{"id":223,"date":"2012-09-18T09:57:43","date_gmt":"2012-09-18T00:57:43","guid":{"rendered":"http:\/\/aihara.la.coocan.jp\/blog\/?p=223"},"modified":"2014-04-16T15:33:08","modified_gmt":"2014-04-16T06:33:08","slug":"%e5%9b%bd%e5%86%85%e3%82%ac%e3%82%a4%e3%83%89%e3%83%a9%e3%82%a4%e3%83%b3%e5%b0%82%e9%96%80%e5%ae%b6%e3%81%aegrade%e3%81%ab%e5%af%be%e3%81%99%e3%82%8b%e8%80%83%e3%81%88%e6%96%b9%ef%bc%8d1","status":"publish","type":"post","link":"http:\/\/aihara.la.coocan.jp\/?p=223","title":{"rendered":"\u56fd\u5185\u30ac\u30a4\u30c9\u30e9\u30a4\u30f3\u5c02\u9580\u5bb6\u306eGRADE\u306b\u5bfe\u3059\u308b\u8003\u3048\u65b9\uff0d(1)"},"content":{"rendered":"<div>\n<p>\u8a3a\u7642\u30ac\u30a4\u30c9\u30e9\u30a4\u30f3\u306e\u305f\u3081\u306e<b>GRADE\u30b7\u30b9\u30c6\u30e0<\/b>\u306b\u95a2\u3057\u3066\u3001\u56fd\u5185\u306e\u30ac\u30a4\u30c9\u30e9\u30a4\u30f3\u5c02\u9580\u5bb6\u306f\u3069\u306e\u3088\u3046\u306b\u8003\u3048\u3066\u3044\u308b\u306e\u304b\u3068\u3044\u3046\u3053\u3068\u3092\u7d39\u4ecb\u3057\u307e\u3059\u3002<\/p>\n<\/div>\n<p><\/p>\n<div>\n<p>\u539a\u52b4\u7701\u79d1\u5b66\u7814\u7a76\u8cbb\u88dc\u52a9\u91d1\u4e8b\u696d\u3068\u3057\u3066\u30012005\u5e74\u304b\u3089\u3001\u4eac\u90fd\u5927\u5b66\u306e\u4e2d\u5c71\u5065\u592b\u6559\u6388\u306e\u7814\u7a76\u73ed\u304c\u7a4d\u6975\u7684\u306b\u53d6\u308a\u7d44\u3093\u3067\u3044\u307e\u3059\u3002\u672c\u7814\u7a76\u73ed\u306e\u6d3b\u52d5\u306f\u3001\u73fe\u5728\u3082\u65e5\u672c\u533b\u7642\u6a5f\u80fd\u8a55\u4fa1\u6a5f\u69cb\u306e\u533b\u7642\u60c5\u5831\u30b5\u30fc\u30d3\u30b9(Minds\uff09\u3068\u3082\u9023\u643a\u3057\u3001\u7814\u7a76\u6210\u679c\u3092\u540c\u4e8b\u696d\u306e\u63a8\u9032\u306b\u69d8\u3005\u306a\u9818\u57df\u3067\u8ca2\u732e\u3057\u3066\u3044\u307e\u3059\u3002<\/p>\n<p>\n<br \/>\n<b>\u300c\u6839\u62e0\u306b\u57fa\u3065\u304f\u8a3a\u7642\u30ac\u30a4\u30c9\u30e9\u30a4\u30f3\u300d\u306e\u9069\u5207\u306a\u4f5c\u6210\u30fb\u5229\u7528\u30fb\u666e\u53ca\u306b\u5411\u3051\u305f\u57fa\u76e4\u6574\u5099\u306b\u95a2\u3059\u308b\u7814\u7a76\uff1a\u60a3\u8005\u30fb\u533b\u7642\u6d88\u8cbb\u8005\u306e\u53c2\u52a0\u63a8\u9032\u306b\u5411\u3051\u3066<\/b><br \/>\n\u5e73\u621016\u5e74\u5ea6\u539a\u751f\u52b4\u50cd\u7701\u79d1\u5b66\u7814\u7a76\u8cbb\u88dc\u52a9\u91d1\u3000\u533b\u7642\u6280\u8853\u8a55\u4fa1\u7dcf\u5408\u7814\u7a76\u4e8b\u696d\u5831\u544a\u66f8\uff082005\u5e744\u6708\uff09 p6-9<\/p>\n<p><\/p>\n<p>\n<b>GRADE\u306b\u3088\u308b\u30a8\u30d3\u30c7\u30f3\u30b9\u306e\u8cea\u3068\u304a\u52e7\u3081\u5ea6\u306e\u5f37\u3055<\/b>\u3068\u3044\u3046\u30bf\u30a4\u30c8\u30eb\u3067\u3001\u8a3a\u7642\u30ac\u30a4\u30c9\u30e9\u30a4\u30f3\u306b\u304a\u3051\u308b\u63a8\u5968\u6c7a\u5b9a\u306e\u65b0\u3057\u3044\u63d0\u6848\u3067\u3042\u308b\u201dGRADE\u201d\u306e\u7ffb\u8a33\u30fb\u7d39\u4ecb\u3092\u884c\u3063\u3066\u3044\u307e\u3059\u3002\uff08\u5206\u62c5\u7814\u7a76\uff1a\u3000\u6d25\u8c37\u559c\u4e00\u90ce\u3001<br \/>\n\u5206\u62c5\u5354\u529b\u8005\uff1a\u3000\u8fbb\u3000\u9999\u7e54\uff09<\/p>\n<\/div>\n<p><\/p>\n<div>\n<p>\u696d\u7e3e\u96c6\u306e\u5f53\u8a72\u8a18\u4e8b\u306e\u4e00\u90e8\u3092\u629c\u7c8b\u3002<\/p>\n<p>&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;<br \/>\n\uff21\uff0e\u7814\u7a76\u76ee\u7684\uff1a <br \/>\n\u3053\u308c\u307e\u3067\u5404\u7a2e\u6a5f\u95a2\u3084\u30b0\u30eb\u30fc\u30d7\u306b\u3088\u3063\u306610\u7a2e\u4ee5\u4e0a\u306e\u300c\u30a8\u30d3\u30c7\u30f3\u30b9\u306e\u5f37\u3055\u300d\u3084\u300c\u304a\u52e7\u3081\u5ea6\u306e\u5f37\u3055\u300d\u306a\u3069\u306egrading\u306e\u8868\u304c\u4f5c\u3089\u308c\u3066\u304d\u305f\u3002\u4e16\u754c\u7684\u306b\u8907\u6570\u306e\u3082\u306e\u304c\u4e26\u5b58\u3057\u30e6\u30fc\u30b6\u30fc\u306b\u6df7\u4e71\u3092\u304d\u305f\u3057\u3066\u3044\u305f\u3002\u7279\u306b\u3001\u8a3a\u7642\u30ac\u30a4\u30c9\u30e9\u30a4\u30f3(CPG)\u3092\u300c\u3064\u304f\u308b\u300d\u8005\u306b\u3068\u3063\u3066\u3069\u306e\u8868\u3092\u63a1\u7528\u3059\u308b\u304b\u3001\u3042\u308b\u3044\u306f\u6539\u3081\u3066\u4f5c\u308b\u304b\u306e\u5224\u65ad\u3092\u8feb\u308c\u3066\u3044\u305f\u3002EBM\u306e\u8f38\u5165\u56fd\u3067\u3042\u308b\u65e5\u672c\u306f\u3053\u308c\u3089\u3092\u65e5\u672c\u8a9e\u5316\u3057\u3066\u7528\u3044\u308b\u305f\u3081\u3055\u3089\u306b\u6df7\u4e71\u304c\u5897\u5e45\u3057\u3066\u3044\u305f\u3068\u3082\u3044\u3048\u308b\u3002<br \/>\n\uff5e(\u7565)\uff5e<\/p>\n<p>\n\u3053\u306e\u3088\u3046\u306a\u72b6\u6cc1\u4e0b\u3067\u3001\u3053\u308c\u307e\u3067\u300c\u30a8\u30d3\u30c7\u30f3\u30b9\u306e\u5f37\u3055\u300d\u3084\u300c\u304a\u52e7\u3081\u5ea6\u306e\u5f37\u3055\u300d\u306a\u3069\u306egrading system\u3092\u4f5c\u6210\u3057\u3066\u304d\u305f\u4e16\u754c\u306e\u6a5f\u95a2\u3084\u30b0\u30eb\u30fc\u30d7\u304b\u3089\u306e\u30e1\u30f3\u30d0\u30fc\u304c\u3042\u3064\u307e\u308a\u3001GRADE project\u304c\u7d042\u5e74\u524d\u306b\u7d50\u6210\u3055\u308c\u3001\u4f1a\u8b70\u3084e-mail\u3092\u7528\u3044\u3066\u4e16\u754c\u7684\u306b\u4f7f\u7528\u3055\u308c\u308b\u3079\u304dgrading system\u3092\u958b\u767a\u3057\u305f\u3002\u672c\u7814\u7a76\u306f\u3001\u305d\u306e\u5185\u5bb9\u3092\u541f\u5473\u3057\u3066\u7d39\u4ecb\u3057\u3001\u65e5\u672c\u3067\u306e\u4f7f\u7528\u306b\u5f53\u305f\u3063\u3066\u306e\u7559\u610f\u70b9\u3092\u8ad6\u3058\u308b\u3002<\/p>\n<\/div>\n<p><\/p>\n<div>\n<p>\uff22\uff0e\u7814\u7a76\u65b9\u6cd5\u3000\uff5e(\u7565)\uff5e<\/p>\n<\/div>\n<p><\/p>\n<div>\n<p>\n\uff23\uff0e:\u7814\u7a76\u7d50\u679c<br \/>\n1) \u30a8\u30d3\u30c7\u30f3\u30b9\u306e\u8cea(quality of evidence)\u3068\u306f\u3001\u300c\u63a8\u5b9a\u52b9\u679c(estimated effect)\u306e\u6b63\u3057\u3055\u306b\u3064\u3044\u3066\u3069\u306e\u7a0b\u5ea6\u306e\u78ba\u4fe1\u3092\u304a\u3051\u308b\u304b\u3092\u793a\u3059\u3082\u306e\u300d\u3068\u5b9a\u7fa9\u3055\u308c\u3066\u3044\u308b\u3002<\/p>\n<p><\/p>\n<p>\n<u>\u300c\u30a8\u30d3\u30c7\u30f3\u30b9\u306e\u8cea\u300d \u306e\u30b0\u30ec\u30fc\u30c7\u30a3\u30f3\u30b0<\/u><br \/>\n\u9ad8\uff08high\uff09\u3001\u4e2d\uff08moderate\uff09\u3001\u4f4e\uff08low\uff09\u3001\u975e\u5e38\u306b\u4f4e\uff08very low\uff09<\/p>\n<p><\/p>\n<p>\n2) \u304a\u52e7\u3081\u5ea6(strength of a recommendation)\u3068\u306f\u300c\u304a\u52e7\u3081\u306b\u3057\u305f\u304c\u3046\u3053\u3068\u306b\u3088\u308b\u5229\u76ca\u306f\u5bb3\u3092\u4e0a\u56de\u308b\u3001\u3068\u3044\u3046\u3053\u3068\u306b\u3064\u3044\u3066\u3069\u306e\u7a0b\u5ea6\u306e\u78ba\u4fe1\u3092\u304a\u3051\u308b\u304b\u3092\u793a\u3059\u3082\u306e\u300d\u3068\u5b9a\u7fa9\u3055\u308c\u308b\n<\/p>\n<p><\/p>\n<p>\n<u>\u300c\u304a\u52e7\u3081\u5ea6\u300d \u306e\u30b0\u30ec\u30fc\u30c7\u30a3\u30f3\u30b0<\/u><br \/>\n\u3057\u306a\u3055\u3044\uff08Do it\uff09\u3001\u3057\u305f\u307b\u3046\u304c\u3088\u3044\uff08probably do it\uff09\u3001\u3057\u306a\u3044\u307b\u3046\u304c\u3088\u3044\uff08probably don&#8217;t it\uff09\u3001\u3059\u308b\u306a\uff08Don&#8217;t it\uff09<\/p>\n<\/div>\n<p><\/p>\n<div>\n<p>\n\uff24\uff0e\u8003\u5bdf<br \/>\n\u30a8\u30d3\u30c7\u30f3\u30b9\u306f\u305d\u308c\u3092\u300c\u3064\u304f\u308b\u300d\u3001\u300c\u3064\u305f\u3048\u308b\u300d\u3001\u300c\u3064\u304b\u3046\u300d\u306e\uff13\u3064\u306e\u5c40\u9762\u306b\u308f\u3051\u308b\u3068\u5206\u304b\u308a\u3084\u3059\u3044\u3002\u540c\u69d8\u306a\u3053\u3068\u304c\u3001CPG\u306b\u3064\u3044\u3066\u3082\u3044\u3048\u308b\u3002\u3053\u306e\u3046\u3061\u65e5\u672c\u533b\u7642\u6a5f\u80fd\u8a55\u4fa1\u6a5f\u69cb\u306eMinds\u304c\u672c\u683c\u7684\u306bCPG\u3092\u300c\u3064\u305f\u3048\u308b\u300d\u3088\u3046\u306b\u306a\u308a\uff08http:\/\/minds.jcqhc.or.jp\/\uff09\u3001\u4eca\u5f8c\u306f\u8cea\u306e\u3088\u3044CPG\u3092\u300c\u3064\u304f\u308b\u300d\u3053\u3068\u3001\u307e\u305f\u305d\u308c\u3092\u3088\u308a\u3088\u304f\u300c\u3064\u304b\u3046\u300d\u3053\u3068\u304c\u671f\u5f85\u3055\u308c\u308b\u3002CPG\u306e\u91cd\u8981\u306a\u69cb\u6210\u8981\u7d20\u306f\u300c\u304a\u52e7\u3081\u5ea6\u300d\u3067\u3042\u308b\u3002CPG\u3092\u300c\u3064\u304f\u308b\u300d\u8005\u306b\u3068\u3063\u3066\u3082\u300c\u3064\u304b\u3046\u300d\u8005\u306b\u3068\u3063\u3066\u3082\u3001\u305d\u3053\u3067\u306e\u300c\u304a\u52e7\u3081\u5ea6\u300d\u304c\u3069\u306e\u7a0b\u5ea6\u4fe1\u7528\u3067\u304d\u308b\u3082\u306e\u304b\u3092\u77e5\u308b\u5fc5\u8981\u304c\u3042\u308b\u3002<br \/>\n\u6e0b\u6ede\u306e\u300c\u30a8\u30d3\u30c7\u30f3\u30b9\u306e\u30ec\u30d9\u30eb\u300d\u3084\u300c\u30a8\u30d3\u30c7\u30f3\u30b9\u306e\u5f37\u3055\u300d\u306f\u3002\u30e9\u30f3\u30c0\u30e0\u5316\u6bd4\u8f03\u8a66\u9a13\u306a\u3069\u306e\u7814\u7a76\u30c7\u30b6\u30a4\u30f3\u3092\u4e3b\u3068\u3057\u305f\u3082\u306e\u3067\u3001\u5404\u300c\u7814\u7a76\u306e\u8cea\u300d\u306f\u3042\u307e\u308a\u8003\u3048\u3066\u3053\u306a\u304b\u3063\u305f\u3002\u300c\u60aa\u3044RCT\u306f\u3001\u826f\u3044\u89b3\u5bdf\u7814\u7a76\u3088\u308a\u59cb\u672b\u304c\u60aa\u3044\u300d\u3068\u3044\u308f\u308c\u308b\u3054\u3068\u304f\u3001\u305d\u308c\u305e\u308c\u306e\u7814\u7a76\u306e\u8cea\u306f\u91cd\u8981\u3067\u3042\u308b\u3002\u307e\u305f\u3001\u6e0b\u6ede\u30e1\u30bf\u30a2\u30ca\u30ea\u30b7\u30b9\u304c\u8ad6\u3058\u3089\u308c\u308b\u3053\u3068\u304c\u591a\u304b\u3063\u305f\u304c\u3001\u3053\u3053\u3067\u306f\u300c\u4e00\u8cab\u6027\u300d\u3068\u3057\u3066\u6349\u3048\u3089\u308c\u300c\u6cbb\u7642\u52b9\u679c\u306e\u63a8\u5b9a\u300d\u304c\u7406\u89e3\u3057\u3084\u3059\u3044\u5f62\u306b\u306a\u3063\u3066\u3044\u308b\u3002\u3053\u308c\u3089\u3092\u7d71\u5408\u3057\u305f\u300c\u30a8\u30d3\u30c7\u30f3\u30b9\u306e\u8cea\u300d\u306f\u3002\u69cb\u6210\u8981\u7d20\u304c\u660e\u78ba\u3067\u5206\u304b\u308a\u3084\u3059\u3044\u3002<br \/>\n\u300c\u304a\u52e7\u3081\u5ea6\u300d\u306f\u3001\u4e0a\u8a18\u300c\u30a8\u30d3\u30c7\u30f3\u30b9\u306e\u8cea\u300d\u306b\u3001\u300c\u5229\u5bb3\u5f97\u5931\u300d\u3001\u300c\u7279\u5b9a\u306e\u72b6\u6cc1\u3078\u306e\u9069\u5fdc\u300d\u3001\u300c\u30d9\u30fc\u30b9\u30e9\u30a4\u30f3\u30fb\u30ea\u30b9\u30af\u306e\u4e0d\u78ba\u5b9f\u6027\u300d\u3092\u52a0\u3048\u3066\u7d71\u5408\u3057\u305f\u3082\u306e\u3067\u3042\u308b\u3002<\/p>\n<p><\/p>\n<p>\n\u6b20\u70b9\u3068\u3057\u3066\u306f\u3001\u5f93\u6765\u306egrading 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