Outdated Guidelines Research Articles

BREAST CANCER ASSISTANCE JOURNEY FROM THE PERSPECTIVE OF THE PUBLIC HEALTHCARE SERVICE OF RIO GRANDE DO SUL

Objective: This study aims to characterize the breast cancer (BC) patient journey in Rio Grande do Sul (RS), Brazil, through the perspectives of the High Complexity Oncology Assistance Centers (CACONs) and High Complexity Oncology Assistance Units (UNACONs). Methods: Conducted between March and May 2023 across 17 RS Oncology public healthcare services, the cross-sectional study utilized a 54-question questionnaire administered to healthcare professionals. The survey covered various aspects, including diagnosis, treatment, funding, and multidisciplinary teamwork. Results: Descriptive analysis revealed that BC patients undergo screening tests upon treatment entry (88.2%), with immunohistochemistry commonly performed externally (64.7%) and PCR often requested (82.4%) for adjuvant therapy initiation, taking an average of 90 to 250 days for all procedures. Patients encounter challenges such as lengthy hospital stays, extensive travel to treatment centers, treatment side effects, and high transportation expenses, often leading to treatment discontinuation. The most time-consuming stage is treatment, with subcutaneous infusion proving more time-efficient than intravenous administration. Physical limitations, mobility issues, late diagnosis (90-day average), and limited access to care significantly impact patients' quality of life. Healthcare teams face difficulties with outdated guidelines, lack of intravenous treatment facilities, and extended administration durations. Institutions confront barriers like drug shortages, guideline disparities, and logistical challenges. Conclusion: The study concludes by emphasizing the identified hurdles in BC patients' public healthcare journey, underscoring the need to address delays in screening, resource constraints, and disparities in access to care based on geographical, socioeconomic, and racial/ethnic factors to enhance overall quality of care and equity within the system.

Factors Associated With Guideline-concordant and Excessive Cervical Cancer Screening: A Mixed Methods Study

IntroductionNational guidelines recommend cervical cancer screening with Papanicolaou (Pap) testing at 3-year intervals or with human papillomavirus (HPV) testing alone or HPV/Pap cotesting at 5-year intervals for average-risk individuals aged 30–65 years. MethodsWe explored factors associated with clinician-reported guideline-concordant screening, as well as facilitators and barriers to appropriate cervical cancer screening. ResultsA national sample of clinicians (N = 1,251) completed surveys; a subset (n = 55) completed interviews. Most (94%) reported that they screened average-risk patients aged 30–65 years with cotesting. Nearly all clinicians who were categorized as nonadherent to national guidelines were overscreening (98%). Guideline concordant screening was reported by 47% and 82% of those using cotesting and HPV testing, respectively (5-year intervals), and by 62% of those using Pap testing only (3-year intervals). Concordant screening was reported more often by clinicians who were aged <40 years, non-Hispanic, and practicing in the West or Midwest, and less often by obstetrician–gynecologists and private practice physicians. Concordant screening was facilitated by beliefs that updated guidelines were evidence-based and reduced harms, health care system dissemination of guidelines, and electronic medical record prompts. Barriers to concordant screening included using outdated guidelines, relying on personal judgment, concern about missing cancers, inappropriate patient risk assessment, and lack of support for guideline adoption through health care systems or electronic medical records. ConclusionsMost clinicians screened with Pap/HPV cotesting and approximately one-half endorsed a 5-year screening interval. Clinician knowledge gaps include understanding the evidence underlying 5-year intervals and appropriate risk assessment to determine which patients should be screened more frequently. Education and tracking systems can promote guideline-concordant screening.

Antimicrobial stewardship in private pharmacies in Wakiso district, Uganda: a qualitative study

BackgroundPrivate pharmacies are the first point of contact for the public regarding acquisition of medicines and other pharmaceuticals in many low- and middle-income countries including Uganda. Most antimicrobial stewardship (AMS) programmes in Uganda have targeted pharmacies in public health facilities, with little known about private pharmacies. This study explored knowledge and practices related to AMS in private pharmacies in Wakiso district, central Uganda.MethodsThis was a qualitative study that involved 31 in-depth interviews to explore AMS among retail private pharmacy staff including pharmacists, pharmacy technicians/dispensers, and nurses. Participants were asked about antimicrobial resistance (AMR) and AMS practices at their pharmacy. The audio-recorded interviews were transcribed verbatim and imported to NVivo 2020 (QSR International) for thematic analysis.ResultsFive major themes emerged from the study: commonly sold antimicrobials; knowledge on AMR and AMS; potential contributors to AMR; practices related to AMS; and challenges to AMS. The commonly sold antimicrobials in the pharmacies with or without prescriptions were oral azithromycin, Ampiclox® (ampicillin and cloxacillin), amoxicillin, ciprofloxacin, Septrin® (co-trimoxazole), metronidazole, Flucamox® (amoxicillin and flucloxacillin), Augmentin® (amoxicillin and clavulanic acid), cephalexin, doxycycline, and chloramphenicol. Participants had heard about AMR but not AMS, although only a few correctly defined AMR. Lack of knowledge among health workers and local communities; the overuse, misuse, and abuse of antimicrobials such as non-adherence to dosage; self-medication; and purchase of drugs without prescription were identified as potential accelerators to the emergence of AMR. Current practices related to AMS in private pharmacies were limited to meetings, antimicrobial dispensing, providing client advice, record keeping, and monitoring of drugs. Cost of healthcare, client satisfaction and retention, outdated guidelines, and the business orientation of pharmacies were the main challenges related to AMS.ConclusionThere was poor knowledge of AMR and AMS, and limited AMS practices in private pharmacies. Private pharmacies have the potential to contribute to Uganda’s fight against AMR if motivated and equipped with adequate knowledge to enhance their practices related to AMS.

Echocardiographic signs of aortic valve dysfunction in patients with Philadelphia-negative myeloproliferative neoplasms

Abstract Background Patients with Philadelphia-negative myeloproliferative neoplasms (MPNs) have an increased prevalence of calcifications on the aortic valve, but the prevalence of aortic valve stenosis or regurgitation has only been reported in one small study based on outdated guidelines, and a few case reports. Chronic inflammation and increased shear stress on the aortic valve increase the risk of developing aortic valve dysfunction. The proliferation of mature blood cells in patients with MPNs leads to increased blood viscosity that increase shear stress on endothelial cells in the blood vessels, and likely also on the aortic valve. Furthermore, there is evidence of chronic inflammation in patients with MPNs. Purpose To investigate if patients with MPNs had a higher prevalence of aortic valve stenosis and/or regurgitation compared to the general population. Methods Patients with the MPN diagnosis were recruited between 2016 and 2018 and examined with echocardiography. The patients were matched 1:1 on sex and 5-year age span, with participants from CCHS, a large on-going population study. Aortic valve stenosis was defined as an AV Vmax &amp;gt;2.5 m/s measured by continuous wave Doppler and aortic valve regurgitation was defined as colour Doppler with a visible regurgitation jet. Results We included 167 patients with MPNs (mean age 66 years [SD ± 10]) and 167 controls (mean age 62 [SD ± 10]). There was a significantly higher median AV Vmax in the MPN cohort (1.4 vs 1.3 m/s, p&amp;lt;0.0001) and a significantly lower mean aortic valve area (2.2 vs 2.6 cm2, p&amp;lt;0.0001). There were nine patients (5%) in the MPN cohort who fulfilled the criterion for aortic valve stenosis while no one in the control group fulfilled this criterion (p=0.0035). Aortic valve regurgitation was found in 41 (25%) MPN patients and 8 (5%) controls (p&amp;lt;0.0001) Conclusion Patients with MPNs have a higher prevalence of aortic valve stenosis and aortic valve regurgitation compared to the general population.Graphical overviewTable 1

Impact of Dry Port on Seaport Competitiveness

Ports play an important role in connecting individuals in need of logistics services with organizations that provide logistics services. Rather of being merely transshipment hubs. Ports have recently evolved into integrated logistics centers with a continuous transport chain, with these developments primarily relying on the supply chain systems of major port operators. Though changes impact terminal handling traffic, rising quantities have increased job pressure, as well as congestion levels and dwell periods in terminal areas. The dry port model relies on a seaport which is directly connected to inland intermodal stations, where freight may be rotated immediately to the seaport in intermodal loading units. This research investigates the influence of vessel growth on port competitiveness and investigates integration between seaports and dry ports to counteract the huge increase in ship size at seaports. To achieve this goal, a survey was conducted to measure the relationship between dry ports and seaports. This paper also illustrates how the vessel expansion is associated with reduced operational efficiency, congestion, limited capacity and infrastructure support, outdated guidelines for existing port development, and the urgent need for additional investment in spatial development, and human resource development.

Impact of Dry Port on Seaport Competitiveness

Ports play an important role in connecting individuals in need of logistics services with organizations that provide logistics services. Rather of being merely transshipment hubs. Ports have recently evolved into integrated logistics centers with a continuous transport chain, with these developments primarily relying on the supply chain systems of major port operators. Though changes impact terminal handling traffic, rising quantities have increased job pressure, as well as congestion levels and dwell periods in terminal areas. The dry port model relies on a seaport which is directly connected to inland intermodal stations, where freight may be rotated immediately to the seaport in intermodal loading units. This research investigates the influence of vessel growth on port competitiveness and investigates integration between seaports and dry ports to counteract the huge increase in ship size at seaports. To achieve this goal, a survey was conducted to measure the relationship between dry ports and seaports. This paper also illustrates how the vessel expansion is associated with reduced operational efficiency, congestion, limited capacity and infrastructure support, outdated guidelines for existing port development, and the urgent need for additional investment in spatial development, and human resource development. Keywords: Dry Ports – Competitiveness – Seaports – Vessel size

Prostate-specific antigen testing for prostate cancer: Time to reconsider the approach to screening.

Prostate cancer is now the most common cancer in men in Australia. Men should be aware of the potential risk of significant prostate cancer despite the lack of symptoms. Screening for prostate cancer using prostate-specific antigen (PSA) has been controversial. General practice guidelines can be confusing leading to men not being tested for prostate cancer. Reasons cited include overdiagnosis andovertreatment with associated morbidity. This article aims to highlight the current evidence for PSA testing and advocate for updating outdated guidelines and resources. Current evidence shows that a risk-stratified approach to PSA screening helps to assess that risk. Recent studies show improved survival rates with early intervention compared with observation/delayed treatment. Imaging, including magnetic resonance imaging and prostate-specific membrane antigen positron emission tomography, have made a significant difference in themanagement pathway. Biopsy techniques have progressed to minimise sepsis risk. Quality and patient-reported outcomes registry data highlight the increased use of active surveillance in patients with low to intermediate risk of prostate cancer, reducing treatment-associated harms in men with low risk of progression. There have also been improvements in medical therapeutics for advanced disease.

Occupational-Related Injuries and Associated Risk Factors Among Healthcare Workers Working in Developing Countries: A Systematic Review.

Occupational-related diseases or illnesses account for an estimated 2.4 million deaths worldwide every year. Currently, occupational hazards threaten healthcare workers' (HCWs) lives, safety, and well-being. Therefore, providing the prevalence and major causes of occupational-related diseases may enable injury reduction and the creation of safer working environments, which are important for providing higher quality services. The current study aimed to determine the prevalence of occupational-related injuries and associated risk factors among HCWs, particularly in developing countries. The articles published in English were retrieved using a combination of Boolean logic operators (AND, OR, and NOT), Medical Subject Headings (MeSH), and keywords in electronic databases (SCOPUS/Science Direct, Web of Science, DOAJ, PubMed/MEDLINE, CINAHL, and Google Scholars). Using Joanna Briggs Institute critical appraisal tools, a quality assessment was conducted to determine the articles' relevance. In addition, the relevant articles were identified through a series of assessment and evaluation stages. About 721 studies were searched using electronic databases, of which 36 articles included 139,578 HCWs. The average prevalence of occupational-related injuries among HCWs in the career and previous last year accounted for 60.17%, ranged from 32% to 87.8% and 39.16%, ranged from 1.14% to 87%, respectively. The current study found that sex and hours worked, stress at work, occupation, age, training in infection prevention, use of universal precautions, recapping needles, ward work experience, staffing and resource adequacy, awareness, outdated guidelines, and previous exposure to sharp injury were statistically associated with occupational-related injuries. This study revealed that 39% and 60% of HCWs experienced occupational-related injuries in the last year and during their career, respectively. Therefore, the appropriate measures must be taken to reduce the burden of occupational-related injuries by following standard precautions or occupational health and safety measures.

The New Calling

The New Calling

Safety and Efficacy of Inpatient Diabetes Management with Non-insulin Agents: an Overview of International Practices.

Purpose of ReviewThe field of inpatient diabetes has advanced significantly over the last 20 years, leading to the development of personalized treatment approaches. However, outdated guidelines still recommend the use of basal-bolus insulin therapy as the preferred treatment approach, and against the use of non-insulin anti-hyperglycemic agents.Recent FindingsSeveral observational and prospective randomized controlled studies have demonstrated that oral anti-hyperglycemic agents are widely used in the hospital, including studies of DPP-4 agents and GLP-1 agonists.SummaryWith advances in the field of inpatient diabetes management, a paradigm shift has occurred, from an approach of recommending “basal-bolus regimens” for all patients to a more precision medicine option for hospitalized non-critically ill patients with type 2 diabetes.

Questioning Our Approach to Hyperbilirubinemia.

Questioning Our Approach to Hyperbilirubinemia.

Role of Isolated Limb Perfusion in the Era of Targeted Therapies and Immunotherapy in Melanoma. A Systematic Review of The Literature.

Simple SummaryMelanoma still represents a major challenge for health systems around the world. A classical treatment for patients with a high tumor burden or rapidly recurrent in-transit metastases is isolated limb perfusion (ILP) therapy instead of locoregional surgical resection, or when the latter is no longer feasible. In this era of modern systemic treatments for melanoma, it still remains interesting to analyze the role of management approaches for locoregionally-advanced disease, such as isolated limb perfusion (ILP). With this purpose, we conducted a systematic review updating the available literature on ILP for malignant melanomas. The main objectives of this review were to focus on the effectiveness and safety of ILP. In conclusion, ILP, with its low incidence of regional and systemic toxicity, is a valuable palliative treatment not only for patients with disease confined to a limb, but also for patients with a metastatic melanoma with a bulky or symptomatic disease, in order to improve their quality of life.Background. Isolated limb perfusion (ILP) is a locoregional procedure indicated by the unresectable melanoma of the limbs. Its complexity and highly demanding multidisciplinary approach means that it is a technique only implemented in a few referral centers around the globe. This report aims to examine its potential role in the era of targeted therapies and immunotherapy by conducting a systematic review of the literature on ILP. Methods. PubMed, Embase and Cochrane Library were searched. The eligibility criteria included publications from 2000–2020 providing valid data o effectiveness, survival or toxicity. Studies in which the perfusion methodology was not clearly described, letters to the editor, non-systematic reviews and studies that applied outdated clinical guidelines were excluded. To rule out studies of a low methodological quality and assess the risk of bias, the following aspects were also required: a detailed description of the applied ILP regimen, the clinical context, follow-up periods, analyzed clinical endpoints, and the number of analyzed ILPs. The disagreements were resolved by consensus. The results are presented in tables and figures. Results. Twenty-seven studies including 2637 ILPs were selected. The median overall response rate was 85%, with a median complete response rate of 58.5%. The median overall survival was 38 months, with a 5-year overall survival of 35%. The toxicity was generally mild according to Wieberdink toxicity criteria. Discussion. ILP still offer a high efficacy in selected patients. The main limitation of our review is the heterogeneity and age of most of the articles, as well as the absence of clinical trials comparing ILP with other procedures, making it difficult to transfer its results to the current era. Conclusions. ILP is still an effective and safe procedure for selected patients with unresectable melanoma of the limbs. In the era of targeted therapies and immunotherapy, ILP remains an acceptable and reasonable palliative treatment alternative, especially to avoid limb amputations. The ongoing clinical trials combining systemic therapies and ILP will provide more valuable information in the future to clarify the potential synergism of both strategies.

The Journey of Developing, Mandating and Applying the National Quality Standards for Care Homes in Egypt

Institutional care is one of the most prevalent alternative care forms in Egypt. There were more than 500 registered care homes when Wataneya Society started its journey in 2008. Care homes in Egypt are managed by civil society and supervised by the government. However, their management system and quality of care vary from one place to another depending on the managers’ background and beliefs. Care homes need intensive and constant technical support to be able to provide a healthy environment that promotes the physical and psychological well-being for children and youth without parental care, an environment that secures their good education, employment and social integration. Therefore, standardising and unifying the care system was crucial to ensure that children received quality of care inside these care homes. As a result, since 2008, Wataneya Society has pioneered the development of the national quality standards for care homes in collaboration with the Egyptian Ministry of Social Solidarity, international and local non-governmental organisations (NGOs and INGOs) working in the alternative care sector. The national quality standards were mandated nationwide by the Ministry of Social Solidarity in 2014. Prior to that, in Egypt there were no standards, there was only a set of outdated guidelines and regulations dating back to 1977. The national quality standards were driven from, (a) UN Guidelines for the Alternative Care of Children (2009); (b) best practices in the field of alternative care; and (c) Wataneya Society’s field experience in piloting the standards with seven care homes for four years starting in the year 2009. Wataneya Society continues to assist care homes to apply the national quality standards to be able to provide a safe environment for children and youth. This article will discuss the journey of developing, mandating and applying the national quality standards for care homes in Egypt.

Hyperlinked Dynamic Standard Operating Procedures for Ensuring Team Safety during the COVID-19 Pandemic.

The COVID-19 pandemic was a rapidly evolving situation that demanded frequent revisions to standard operating procedures1 and published guidelines. This high frequency of revisions was a peculiar aspect of the pandemic. We work in a high-volume plastic surgery department at an apex medical institute in India, and with the onset of the pandemic, sweeping changes to the hospital and departmental functions ensued. Considering the need for implementing stringent and uniform infection control protocols to ensure patient and personnel safety,2 we embarked to design standard operating procedures for the activities of our department that were adherent to the superseding institutional guidelines while being specifically tailored to the unique aspects and functions of our clinical specialty. Case-specific standard operating procedures were also necessary to ensure that our management teams were well informed and could minimize procedural delays, especially in time-critical cases of reimplantation and revascularization.3 Intended for doctors, physiotherapists, and nursing staff, we distributed the initial version as a read-only PDF file through e-mail and the WhatsApp Messaging platform (Facebook Inc., Mountain View, Calif.). When preparing the first revision to our standard operating procedures, we recognized several potential problems with this distribution method. For these standard operating procedures to be effective, the new essential information, especially revisions to previously published guidelines, had to be rapidly disseminated to those concerned. Because multiple revisions were expected over a short time span and we did not have the ability to prevent access to obsolete versions, there would be a fragmentation of versions and poor penetration of updated documents over time. This would cause confusion and could lead to accidentally following the outdated guidelines (Fig. 1, left).Fig. 1.: Diagrammatic representation of the fundamental differences between static standard operating procedures and hyperlinked dynamic standard operating procedures. (Left) Static standard operating procedures distributed individually. (Right) Hyperlinked dynamic standard operating procedures distributed using cloud services. SOPs, standard operating procedures.To address this flaw, we decided to host the standard operating procedure document (Fig. 1, right) on Google Drive (Google, Inc., Mountain View, Calif.) (dynamic standard operating procedure), one of many free online cloud storage and synchronization services. This gave us the ability to store our document online as a single file that can be accessed through a unique URL link. Any changes to the standard operating procedure were stored as new versions of the same file and could be accessed through the same URL. Thus, whenever the link is accessed, it will always serve the most recent version. Hyperlinks4 (Web links) were used to provide access to relevant institutional documents and external sources, allowing users an easy access to all relevant information at a single location, rather than having to search for them externally. The file could also be shared with others individually, whereby access is provided only after authentication through their Google account. This can prevent unauthorized individuals from accessing the document and provide feedback regarding which recipients have accessed and are thus up to date. We encouraged all members to always use the link to access the document and to not store an offline copy. We highlighted the changes in each version and maintained an amendment log at the end of the document. Added benefits included the ability for recipients to leave feedback in the form of comments and to be notified of updates. There are many other free and paid services with similar capabilities.5 DISCLOSURE None of the authors has financial conflicts of interest to disclose.

Increasing the Rate of Completion of the Therapeutic Hypothermia Procedure in the NICU

The most effective treatment currently available for perinatal asphyxia-induced hypoxic-ischemic encephalopathy is therapeutic hypothermia, which reduces the mortality rate and neurological disorders in newborns. The earlier this therapy is performed, the better the protective effects on the nerves of the patient. In our neonatal intensive care unit (NICU), we discovered that nurses lack experience caring for patients undergoing hypothermia therapy due to the limited number of cases. In addition, outdated guidelines, the disorganized placement of equipment, and the paucity of hands-on simulations exacerbate the unfamiliarity of the nurses with this therapy. To expand the knowledge of nurses regarding therapeutic hypothermia in the NICU and to increase the rate of completion of the therapeutic hypothermia procedure. 1. Regular care training programs and scenario-based simulations were conducted to help nurses obtain related knowledge and become more familiar with therapeutic hypothermia. 2. In order to reduce the preparation time, a specific preparation kit and an instruction folder for therapeutic hypothermia was developed that included a material placement checklist. 3. The procedure guidance booklet for therapeutic hypothermia was revised and a monitoring system was established. The accuracy of nurses' knowledge regarding therapeutic hypothermia in the NICU improved from 82.0% to 94.5%. The completion rate for the therapeutic hypothermia procedure rose from 75.6% to 100.0%. This project successfully enhanced the accuracy of nurses' knowledge regarding therapeutic hypothermia and increased the rate of completion for this care procedure, resulting in a safer and more-standardized procedure for neonates undergoing therapeutic hypothermia.

Benefits Are Limited with High Nitrogen Fertiliser Rates in Kikuyu-Ryegrass Pasture Systems

Nitrogen (N) fertiliser is applied to pastures in dairy farming systems to ensure productivity, but it is an expensive input that could be damaging to the environment if used excessively. In the southern Cape region of South Africa, N fertilisation guidelines for pastures were developed under conditions different to current management practices, yet dairy producers still base fertiliser programmes on these outdated guidelines. This study aimed to determine the efficiencies of N fertilisation. Various N fertiliser rates (0, 20, 40, 60 and 80 kg ha−1 applied after grazing), as well as a variable rate according to the nitrate concentration in the soil water solution, were assessed on a grazed pasture. Dairy cows returned to a pasture approximately 11 times per year. Pasture production showed a minimal response to fertilisation within each season. The most responsive parameters to fertilisation were the herbage crude protein content, soil mineral N content and urease activity. Reduced microbial activity was observed when more than 40 kg N ha−1 was applied. When considering the soil total mineral N content, N is used inefficiently at rates above 40 kg N ha−1. The results are indicative of an N saturated system that provides a rationale for reducing N fertiliser rates.

Transformative Teaching and Educational Fair Use after Georgia State

The Supreme Court has said that copyright’s fair use doctrine is a “First Amendment safety valve” because it ensures that certain crucial cultural activities are not unduly burdened by copyright. While many such activities (criticism, commentary, parody) have benefited from the courts’ increased attention to first amendment values, one such activity, education, has been mired for years in a minimalist, market-based vision of fair use that is largely out of touch with mainstream fair use jurisprudence. The latest installment in the history of educational fair use, the 11th Circuit’s opinion in the Georgia State e-reserves case, may be the last judicial word on the subject for years to come, and I argue that its import is primarily in its rejection of outdated guidelines and case law, rather than any affirmative vision of fair use (which the court studiously avoids). Because of the unique factual context of the case, it stops short of bridging the gap between educational fair use and modern transformative use jurisprudence. With help from recent scholarship on broad patterns in fair use caselaw, I pick up where the GSU court left off, describing a variety of common educational uses that are categorizable as transformative, and therefore entitled to broad deference under contemporary fair use doctrine. In the process, I show a way forward for vindicating fair use rights, and first amendment rights, by applying the transformative use concept at lower levels of abstraction to help practice communities make sense of the doctrine.

Site Index Models for Main Forest-Forming Tree Species in Poland

Site index is the most commonly used measure of potential site productivity, providing key information for forest management practices. It is determined using species-specific site index models that take into account climatic and edaphic factors. To reliably estimate the site index, appropriate models are necessary. In Poland, however, outdated guidelines, i.e., yield tables, are used to determine site classes, which result in the inappropriate estimation of height growth and increments of stands. Therefore, the aim of this study is to develop new site index models for the main forest forming tree species in Poland, in a total of eight species. For the development of site index models, we used growth trajectories of 3052 sample trees, representing the whole range of geographic locations and site conditions. Five dynamic models were selected and parametrized to develop the site index models. The models were evaluated using quantitative measures of goodness of fit (MAE, R2, and AIC), the analysis of residuals, and the assessment of how the model reflects the biological phenomena of height growth. Results showed that depending on the species, different models have the highest predictive ability. There are significant differences in results using traditional yield tables and developed site index models. For most of the species, the largest differences characterized either the youngest or the oldest age classes. These differences can be attributed to the changes in growth conditions from the time when yield tables were developed. Growth dynamics of forest stands may also show spatial variability, thus, in future research additional site variables and, regional variability should be taken into account.

Clinical Track Promotion Guideline Development for Nursing Faculty in a Traditional Research-Focused University.

The clinical track is a newer concept for universities traditionally placing a hefty emphasis on research and funding. Guidelines should ensure equitable criteria for promotion of practicing faculty reflect teaching, scholarship, and academic outreach milestones. This article describes the process, challenges, and overall experience of developing clinical track promotion guidelines within a research-focused university setting. The department's outdated clinical track promotion guidelines were revised to reflect current roles of clinical faculty. As DNP and clinically focused advanced practice faculty flood into 4-year academic settings, universities must ensure that criteria for promotion reflects clear and equitable teaching, scholarship, and academic outreach milestones. The recent influx of DNP clinical faculty and advanced nursing practice faculty roles requires an overhaul of outdated guidelines.

First week of integral health for the newborn: nursing actions of the Family Health Strategy.

To describe the nurses' actions of the Family Health Strategy about the First Week for Integral Health regarding the care devoted to the newborn. It is a descriptive, exploratory research with qualitative approach carried out from October 2014 to February 2015, through a semi-structured interview, with nine nurses from the Family Health Strategy of João Pessoa-PB. Data were submitted to thematic analysis. The actions identified at the first visit to the newborn child are based on maternal guidance on basic newborn care, breastfeeding, neonatal screening, immunization and childcare, as well as evaluation of the puerperal, but it was sometimes performed outside the period recommended and with incomplete and outdated guidelines. Although there are potentialities in nurses' actions to this population, the fragilities compromise the care of the newborn and the puerperium, and it is necessary to sensitize these professionals about the importance and effectiveness of First Week for Integral Health.