruation and is characterized by the repair of the endometrium and the proliferation of relatively straight, tubular uterine glands. Note the rather dense, cellular appearance of the endometrial stroma (region between glands) at this stage. Left to right: spongy zone, stratum basale, myometrium What is the primary ovarian hormone stimulating the endometrium during this stage? There has been a considerable increase in glandular development, characterized by their convoluted and "saw- toothed" appearance in sections. The glands are Secretory endometrium 72 frequently distended by a lightly acidophilic secretion rich in glycogen and this serves as an important source of nutrients to the developing embryo prior to implantation. Note the coiled arterioles in the endometrium, and be certain that you understand the significance of the arterial supply to the endometrium. Locate at higher magnification some of the mucus-secreting epithelial cells, which line the cervical mucosa. Note also the abrupt transition between the simple columnar epithelium of the endocervix and the stratified squamous epithelium of the ectocervix. The bulk of the wall of the cervix is made up of bundles of smooth muscle interlaced with connective tissue. In what other regions of the body does one observe an abrupt junction between simple columnar and stratified epithelia? The period of placentation is initiated by the attachment of the blastocyst to the endometrium, and it is terminated by the delivery of the newborn infant at the time of parturition. The placenta is the first organ to be differentiated, and performs functions analogous to those of the lung (gas exchange), intestine (nutrient absorption), kidney (excretion and ion regulation), liver (synthesis of serum proteins, steroid metabolism), pituitary (synthesis of hormones including gonadotropic and prolactin-like hormones), and gonads (incomplete synthesis of progestins and estrogens). The fetal portion of the placenta consists of the chorionic plate, composed of an outer layer of trophoblast and an inner layer of vascularized extra- embryonic mesodermal connective tissue. The bulk of the placenta fetalis consists of outgrowths of villi from the surface of the chorionic plate. The villi are sectioned in many 73 different planes, and their attachment to the chorionic plate may not be evident. Attached to the inner (fetal) surface of the chorionic plate is the amnion, consisting of an inner squamous amniotic epithelium and an outer layer of avascular mesoderm. Study the chorionic villi in detail, and identify all of the layers that separate the maternal and fetal blood.

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In developed countries discount rogaine 5 60 ml with visa, mercury type thermometers are no more use in hospital setup but in our context still very important rogaine 5 60 ml without a prescription. Procedure • Explain the procedure to the patient • Wash hands and assemble necessary equipment and bring to the patient bedside purchase rogaine 5 60 ml with amex. Oral Procedure • Explain the procedure to the patient • Wash hands and assemble necessary equipment and bring to the patient bedside. Ensure that the bulb rests well under the tongue, where it will be in contact with blood vessels close to the surface. Contraindication • Child below 7 yrs • If the patient is delirious, mentally ill • Unconscious • Uncooperative or in severe pain • Surgery of the mouth • Nasal obstruction • If patient has nasal or gastric tubs in place 4. Axillary Procedure • Wash hands • Make sure that the client’s axilla is dry, If it is moist, pat it dry gently before inserting the thermometer. Hold the electronic thermometer in place until the reading registers directly • Remove and read the thermometer. Many pediatric and intensive care units use this type of thermometer because it records a temperature so rapidly. Procedure • Wash the hands • Explain the procedure to the client to ensure cooperation and understanding • Hold the probe in the dominant hand. For a 76 Basic Clinical Nursing Skills child of 6 years or younger, use your nondominant hand to pull the ear down and back. Position changes: when a patient assumes a sitting or standing position blood usually pools in dependent vessels of the venous system. Carotid: at the side of the neck below tube of the ear (where the carotid artery runs between the trachea and the sternoclidiomastoid muscle) 2. Apical: at the apex of the heart: routinely used for infant and children < 3 yrs th th th In adults – Left midclavicular line under the 4 , 5 , 6 intercostals space Children < 4 yrs of the Lt. Brachial: at the inner aspect of the biceps muscle of the arm or medially in the antecubital space (elbow crease) 5. Pedal (Dorslais Pedis): palpated by feeling the dorsum (upper surface) of the foot on an imaginary line drawn from nd the middle of the ankle to the surface between the big and 2 toes 79 Basic Clinical Nursing Skills Method Pulse: is commonly assessed by palpation (feeling) or auscultation (hearing) The middle 3 fingertips are used with moderate pressure for palpation of all pulses except apical; the most distal parts are more sensitive, Assess the pulse for • Rate • Rhythm • Volume • Elasticity of the arterial wall Assess the Pulse for Fig. Hyperventilation: very deep, rapid respiration Hypoventilation: very shallow respiration Two Types of Breathing 1. Costal (thoracic) • Involves the external muscles and other accessory muscles (sternoclodio mastoid) • Observed by the movement of the chest up ward and down ward. Diaphragmatic (abdominal) • Involves the contraction and relaxation of the diaphragm, observed by the movement of abdomen. Assessment • The client should be at rest • Assessed by watching the movement of the chest or abdomen. Systolic pressure: is the pressure of the blood as a result of contraction of the ventricle (is the pressure of the blood at the height of the blood wave); 2. Pulse pressure: is the difference between the systolic and diastolic pressure Blood pressure is measured in mm Hg and recorded as fraction. Conditions Affecting Blood Pressure Fever Increase 84 Basic Clinical Nursing Skills Stress " Arteriosclerosis " Obesity " Hemorrhage Decrease Low hematocrit " External heat " Exposure to cold Increase Sites for Measuring Blood Pressure 1. Leg using posterior tibial or dorsal pedis Methods of Measuring Blood Pressure Blood pressure can be assessed directly or indirectly 1. Direct (invasive monitoring) measurement involves the insertion of catheter in to the brachial, radial, or femoral artery. Phase 1: The pressure level at which the 1st joint clear tapping sound is heard, these sounds gradually become more intense. To ensure that they are not extraneous sounds, the nurse should identify at least two consecutive tapping sounds. Phase 2: The period during deflation when the sound has a swishing quality Phase 3: The period during which the sounds are crisper and more intense Phase 4: The time when the sounds become muffled and have a soft blowing quality Phase 5: The pressure level when the sounds disappear Procedure Assessing Blood pressure Purpose o To obtain base line measure of arterial blood pressure for subsequent evaluation o To determine the clients homodynamic status o To identify and monitor changes in blood pressure resulting from a disease process and medical therapy. Prepare and position the patient appropriately • Make sure that the client has not smoked or ingested caffeine, with in 30 minutes prior to measurement. The arm should be slightly flexed with the palm of the hand facing up and the fore arm supported at heart level • Expose the upper arm 2. The bladder inside the cuff must be directly over the artery to be compressed if the reading to be accurate. For initial examination, perform preliminary palipatory determination of systolic pressure 87 Basic Clinical Nursing Skills • Palpate the brachial artery with the finger tips • Close the valve on the pump by turning the knob clockwise. Position the stethoscope appropriately • Insert the ear attachments of the stethoscope in your ears so that they tilt slightly fore ward. Key Terminology: 90 Basic Clinical Nursing Skills Hemoglobine Hematocrite Leukocyte Occult Stroke Urinalysis Specimen Collection Specimen collection refers to collecting various specimens (samples), such as, stool, urine, blood and other body fluids or tissues, from the patient for diagnostic or therapeutic purposes. General Considerations for Specimen Collection When collecting specimen, wear gloves to protect self from contact with body fluids. Get request for specimen collection and identify the types of specimen being collected and the patient from which the specimen collected. Give adequate explanation to the patient about the purpose, type of specimen being collected and the method used. Get the appropriate specimen container and it should be clearly labeled have tight cover to seal the content and placed in the plastic bag or racks, so that it protects the laboratory technician from contamination while handling it. Put the collected specimen into its container without contaminating outer parts of the container and its cover. All the specimens should be sent promptly to the laboratory, so that the temperature and time changes do not alter the content. Collecting Stool Specimen Purpose • For laboratory diagnosis, such as microscopic examination, culture and sensitivity tests. Equipments required o Clean bedpan or commode o Wooden spatula or applicator o Specimen container o Tissue paper 92 Basic Clinical Nursing Skills o Laboratory requests o Disposable glove, for patients confined in bed o Bed protecting materials o Screen Procedure i) For ambulatory patient Give adequate instruction to the patient to • Defecate in clean bedpan or commode (toilet) • Avoid contaminating the specimen by urine, menstrual period or used tissue papers, because these may affect the laboratory analysis. Obtain stool sample • Take the used bedpan to utility room/toilet container using spatula or applicator without contaminating the outside of the container. Timed urine specimen • It is two types Short period → 1-2 hours Long period → 24 hours Purpose • For diagnostic purposes - Routine laboratory analysis and culture and sensitivity tests Equipments Required • Disposable gloves • Specimen container • Laboratory requisition form (Completely filled) 95 Basic Clinical Nursing Skills • Water and soap or cotton balls and antiseptic solutions (swabs). Obtain urine specimen • Ask patient to void • Let the initial part of the voiding passed into the receptacle (bed pan or urinal) then pass the next part (the midstream) into the specimen container. Care of the specimen and the equipment • Handle and label the container correctly • Send the urine specimen to the laboratory immediately together with the completed laboratory requested forms • Empty the receptacles content properly • Give appropriate care for the used equipments 6. Collecting the urine • Usually it begin in the morning • Before you begin the timing, the patient should void and do not use this urine (It is the urine that has been in the bladder some time) • Then all urine voided during the specified time (e. Collecting sputum specimen Sputum is the mucus secretion from the lungs, bronchi and trachea, but it is different from saliva. The best time for sputum specimen collection is in the mornings up on the patient’s awaking (that have been accumulated during the night). If the patient fails to cough out, the nurse can obtain sputum specimen by aspirating pharyngeal secretion using suction. Purpose 99 Basic Clinical Nursing Skills Sputum specimen usually collected for: • Culture and sensitivity test (i. Patient preparation • Before collecting sputum specimen, teach pt about the difference between sputum and saliva, how to cough deeply to raise sputum. Obtain sputum specimen 100 Basic Clinical Nursing Skills • Put on gloves, to avoid contact with sputum particularly it hemoptysis (blood in sputum) present. Recomfort the patient • Give oral care following sputum collection (To remove any unpleasant taste) 4. Care of the specimen and the equipments used • Label the specimen container • Arrange or send the specimen promptly and immediately to laboratory. Document the amount, color, consistency of sputum, (thick, watery, tenacious) and presence of blood in the sputum. Collecting Blood Specimen 101 Basic Clinical Nursing Skills The hospital laboratory technicians obtain most routine blood specimens. Patient preparation 102 Basic Clinical Nursing Skills • Instruct the pt what to expect and for fasting (if required) • Position the pt comfortably 2. Obtain specimen of the venous to blood • Adjust the syringe and needles • Clean/disinfect the area with alcohol swab, dry with sterile cotton swab • Puncture the vein sites • Release the tourniquet when you are sure in the vein • Withdraw the required amount of venous blood specimen 103 Basic Clinical Nursing Skills • Withdraw the needle and hold the sites with dry cotton (to apply pressure) • Put the blood into the specimen container • Made sure not to contaminate outer part of the container and not to distract the blood cells while putting it into the container 4. Care of the specimen and the equipment • Label the container • Shake gently (if indicated to mix) • Send immediately to laboratory, accompanying the request • Give care of used equipments 6. Chart Definition: it is a written record of history, examination, tests, diagnosis, and prognosis response to therapy Purpose of Patients Chart a. For diagnosis or treatment of a patient while in the hospital (find after discharge) if patient returns for treatment in the future time b. For serving an information in the education of health personnel (medical students, interns, nurses, dietitians, etc) e.

Sponsors cannot be allowed to influence or even change the core statement of your texts in any way buy 60 ml rogaine 5. You will find important details about this and about the criteria for selecting sponsors at the end of this chapter rogaine 5 60 ml low cost. But first generic rogaine 5 60 ml fast delivery, there is still some detailed work on the agenda: 48 Opening and closing credits How do we shape the first and last pages of our book? How do we found a publishing house, how to we reserve the domain name for our website and how do we set it up? Opening and closing credits Every book has “opening credits”: empty or almost empty pages upon which only the title is repeated, and an imprint, foreword, list of collaborators and contents are printed. Open the document and remain in standard view (View->Normal), so that you can see the horizontal lines “Page break” and “Section break”. Make sure that you do not delete these lines; they contain important information regarding page number, header and footer. Change title and publisher, enter your address on page 4, write 3 sentences in the foreword and enter the first colleagues in the list of collaborators. Name the first chapters from page 11 onwards and, finally, update the contents in page 9. Procedure: position the cursor anywhere in the Contents and press the right-hand mouse key. From the menu which appears, select “Update field” and, in the next window, “Update entire table”. Foreword You should draft a foreword very early on – even if nothing is left of it in the final version. List of collaborators You asked your authors to supply you with the details for the list of collaborators in your first letter. You can only compile one if, within the individual chapters, you have already defined which words will be recorded in the index. You will not edit these so-called index entries until you reach the final stages (see Page 59). The reason: you should be able to tell from the new colour that you are looking at the current edition, in which the texts are less than 12 months old. The back cover should be planned just as early as the graphic design of the front cover. The text which appears there must be able to convince a potential but as yet undecided buyer. Founding a publishing house Founding a publishing house is very easy in some countries. In Germany, for example, all you need is to register a business with the appropriate local authority. This number guarantees that your book will appear in the electronic registers of the booksellers. The allocation of these numbers is regulated differently in every country, so that we cannot give you any detailed information here. Setting up a website The foundation of a publishing house is followed by the setting up of a website. First, you must reserve an internet domain and find a service provider upon whose computer your texts can be connected with the internet. This service provider is called a “web provider” or “internet provider”, the service is known as “webhosting”. Almost all the catchy names have been reserved by people who were in the net before you. If you are in search of domain names, you should make sure that you reserve both the *. Webhosting It is wise to make webhosting contracts with companies in your own country. The advantage here is that you can get an answer quickly and easily if you have any questions or problems. It only makes sense to make webhosting contracts with companies abroad if you have a good command of the language. In addition, the difference between the time zones should not be too large – so that the hotline is not asleep when you are having problems. Maintenance of the website As soon as the domain names have been reserved and the webhosting contract signed, you must decide who is responsible for maintaining the website. For all subsequent work, student assistants should be your first choice – it is motivating to be involved in a prestigious project and everyone benefits from this collaboration. Behind the scenes Your website is brought to life by the texts you publish there: whether further information (daily or weekly news, congress reports, calendar of events, “frequently asked questions”, and address lists) is offered, is dependent on the time you have and the dedication of your students. This is where readers can show their interest in being informed by e-mail about new or updated texts in the future. This direct contact to the readers is eminently important for the success of your project! It is not always easy to make it into a real dead line, because the publisher is dependent on the contributions of his authors. As a publisher, you should not be afraid of the fact that this is an annoying procedure. On the contrary: most authors are grateful to be reminded in good time of the task they have taken on. And as for the authors – we already mentioned it earlier: anyone who worries or knows that he can’t meet a deadline should not become involved in book projects. Project Centre In Chapter 2, we indicated how important it is to know the current status of every text (see Page 31). The project centre – which is sometimes one and the same person as the publisher – keeps account. Ideally, every text should be read by two qualified colleagues with a good sense of literary style. After being read twice, the text should be returned to the author with any unanswered questions. The corrections of the authors must be recorded using the function “track changes” (click Tools->track changes ->highlight changes + highlight changes while editing). The authors’ corrections are checked by both readers and the chapter subjected to Word spell verification (see next section). Microsoft Word spell verification Word spell check is a valuable tool and should be used by the authors, the readers and the proofreaders. As soon as the dialog window opens, check that the window shows correctly “Spelling < your mother tongue >”. The final version of the texts The individual chapters gradually pass though the stages of reading and final proofreading and assume their definitive form. You are on the verge of publishing the first chapters on the internet and the authors are waiting impatiently to see themselves on the net. Behind the scenes Negotiations with sponsors Foundations and pharmaceutical companies can be considered as possible sponsors for your project. Foundations will generally subsidise your project, while pharmaceutical companies will buy up part of the printed version in order to distribute the books to interested doctors. As every type of co-operation between doctors and pharmaceutical companies must remain free of any conflict of interests, there are a few rules you should know. Leprosy When you wrote, you wrote the truth and did not formulate your texts with company X or company Y in mind. The standards regarding independence of statements and recommended therapies cannot be set high enough. Any doctor who writes something against his own convictions for his own benefit is guilty. Doctors who practise accommodating journalism quickly end up on a par with drug barons and arms dealers. May anyone who practises this kind of accommodating journalism in medicine be struck down by leprosy so that he can no longer write! Selection of potential sponsors The chances of reaching an agreement with sponsors from the pharmaceutical industry depend on various factors. One of the golden rules of a colleague who had 30 years experience with the publication of medical textbooks was: “The marketing budgets of pharmaceutical companies are structured according to drugs.

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