La terapia biológica en las enfermedades reumáticas

Inclou referències bibliogràfique

An overview of ensemble and feature learning in few-shot image classification using siamese networks

Siamese Neural Networks (SNNs) constitute one of the most representative approaches for addressing Few-Shot Image Classification. These schemes comprise a set of Convolutional Neural Network (CNN) models whose weights are shared across the network, which results in fewer parameters to train and less tendency to overfit. This fact eventually leads to better convergence capabilities than standard neural models when considering scarce amounts of data. Based on a contrastive principle, the SNN scheme jointly trains these inner CNN models to map the input image data to an embedded representation that may be later exploited for the recognition process. However, in spite of their extensive use in the related literature, the representation capabilities of SNN schemes have neither been thoroughly assessed nor combined with other strategies for boosting their classification performance. Within this context, this work experimentally studies the capabilities of SNN architectures for obtaining a suitable embedded representation in scenarios with a severe data scarcity, assesses the use of train data augmentation for improving the feature learning process, introduces the use of transfer learning techniques for further exploiting the embedded representations obtained by the model, and uses test data augmentation for boosting the performance capabilities of the SNN scheme by mimicking an ensemble learning process. The results obtained with different image corpora report that the combination of the commented techniques achieves classification rates ranging from 69% to 78% with just 5 to 20 prototypes per class whereas the CNN baseline considered is unable to converge. Furthermore, upon the convergence of the baseline model with the sufficient amount of data, still the adequate use of the studied techniques improves the accuracy in figures from 4% to 9%.First author is supported by the “Programa I+D+i de la Generalitat Valenciana” through grant APOSTD/2020/256. This research work was partially funded by the Spanish “Ministerio de Ciencia e Innovación” and the European Union “NextGenerationEU/PRTR” programmes through project DOREMI (TED2021-132103A-I00). Open Access funding provided thanks to the CRUE-CSIC agreement with Springer Nature

Clinical Case Management for Patients with Schizophrenia with High Care Needs

The aim of this study is to establish the effectiveness of a clinical case management (CM) programme compared to a standard treatment programme (STP) in patients with schizophrenia. Patients for the CM programme were consecutively selected among patients in the STP with schizophrenia who had poor functioning. Seventy-five patients were admitted to the CM programme and were matched to 75 patients in the STP. Patients were evaluated at baseline and at 1 year follow-up. At baseline, patients in the CM programme showed lower levels of clinical and psychosocial functioning and more care needs than patients in the STP. Both treatment programmes were effective in maintaining contact with services but the CM programme did not show advantages over the STP on outcomes. Differences between groups at baseline may be masking the effects of CM at one year follow-up. A longer follow-up may be required to evaluate the real CM practices effect

Statistical semi-supervised system for grading multiple peer-reviewed open-ended works

In the education context, open-ended works generally entail a series of benefits as the possibility of develop original ideas and a more productive learning process to the student rather than closed-answer activities. Nevertheless, such works suppose a significant correction workload to the teacher in contrast to the latter ones that can be self-corrected. Furthermore, such workload turns to be intractable with large groups of students. In order to maintain the advantages of open-ended works with a reasonable amount of correction effort, this article proposes a novel methodology: students perform the corrections using a rubric (closed Likert scale) as a guideline in a peer-review fashion; then, their markings are automatically analyzed with statistical tools to detect possible biased scorings; finally, in the event the statistical analysis detects a biased case, the teacher is required to intervene to manually correct the assignment. This methodology has been tested on two different assignments with two heterogeneous groups of people to assess the robustness and reliability of the proposal. As a result, we obtain values over 95% in the confidence of the intra-class correlation test (ICC) between the grades computed by our proposal and those directly resulting from the manual correction of the teacher. These figures confirm that the evaluation obtained with the proposed methodology is statistically similar to that of the manual correction of the teacher with a remarkable decrease in terms of effort.This work has been supported by the Vicerrectorado de Calidad e Innovación Educativa-Instituto de Ciencias de la Educación of the Universidad de Alicante (2016-17 edition) through the Programa de Redes-I3CE de investigación en docencia universitaria (ref. 3690)

Review of psychotherapeutic interventions for people with schizophrenia

In recent years, various clinical practice guidelines have been developed for people with schizophrenia recommending different psychotherapeutic interventions. The objective of this study is to identify, review and compare the recommendations in these guidelines on the efficacy of psychotherapeutic interventions in schizophrenia. We conducted a computerized search of the main clinical practice guideline developers and repositories, identifying five different clinical practice guidelines. We extracted descriptive information from each and compared their recommendations on the efficacy of psychotherapeutic interventions. They were evidence-based consensus guidelines developed by multidisciplinary groups. Family intervention, cognitive behavioural therapy (CBT), social skills training, arts therapies, cognitive rehabilitation, psychoeducation, psychodynamic psychotherapy and counselling were recommended in the identified guidelines. There was strong consensus on the efficacy of CBT and family intervention and high-quality evidence supporting their use. When choosing psychotherapeutic interventions for people with schizophrenia, it is recommended that mental health professionals take clinical practice guidelines into account as well as the setting in which they are being applied, since implementation of health-care interventions is associated with the characteristics of the service system. Schizophrenia treatment should include biological, psychosocial and community intervention

Identifying Student Profiles Within Online Judge Systems Using Explainable Artificial Intelligence

Online Judge (OJ) systems are typically considered within programming-related courses as they yield fast and objective assessments of the code developed by the students. Such an evaluation generally provides a single decision based on a rubric, most commonly whether the submission successfully accomplished the assignment. Nevertheless, since in an educational context such information may be deemed insufficient, it would be beneficial for both the student and the instructor to receive additional feedback about the overall development of the task. This work aims to tackle this limitation by considering the further exploitation of the information gathered by the OJ and automatically inferring feedback for both the student and the instructor. More precisely, we consider the use of learning-based schemes—particularly, Multi-Instance Learning and classical Machine Learning formulations—to model student behaviour. Besides, Explainable Artificial Intelligence is contemplated to provide human-understandable feedback. The proposal has been evaluated considering a case of study comprising 2,500 submissions from roughly 90 different students from a programming-related course in a Computer Science degree. The results obtained validate the proposal: the model is capable of significantly predicting the user outcome (either passing or failing the assignment) solely based on the behavioural pattern inferred by the submissions provided to the OJ. Moreover, the proposal is able to identify prone-to-fail student groups and profiles as well as other relevant information, which eventually serves as feedback to both the student and the instructor.This work has been partially funded by the “Programa Redes-I3CE de investigacion en docencia universitaria del Instituto de Ciencias de la Educacion (REDES-I3CE-2020-5069)” of the University of Alicante. The third author is supported by grant APOSTD/2020/256 from “Programa I+D+I de la Generalitat Valenciana”

Revisión de intervenciones psicoterapéuticas para personas con esquizofrenia

In recent years, various clinical practice guidelines have been developed for people with schizophrenia recommending different psychotherapeutic interventions. The objective of this study is to identify, review and compare the recommendations in these guidelines on the efficacy of psychotherapeutic interventions in schizophrenia. We conducted a computerized search of the main clinical practice guideline developers and repositories, identifying five different clinical practice guidelines. We extracted descriptive information from each and compared their recommendations on the efficacy of psychotherapeutic interventions. They were evidence-based consensus guidelines developed by multidisciplinary groups. Family intervention, cognitive behavioural therapy (CBT), social skills training, arts therapies, cognitive rehabilitation, psychoeducation, psychodynamic psychotherapy and counselling were recommended in the identified guidelines. There was strong consensus on the efficacy of CBT and family intervention and high-quality evidence supporting their use. When choosing psychotherapeutic interventions for people with schizophrenia, it is recommended that mental health professionals take clinical practice guidelines into account as well as the setting in which they are being applied, since implementation of health-care interventions is associated with the characteristics of the service system. Schizophrenia treatment should include biological, psychosocial and community interventionsEn los últimos años han aparecido varias guías de práctica clínica para personas con esquizofrenia que recomiendan diversas intervenciones psicoterapéuticas. El objetivo de este estudio es identificar, revisar y comparar las recomendaciones sobre la eficacia de las intervenciones psicoterapéuticas en la esquizofrenia de estas guías. Se realizó una búsqueda electrónica sobre la esquizofrenia en los principales elaboradores y repositorios de guías de práctica clínica. Se identificaron cinco guías de práctica clínica. Se extrajeron datos descriptivos de cada una y se compararon sus recomendaciones sobre las intervenciones psicoterapéuticas. Las guías fueron desarrolladas por grupos multidisciplinarios, consensuadas y se basaban en la evidencia. El arte terapia, la terapia cognitivo-conductual (TCC), la rehabilitación cognitiva, el asesoramiento, la intervención familiar, la psicoterapia psicodinámica, la psicoeducación y entrenamiento en habilidades sociales se recomendaban en las guías identificadas. Hubo un alto consenso sobre la eficacia de la TCC y de la intervención familiar, así como evidencias de alta calidad que apoyaban su uso. Al elegir intervenciones psicoterapéuticas para personas con esquizofrenia, se recomienda que los profesionales de la salud mental tengan en cuenta las guías de práctica clínica y el contexto en el que se ofrecerán ya que las características del sistema están asociadas a la implementación de estas intervenciones. El tratamiento de la esquizofrenia debe incluir intervenciones biológicas, psicosociales y comunitaria

Validation of the modified DUKE-UNC functional social support questionnaire in patients with schizophrenia

Abstract Purpose: The modified DUKE-UNC Functional Social Support Questionnaire (FSSQ) is considered an assessment tool for patients with schizophrenia. However, it has not been validated in this patient population. This issue is addressed here by examining the tool's psychometric properties in a clinical sample of patients with schizophrenia. Methods: Two hundred and forty-one patients from 10 Adult Mental Health Centres (AMHC) meeting the following inclusion criteria were included: 1) International Classification of Diseases-10 (ICD-10) diagnosis of schizophrenia; 2) Global Assessment of Functioning (GAF) scores ≤50; 3) Illness duration of more than 2 years; and 4) Clinical stability. Patients were evaluated at baseline and at one-year follow-up for clinical and psychosocial variables. Results: The factor analysis revealed two factors that explained 54.15% of the variance. Internal consistency was excellent for the total FSSQ (0.87 at baseline and 0.88 at one year follow-up) and ranged between adeq uate and excellent for FSSQ domains. Correlations between FSSQ scores and those of global functioning, psychiatric symptoms, disability and quality of life ranged between small and large. There were significant differences between groups of patients with schizophrenia in FSSQ scores. Patients with higher levels of somatic complaints and patients who were disabled scored significantly lower in some or all FSSQ scores. After one-year follow-up, patients improved in overall functioning and there was a decrease in psychiatric symptoms. Conclusions: The FSSQ is a reliable and valid instrument for the assessment of perceived social support in patients with schizophrenia

Revisión de intervenciones psicoterapéuticas para personas con esquizofrenia

In recent years, various clinical practice guidelines have been developed for people with schizophrenia recommending different psychotherapeutic interventions. The objective of this study is to identify, review and compare the recommendations in these guidelines on the efficacy of psychotherapeutic interventions in schizophrenia. We conducted a computerized search of the main clinical practice guideline developers and repositories, identifying five different clinical practice guidelines. We extracted descriptive information from each and compared their recommendations on the efficacy of psychotherapeutic interventions. They were evidence-based consensus guidelines developed by multidisciplinary groups. Family intervention, cognitive behavioural therapy (CBT), social skills training, arts therapies, cognitive rehabilitation, psychoeducation, psychodynamic psychotherapy and counselling were recommended in the identified guidelines. There was strong consensus on the efficacy of CBT and family intervention and high-quality evidence supporting their use. When choosing psychotherapeutic interventions for people with schizophrenia, it is recommended that mental health professionals take clinical practice guidelines into account as well as the setting in which they are being applied, since implementation of health-care interventions is associated with the characteristics of the service system. Schizophrenia treatment should include biological, psychosocial and community interventionsEn los últimos años han aparecido varias guías de práctica clínica para personas con esquizofrenia que recomiendan diversas intervenciones psicoterapéuticas. El objetivo de este estudio es identificar, revisar y comparar las recomendaciones sobre la eficacia de las intervenciones psicoterapéuticas en la esquizofrenia de estas guías. Se realizó una búsqueda electrónica sobre la esquizofrenia en los principales elaboradores y repositorios de guías de práctica clínica. Se identificaron cinco guías de práctica clínica. Se extrajeron datos descriptivos de cada una y se compararon sus recomendaciones sobre las intervenciones psicoterapéuticas. Las guías fueron desarrolladas por grupos multidisciplinarios, consensuadas y se basaban en la evidencia. El arte terapia, la terapia cognitivo-conductual (TCC), la rehabilitación cognitiva, el asesoramiento, la intervención familiar, la psicoterapia psicodinámica, la psicoeducación y entrenamiento en habilidades sociales se recomendaban en las guías identificadas. Hubo un alto consenso sobre la eficacia de la TCC y de la intervención familiar, así como evidencias de alta calidad que apoyaban su uso. Al elegir intervenciones psicoterapéuticas para personas con esquizofrenia, se recomienda que los profesionales de la salud mental tengan en cuenta las guías de práctica clínica y el contexto en el que se ofrecerán ya que las características del sistema están asociadas a la implementación de estas intervenciones. El tratamiento de la esquizofrenia debe incluir intervenciones biológicas, psicosociales y comunitaria

Current case management models

Case management is one of the principal components of service delivery in mental health services. Over time, it has evolved into new models, and various meta-analytic studies have been carried out to establish its effects. Those studies have yielded non-homogeneous results, which might be related in part to the progress of case management models. Therefore, there is a need to understand the relationship between CM models and CM effects. This paper deals with this issue by reviewing and updating the literature regarding case management models and effects in order to help understand its current role and suggest how CM could be reorganized. Assertive community treatment and any other case management model seem to have fused and turned into two models that differ mainly with regard to the intensity of care provided to patients. The results of the meta-analyses on the efficacy/effectiveness of case management are not homogeneous across all studies, which seems to be related to the case management model used and the strictness of the methodology followed. When the model of case management used is congruent with clinical practice, the results favor case management over standard care and show that intensive and non-intensive case management may be provided depending on the previous use of hospital resources. Our paper suggests that case management models could be reconfigured by offering an intensity of care based on patients'needs