European Psychiatric Association Guidance on psychotherapy in chronic depression across Europe

PURPOSE: Patients with chronic depression (CD) by definition respond less well to standard forms of psychotherapy and are more likely to be high utilizers of psychiatric resources. Therefore, the aim of this guidance paper is to provide a comprehensive overview of current psychotherapy for CD. The evidence of efficacy is critically reviewed and recommendations for clinical applications and research are given. METHODS: We performed a systematic literature search to identify studies on psychotherapy in CD, evaluated the retrieved documents and developed evidence tables and recommendations through a consensus process among experts and stakeholders. RESULTS: We developed 5 recommendations which may help providers to select psychotherapeutic treatment options for this patient group. The EPA considers both psychotherapy and pharmacotherapy to be effective in CD and recommends both approaches. The best effect is achieved by combined treatment with psychotherapy and pharmacotherapy, which should therefore be the treatment of choice. The EPA recommends psychotherapy with an interpersonal focus (e.g. the Cognitive Behavioural Analysis System of Psychotherapy [CBASP]) for the treatment of CD and a personalized approach based on the patient's preferences. DISCUSSION: The DSM-5 nomenclature of persistent depressive disorder (PDD), which includes CD subtypes, has been an important step towards a more differentiated treatment and understanding of these complex affective disorders. Apart from dysthymia, ICD-10 still does not provide a separate entity for a chronic course of depression. The differences between patients with acute episodic depression and those with CD need to be considered in the planning of treatment. Specific psychotherapeutic treatment options are recommended for patients with CD. CONCLUSION: Patients with chronic forms of depression should be offered tailored psychotherapeutic treatments that address their specific needs and deficits. Combination treatment with psychotherapy and pharmacotherapy is the first-line treatment recommended for CD. More research is needed to develop more effective treatments for CD, especially in the longer term, and to identify which patients benefit from which treatment algorithm.

Non-metastatic castrate-resistant prostate cancer: a call for improved guidance on clinical management.

BACKGROUND Guidelines on the clinical management of non-metastatic castrate-resistant prostate cancer (nmCRPC) generally focus on the need to continue androgen deprivation therapy and enrol patients into clinical trials of investigational agents. This guidance reflects the lack of clinical trial data with established agents in the nmCRPC patient population and the need for trials of new agents. AIM To review the evidence base and consider ways of improving the management of nmCRPC. CONCLUSION Upon the development of castrate resistance, it is essential to rule out the presence of metastases or micrometastases by optimising the use of bone scans and possibly newer procedures and techniques. When nmCRPC is established, management decisions should be individualised according to risk, but risk stratification in this diverse population is poorly defined. Currently, prostate-specific antigen (PSA) levels and PSA doubling time remain the best method of assessing the risk of progression and response to treatment in nmCRPC. However, optimising imaging protocols can also help assess the changing metastatic burden in patients with CRPC. Clinical trials of novel agents in nmCRPC are limited and have problems with enrolment, and therefore, improved risk stratification and imaging may be crucial to the improved management. The statements presented in this paper, reflecting the views of the authors, provide a discussion of the most recent evidence in nmCRPC and provide some advice on how to ensure these patients receive the best management available. However, there is an urgent need for more data on the management of nmCRPC.

Feasibility of stereotactic MRI-based image guidance for the treatment of vascular malformations: a phantom study.

PURPOSE Treatment of vascular malformations requires the placement of a needle within vessels which may be as small as 1 mm, with the current state of the art relying exclusively on two-dimensional fluoroscopy images for guidance. We hypothesize that the combination of stereotactic image guidance with existing targeting methods will result in faster and more reproducible needle placements, as well as reduced radiationexposure, when compared to standard methods based on fluoroscopy alone. METHODS The proposed navigation approach was evaluated in a phantom experiment designed to allow direct comparison with the conventional method. An anatomical phantom of the left forearm was constructed, including an independent control mechanism to indicate the attainment of the target position. Three interventionalists (one inexperienced, two of them frequently practice the conventional fluoroscopic technique) performed 45 targeting attempts utilizing the combined and 45 targeting attempts utilizing the standard approaches. RESULTS In all 45 attempts, the users were able to reach the target when utilizing the combined approach. In two cases, targeting was stopped after 15 min without reaching the target when utilizing only the C-arm. The inexperienced user was faster when utilizing the combined approach and applied significantly less radiation than when utilizing the conventional approach. Conversely, both experienced users were faster when using the conventional approach, in one case significantly so, with no significant difference in radiation dose when compared to the combined approach. CONCLUSIONS This work presents an initial evaluation of a combined navigation fluoroscopy targeting technique in a phantom study. The results suggest that, especially for inexperienced interventionalists, navigation may help to reduce the time and the radiation dose. Future work will focus on the improvement and clinical evaluation of the proposed method.

Safe abortion: technical and policy guidance for health systems

Esta 2da edición de la Guía recoge la última evidencia disponible no sólo respecto de la atención del aborto seguro sino también de cómo deben organizarse los recursos humanos, los insumos y las instituciones de salud para garantizar los derechos humanos, incluyendo los derechos sexuales y reproductivos de las mujeres.

Practice advisory: interim guidance for care of obstetric patients during a zika virus outbreak

Zika during pregnancy has been associated with birth defects, specifically significant microcephaly. Transmission of Zika to the fetus has been documented in all trimesters; Zika virus RNA has been detected in fetal tissue from early missed abortions, amniotic fluid, term neonates and the placenta. However, much is not yet known about Zika virus in pregnancy. Uncertainties include the incidence of Zika virus infection among pregnant women in areas of Zika virus transmission, the rate of vertical transmission and the rate with which infected fetuses manifest complications such as microcephaly or demise. The absence of this important information makes management and decision making in the setting of potential Zika virus exposure (i.e. travel to endemic areas) or maternal infection, difficult. Currently, there is no vaccine or treatment for this infection.

The XXI century guidance and its social responsibility

El presente trabajo tiene como finalidad considerar la orientación del siglo XXI en Venezuela como una disciplina con un alto compromiso social. Como programa, debe, hoy día, redefinirse con el objeto de impulsar propuestas conducentes a la inclusión de todas aquellas personas, que tradicionalmente han sido excluidas por su raza, etnia, género y/o discapacidad física y que como praxis social esté dirigida a la facilitación de los procesos de desarrollo humano en las dimensiones del Ser, Convivir, Servir, Conocer y Hacer, en el contexto personal, familiar y comunitario a lo largo del continuo del ciclo vital. L as competencias adquiridas a través de los procesos de orientación, son determinantes para proporcionar los medios a las ciudadanas y los ciudadanos para gestionar su propio desarrollo y el de su comunidad Se plantea la necesidad de un cambio de paradigma que deje atrás la clásica postura de un orientador que ayuda al orientado, desde el que conoce, el que tiene experiencia. Se sugiere más bien una relación de orientación intersubjetiva. Por otra parte, se habla de la necesidad de fortalecer el capital social de los espacios que contextualizan el proceso orientador. Se explican además, los alcances del Sistema Nacional de Orientación.

Equity and guidance : The challenge of a proposal

La presente propuesta corresponde a un proyecto de extensión universitaria, acreditado y subsidiado por la Secretaría de Extensión Universitaria de la Universidad Nacional de La Plata. Este plan de trabajo interinstitucional e interdisciplinario formó parte de una de las acciones de transferencia de nuestro último proyecto de investigación denominado La Orientación Vocacional Ocupacional en escuelas denominadas de alta vulnerabilidad psicosocial.

Career guidance in Denmark : Social control in a velvet glove

La Orientación Vocacional en Dinamarca está bien organizada y es altamente profesional. Esto refleja una política orientadora centrada en el papel que la orientación juega como instrumento en el ejercicio de un leve control social. Con este telón de fondo, el dilema de la Orientación en Dinamarca reside en el delicado equilibrio existente entre la orientación considerada como una herramienta para el desarrollo personal, y como un instrumento de control social.

Vocational guidance in people with special educational needs as the result of visual impairment during the transition stage from high school to advanced education

This work proposes to seek for the factors related to the choices that people with special educational needs make as the result of the visual impairment, during the transition stage from high school to advanced education. Therefore, we have taken into consideration that Vocational Guidance and the transition towards adulthood get specific characteristics in case of visually impaired young people, particularly in what's related to continue with advanced education. The focus of this work is to be able to clarify the existence of factors that make this transition stage easier or harder, through the observation of visually impaired and blind people who complete high school. This matter has aroused interest and concern about the strategies to follow to ensure the successful entrance and remaining in the selected advanced education. However, if we don?t know the factors involved in the described fact, it's difficult to design an appropriate intervention strategy. Then, in order to take acknowledge about the specific issues of visually impaired young people who complete high school, we chose a special school for this disability and some students who will join this project

Career guidance in Quebec, Canadá

First, the guidance counselor profession in the province of Quebec will be described: the professional association to which it belongs, the required in- struction, the counselors' tasks and the institutions for which they work. There follows the description of the main current tendencies in career guidance devel- opment in this French-speaking area of Canada with about 7.2 million inhabit- ants, approximately one fourth of the total country population. Finally, a brief description of the Center for Research on Education and Labor of the University of Shebrooke as well as of some instruments that one of the teams is constructing will be provided.

Model of ICT skills and new professional profile of the Guidance Counsellors in some European countries

El artículo analiza la utilización de las Tecnologías de la Información y Comunicación en el escenario de algunos países europeos en el ámbito de la Orientación Educativa y Profesional.