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Journal of Integrative Medicine ›› 2015, Vol. 13 ›› Issue (1): 9-19.doi: 10.1016/S2095-4964(15)60151-0

• Methodology • Previous Articles     Next Articles

SimTCM: A human patient simulator with application to diagnostic accuracy studies of Chinese medicine

Arthur de Sá Ferreiraa,Antonio Guilherme Pachecob   

  1. a Postgraduation Program in Rehabilitation Science, Augusto Motta University Center, Rio de Janeiro, Brazil
    b Program of Scientific Computing, Fiocruz, Rio de Janeiro, Brazil
  • Received:2014-08-22 Accepted:2014-09-23 Online:2015-01-10 Published:2015-01-15

Objective
The aim of this work is to develop and implement the SimTCM, an advanced computational model that incorporates relevant aspects from traditional Chinese medicine (TCM) theory as well as advanced statistical and epidemiological techniques for simulation and analysis of human patients.
Methods
SimTCM presents five major attributes for simulation: representation of true and false profiles for any single pattern; variable count of manifestations for each manifestation profile; empirical distributions of patterns and manifestations in a disease-specific population; incorporation of uncertainty in clinical data; and the combination of the four examinations. The proposed model is strengthened by following international standards for reporting diagnostic accuracy studies, and incorporates these standards in its treatment of study population, sample size calculation, data collection of manifestation profiles, exclusion criteria and missing data handling, reference standards, randomization and blinding, and test reproducibility.
Results
Simulations using data from patients diagnosed with hypertension and post-stroke sensory-motor impairments yielded no significant differences between expected and simulated frequencies of patterns (P = 0.22 or higher). Time for convergence of simulations varied from 9.90 s (9.80, 10.27) to 28.31 s (26.33, 29.52). The ratio iteration profile necessary for convergence varied between 1:1 and 5:1.
Conclusion
This model is directly connected to forthcoming models in a large project to design and implement the SuiteTCM: ProntTCM, SciTCM, DiagTCM, StudentTCM, ResearchTCM, HerbsTCM, AcuTCM, and DataTCM. It is expected that the continuity of the SuiteTCM project enhances the evidence-based practice of Chinese medicine. The software is freely available for download at: http://suitetcm.unisuam.edu.br.

Key words: Medicine, Chinese traditional, Evidence-based medicine, Computer-assisted decision making, Rehabilitation medicine (TCM)

[1] Ljung L, Glad T . Modeling of dynamics systems. New Jersey: Prentice-Hall. 1994.
[2] Sadiq SK, Mazzeo MD, Zasada SJ, Manos S, Stoica I, Gale CV, Watson SJ, Kellam P, Brew S, Coveney PV . Patient-specific simulation as a basis for clinical decision-making. Philos Transact A Math Phys Eng Sci, 2008,366(1878):3199-3219
doi: 10.1098/rsta.2008.0100 pmid: 18573758
[3] Jones A, Sheppard L . Can human patient simulators be used in physiotherapy education? Int[J] Allied Health Sci Pract. 2007; 5(2):1-5.
[4] Shoemaker MJ, Riemersma L, Perkins R . Use of high fidelity human simulation to teach physical therapist decision-making skills for the intensive care setting. Cardiopulm Phys Ther J, 2009,20(1):13-18
[5] de Sá Ferreira A . Statistical validation of strategies for Zang-fu single pattern differentiation. J Chin Integr Med, 2008,6(11):1109-1116
doi: 10.3736/jcim
[6] Ferreira AS . Diagnostic accuracy of pattern differentiation algorithm based on traditional Chinese medicine theory: a stochastic simulation study. Chin Med, 2009,4:24
doi: 10.1186/1749-8546-4-24 pmid: 20025772
[7] Sá Ferreira A . Misdiagnosis and undiagnosis due to pattern similarity in Chinese medicine: a stochastic simulation study using pattern differentiation algorithm. Chin Med, 2011,6:13
doi: 10.1186/1749-8546-6-13
[8] Guang JY . The mode of thinking in Chinese clinical medicine: characteristics, steps and forms. Clin Acupunct Orient Med, 2001,2(1):23-28
doi: 10.1054/caom.2001.0075
[9] Zaslawki C . Clinical reasoning in traditional Chinese medicine: implications for clinical research. Clin Acupunct Orient Med, 2003,4(2-3):94-101
doi: 10.1016/S1461-1449(03)00044-6
[10] Shin BC, Kim S, Cho YH . Syndrome pattern and its application in parallel randomized controlled trials. Chin J Integr Med, 2013,19(3):163-171
doi: 10.1007/s11655-012-1256-y pmid: 23212576
[11] Ferreira AS . Promoting the integrative medicine by the computerization of traditional Chinese medicine for scientific research and clinical practice: The SuiteTCM Project. J Integr Med, 2013,11(2):135-139
doi: 10.3736/jintegrmed2013013
[12] Buetow S, Kiata L, Liew T, Kenealy T, Dovey S, Elwyn G . Patient error: a preliminary taxonomy. Ann Fam Med, 2009,7(3):223-231
doi: 10.1370/afm.941
[13] Maciocia G. Os fundamentos da medicina tradicional Chinesa: Um texto abrangente para acupunturistas e fitoterapeutas. Rio de Janeiro: Roca. 1996. Portuguese.
[14] Yang SZ, Chace C. The systematic classic of acupuncture and moxibustion. Boulder: Blue Poppy Press. 2004.
[15] Luo XW. Synopsis of prescriptions of the golden chamber with 300 cases. Beijing: New World Press. 1995. Chinese.
[16] Yang SZ. Master Hua’s classic of the central viscera. Boulder: Blue Poppy Press. 2003.
[17] Flaws B. The classic of difficulties. 4th ed. Boulder: Blue Poppy Press. 2004.
[18] Yang SZ, Li JY. Treatise on the spleen and stomach. Boulder: Blue Poppy Press. 1993.
[19] Bossuyt PM, Reitsma JB, Bruns DE, Gatsonis CA, Glasziou PP, Irwig LM, Moher D, Rennie D, de Vet HCW, Lijmer JG . The STARD statement for reporting studies of diagnostic accuracy: explanation and elaboration. Clin Chem, 2003,49:17-18
[20] Chen J, Lu P, Zuo X, Shi Q, Zhao H, Luo L, Yi J, Zheng C, Yang Y, Wang W . Clinical data mining of phenotypic network in angina pectoris of coronary heart disease. Evid Based Complement Alternat Med, 2012,2012:546230
doi: 10.1155/2012/546230 pmid: 3378973
[21] Efrom B, Tibshirani RJ . An introduction to the bootstrap. Florida: Chapman & Hall/CR. 1998.
doi: 10.1111/1467-9639.00050
[22] Hanley JA , McNeil BJ.A method of comparing the areas under receiver operating characteristic curves derived from the same cases. Radiology, 1983,148(3):839-843
doi: 10.1148/radiology.148.3.6878708
[23] Altman DG, Bland JM . Diagnostic tests 3: receiver operating characteristic plots. BMJ, 1994,309(6948):188
doi: 10.1136/bmj.309.6948.188
[24] Altman DG, Bland JM . Diagnostic tests 1: sensitivity and specificity. BMJ, 1994,308(6943):1552
doi: 10.1136/bmj.308.6943.1552
[25] Altman DG, Bland JM . Diagnostic tests 2: predictive values. BMJ, 1994,309(6947):102
doi: 10.1007/s10654-016-0149-3 pmid: 8038641
[26] Wang X, Qu H, Liu P, Cheng Y . A self-learning expert system for diagnosis in traditional Chinese medicine. Expert Syst Appl, 2004,26(4):557-566
doi: 10.1016/j.eswa.2003.10.004
[27] Liu GP, Li GZ, Wang YL, Wang YQ . Modelling of inquiry diagnosis for coronary heart disease in traditional Chinese medicine by using multi-label learning. BMC Complement Altern Med, 2010,10:37
doi: 10.1186/1472-6882-10-37
[28] Whiting P, Rutjes AW, Reitsma JB, Glas AS, Bossuyt PM, Kleijnen J . Sources of variation and bias in studies of diagnostic accuracy: a systematic review. Ann Intern Med, 2004,140(3):189-202
doi: 10.7326/0003-4819-140-3-200402030-00010
[29] Ljung L . System identification: Theory for the user. New Jersey: Prentice-Hall. 1987.
[30] Davis CS . The computer generation of multinomial random variates. Comput Stat Data Analysis, 1993,16(2):205-217
doi: 10.1016/0167-9473(93)90115-A
[31] Luiz AB, Cordovil I, Barbosa Filho J, Ferreira AS . Zangfu zheng(patterns) are associated with clinical manifestations of zang shang(target-organ damage) in arterial hypertension. Chin Med, 2011,6:23
doi: 10.1186/1749-8546-6-23
[32] Fragoso APS, Ferreira AS . Immediate effects of acupuncture on bíceps brachii muscle function in healthy and post-stroke subjects. Chin Med, 2012,7:7
doi: 10.1186/1749-8546-7-7
[33] Kanji GK . 100 statistical tests. 3rd ed. London: SAGE. 2006.
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