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題名:醫學資料分析之研究
作者:張永昌
作者(外文):Yung-Tsang Chang
校院名稱:國立中興大學
系所名稱:資訊科學與工程學系所
指導教授:喻石生
學位類別:博士
出版日期:2010
主題關鍵詞:流行病學預測危險因子邏輯式迴歸epidemiologypredictionrisk factorlogistic regression
原始連結:連回原系統網址new window
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流行病學在人類疾病的來源和疾病發生原因上的研究上提供了科學的法則,確實為了大眾的健康照護研究建立的重要的旅程碑。流行病學從研究資料的收集到資料的分析上都有科學上的方法和法則,但是在這樣嚴謹的法則下所得到研究成果被醫療從事人員視為是他們的醫療知識,卻沒有將這些寶貴的研究成果大量的透過電腦系統來提供疾病治療或是治療方法的風險評估上的輔助建議,很多非常有經驗的醫師在疾病的醫治上憑藉著個人經驗而非透過風險評估或是依循治療準則。因為即使是在現在有大量醫學研究成果以電子文件方式來傳播的今天,只有為數不多的治療上的風險評估預測法則被建立在電腦系統上,以致於很難被大量的使用,綜合以上的觀察,在本論文中以流行病學研究法則為基礎,提供了一套方法步驟來預測婦科子宮鏡手術的成功率。
大致上來說,從醫院的病人資料庫收集的資料被分成兩類資料,病人在手術的過程中有出現併發症或經過五年的追蹤中有再復發的現象並進行第二次手術被歸成一類,而沒有併發症或是再復發的病人是另一類,從這兩類的病人之中,透過卡方測試的方法來找出手術時的危險因子,並將這危險因子放入邏輯式迴歸分析中,進而得到透過這些危險因子所建立起來的手術成功率的預測公式。
總結以上的說明,本論文提供了一套清楚的規則如何得到會影響到手術成功與否的危險因子,並找出手術成功率預測的公式。這個數學上公式很適合套用到實證醫學的領域上,進而提高醫療服務的品質。
Epidemiology is the study of causal inferences of the health problems and the occurrence of illness on people. It is considered as the cornerstone of scientific public health research based on scientific disciplines. These disciplines include study design, data collection and statistical models. However, the results of studies through these scientific disciplines are used as medical knowledge to the health-care workers. Unfortunately, these precious research results are not used widely through the computer systems to supply decision supports, such as risk assessment of surgical operations. Many well-knowledge doctors decide their treatment polices to their patients by their experienced knowledge without the risk assessment or following the guidelines of treatment. Even though many well research results are announced to the world in an electronic documentation manner, only a few risk predictions of disease treatments have been supported by the computer system so far. Based on these observations, this dissertation proposes an epidemiological scheme for the success rate prediction of surgery in gynecology.
In general, the medical data are collected from the hospital’s database; the retrospective cohort study is to category the patients’ records into surgical complication and not surgical complication groups after the surgical operation with a 5-year followed-up. The chi-square test is used to find out the risk factors (predictors) by comparing the outcome of these two cohorts. Then the risk factors are applied to the logistic regression model to construct a prediction function of the success rate of the hysteroscopic surgery based on the risk factors.
In conclusion, this dissertation proposes a clear method to construct a prediction function based on risk factors. This procedure of prediction model can be feasible to decision supports in the evidence-based medicine to make a high quality medical service.
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