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MEDLINE® often puts “no authors listed” and includes the name of the collective authorship in the title ceftin 500 mg cheap antibiotics for uti pediatric. At the other end of the scale buy ceftin 250mg low cost antibiotics for uti e coli, EMBASE® lists the names of up to 19 authors drawn from the byline before et al. Some suggestions include dividing the author’s rank in the authorship list by the sum of the ranks for all authors,51 dividing each publication unit by the number of authors,52 or attributing a proportion of the productivity to each author. However, it is ironical that attempts to minimise author lists contradicts the current trend of universities, hospitals, and granting bodies to promote collaboration between research groups. Some research groups write their own formal policies for deciding authorship. A policy entitled “The money, fame and 38 Getting started happiness document” has been developed by a clinical research unit in Sydney and is given to all new researchers who join the unit (www12). This policy acknowledges the Vancouver guidelines for authorship but includes an algorithm for allocating points for specific contributions to a research project as shown in Box 2. The policy states that the Vancouver guidelines do not need to be used for most papers but that they are helpful at times when authorship decisions are difficult to make. The policy also gives advice on how to circumvent and resolve authorship problems and includes a statement that the organisation reserves the right to publish important reports without an author rather than waste the product of research conducted using public money. What is important is that policies are developed in a collaborative way, are regularly revisited and revised if necessary, and are available to all potential authors. Senior researchers are occasionally criticised for being only second or final authors when the system of using author order as an acknowledgement of mentoring, intellectual, and/or management credentials is not recognised. Until a consensus on the meaning of author order is achieved, researchers who strive to gain recognition for their own intellectual contribution whilst mentoring junior staff in the processes of writing and publication will always be disadvantaged. To deal with this issue, researchers applying for promotion often specify the exact contributions that they made to publications listed in their curriculum vitae. Gift, ghost, and guest authors Ghost writing is what you do for a football player when it is painfully obvious from his every utterance on and off the field that he has little to say but still needs help to say it. David Sharp55 “Gift” authorship occurs when someone who has not made an intellectual contribution to a paper accepts an authorship. This type of authorship often develops because both the author and the “gift” author benefit from the relationship. Senior “gift” authors are often enrolled because they tend to confer a stamp of authority on a paper. Many researchers are willing to cite senior authors if they think that this will facilitate the publication of their work or enhance their career prospects. Most of all, gift authors should definitely not be included “because everyone does it”. In a survey of journal articles published in three peer-reviewed journals (Annals of Internal Medicine, JAMA, and the New England Journal of Medicine) in 1996, 11% of articles involved the use of ghost authors and 19% had evidence of honorary authors. Although “guest” authors may have final control over the manuscript, they may not thoroughly review the paper if it does not have high priority in their workload. Given that science must be based on truth and trust, practices of “gift” and “ghost” authorship are to be avoided at all costs. CF Wooley61 The issues of whether, and how, contributors other than the authors of a paper should be listed and have their role acknowledged continues to be debated. This issue becomes especially problematic in the case of large multicentre trials. As a result, there has been a move towards some papers including guarantors and contributors instead of authors62 and some journals now publish a byline disclosure of multicentre trials with a list of clinicians and study-organisation contributors, and a statement of the contribution of each author. A move to naming “contributors” rather than authors was suggested to improve both the credibility and the accountability of authorship lists62 and some large multicentre studies have adopted this approach. Journals such as the Lancet and the BMJ now list the contributions of researchers to some 41 Scientific Writing journal articles, often when the number of authors exceeds a prespecified threshold. However, in JAMA and in other journals, studies are often published with more than 40 authors who are listed in alphabetical order. Whereas some journal editors and readers see long lists of contributors as a way to reward and encourage researchers, others see it as wasted space. When the review is submitted, contributors are asked to describe in their own words their exact role in the review and this statement of contribution is then made available to readers.

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Attention then should be turned to placement of intravenous lines and invasive monitors such as arterial lines best ceftin 250mg infection vs intoxication. We generally ceftin 500mg sale antibiotics for deep sinus infection, perform operations with a multilumen subclavian venous catheter with one other large-bore venous line. We also place a catheter in the femoral artery to measure blood pressure continuously during the operation and to obtain arterial blood for gas analysis; again, this may not be necessary in cases of smaller burns. An oxygen saturation monitor and continuous electrocardiogram leads should also be placed. We have found that alligator clips attached to staples inserted into the skin work well as electrocardiographic leads instead of adhesive pads. Once the monitors are in place and anesthesia induced, the patient can be prepared for the operation. While the patient is in the supine position, the head The Major Burn 237 should be shaved if the scalp is burned or if the scalp will be used as a donor site. The skin for the donor site area as well as the burn wound should then be prepared by gentle scrubbing and washing with an antiseptic solution such as Betadine or chlorhexidine solu- tion. For burns over 20% of the body surface area, this will include most of the body; therefore, in these cases we will prepare the skin of the whole body in order to make all the donor sites available. In fact, it is rare for us to prepare and drape specific areas without preparing the whole body. Once the anterior areas are scrubbed, the cleaning solution is irrigated away with warm water (37 C). Then we turn the patient on his or her side to wash and irrigate the back. During the irrigation, the bed should be tilted toward the drain to facilitate removal of the irrigant. Before rolling the patient back to the supine position, a foam pad is placed, which is covered by sterile drapes under the patient. The last task required before beginning the operation is to ensure that the electro- cautery devices are functional, that the dermatome is functional and calibrated properly, and that the table is at the proper height for the surgical team. Considera- tion should also be given at this point to whether perioperative antibiotics (if to be used) have been given. What I will describe in the next few paragraphs are the principles of an operation for a massive burn ( 50% TBSA). In general, excision and donor site procurement should be done anteriorly followed by repositioning of the patient to the prone position. Posterior donor sites procurement and excision can then take place, followed by placement of grafts. The patient is again rolled supine, with placement of grafts anteriorly. Beginning the operation can be done in one of two ways, depending on the depth of the burn. If most of the wound is of an indeterminate depth, it is not clear whether autograft skin will be necessary at all. If good punctate bleeding is reached with one or two passes at this depth and dermal elements are still present in the wound bed with no exposed fat, this wound will heal spontaneously and will not require autografting. Once hemostasis is established, appropriate dressings can be applied (discussed later in this chapter). If it is found to be of a depth that will require autografting, these can be obtained after excision. In most cases, what will be found is that some areas will heal spontaneously and others will not. The appropri- ate amount of donor site skin can then be procured, thus minimizing donor site scarring. I generally begin by taking anterior donor sites at 10/1000 of an inch with a Zimmer dermatome. If possible, donor sites should be chosen that are conspicuous and will have a good color match for the wound bed. Donor sites on the abdomen, in the groin and perineum, and in the axillae are best harvested after clysis of the sites with a Pitkin’s device. I generally avoid taking donor grafts from the dorsum or sole of the foot because of poor healing and improper skin type for most wound beds, respectively.

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Although fractures The correction principle employed for clubfoottreat- were doubtless splinted and bandaged well before this Fa- ment also hardly changed at all for centuries after Hip- ther of Medicine appeared on the scene order ceftin 250mg without prescription bacteria examples, we lack the writ- pocrates buy ceftin 500 mg online antibiotic resistant klebsiella uti, even beyond the Middle Ages. The congenital aspect of the problem was development of a clubfoot splint. This and other splints of only established in the 17th century (Theodor Kerckring the time were able to maintain a particular position to a 1640–1693, Theodor Zwinger 1658–1724). This boot, which was the archetype of all current ful attempts at closed reduction were achieved by C. The work of Adolf Lorenz correction of clubfoot with plaster casts was only subse- (1854–1946) also represented a milestone in the treat- quently introduced in the 19th century. His bloodless method Congenital hip dislocation is a condition whose dis- of reduction with retention of the patient in a frog-leg semination is closely associated with civilization. It is plaster cast developed at the end of the 19th century was, largely unknown among primitive peoples, but has been for many decades, the standard method for the early known in Europe, particularly Central Europe, since an- treatment of congenital hip dislocation. The condition is even mentioned by Hip- 1968 that this plaster treatment was finally replaced by the less pronounced abducted position in a pelvis-leg cast described by Fettweis and associated with a reduced risk of femoral head necrosis. Other therapeutic landmarks included the development of splints (Hilgenreiner, Brown) and bandages (Pavlik, Hoffmann-Daimler). Numerous illustrations from the earliest his- torical records testify to the existence of such treatments [3, 7, 8]. In the 19th century, the fixation technique was significantly improved with the introduction of plaster. The actual plas- ter of Paris cast was invented by the Dutchman Antonius Mathysen in 1851. A particularly discriminating approach to fracture management, with standardization of treatment according to the type of fracture, was developed by Lorenz Böhler in Vienna at the start of the 20th century. Pliny the Elder relates how the Roman soldier Mar- cus Sergius lost his right hand in the Second Punic War (218–201 BC) and ordered an »iron hand« to be fashioned so that he was able to return to active duty in later military ⊡ Fig. In the Middle Ages, the use of prostheses as re- ment), from: Chirurgia è Graeco in Latinum conuersa, 1544. This ladder is then repeatedly raised using placements for arms and legs was widespread, in the latter ropes and allowed to fall under its own weight. One famous prosthesis wearer was Götz von Berlich- ingen, who had lost his right hand in the Landshut wars of succession (1504–1505). The options for prosthetic production were substantially increased by Otto Bock (1888–1953), who designed a system for the mass pro- duction of individual functional components. Prosthetic joints allowing much smoother movement, particularly of the lower extremity, were also developed around this time. The above-mentioned André Venel also achieved pio- neering work in another field by establishing the world’s first orthopaedic institute in Orbe (Canton of Vaud, Swit- zerland) in 1780. This institute provided conservative treat- ment exclusively for children with orthopaedic conditions. Hans von Gersdorff: Corrective knee extension, from : Feldt- an orthopaedic hospital, in 1812 in Würzburg. In France, buch der Wundarztney, 1517 Jacques Mathieu Delpech founded an orthopaedic institute 20 Chapter 1 · General in 1825 in Montpellier, while Jules-René Guerin and Charles- 1 Gabriel Pravaz began their work in an orthopaedic hospital in Paris in 1826. Delpech (1777–1832) is also considered to be the actual founder of the science of orthopaedics. In England an orthopaedic institution was founded in 1837 by William Little. The first American orthopaedic institute was inaugurated in Boston in 1839 by John Paul Brown. Other important institutes were founded by Wilhelm Schulthess in Zurich, Switzerland (Wilhelm Schulthess Klinik and Balgrist Hospital) and the Riz- zoli Institute in Bologna, named for the orthopaedist Francesco Rizzoli and opened in 1896. Physical therapy is another form of treatment that was already known to the ancient world. Hippocrates was aware of this mechanical therapy, while Aesculapius and Galen recommended massages. Hydrotherapy and balneotherapy arrived from the Orient and were known to the ancient Greeks and Romans. In Central Europe, bath houses and bathing masters are even mentioned in legislative texts (Volksrechten) dating back to the 6th–8th centuries.

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