Warning: Use of undefined constant memo - assumed 'memo' (this will throw an Error in a future version of PHP) in /home/redtea/html/pb/lib.php on line 278
홍차넷
Warning: Use of undefined constant level - assumed 'level' (this will throw an Error in a future version of PHP) in /home/redtea/html/pb/outlogin_toby.php on line 34
Warning: Use of undefined constant no - assumed 'no' (this will throw an Error in a future version of PHP) in /home/redtea/html/pb/outlogin_toby.php on line 45
Warning: Use of undefined constant r - assumed 'r' (this will throw an Error in a future version of PHP) in /home/redtea/html/pb/outlogin_toby.php on line 47
Warning: Use of undefined constant r - assumed 'r' (this will throw an Error in a future version of PHP) in /home/redtea/html/pb/outlogin_toby.php on line 51
Warning: Use of undefined constant memo - assumed 'memo' (this will throw an Error in a future version of PHP) in /home/redtea/html/pb/lib.php on line 237
Warning: Use of undefined constant level - assumed 'level' (this will throw an Error in a future version of PHP) in /home/redtea/html/pb/outlogin_toby.php on line 34
Warning: Use of undefined constant no - assumed 'no' (this will throw an Error in a future version of PHP) in /home/redtea/html/pb/outlogin_toby.php on line 45
Warning: Use of undefined constant r - assumed 'r' (this will throw an Error in a future version of PHP) in /home/redtea/html/pb/outlogin_toby.php on line 47
Warning: Use of undefined constant r - assumed 'r' (this will throw an Error in a future version of PHP) in /home/redtea/html/pb/outlogin_toby.php on line 51
Warning: Use of undefined constant memo - assumed 'memo' (this will throw an Error in a future version of PHP) in /home/redtea/html/pb/lib.php on line 237
Warning: Use of undefined constant is_admin - assumed 'is_admin' (this will throw an Error in a future version of PHP) in /home/redtea/html/zero_header.php on line 269
Warning: Use of undefined constant level - assumed 'level' (this will throw an Error in a future version of PHP) in /home/redtea/html/zero_header.php on line 300
Warning: Use of undefined constant title - assumed 'title' (this will throw an Error in a future version of PHP) in /home/redtea/html/pb/bbs_title.php on line 16
추천
Warning: Use of undefined constant no - assumed 'no' (this will throw an Error in a future version of PHP) in /home/redtea/html/pb/bbs_title.php on line 21
Warning: Use of undefined constant header - assumed 'header' (this will throw an Error in a future version of PHP) in /home/redtea/html/pb/bbs_title.php on line 31
- 회원들이 추천해주신 좋은 글들을 따로 모아놓는 공간입니다.
- 추천글은 매주 자문단의 투표로 선정됩니다.
Warning: Use of undefined constant use_formmail - assumed 'use_formmail' (this will throw an Error in a future version of PHP) in /home/redtea/html/pb/lib.php on line 519
Warning: Use of undefined constant use_category - assumed 'use_category' (this will throw an Error in a future version of PHP) in /home/redtea/html/pb/include/print_category.php on line 9
전체기타일상/생각꿀팁/강좌게임문학영화의료/건강문화/예술경제체육/스포츠과학철학/종교정치/사회요리/음식역사여행IT/컴퓨터음악창작사진
Warning: Use of undefined constant level - assumed 'level' (this will throw an Error in a future version of PHP) in /home/redtea/html/a_skin/bbsd/setup.php on line 29
Warning: Use of undefined constant no - assumed 'no' (this will throw an Error in a future version of PHP) in /home/redtea/html/a_skin/bbsd/setup.php on line 41
Warning: Use of undefined constant memo - assumed 'memo' (this will throw an Error in a future version of PHP) in /home/redtea/html/pb/view.php on line 389
Warning: Use of undefined constant memo - assumed 'memo' (this will throw an Error in a future version of PHP) in /home/redtea/html/pb/view.php on line 389
Warning: Use of undefined constant memo - assumed 'memo' (this will throw an Error in a future version of PHP) in /home/redtea/html/pb/view.php on line 389
Warning: Use of undefined constant memo - assumed 'memo' (this will throw an Error in a future version of PHP) in /home/redtea/html/pb/view.php on line 389
Warning: Use of undefined constant memo - assumed 'memo' (this will throw an Error in a future version of PHP) in /home/redtea/html/pb/view.php on line 389
Warning: Use of undefined constant memo - assumed 'memo' (this will throw an Error in a future version of PHP) in /home/redtea/html/pb/view.php on line 389
Warning: Use of undefined constant memo - assumed 'memo' (this will throw an Error in a future version of PHP) in /home/redtea/html/pb/view.php on line 389
Warning: Use of undefined constant memo - assumed 'memo' (this will throw an Error in a future version of PHP) in /home/redtea/html/pb/view.php on line 389
Warning: Use of undefined constant memo - assumed 'memo' (this will throw an Error in a future version of PHP) in /home/redtea/html/pb/view.php on line 389
Warning: Use of undefined constant memo - assumed 'memo' (this will throw an Error in a future version of PHP) in /home/redtea/html/pb/view.php on line 389
Warning: Use of undefined constant memo - assumed 'memo' (this will throw an Error in a future version of PHP) in /home/redtea/html/pb/view.php on line 389
Warning: Use of undefined constant memo - assumed 'memo' (this will throw an Error in a future version of PHP) in /home/redtea/html/pb/view.php on line 389
Warning: Use of undefined constant memo - assumed 'memo' (this will throw an Error in a future version of PHP) in /home/redtea/html/pb/view.php on line 389
Warning: Use of undefined constant memo - assumed 'memo' (this will throw an Error in a future version of PHP) in /home/redtea/html/pb/view.php on line 389
Warning: Use of undefined constant memo - assumed 'memo' (this will throw an Error in a future version of PHP) in /home/redtea/html/pb/view.php on line 389
Warning: Use of undefined constant x - assumed 'x' (this will throw an Error in a future version of PHP) in /home/redtea/html/pb/view.php on line 398
Warning: Use of undefined constant subject - assumed 'subject' (this will throw an Error in a future version of PHP) in /home/redtea/html/pb/view.php on line 402
Warning: Use of undefined constant x - assumed 'x' (this will throw an Error in a future version of PHP) in /home/redtea/html/pb/view.php on line 403
Warning: Use of undefined constant reg_date - assumed 'reg_date' (this will throw an Error in a future version of PHP) in /home/redtea/html/pb/view.php on line 405
Warning: Use of undefined constant total_comment - assumed 'total_comment' (this will throw an Error in a future version of PHP) in /home/redtea/html/pb/view.php on line 406
Warning: Use of undefined constant subject - assumed 'subject' (this will throw an Error in a future version of PHP) in /home/redtea/html/pb/view.php on line 402
Warning: Use of undefined constant x - assumed 'x' (this will throw an Error in a future version of PHP) in /home/redtea/html/pb/view.php on line 403
Warning: Use of undefined constant reg_date - assumed 'reg_date' (this will throw an Error in a future version of PHP) in /home/redtea/html/pb/view.php on line 405
Warning: Use of undefined constant total_comment - assumed 'total_comment' (this will throw an Error in a future version of PHP) in /home/redtea/html/pb/view.php on line 406
Warning: Use of undefined constant subject - assumed 'subject' (this will throw an Error in a future version of PHP) in /home/redtea/html/pb/view.php on line 402
Warning: Use of undefined constant x - assumed 'x' (this will throw an Error in a future version of PHP) in /home/redtea/html/pb/view.php on line 403
Warning: Use of undefined constant reg_date - assumed 'reg_date' (this will throw an Error in a future version of PHP) in /home/redtea/html/pb/view.php on line 405
Warning: Use of undefined constant total_comment - assumed 'total_comment' (this will throw an Error in a future version of PHP) in /home/redtea/html/pb/view.php on line 406
Warning: Use of undefined constant subject - assumed 'subject' (this will throw an Error in a future version of PHP) in /home/redtea/html/pb/view.php on line 402
Warning: Use of undefined constant x - assumed 'x' (this will throw an Error in a future version of PHP) in /home/redtea/html/pb/view.php on line 403
Warning: Use of undefined constant reg_date - assumed 'reg_date' (this will throw an Error in a future version of PHP) in /home/redtea/html/pb/view.php on line 405
Warning: Use of undefined constant total_comment - assumed 'total_comment' (this will throw an Error in a future version of PHP) in /home/redtea/html/pb/view.php on line 406
Warning: Use of undefined constant name - assumed 'name' (this will throw an Error in a future version of PHP) in /home/redtea/html/a_skin/bbsd/view.php on line 2
Warning: Use of undefined constant HTTP_HOST - assumed 'HTTP_HOST' (this will throw an Error in a future version of PHP) in /home/redtea/html/pb/memo_replace.php on line 3
Warning: Use of undefined constant x - assumed 'x' (this will throw an Error in a future version of PHP) in /home/redtea/html/a_skin/bbsd/view.php on line 10
Warning: Use of undefined constant use_category - assumed 'use_category' (this will throw an Error in a future version of PHP) in /home/redtea/html/a_skin/bbsd/view.php on line 40
| Date |
Warning: Use of undefined constant reg_date - assumed 'reg_date' (this will throw an Error in a future version of PHP) in /home/redtea/html/a_skin/bbsd/view.php on line 53 19/03/21 17:45:33 Warning: Use of undefined constant mod_date - assumed 'mod_date' (this will throw an Error in a future version of PHP) in /home/redtea/html/a_skin/bbsd/view.php on line 56 수정됨 |
| Name | 세란마구리 |
| File #1 | 다운로드ddd.jpg (7.6 KB), Download : 36 |
| File #2 | maxresdefault.jpg (56.8 KB), Download : 35 |
| Link #1 | https://redtea.kr/?b=3&n=8351 |
| Subject | 어떻게 의사는 사고하는가 - 1. 단어 정의 |
  아직 의사가 된지 이제 1년 밖에 안된 물론 의사들 개개인마다 사고하는 방식이 다르고 무엇보다도 과별로 천차만별이 되기에(특히 정신과) 일률적으로 적용할 수는 없습니다만, 현대의 의학적 진단의 기준이 되는 베이즈식 사고의 기초에 대해 설명드리고 싶습니다. 일단 진단과정을 설명하기 위해서는 그 주축이 되는 개념들에 대한 정의가 필요하기에, 이번에는 이에 대해서 간략하게 설명하도록 하겠습니다. 의료에 대한 글을 적을 때에는 많은 분들이 오해를 살 수 있기에 쓰는 것이 좀 부담스러운 편입니다만, 이 곳에는 제 스승뻘 되시는 선생님들도 많아서 틀린 사항에 대해서는 피드백을 주실 것이라 생각하고 작성을 해 보도록 하겠습니다. 1. 민감도와 특이도(Sensitivity and Specificity) 일반적으로 의사들이 어떠한 검사에 대한 평가를 내릴 때, 저희는 '민감도'와 '특이도'라는 개념을 사용하게 됩니다. 여기서 민감도(Sensitivity)란 '질병이 있는 환자에게, 어떤 검사를 하였을 때 그 검사 결과가 양성이 나올 확률'을 뜻합니다. 특이도(Specificity)는 '질병이 없는 환자에게, 어떤 검사를 하였을 때 그 검사 결과가 음성이 나올 확률'을 뜻하지요. 아래의 표를 보면 보다 잘 이해가 되실 것이라 생각합니다. 사실 위의 민감도, 특이도는 검사 결과에만 적용되는 개념이 아니라 병력, 신체진찰 등 거의 의사가 진단을 위해서 하는 모든 행위에 적용이 가능한 개념입니다. 이를 약간 비틀면 1-민감도 즉, '질병이 있는 환자에게, 어떤 검사를 하였을 때 그 검사 결과가 음성이 나올 확률'을 실제 음성이 아닌데, 음성으로 나왔다고 하여 '위음성률'이라고 하며 1-특이도 즉, '질병이 없는 환자에게, 어떤 검사를 하였을 때 그 검사 결과가 양성이 나올 확률'을 '위양성률'이라고 합니다. 여담이지만, 의사들은 일반적으로 어떤 질환을 놓치는 것을 무서워 하기에 '위음성률'을 낮추려고 노력을 하는 편입니다.(후에 설명드리지만, 그러면 위양성률이 높아지게 되어 과잉진단이라는 문제가 생기지요.) 2. 우도비(Likelihood Ratio) 위의 민감도와 특이도는 독립적으로 해석하는 경우 함정에 빠질 수가 있습니다. 예를 들어, 어떤 검사를 적용하는 모든 환자에 대해서 '심근경색'이라는 진단을 하게 되면 이 검사의 '심근경색'에 대한 민감도는 1이(즉 100%) 될 것입니다.(반면에 특이도는 0이 되겠지요) 이러한 검사가 의미가 있을까요? 또한 어떠한 질환에 대해 민감도와 특이도가 0.5인 검사가 있다고 하면 이것이 어떤 의미가 있을까요?(동전이 앞면이면 양성, 뒷면이면 음성이라는 식으로 판단하는 경우겠네요) 위 두 검사가 의미가 없다는 것은 금방 알 수 있을 것입니다. 그렇기에 '민감도와 '특이도를 각각 보는게 아니라 이 둘을 조합하여 사용해보자.' 해서 나오게 된 개념이 우도비(가능도비) 입니다. 양성우도비란 '민감도/(1-특이도)'로 나타내며 결국은 '실제로 병이 있는데 있다고 한 사람의 비율이, 실제로 병이 없는데 있다고 한 사람의 비율의 몇배인가'를 나타낸 말입니다. 간단히 '민감도/위양성률'이며 음성우도비란 '(1-민감도)/특이도'로 나타내며, '실제로 병이 있는데 없다고 한 사람의 비율이, 실제로 병이 없는데 없다고 한 사람의 비율의 몇배인가'를 나타낸 말입니다. '위음성률/특이도'이지요. 결국엔 검사, 병력, 신체진찰의 정확도를 확인하기 위해서는 위의 '우도비'란 개념을 사용하게 됩니다. 일반적으로 의사들은 2,5,10의 원칙을 사용합니다. 대략 양성우도비가 2인 경우 15%, 5인 경우 30%, 10인 경우 45% 질병의 확률이 올라가며 음성우도비는 위의 역수인 0.5인 경우 15%, 0.2인 경우 30%, 0.1인 경우 45% 질병의 확률이 내려가게 됩니다. 일반적으로는 양성우도비가 5이상, 또는 음성우도비가 0.2 이하면 쓸만하다고 봅니다. 반면 위의 두 예를 든 검사는 양성우도비, 음성우도비가 1이 나오는 검사이기에 아무런 정보를 주지 못한다. 즉, 쓸수가 없다고 보게 됩니다. 3.양성예측도와 음성예측도 (Positive Predictive Value and Negative Predictive Value; PPV and NPV) 지금까지 설명한 것은 '검사 자체'에 대한 설명입니다. 사실 우리가 알고 싶은 것은, '이 검사가 양성일 때 실제 병에 걸려있을 확률이 얼마인가'인데 위에서 설명한 개념들은 이에 대한 역만 설명하고 있지요. 지금 설명할 개념에 대해서는 이전에 Sophie 님께서 티타임에 올린 글이 있으니('당신은 암에 걸리지 않았다 - 의사들도 잘 모르는 사실) 이 글을 참조하는 것도 좋을 것 같습니다.(링크1입니다.) 양성예측도란 '검사가 양성일 때, 실제 환자가 병에 걸려있을 확률'을 나타내며 음성예측도란 '검사가 음성일 때, 실제 환자가 병이 없을 확률'을 나타냅니다. 전에 제가 타임라인에서 대장내시경 관련으로 적은 적이 있습니다만, 분변잠혈검사의 민감도는 0.3 정도, 특이도는 0.95 이상입니다. 그런데 이 검사의 양성예측도는 33%정도라고 하였습니다. 특이도가 0.95 이상일 테니, 위양성도 0.05 이하가 될텐데 실제로 검사해서 양성이 나올 확률이 33% 밖에 안되다니 이상하게 느껴집니다. 이는 정상인 사람이 너무많다보니(즉 질환의 유병률이 낮다보니) 이들 중 위양성으로 나온 숫자가, 실제로 질병을 가진 사람보다 많게 되어 발생하는 현상입니다. 예를 들어 계산 해보지요. 파킨슨병의 유병율이 1000명 중 1명이라고 하고, 어떤 검사가 파킨슨병에 대하여 민감도가 0.9, 특이도가 0.9라 가정해 봅시다. 10만명의 집단에서 파킨슨병 환자는 100명이 되며, 파킨슨병이 아닌 사람은 9만 9천 9백명이 되지요. 민감도가 0.9이니까 파킨슨병 환자 100명 중, 90명이 검사결과 양성이 됩니다. 또한, 특이도가 0.9이기에(즉, 위양성률이 0.1이기에) 파킨슨병이 아닌 사람 약 10만명 중 1만명이 양성이 됩니다. 위를 바탕으로 양성이 나온사람은 약 90+1만명이 되지요. 이 중에서 실제 파킨슨병을 가진 사람은 90명이니 양성예측도는 90/(90+1만) 즉 대략 0.9%가 됩니다. 0.1%에서 오르기는 하였지만, 0.9%면 파킨슨병이라 하기는 어렵겠지요... 위 검사의 우도비를 측정해보면 양성우도비는 9, 음성우도비는 0.11로서 검사 자체는 훌륭하다고 볼 수 있습니다. 그런데 왜??? 이는 양성예측도와 음성예측도가 유병률(정확히는 사전확률)에 크게 영향을 받기 때문입니다. 아무리 우도비가 높다 한들 사전확률이 너무 높거나, 너무 낮으면 검사 자체가 의미가 적게 됩니다. 위의 2,5,10의 법칙은 어떤 질병의 '사전확률'이 0.5인 경우를 가정하여 쓰는 것이지요. 댓글의 그림처럼 질병의 사전 확률이 너무 높은 경우, 음성우도비가 0에 가깝다고 한들 '사후확률'이 크게 감소하지 않으며, 역으로 '사전확률'이 너무 낮은 경우 양성우도비가 높다고 한들 '사후확률'이 크게 증가하지 않습니다. 즉, 가장 중요한 것은 '사전확률' 입니다. 이 '사전 확률'이란 것은 일반적으로 유병률에 의존합니다만, 의사가 근무하는 환경이 크게 작용합니다. 예를 들어서 제가 있는 동네병원에서 기침 환자가 오면 감기일 확률이 높습니다만, 대학병원에 기침 환자가 올 경우 감기일 확률은 떨어지게 되고 보다 중한 질환을 생각해야 합니다. 이렇듯 질병에 대한 '사전 확률' 자체는 딱히 정의되기가 어렵기 때문에, 이는 의사의 경험을 바탕으로 대략적인 그림을 그려나갈 필요가 있습니다. 고로 의사는 경험이 스승이지요. 다음 글에는 위 개념들에 대한 보충설명 같은것을 하고(ROC 나 카파통계량) 본격적으로 들어가도록 하겠습니다. 뭔가 상당히 두서없이 길어진 것 같은데, 피드백을 주신다면 정말 감사드리겠습니다. * Cascade님에 의해서 티타임 게시판으로부터 게시물 복사되었습니다 (2019-04-01 16:33) * 관리사유 : 추천게시판으로 복사합니다. Warning: Use of undefined constant no - assumed 'no' (this will throw an Error in a future version of PHP) in /home/redtea/html/a_skin/bbsd/view.php on line 133 Warning: Use of undefined constant no - assumed 'no' (this will throw an Error in a future version of PHP) in /home/redtea/html/a_skin/bbsd/view.php on line 146 Warning: Use of undefined constant vote - assumed 'vote' (this will throw an Error in a future version of PHP) in /home/redtea/html/a_skin/bbsd/view.php on line 161 15
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17178 class='vcm '>
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17178'> 세란마구리
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수정됨
Warning: Use of undefined constant no - assumed 'no' (this will throw an Error in a future version of PHP) in /home/redtea/html/a_skin/bbsd/view_comment.php on line 140
Warning: Use of undefined constant no - assumed 'no' (this will throw an Error in a future version of PHP) in /home/redtea/html/a_skin/bbsd/view_comment.php on line 140
Warning: Use of undefined constant reg_date - assumed 'reg_date' (this will throw an Error in a future version of PHP) in /home/redtea/html/a_skin/bbsd/view_comment.php on line 142
19/03/21 17:45
17178>삭제 주소복사
Warning: Use of undefined constant level - assumed 'level' (this will throw an Error in a future version of PHP) in /home/redtea/html/a_skin/bbsd/view_comment.php on line 150
댓글의 그림을 좀 설명하자면 x축은 사전확률, y축은 사후확률을 나타내며, 각 곡선들은 우도비를 나타내고 있습니다. y=x(우도비가 1인) 직선의 위에 있는 곡선들은 양성우도비를, 아래에 있는 곡선들은 음성우도비를 나타냅니다.
예를 들어 사전확률(x값) 이 70%인 상태에서 음성우도비가 0.2인 검사(노란곡선) 를 시행해 음성이 나왔다면 사후확률(y값) 은 30%다고 해석합니다.
Warning: Use of undefined constant level - assumed 'level' (this will throw an Error in a future version of PHP) in /home/redtea/html/a_skin/bbsd/view_comment.php on line 158
Warning: Use of undefined constant password - assumed 'password' (this will throw an Error in a future version of PHP) in /home/redtea/html/a_skin/bbsd/view_comment.php on line 166
Warning: Use of undefined constant vote - assumed 'vote' (this will throw an Error in a future version of PHP) in /home/redtea/html/a_skin/bbsd/view_comment.php on line 171
Warning: Use of undefined constant vote - assumed 'vote' (this will throw an Error in a future version of PHP) in /home/redtea/html/a_skin/bbsd/view_comment.php on line 172
Warning: Use of undefined constant vote - assumed 'vote' (this will throw an Error in a future version of PHP) in /home/redtea/html/a_skin/bbsd/view_comment.php on line 172
Warning: Use of undefined constant no - assumed 'no' (this will throw an Error in a future version of PHP) in /home/redtea/html/a_skin/bbsd/view_comment.php on line 173
Warning: Use of undefined constant no - assumed 'no' (this will throw an Error in a future version of PHP) in /home/redtea/html/a_skin/bbsd/view_comment.php on line 173
Warning: Use of undefined constant vote - assumed 'vote' (this will throw an Error in a future version of PHP) in /home/redtea/html/a_skin/bbsd/view_comment.php on line 173
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