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      Maximizing the Potential of Patient-Reported Assessments by Using the Open-Source Concerto Platform With Computerized Adaptive Testing and Machine Learning

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          Abstract

          Patient-reported assessments are transforming many facets of health care, but there is scope to modernize their delivery. Contemporary assessment techniques like computerized adaptive testing (CAT) and machine learning can be applied to patient-reported assessments to reduce burden on both patients and health care professionals; improve test accuracy; and provide individualized, actionable feedback. The Concerto platform is a highly adaptable, secure, and easy-to-use console that can harness the power of CAT and machine learning for developing and administering advanced patient-reported assessments. This paper introduces readers to contemporary assessment techniques and the Concerto platform. It reviews advances in the field of patient-reported assessment that have been driven by the Concerto platform and explains how to create an advanced, adaptive assessment, for free, with minimal prior experience with CAT or programming.

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          Most cited references38

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          Dermatologist-level classification of skin cancer with deep neural networks

          Skin cancer, the most common human malignancy, is primarily diagnosed visually, beginning with an initial clinical screening and followed potentially by dermoscopic analysis, a biopsy and histopathological examination. Automated classification of skin lesions using images is a challenging task owing to the fine-grained variability in the appearance of skin lesions. Deep convolutional neural networks (CNNs) show potential for general and highly variable tasks across many fine-grained object categories. Here we demonstrate classification of skin lesions using a single CNN, trained end-to-end from images directly, using only pixels and disease labels as inputs. We train a CNN using a dataset of 129,450 clinical images—two orders of magnitude larger than previous datasets—consisting of 2,032 different diseases. We test its performance against 21 board-certified dermatologists on biopsy-proven clinical images with two critical binary classification use cases: keratinocyte carcinomas versus benign seborrheic keratoses; and malignant melanomas versus benign nevi. The first case represents the identification of the most common cancers, the second represents the identification of the deadliest skin cancer. The CNN achieves performance on par with all tested experts across both tasks, demonstrating an artificial intelligence capable of classifying skin cancer with a level of competence comparable to dermatologists. Outfitted with deep neural networks, mobile devices can potentially extend the reach of dermatologists outside of the clinic. It is projected that 6.3 billion smartphone subscriptions will exist by the year 2021 (ref. 13) and can therefore potentially provide low-cost universal access to vital diagnostic care.
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            Development of the World Health Organization WHOQOL-BREF Quality of Life Assessment

            (1998)
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              What Is Value in Health Care?

              New England Journal of Medicine, 363(26), 2477-2481
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                Author and article information

                Contributors
                Journal
                J Med Internet Res
                J Med Internet Res
                JMIR
                Journal of Medical Internet Research
                JMIR Publications (Toronto, Canada )
                1439-4456
                1438-8871
                October 2020
                29 October 2020
                : 22
                : 10
                : e20950
                Affiliations
                [1 ] Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences University of Oxford Oxford United Kingdom
                [2 ] The Psychometrics Centre University of Cambridge Cambridge United Kingdom
                [3 ] MD Anderson Center for INSPiRED Cancer Care University of Texas Houston, TX United States
                Author notes
                Corresponding Author: Conrad Harrison conrad.harrison@ 123456medsci.ox.ac.uk
                Author information
                https://orcid.org/0000-0002-1428-5751
                https://orcid.org/0000-0001-6310-1608
                https://orcid.org/0000-0003-1969-7146
                https://orcid.org/0000-0002-4732-7305
                Article
                v22i10e20950
                10.2196/20950
                7661245
                33118937
                fcef4747-f9b6-414e-94a6-9ed4c199b762
                ©Conrad Harrison, Bao Sheng Loe, Przemysław Lis, Chris Sidey-Gibbons. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 29.10.2020.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on http://www.jmir.org/, as well as this copyright and license information must be included.

                History
                : 2 June 2020
                : 21 July 2020
                : 28 July 2020
                : 18 August 2020
                Categories
                Tutorial
                Tutorial

                Medicine
                computerized adaptive testing,computerized adaptive test,cat,machine learning,patient reported outcome measures,outcome assessment,concerto

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