• 제목/요약/키워드: Clinical Reasoning

검색결과 86건 처리시간 0.033초

유전자 알고리즘과 나이브 베이지언 기법을 이용한 의료 노모그램 생성 방법 (A Clinical Nomogram Construction Method Using Genetic Algorithm and Naive Bayesian Technique)

  • 이건명;김원재;윤석중
    • 한국지능시스템학회논문지
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    • 제19권6호
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    • pp.796-801
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    • 2009
  • 복잡한 진단이나 예측 모델은 계산이 복잡하고 추론 과정을 해석하기 어렵기 때문에 임상현장에서 널리 사용되지 않고 있다. 의료 종사자들은 이러한 복잡한 모델 대신에, 복잡한 함수를 컴퓨터 등을 사용하지 않고도 쉽게 계산할 수 있도록 수치 관계를 그래픽으로 표현한 노모그램을 사용해 왔다. 의료분야에서 질병의 진단과 질병예후의 예측은 매우 주요한 관심사이다. 노모그램은 증상검사결과치료이력질병의 진단 결과 등의 속성을 포함한 임상 데이터들로부터 만들어진다. 노모그램을 만들 때는 가용한 여러 가지 속성 중에서 효과적인 것들을 찾아야 하고, 경우에 따라서는 속성에 대한 파라미터를 함께 결정해야 한다. 이 논문에서는 효과적인 속성과 파라미터를 선택하기 위해 유전자 알고리즘을 사용하고, 노모그램을 생성하기 위해 나이브 베이지언 기법을 사용하는 방법을 제안한다. 또한 제안한 방법을 실제 임상 데이터에 적용한 결과를 보인다.

베이지안 망에 기초한 불임환자 임상데이터의 분석 (Bayesian Network-Based Analysis on Clinical Data of Infertility Patients)

  • 정용규;김인철
    • 정보처리학회논문지B
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    • 제9B권5호
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    • pp.625-634
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    • 2002
  • 본 논문에서는 베이지안 망을 기초로 불임환자의 임상 데이터에 대한 다양한 분석 실험을 전개하였다. 이 실험을 통해 임신여부에 영향을 주는 요인들간의 상호의존성을 분석해보고, 또 NBN, BAN, GBN 등 제약조건이 다른 다양한 유형의 베이지안 망 분류기들의 분류성능을 서로 비교해보았다. 그리고 우리는 이와 같은 실험을 통해 임신가능여부(Clin)에 직접적인 영향을 미치는 중요한 요인들로 증상(IND), 약물치료법(stimulation), 여성의 나이(FA), 미세조작 난자의 수(ICT), Wallace 사용여부(ETM) 등 5개의 특성들을 가려낼 수 있었고, 이 요인들간의 상호 의존성도 찾아낼 수 있었다. 또 서로 다른 유형의 베이지안 망 분류기들 중에서 요인들간의 상호의존관계를 허용하는 좀 더 일반적인 BAN과 GBN 등이 그렇지 못한 NBN에 비해 상대적으로 더 높은 분류 성능을 보여준다는 것을 확인하였다. 또 결정트리와 k-최근접 이웃과 같은 다른 분류기들과의 성능 비교를 통해, 임상 데이터의 특성상 확률적 표현과 추론에 기초한 베이지안 망 분류기들이 보다 높은 성능을 보여준다는 사실도 확인할 수 있었다. 또 본 논문에서는 클래스 노드의 Markov blanket에 속한 특성들로 특성집합을 축소하는 것을 제안하고, 실험을 통해 이 특성 축소방법이 베이지안 망 분류기들의 성능을 높여 줄 수 있는지 알아보았다.

산소 에틸렌 토치로 동파이프 절단작업 후 발생한 이산화질소 중독에 의한 비심인성 폐부종 1례 (A Case of Non-cardiogenic Pulmonary Edema caused by Nitrogen Dioxide Poisoning after Cutting Copper Pipe with an Oxyethylene Torch)

  • 제갈양진;안종준;서광원;차희정;권운정;김양호
    • 대한임상독성학회지
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    • 제4권2호
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    • pp.175-179
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    • 2006
  • Welders are exposed to a number of hazards including metal fumes, toxic gases, electricity, heat, noise, and radiation such as ultraviolet and infrared light. We encountered a patient who developed non-cardiogenic pulmonary edema within a day after cutting copper pipe with an oxyethylene torch. The patient was a 26-year-old welder. He complained of dyspnea, generalized myalgia, and febrile sensation the following morning. The patient's chest X-ray and chest CT scan showed extensively distributed and ill-defined centrilobular nodules. Both his symptoms and chest X-ray abnormalities improved spontaneously. We attributed the patient's symptoms to non-cardiogenic pulmonary edema due to nitrogen dioxide, reasoning that: 1) the pipe consisted only of copper, according to material safety data sheet (MSDS); 2) a previous report in the literature demonstrated increased nitrogen dioxide levels under similar conditions; 3) the patient's clinical course and radiologic findings were very reminiscent of non-cardiogenic pulmonary edema following accidental exposure to nitrogen dioxide.

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현대 361개 경혈체계를 마련한 19세기 『침구봉원』의 침구의학과 침구경락 음양론 발전상 의의 (History of Acupuncture Medicine Witnessed the Setting of Modern Set of 361 Acupoints in the Classical Title of 19th Century, 『Exploring the Origin of Acupuncture Medicine (針灸逢源)』)

  • 정일경;이혜정;인창식
    • 턱관절균형의학회지
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    • 제9권1호
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    • pp.1-3
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    • 2019
  • Objectives: "Exploring the origin of acupuncture medicine (針灸逢源)", a classical title of acupuncture medicine in the 19th century, has been reviewed with focus on its impact on the standardization of acupoint in the history of acupuncture medicine as an approach of yin-yang balancing medicine like the Temporomandibular joint Balancing Medicine. Methods: A narrative review of literature was performed with a focus on continuous development and revision of the knowledge system of acupuncture medicine in medical education and clinical application. Results: This title has provided a systematized knowledge on acupoint-acupuncutre including 361 acupoints, acupoint location, and acupoint-meridian association, which was adopted as a frame of core knowledge in modern acupuncture medicine. Critical review and rational reasoning on previously accepted but apparently incongruous strips of knowledge led to the accomplishment of this title. Conclusions: This title provided a revised and standard knowledge system in the field of medical education and clinical practice of acupuncture medicine, and also provided an exemplary model of unrelenting change and development of an approach based on the concept of yin-yang balance such as acupuncture medicine and the Temporomandibular joint Balancing Medicine.

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A Case Note on the Medical Negligence of Traditional Chinese Herbal Medicine in the UK

  • Lee, Hai Woong
    • 대한예방한의학회지
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    • 제18권3호
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    • pp.105-115
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    • 2014
  • Objective : Traditional medicine (TM) has been playing its role in national healthcare system and it is taken as complementary and alternative medicine (CAM) from the viewpoint of modern Western medicine. In the UK, not a few practitioners of Traditional Chinese Medicine (TCM) are working as CAM practitioners using herbal medicine and acupuncture therapy. Cases of dispute in the TCM practice are not rare these days because patients who take TCM service are increasing by year. Method : In the UK, dispute cases of the Traditional Medicine of East Asia can be found these days, however, it is hard to find a reported court case. A medical dispute case of TCM will be analysed to see the legal management and the resolving principle in the alternative medicine practice with some cases of Korean Medicine (KM) being discussed. Results : The usual pattern of clinical negligence can be discussed from the points of a duty of care, breach of that duty by negligence, and the harm to the patient from that breach of duty. The judge followed this procedure In this case to discuss the claims. The department of health proposed to introduce regulation to provide the reasonable quality in TCM practice, and the governmental system would be essential to regulate both the TCM practice and practitioners. Conclusion : The dispute case of traditional Chinese herbal medicine (TCHM) practice is important for the clinical negligence in TCHM practice. Judging the negligence of a TCHM practitioner involves the conventional negligence principle in tort law, and the TCHM practitioners are required to keep up with the up-to-date information on the related medical specialty. The reasoning is almost the same as that shown in the court case of Korea. The TCHM practice in the UK needs to be under the regulation by the government. The standard of care we expect of a TCHM practitioner is a further matter to discuss from the healthcare and social viewpoints.

'한의학 과학화'명제에서 과학의 개념과 과학화의 목록 (Concept of Science and Indices of Scientification in the Task of 'Scientification of Korean Medicine')

  • 지규용
    • 동의생리병리학회지
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    • 제33권6호
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    • pp.303-310
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    • 2019
  • In order to search for the causes of having difficulty with the scientification task of the Korean medicine, the definition and conception of science were reviewed first and then formalization of reasoning scheme and a practical method of scientification were proposed. Science in its definition is meant by foundation of method and system for production of scientific knowledge not by knowledge of science itself. The formation of science is composed of complex processes including not only scientific knowledge but also politicosocial output containing activity of scientist society, spreading of social value and intercommunication. The production of scientific knowledge of Korean medicine is begun from logicality of the differential diagnosis and treatment theory through abductive verification of analogical inference by yinyang and 5 phase theory. For the commensurability between the various heterogenic theories within Korean medicine, the scientific activity of collecting, compiling, analyzing, distributing, and discussing the significant knowledge gained through abductive verification in the experiment and clinical process should be formed broadly. Based on these knowledge database, organization of scientist society with Korean medicine, life science, medical engineering, social expansion and generalization of pattern conception, and then social propagation and contribution for national health should be driven forward.

수술 후 재활 사례 기반의 시뮬레이션 교과 운영이 학습성과에 미치는 효과 (Effects of Simulation based Training using a Post-operating Rehabilitation Case on Learning Outcomes)

  • 오혜경;전은영
    • 재활간호학회지
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    • 제17권2호
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    • pp.90-96
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    • 2014
  • Purpose: The purpose of this study was to determine the effects of simulation based training using a post-operating rehabilitation case on learning outcomes in nursing students. Methods: A quasi-experimental research design (one group pretest and posttest design) and a questionnaire for measuring learning outcomes were used in this study. The participants were 35 students in a college of nursing. Data were collected before the program and immediately after the program that applied simulation based training using a post-operating rehabilitation case consisted of 4th running and debriefing for 26 hours. With SAS 9.2 program, descriptive statistics and paired t-test were used to analyze the data. Results: There were statistically significant increases in necessity (p=.001) and performance of learning outcome (p<.001) of simulation based training using a post-operating rehabilitation case among students in a college of nursing. Conclusion: The findings of this study demonstrate that simulation based training using a post-operating rehabilitation case for nursing students may increase performance of learning outcomes on clinical reasoning and critical thinking.

『의관(醫貫)』에서 명문진군(命門眞君) 개념의 도출(導出)에 대한 고찰 (A Study on the Deduction of the Concept of Mingmen(命門) as the Monarch of the Body)

  • 殷晳玟
    • 대한한의학원전학회지
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    • 제34권4호
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    • pp.79-93
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    • 2021
  • Objectives : This study analyzes the theoretical and clinical reasoning process of Zhao Xian-Ke that argued that the Mingmen is the true monarch of the body. Methods :The analysis focuses on how the arguments of Li Dong-yuan and Zhu Danxi was succeeded and supplemented by Zhao Xian-Ke into a new theoretical system in the Yiguan(醫貫). Results & Conclusions : Zhao's argument that the Mingmen is the true monarch of the body is a result of emphasis on the meaning of innate Qi that is separate from the Water and Fire of the Heart and Kidney, which is derived from the innate Qi concept of Li Dong-yuan's Spleen-Stomach Theory. Zhu Danxi's Ministerial Fire Theory was also accepted through the innate Qi concept of Ministerial Fire and True Yin, which contributed to the establishment of a systematical theory on Mingmen, Miniterial Fire, and True Yin as constituents of innate Qi. In conclusion, the Neijing's explanation that the Heart radiates Shenming as the monarch organ has been modified into innate Qi from the Mingmen reaching the Heart to radiate Shenming.

서영태(徐靈胎)의 본초관(本草觀)에 대한 연구(硏究) - 『신농본초경백종록(神農本草經百種錄)』을 중심으로 - (A Study on Xu Dachun's Understanding of Medicinals According to the Shennong Bencao Baizhonglu)

  • 李相協
    • 대한한의학원전학회지
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    • 제34권4호
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    • pp.95-117
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    • 2021
  • Objectives : Based on the entries on each medicinal's 'specification' and the phrase '所以然' in the Shennong Bencao Baizhonglu, this paper aims to examine Xu Dachun's understanding of herbal medicinals. Methods : One hundred medicinals from the text were sorted into eight categories: Qi, flavor, color, form, quality, nature and characteristic, time of growth, and producer, then examined. Results : 1. Medicinals related to Qi were aromatic and pungent and warm. 2. Medicinals related to flavor were explained according to the Five Flavors' nature in terms of the thing and its functions theory. 3. Medicinals related to color were explained in relation to the Five Colors, whose interpretations were rather erratic. 4. Medicinals related to form were explained as it being possible to figure out their effects based on each medicinal's shape and form. 5. Medicinals related to quality were those that were used to manage dryness and dampness using their dry or wet qualities. 6. Medicinals related to nature and characteristics needed to be understood in their originality to grasp their unique abilities. 7. Both producer and time of growth were closely related to each medicinal's efficacy. Conclusions : Understanding of the application of medicinals in the Shennong Bencaojing through continuous examination into each medicinal's 'specification' and 'its reasoning', together with their clinical application, will allow for learners to build an understanding of herbal medicinals.

감각통합기능장애를 가진 청소년의 작업수행에 초점을 맞춘 작업치료 사례 (Occupation-based Occupational Therapy for an Youth With Sensory Integrative Dysfunction - A Single Case Study)

  • 지석연;이경민;김미선
    • 대한감각통합치료학회지
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    • 제6권1호
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    • pp.47-62
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    • 2008
  • 서론: 감각통합은 작업치료의 치료적 중재 근거이론(frames of reference)들에서 가장 중요하고 널리 사용되는 것 중 하나이다. 이는 작업치료사인 Jean Ayres가 클라이언트의 적응행동을 향상하기 위한 목적을 두고 발전된 이론이며, 시작된 이래로 많은 작업치료사들이 같은 목표를 가지고 적용해 왔기 때문이다. 감각통합이론을 적용하는 작업치료사로써, 임상에서 감각통합과 그 목표가 되는 적응행동인 작업수행을 치료의 결과로써 증명해 내는 것은 작업치료의 목표가 작업수행의 향상을 전제로 하는 것이기에 매우 중요하며 도전이 되는 것이다. 본론: 본 연구는 작업치료중재과정모델인 OTIPM(Occupational Therapy Intervention Process Model)이라고 하는 하향식(Top-down) 접근의 중재모델을 감각통합의 기능장애를 가지면서 일상의 작업수행에 어려움을 보이는 16세의 청소년에게 적용하여, 감각통합이론의 적용이 작업수행향상에 어떠한 의미를 가지는지 살펴보고자 하였다. 결론: 본 연구에서 적용한 OTIPM의 적용 사례를 통해, 감각통합적인 접근은 클라이언트가 일상에서 수행하기 어려웠던 작업수행에 대한 원인을 추론하는 데 유용하였다. 본 연구의 사례에서 감각통합적인 관점과 접근은 작업수행(Top)에 영향을 주는 기본적인 요소적 문제(Bottom)를 연결하는 첫단계의 중재로써 큰 의미를 가졌고, OTIPM의 적용과정은 클라이언트에게 의미 있는 작업수행을 발견하고 이에 초점을 두어 가장 우선되는 중재를 단계적으로 전개하여, 감각통합치료 이후 실제 작업수행에 초점을 둔 접근을 전개하는 데 유용하였다.

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