Impact of a virtual learning environment on the conscious prescription of antibiotics among Colombian dentists.

Appropriate antibiotic prescription contributes to reducing bacterial resistance; therefore, it is critical to provide training regarding this challenge. The objective of this study was to develop a virtual learning environment for antibiotic prescription and to determine its impact on dentists' awareness, attitudes, and intention to practice. First, the learning content on multimedia resources was developed and distributed into three challenges that participants had to overcome. Then, a quasi-experimental study was performed in which the virtual learning environment was implemented on dentists from seven Colombian cities. The median of correct answers and the levels of awareness, attitudes, and intention to practice were compared before, immediately after, and 6-months post-intervention. Wilcoxon signed-rank and McNemar's tests were used to determine the differences. A total of 206 participants who finished the virtual learning environment activities exhibited a favorable and statistically significant impact on the median of correct answers of awareness (p < 0.001), attitudes (p < 0.001), and intention to practice (p = 0.042). A significant increase occurred in the number of participants with a high level of awareness (p < 0.001) and a non-significant increase in participants with high levels of attitudes (p = 0.230) and intention to practice (p = 0.286). At 6 months, the positive effect on the median of correct answers on awareness and intention to practice persisted (p < 0.001); however, this was not evident for attitudes (p = 0.105). Moreover, there was a significant decrease in the number of participants who showed low levels of awareness (p = 0.019) and a slight increase in those with high levels of the same component (p = 0.161). The use of a virtual learning environment designed for dentists contributed to a rapid improvement in awareness and intention to practice antibiotic prescription; however, their attitudes and information retention need reinforcement.

Patients' medication reconciliation in a university hospital

Abstract Medication reconciliation is a strategy to minimize medication errors at the transition points of care. This study aimed to demonstrate the effectiveness of medication reconciliation in identifying and resolving drug discrepancies in the admission of adult patients to a university hospital. The study was carried out in a 300-bed large general public hospital, in which a reconciled list was created between drugs prescribed at admission and those used at pre-admission, adapting prescriptions from the pharmacotherapeutic guidelines of the hospital studied and the patients' clinical conditions. One hundred seven patients were included, of which 67,3% were women, with a mean age of 56 years. Two hundred twenty-nine discrepancies were found in 92 patients; of these, 21.4% were unintentional in 31.8% of patients. The pharmacist performed 49 interventions, and 47 were accepted. Medication omission was the highest occurrence (63.2%), followed by a different dose (24.5%). Thirteen (26.5%) of the 49 unintentional discrepancies included high-alert medications according to ISMP Brazil classification. Medication reconciliation emerges as an important opportunity for the review of pharmacotherapy at transition points of care, based on the high number of unintentional discrepancies identified and resolved. During the drug reconciliation process, the interventions prevented the drugs from being misused or omitted during the patient's hospitalization and possibly after discharge.

SEOR SBRT-SG survey on SRS/SBRT dose prescription criteria in Spain.

AIM: Stereotactic body radiotherapy (SBRT) and stereotactic radiosurgery (SRS) are essential tools in radiation oncology. In Spain, the use of these techniques continues to grow as older linear accelerators (linacs) are replaced with modern equipment. However, little is known about inter-centre variability in prescription and dose heterogeneity limits. Consequently, the SBRT-Spanish Task Group (SBRT-SG) of the Spanish Society of Radiation Oncology (SEOR) has undertaken an initiative to assess prescription and homogeneity in SRS/SBRT treatment. In the present study, we surveyed radiation oncology (RO) departments to obtain a realistic overview of prescription methods used for SBRT and SRS treatment in Spain. METHODS: A brief survey was developed and sent to 34 RO departments in Spain, mostly those who are members of the SEOR SBRT-SG. The survey contained seven questions about the specific prescription mode, dose distribution heterogeneity limits, prescription strategies according to SRS/SBRT type, and the use of IMRT-VMAT (Intensity Modulated Radiation Therapy-Volumetric Modulated Arc Therapy). RESULTS: Responses were received from 29 centres. Most centres (59%) used the prescription criteria D95% ≥ 100%. Accepted dose heterogeneity was wide, ranging from 107 to 200%. Most centres used IMRT-VMAT (93%). CONCLUSIONS: This survey about SRS/SBRT prescription and dose heterogeneity has evidenced substantial inter-centre variability in prescription criteria, particularly for intended and accepted dose heterogeneity. These differences could potentially influence the mean planning target volume dose and its correlation with treatment outcomes. The findings presented here will be used by the SEOR SBRT-SG to develop recommendations for SRS/SBRT dose prescription and heterogeneity.

Profile of pharmaceutical care in primary health centers in São Bernardo do Campo, Southeastern Brazil

The effective insertion of the pharmacist into primary care is an important goal for health policies. The objective of this study was to describe and analyze pharmacists and Pharmaceutical Care in the primary health centers (UBS) of São Bernardo do Campo. Data were obtained through an interview applied to pharmacists. The instrument has three sections: (1) Pharmacist identification; (2) Pharmacist work; and (3) Pharmaceutical activities. Items in section 3 correspond to the guidelines of agencies that promote Pharmaceutical Care in the primary health system. All 24 pharmacists working in UBS in São Bernardo do Campo were interviewed. Every center dispensing medicines has a responsible pharmacist. These pharmacists are predominantly women and postgraduates. Activities of Pharmaceutical Care reported were: daily prescription analysis (75% of interviewees); monthly participation in patient groups (70.8%); monthly follow-up of pharmacotherapy adherence (58.3%); monthly participation in multiprofessional team meetings (54.2%); monthly home visits (12.5%); health education to the community (83.3%); and pharmacist consultation (37.5%). Frequency of prescription analysis and home visits was weakly associated with aspects of the pharmacist and the facility. This study showed that Pharmaceutical Services are structured in primary care in São Bernardo do Campo and many Pharmaceutical Care activities are offered in its UBS

Evaluation of platelet concentrate prescription in pediatric patients at a tertiary care hospital.

OBJECTIVE: To verify the adequacy of platelet concentrate prescription by pediatricians in different pediatric sectors of a general hospital. METHODS: A cross-sectional study evaluating 218/227 platelet concentrate records in children and adolescents (zero to 13 years old), from January 2007 to April 2015, by the pediatricians of the emergency room, sick bay and intensive care unit. The requisitions were excluded in patients with hematological diseases and those without the number of platelets. RESULTS: Children under 12 months received 98 platelet concentrates (45.2%). Most of the transfusions were prophylactic (165; 79%). Regarding the transfusion site, 39 (18%) were in the emergency room, 27 (12.4%) in the sick bay and 151 (69.6%) in the intensive care unit. The trigger, prescribed volume and platelet concentrate subtype were adequate in 59 (28.2%), 116 (53.5%) and 209 (96.3%) of the transfusions, respectively. Patients with hemorrhage presented adequacy in 42 (95.5%), while children without bleeding presented in 17 (10.3%). The most common inadequacy related to volume was the prescription above recommendation (95; 43.8%). Eight platelet concentrates were prescribed with subtype requests without indication. CONCLUSION: The results obtained in this study showed that transfusion of platelet concentrate occurred more adequately in children with active bleeding compared to prophylactic transfusion. There was a tendency to prescribe high volumes and platelet subtypes not justified according to current protocols. The teaching of transfusion medicine should be more valued at undergraduate and medical residency.

Evaluation of platelet concentrate prescription in pediatric patients at a tertiary care hospital / Avaliação da prescrição de concentrado de plaquetas em pacientes pediátricos em hospital terciário

ABSTRACT Objective: To verify the adequacy of platelet concentrate prescription by pediatricians in different pediatric sectors of a general hospital. Methods: A cross-sectional study evaluating 218/227 platelet concentrate records in children and adolescents (zero to 13 years old), from January 2007 to April 2015, by the pediatricians of the emergency room, sick bay and intensive care unit. The requisitions were excluded in patients with hematological diseases and those without the number of platelets. Results: Children under 12 months received 98 platelet concentrates (45.2%). Most of the transfusions were prophylactic (165; 79%). Regarding the transfusion site, 39 (18%) were in the emergency room, 27 (12.4%) in the sick bay and 151 (69.6%) in the intensive care unit. The trigger, prescribed volume and platelet concentrate subtype were adequate in 59 (28.2%), 116 (53.5%) and 209 (96.3%) of the transfusions, respectively. Patients with hemorrhage presented adequacy in 42 (95.5%), while children without bleeding presented in 17 (10.3%). The most common inadequacy related to volume was the prescription above recommendation (95; 43.8%). Eight platelet concentrates were prescribed with subtype requests without indication. Conclusion: The results obtained in this study showed that transfusion of platelet concentrate occurred more adequately in children with active bleeding compared to prophylactic transfusion. There was a tendency to prescribe high volumes and platelet subtypes not justified according to current protocols. The teaching of transfusion medicine should be more valued at undergraduate and medical residency.

RESUMO Objetivo: Verificar a adequação na prescrição de concentrado de plaquetas por pediatras em diferentes setores da pediatria de um hospital geral. Métodos: Estudo transversal avaliando 218/227 fichas de requisição de concentrado de plaquetas de crianças e adolescentes (zero a 13 anos), de janeiro de 2007 a abril de 2015 pelos pediatras do pronto-socorro, enfermaria e unidade de terapia intensiva. Excluíram-se as requisições em portadores de doenças hematológicas e aquelas sem o número de plaquetas. Resultados: Crianças com menos de 12 meses receberam 98 prescrições de concentrado de plaquetas (45,2%). A maioria das transfusões foi profiláticas (165; 79%). Em relação ao local da transfusão, 39 (18%) foram no pronto-socorro, 27 (12,4%) na enfermaria e 151 (69,6%) na unidade de terapia intensiva. O gatilho, o volume prescrito e o subtipo de concentrado de plaquetas foram adequados em 59 (28,2%), 116 (53,5%) e 209 (96,3%) das transfusões, respectivamente. Prescrições para pacientes com hemorragia apresentaram adequação em 42 (95,5%) transfusões, enquanto para crianças sem hemorragia houve adequação em 17 (10,3%) vezes. A inadequação mais comum em relação ao volume foi a prescrição acima da recomendação (95; 43,8%). Foram prescritos oito concentrados de plaquetas sem indicação de solicitação de subtipos. Conclusão: Os resultados obtidos nesse estudo mostraram que a prescrição de transfusão de concentrado de plaquetas foi mais adequada em crianças com hemorragia ativa em comparação com a transfusão profilática. Houve tendência à prescrição de volumes elevados e de subtipos de plaquetas, o que não se justifica segundo os protocolos atuais. O ensino da medicina transfusional deve ser mais valorizado na graduação e na residência médica.

Assessment of the prescription of red blood cell concentrates in the pediatric age group.

OBJECTIVE: To verify the adequacy of red blood cell (RBC) prescription to pediatric patients in different sectors of a pediatric hospital. METHOD: A retrospective study was conducted including 837/990 RBC transfusion requisition forms for children and adolescents (0 to 13 years old) filed in between January 2007 and April 2015 by the pediatricians of the emergency room (ER), infirmary ward and intensive care unit (pICU). Transfusion requisition forms belonging to patients with chronic anemia or acute hemorrhage, as well as incompletes requisition forms, were excluded. RESULTS: Trigger, prescribed volume and subtype of RBC concentrates were adequate in 532 (65.3%), 460 (58.8%) and 805 (96.2%) of the transfusions, respectively. When the clinical picture was considered, prescription adequacy was higher compared to the use of the hemoglobin level alone (70.9% vs. 41%). The pICU had the highest correct trigger percentage (343 [71.6%]; p<0.001) while the ER showed more often adequate prescribed volumes (119 [66.1%]; p=0.020). The most common inadequacy regarding volume was that of prescriptions above the recommendation > 15 mL/kg found in 309 cases (36.9%). Thirty-two (32) RBC subtypes were requested and none were consistent with current recommendations. CONCLUSION: The results obtained in our study showed that RBC transfusion occurred more appropriately when the clinical picture was taken into account at request. There was a tendency to prescribe higher volumes and RBC subtypes without the justification of current protocols. Hemotherapic teachings at undergraduate level and medical residency must be improved.

Assessment of the prescription of red blood cell concentrates in the pediatric age group / Avaliação da prescrição de concentrados de hemácias na faixa etária pediátrica

Summary Objective: To verify the adequacy of red blood cell (RBC) prescription to pediatric patients in different sectors of a pediatric hospital. Method: A retrospective study was conducted including 837/990 RBC transfusion requisition forms for children and adolescents (0 to 13 years old) filed in between January 2007 and April 2015 by the pediatricians of the emergency room (ER), infirmary ward and intensive care unit (pICU). Transfusion requisition forms belonging to patients with chronic anemia or acute hemorrhage, as well as incompletes requisition forms, were excluded. Results: Trigger, prescribed volume and subtype of RBC concentrates were adequate in 532 (65.3%), 460 (58.8%) and 805 (96.2%) of the transfusions, respectively. When the clinical picture was considered, prescription adequacy was higher compared to the use of the hemoglobin level alone (70.9% vs. 41%). The pICU had the highest correct trigger percentage (343 [71.6%]; p<0.001) while the ER showed more often adequate prescribed volumes (119 [66.1%]; p=0.020). The most common inadequacy regarding volume was that of prescriptions above the recommendation > 15 mL/kg found in 309 cases (36.9%). Thirty-two (32) RBC subtypes were requested and none were consistent with current recommendations. Conclusion: The results obtained in our study showed that RBC transfusion occurred more appropriately when the clinical picture was taken into account at request. There was a tendency to prescribe higher volumes and RBC subtypes without the justification of current protocols. Hemotherapic teachings at undergraduate level and medical residency must be improved.

Resumo Objetivo: Verificar a adequação na prescrição de concentrado de hemácias (CH) por pediatras em diferentes setores de um hospital pediátrico. Método: Realizou-se estudo retrospectivo onde avaliamos 837/990 fichas de requisição de CH para crianças e adolescentes (0 a 13 anos), preenchidas entre janeiro de 2007 e abril de 2015 pelos médicos pediatras do pronto-socorro (PS), da enfermaria e da unidade de terapia intensiva (UTI). Excluíram-se as transfusões realizadas em portadores de anemia crônica, crianças com hemorragia aguda e requisições incompletas. Resultados: Gatilho, volume prescrito e subtipo de concentrado de hemácias foram adequados em 532 (65,3%), 460 (58,8%) e 805 (96,2%) das transfusões, respectivamente. Quando foi considerado o quadro clínico, a adequação foi maior em comparação à prescrição pelo valor isolado da hemoglobina (70,9% vs. 41%). A UTI teve o maior percentual de acerto no gatilho (343 [71,6%]; p<0,001) e o PS, no volume prescrito (119 [66,1%]; p=0,020). A inadequação mais comum, em relação ao volume, foi a prescrição acima da recomendação (> 15 mL/kg, 309 [36,9%]). Foram solicitados 32 subtipos de CH e nenhum estava de acordo com as indicações atuais. Conclusão: Os resultados obtidos mostram que a transfusão de CH aconteceu de forma mais adequada quando a situação clínica era levada em conta na solicitação. Houve uma tendência à prescrição de volumes elevados e de subtipos de hemácias não justificados segundo os protocolos atuais. É necessário melhorar o ensino de hemoterapia na graduação e residência médica.

Anaerobic threshold employed on exercise training prescription and performance assessment for laboratory rodents: A short review.

Several studies have generated numerous terms in the field of exercise training prescription and performance assessment that often do not match the information previously demonstrated by many other works, generating much debate and resulting in an immense pool of scientific results. Several protocols in exercise training prescription and performance assessment have been proposed for these purposes by many reasons. In the field of exercise science, the protocol must be thoroughly investigated and provide real tools to be reproducible. Many laboratories have been adapting and developing evaluation protocols and testing on physical training of rodents in different experimental conditions. In this context, mice, rats and rabbits are preferentially chosen due to easy manipulation and good response to exercise, and comparable at results obtained with humans in compatible effort intensities. But, the exercise training programs and aerobic-anaerobic transition assessment proposed for animal models vary extensively, depending on the species, gender, age, type of stimulus, type of exercise, type of method and also on the specific objectives of the program. This short review demonstrates the need in offering tools performed by invasive measurement to assess the anaerobic threshold by blood lactate employed on evolution of aerobic-anaerobic parameters of rodents. The objective of this short review was to present and to discuss physical evaluation protocols applications to rodents. The table submitted may give a basis for anaerobic threshold employed on exercise training prescription and performance assessment for laboratory rodents in future research.

Utilização da lógica fuzzy na determinação da intensidade do exercício aeróbico / Use of fuzzy logic in determining the intensity of aerobic exercise / El uso de la lógica difusa en la determinación de la intensidad del ejercicio aeróbico

Considerando que as diretrizes de prescrição do treinamento aeróbio são gerais, alguns autores propuseram modelos que aumentem a precisão da prescrição. A lógica nebulosa tem sido utilizada para solução de problemas na área da saúde e sua utilização poderia melhorar o processo decisório sobre a intensidade com que cada indivíduo deverá se exercitar. O objetivo deste estudo é propor um modelo para determinação da intensidade do exercício aeróbio através da lógica nebulosa. Os conjuntos nebulosos foram moldados através de cinco variáveis de entrada, tendo como única variável de saída a intensidade do exercício. A partir desses conjuntos, foi desenvolvida uma matriz composta por 40 regras posteriormente incluídas no software MATLAB. A inferência e a defuzzyficação foram trabalhadas segundo os métodos de Mamdani e centro de área, respectivamente. O modelo desenvolvido é um aperfeiçoamento dos existentes na literatura e mostrouse promissor como estratégia de apoio à tomada de decisão para prescrição do treinamento aeróbio...

Since the prescribing guidelines of aerobic training are general, some authors have proposed modelsthat provide an increase in the accuracy of the prescription. Fuzzy logic has been used to solve problemsin the field of health and the use of this technique of artificial intelligence in exercise prescription could improve decision-making about the degree of intensity with which each individual must exercise himself. The objective of the present study is to propose a model for determining the intensity of aerobic exercise through a strategy of artificial intelligence (fuzzy logic). Fuzzy sets were shaped through five input variables having as output variable the intensity of the exercise. From these sets it was developed a matrix composed of 40 rules and subsequently these rules were included in the MATLAB software. The inference and the defuzzyfication were worked according to the methods of Mamdani and the center of area, respectively.The developed model is a refinement of those existing in the literature about the subject and proved to be apromising strategy giving support to the decision-making for the prescription of aerobic activities...

Teniendo en cuenta que las directrices de prescripción de entrenamiento aeróbico son generales, algunos autores han propuesto modelos para aumentar la precisión de la prescripción. La lógica difusa es utilizada com frequencia para resolver problemas en el cuidado de la salud y su uso podría mejorar la toma de decisiones dela intensidad con la cual cada individuo debe practicar el ejercicio. El objetivo de este estudio es proponer un modelo para determinar la intensidad del ejercicio aeróbico a través de la lógica difusa. Los conjuntos difusos se formaron a través de cinco variables de entrada, y la única variable de salida es la intensidad del ejercicio. Apartir de los conjuntos se ha desarrollado una matriz de 40 reglas más tarde incluidas en el software MATLAB. La inferencia y la defuzzyficación fueron elaboradas utilizando los métodos de Mamdani y el del centroide, respectivamente. El modelo es una mejora del modelo actual y se reveló prometedor como una estrategia de apoyo a la toma de decisiones para prescribir el entrenamiento aeróbico...

Orientação dos Prescritores do AE Tucuruvi quanto à Portaria 1535/06: critérios da prescrição para dispensação

Estratégia a fim de orientar os prescritores do Ambulatório de Especialidades do Tucuruvi (AE Tucuruvi) a prescreverem de acordo com a norma estabelecida pela PMSP (Prefeitura Municipal de São Paulo), uma vez que prescrições que não estão de acordo com a legislação vigente não podem ser atendidas nas farmácias pertencentes ao SUS, no município de São Paulo

Orientação dos Prescritores do AE Tucuruvi quanto à Portaria 1535/06: critérios da prescrição para dispensação / Prescribers orientation of the AE Tucuruvi regarding Ordinance 1535/06 - Criteria for Prescription dispensing

Estratégia a fim de orientar os prescritores do Ambulatório de Especialidades do Tucuruvi (AE Tucuruvi) a prescreverem de acordo com a norma estabelecida pela PMSP (Prefeitura Municipal de São Paulo), uma vez que prescrições que não estão de acordo com a legislação vigente não podem ser atendidas nas farmácias pertencentes ao SUS, no município de São Paulo(AU)

Physicians and pharmacists: collaboration to improve the quality of prescriptions in primary care in Mexico.

BACKGROUND: Inappropriate prescription is a relevant problem in primary health care settings in Mexico, with potentially harmful consequences for patients. OBJECTIVE: To evaluate the effectiveness of incorporating a pharmacist into primary care health team to reduce prescription errors for patients with diabetes and/or hypertension. SETTING: One Family Medicine Clinic from the Mexican Institute of Social Security in Mexico City. METHOD: A "pharmacotherapy intervention" provided by pharmacists through a quasi experimental (before-after) design was carried out. Physicians who allowed access to their diabetes and/or hypertensive patients' medical records and prescriptions were included in the study. Prescription errors were classified as "filling", "clinical" or "both". Descriptive analysis, identification of potential drug-drug interactions (pD-DI), and comparison of the proportion of patients with prescriptions with errors detected "before" and "after" intervention were performed. MAIN OUTCOME MEASURE: Decrease in the proportion of patients who received prescriptions with errors after the intervention. RESULTS: Pharmacists detected at least one type of error in 79 out of 160 patients. Errors were "clinical", "both" and "filling" in 47, 21 and 11 of these patient's prescriptions respectively. Predominant errors were, in the subgroup of patient's prescriptions with "clinical" errors, pD-DI; in the subgroup of "both" errors, lack of information on dosing interval and pD-DI; and in the "filling" subgroup, lack of information on dosing interval. The pD-DI caused 50 % of the errors detected, from which 19 % were of major severity. The impact of the correction of errors post-intervention was observed in 19 % of patients who had erroneous prescriptions before the intervention of the pharmacist (49.3-30.3 %, p < 0.05). CONCLUSION: The impact of the intervention was relevant from a clinical point of view for the public health services in Mexico. The implementation of early warning systems of the most widely prescribed drugs is an alternative for reducing prescription errors and consequently the risks they may cause.

Anvisa e o cirurgião-dentista: do controle de qualidade de insumos às normas de prescrição de antimicrobianos / Health agency and the dentist: antimicrobial prescription and quality control of health apparatus

O objetivo do presente trabalho é descrever e discutir as normas de prescrição de Antimicro¬bianos definidas pela Anvisa (Agência Nacional de Vigilância Sanitária], e suas atividades regu¬latórias. Sendo os Cirurgiões-Dentistas, dentre os profissionais de saúde, aptos a prescrever uma série de grupos medicamentosos, estes deverão conhecer as normas, viabilizando o uso racional de drogas. A RDC n° 44, de 26 de outubro de 2010 altera a forma de prescrição de antimicrobia¬nos, exigindo que o estabelecimento dispensador retenha cópia de receita de controle especial. A Anvisa, através da RDC n° 3, 4, e 5, de 2011, também modificou as exigências relativas à im¬portação de agulhas, dentre elas as gengivais de uso odontológico, objetivando a padronização de tais produtos em obediência às Boas Práticas de Fabricação (BPF). Os profissionais de saúde deverão estar cientes das modificações definidas pela Anvisa, a fim de garantir o maior controle na prescrição e venda de medicamentos, assim como do controle que essa Agência promove diante dos produtos de uso em saúde.

The objective of this study is to describe and discuss the limitations rules designed by Anvisa,as their regulatory activities. The dentists are able to prescribe medicines and they should be aware of the Legal Rules enabling the rational use of drugs. The Law number 44, October 26, 2010, considering the rule for antimicrobial prescription, requires the drugstore/pharmacy to dispense and to retain a copy of special control prescriptions. The Anvisa also changed the re¬quirements for needles importation, including the needles for dental use, aiming the standardi¬zation of such products in compliance with Good Manufacturing Practices. Health professionals should be aware of the changes to ensure greater control in prescribing medicines, as well as the control that this agency promotes considering the products used in Health.

Optimizing antimicrobial prescribing.

Antibiotics are universally prescribed drugs. Because they exert selective pressure and because of the innate bacterial ability for adaptation, even the appropriate clinical use of these potentially life-preserving agents inevitably fosters the development and spread of resistance by a variety of microorganisms. Inappropriate use has accelerated and increased the magnitude of a problem that is now considered a public health crisis. For Gram-positive pathogens some compounds offer limited hope, but for Gram-negative organisms no new drugs with radically increased spectra are available for clinical trials. Patients with serious infections due to multiresistant organisms are experiencing adverse, sometimes fatal, clinical outcomes. Use of multiple drugs increases side effects and exposes additional susceptible bacteria to selective pressure. There is evidence that the appropriate use of currently available antibiotics can be associated with a reduction of the spread of resistance. Antibiotic stewardship programmes and the antibiotic 'care bundle' approach can be effective measures to lengthen the useful life of antibiotics and can be implemented in most clinical situations.

Documentos médicos / Medical documents

O artigo ressalta os aspectos jurídicos dos documentos médicos, privilegiando a sua vocação como meios de prova em processos judiciais. Procurase trazer uma abordagem prática da questão dos documentos médicos, com vistas ao exercício profissional cotidiano e sem que se pretenda minimizar a importância da investigação aprofundada da matéria, e muito menos desvalorizar a finalidade principal desses documentos que decorre da sua natureza médica. Os principais instrumentos que retratam os cuidados prestados ao paciente, quais sejam Prontuário Médico, Termo de Consentimento Informado, Atestados e Receituário, são comentados sob o enfoque legal, buscando-se apontar quais características lhe conferem legitimidade jurídica

This article emphasizes the legal aspects of medical documents, giving priority to their potential use as evidence in legal proceedings. It seeks to provide a practical approach to the issue of medical documents, which is addressed to everyday professional practice but has no intention of minimizing the importance of a thorough investigation of the matter, and much less underestimating the main purpose of these documents arising from its medical nature. The main instruments that reflect the care delivered to the patient, namely, Medical Chart, Informed Consent Form, Certificates and Prescriptions, are discussed under the legal point of view, aiming to point out which features grant them legal legitimacy