Guías y algoritmos clínicos de tratamiento de la depresión en atención primaria: ¿son todos iguales? / Evaluation of clinical guidelines and algorithms for treatment of depression in primary care: are they all the same?

Objetivo. La consulta por depresión ocupa el 40% de las consultas al médico de asistencia primaria. Se buscan maneras de reorganizar el proceso de atención a la depresión integrando herramientas como el uso de guías y algoritmos clínicos. Objetivo. Ante la diversidad de opciones es importante conocer una o dos herramientas para aplicarlas adecuadamente. El objetivo es analizar y comparar las guías de tratamiento de la depresión con mayor difusión que incluyan la consulta de atención primaria. Material y métodos. Se realiza una revisión de la bibliografía encontrada en PubMed y en publicaciones de Sociedades Científicas. Las guías se comparan aplicando el instrumento «Appraisal of Guidelines Research and Evaluation Colaboration» (AGREE). Resultados. Los algoritmos de tratamiento tienen unas características comunes respecto el contenido, la secuenciación del tratamiento y la elección del antidepresivo. Se prefiere elegir la opción más sencilla, más eficaz y con menor riesgo. Existen diferencias en cuanto al rigor, participación de los implicados y aplicabilidad. Conclusiones. Las guías presentan más similitudes que diferencias. Las diferencias se hallan en las dimensiones rigor y participación. Ante el creciente número de guías y algoritmos se recomienda elegir uno y adaptarlo al territorio donde se interviene (AU)

Objective. Depression accounts for 40% of family doctor consultations. Ways of reorganising the process of care for depression are being looked for by integrating tools such as the use of clinical guidelines and algorithms. It is important to know of one or two tools and to implement them properly. The aim is to analyse and compare the guidelines for the treatment of depression in Primary Care cjinics. Material and methods. We reviewed of the literature found on PubMed and in publications of scientific societies. The guidelines are compared using the Appraisal of Guidelines Research and Evaluation Colaboration. Results. The processing algorithms have some common features regarding the content, sequencing of treatment and choice of antidepressant. The preferred choice should be easier, more efficient and less risk. There are differences in the rigor of the implications and applications. Conclusions. The guidelines have more similarities than differences. The differences are in size and participation rigor. With the increasing number of guidelines and algorithms it is recommended to choose one and adapt it to the area where it will be used (AU)

Competing symmetries and broken bonds in superconducting vortex-antivortex molecular crystals.

Hall probe microscopy has been used to image vortex-antivortex molecules induced in superconducting Pb films by the stray fields from square arrays of magnetic dots. We have directly observed spontaneous vortex-antivortex pairs and studied how they interact with added free (anti)fluxons in an applied magnetic field. We observe a variety of phenomena arising from competing symmetries which either drive added antivortices to join antivortex shells around dots or stabilize the translationally symmetric antivortex lattice between the dots. Added vortices annihilate antivortex shells, leading first to a stable "nulling state" with no free fluxons and then, at high densities, to vortex shells around the dots stabilized by the asymmetric antipinning potential. Our experimental findings are in good agreement with Ginzburg-Landau calculations.

Utilidad de sildenafilo en disfunciones sexuales secundarias a patología psiquiátrica y psicofármacos / Usefulness of sildenafil in sexual dysfunctions secondary to psychiatric disorders and psychotropic drugs

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