{"id":225,"date":"2012-09-24T15:39:08","date_gmt":"2012-09-24T06:39:08","guid":{"rendered":"http:\/\/aihara.la.coocan.jp\/blog\/?p=225"},"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%8d2","status":"publish","type":"post","link":"http:\/\/aihara.la.coocan.jp\/?p=225","title":{"rendered":"\u56fd\u5185\u30ac\u30a4\u30c9\u30e9\u30a4\u30f3\u5c02\u9580\u5bb6\u306eGRADE\u306b\u5bfe\u3059\u308b\u8003\u3048\u65b9\uff0d(2)"},"content":{"rendered":"

\u8a3a\u7642\u30ac\u30a4\u30c9\u30e9\u30a4\u30f3\u306e\u305f\u3081\u306eGRADE\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\u304d\u305f\u306e\u304b\u30fb\u30fb\u30fb\u3002<\/p>\n

<\/p>\n

\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\uff1a\u3000\u5e73\u621017\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\uff082006\u5e744\u6708\uff09 p432-449<\/p>\n

\u696d\u7e3e\u96c6\u306e\u5f53\u8a72\u8a18\u4e8b\u306e\u4e00\u90e8\u3092\u629c\u7c8b\u7d39\u4ecb\u3057\u307e\u3059\u3002<\/p>\n

\n\u30a8\u30d3\u30c7\u30f3\u30b9\u306b\u57fa\u3065\u304f\u533b\u7642\uff08\uff25\uff22\uff2d\uff09\u306e\u7cfb\u8b5c\u3068\u65b9\u5411\u6027\uff1a\u4fdd\u5065\u533b\u7642\u8a55\u4fa1\u306b\u679c\u305f\u3059\u30b3\u30af\u30e9\u30f3\u5171\u540c\u8a08\u753b\u306e\u5f79\u5272\u3068\u672a\u6765<\/b>
\n\uff08\u5206\u62c5\u7814\u7a76\uff1a\u3000\u6b63\u6728\u670b\u4e5f\u3001\u6d25\u8c37\u559c\u4e00\u90ce\uff09 \u65e5\u672c\u8a55\u4fa1\u5b66\u4f1a\u3000\u300c\u65e5\u672c\u8a55\u4fa1\u7814\u7a76\u300d\u3000\u7b2c6\u5dfb\u7b2c1\u53f7 2006\u5e74\u3001pp3-20
\n————————————————————————————————————<\/p>\n

\nEBM\u306b\u306f\u3001\u5e83\u7fa9\u3068\u72ed\u7fa9\u306e\u610f\u5473\u304c\u3042\u308b\u304c\u3001\u305d\u306e\u6839\u5e95\u306b\u306f\u5bfe\u8c61\u3068\u306a\u308b\u60a3\u8005\u306e\u597d\u307f(patient preference)\u3001\u4fa1\u5024\u30b7\u30b9\u30c6\u30e0(value systems\uff09\u3001\u304a\u3088\u3073\u73fe\u5834\u306e\u72b6\u6cc1\u306a\u3069\u3082\u8e0f\u307e\u3048\u305f\u5171\u901a\u70b9\u304c\u3042\u308b\u3002EBM\u306e\u57fa\u672c\u306f\u3001\u7814\u7a76\u306b\u3088\u308b\u30a8\u30d3\u30c7\u30f3\u30b9\u306e\u7b97\u51fa\u306b\u3042\u308a\u3001\u305d\u306e\u30a8\u30d3\u30c7\u30f3\u30b9\u306b\u306f\u30b0\u30ec\u30fc\u30c9\u304c\u3042\u308b\u3053\u3068\u3092\u660e\u767d\u306b\u3057\u305f\u3046\u3048\u3067\u3001\u305d\u308c\u3092\u5834\u306e\u72b6\u6cc1\u306b\u5fdc\u3058\u3066\u9069\u5207\u306b\u5229\u7528\u3059\u308b\u3053\u3068\u3067\u3042\u308b\u3002<\/p>\n

\np441:
\n(4) \u30a8\u30d3\u30c7\u30f3\u30b9\u306e\u8cea\u3068\u304a\u52e7\u3081\u5ea6\u306e\u30b0\u30ec\u30fc\u30c7\u30a3\u30f3\u30b0
\n\u8907\u6570\u306e\u30b0\u30ec\u30fc\u30c7\u30a3\u30f3\u30b0\u30fb\u30b9\u30b1\u30fc\u30eb\u304c\u4e26\u5b58\u3059\u308b\u4e2d\u3067\u305d\u306e\u904b\u7528\u306b\u3064\u3044\u3066\u306e\u6b20\u70b9\u3068\u554f\u984c\u70b9\u3092\u6539\u5584\u3059\u308b\u76ee\u7684\u3067\u6709\u5fd7\u3089\u304c\u96c6\u307e\u308a\u30012000\u5e74\u3088\u308aGRADE Working Group\u3068\u3057\u3066\u975e\u516c\u5f0f\u306a\u6d3b\u52d5\u3092\u958b\u59cb\u3057\u3066\u3044\u308b\u3002\u5f7c\u3089\u306f\u30012004\u5e74\u306b\u306f\u30a8\u30d3\u30c7\u30f3\u30b9\u5229\u7528\u8005\u306e\u8996\u70b9\u306b\u7acb\u3061\u3001\u300c\u30a8\u30d3\u30c7\u30f3\u30b9\u306e\u8cea\u300d\u3068\u305d\u306e\u304a\u52e7\u3081\u5ea6(strength of recommendation\uff09\u3092\u8a55\u4fa1\u3059\u308b\u30b7\u30b9\u30c6\u30e0\u3092\u958b\u767a\u3057\u305f(BMJ 2004, \u6d25\u8c37\u4ed6\u8a332005)\u3002\u305d\u306e\u4e2d\u3067\u3001\u500b\u3005\u306e\u4e3b\u8981\u306a\u30a2\u30a6\u30c8\u30ab\u30e0\u306b\u304a\u3051\u308b\u30a8\u30d3\u30c7\u30f3\u30b9\u306e\u8cea\u306f\u3001(1)\u7814\u7a76\u30c7\u30b6\u30a4\u30f3\u3001(2)\u7814\u7a76\u306e\u8cea\u3001(3)\u4e00\u8cab\u6027\u3001(4)\u76f4\u63a5\u6027\u3001\u3092\u305d\u308c\u305e\u308c\u8003\u616e\u3057\u305f\u3046\u3048\u3067\u6c7a\u5b9a\u3059\u3079\u304d\u3068\u3057\u3066\u3044\u308b\u3002\u305d\u3053\u3067\u306f\u3001\u307e\u305a\u7814\u7a76\u30c7\u30b6\u30a4\u30f3\u3092RCT\u3068\u89b3\u5bdf\u7814\u7a76\u306b\u5206\u985e\u3057\u3001\u305d\u306e\u4ecb\u5165\u306b\u3088\u308b\u5229\u76ca\u304c\u5bb3\u3088\u308a\u591a\u3044\u304b\u5426\u304b\u3092\u5229\u5bb3\u5f97\u5931\u306e4\u6bb5\u968e\u306b\u5206\u985e\u3059\u308b\u3053\u3068\u3092\u63d0\u6848\u3057\u305f\u3002\u3055\u3089\u306b\u3053\u308c\u3089\u3092\u3082\u3068\u306b\u300c\u304a\u52e7\u3081\u5ea6\u300d\u306e\u30b0\u30ec\u30fc\u30c9\uff14\u6bb5\u968e\u30ab\u30c6\u30b4\u30ea\u30fc(*)\u3092\u63d0\u6848\u3057\u305f\u3002<\/p>\n

\n\u5f7c\u3089\u306e\u6d3b\u52d5\u306e\u91cd\u8981\u306a\u70b9\u306e\u3072\u3068\u3064\u306f\u3001\u610f\u601d\u6c7a\u5b9a\u306b\u5fc5\u8981\u306a\u7c21\u6f54\u6027(simplicity)\u3068\u660e\u77ad\u6027(clarity)\u3092\u3046\u307e\u304f\u30d0\u30e9\u30f3\u30b9\u3059\u308b\u3088\u3046\u8a66\u307f\u305f\u70b9\u3067\u3042\u308b\u3002\u30b7\u30b9\u30c6\u30e0\u3092\u5358\u7d14\u5316\u3059\u308c\u3070\u5224\u65ad\u304c\u9ed9\u793a\u7684\u306b\u306a\u308a\u3084\u3059\u304f\u3001\u660e\u77ad\u6027\u3092\u6b20\u304f\u3053\u3068\u306b\u306a\u308a\u3001\u9006\u306b\u3001\u660e\u77ad\u6027\u3092\u9ad8\u3081\u610f\u601d\u6c7a\u5b9a\u306e\u30d7\u30ed\u30bb\u30b9\u3092\u308f\u304b\u308a\u3084\u3059\u304f\u3057\u3088\u3046\u3068\u3059\u308c\u3070\u3001\u30b7\u30b9\u30c6\u30e0\u306f\u8907\u96d1\u306a\u3082\u306e\u3068\u306a\u308a\u3084\u3059\u3044\u3002\u3082\u3046\u3072\u3068\u3064\u306e\u91cd\u8981\u306a\u70b9\u306f\u3001\u5f7c\u3089\u306e\u30a2\u30d7\u30ed\u30fc\u30c1\u306f\u3001\u69cb\u9020\u5316\u3055\u308c\u305f\u719f\u8003(structured reflection)\u306e\u305f\u3081\u306e\u67a0\u8e0f\u307f\u3092\u63d0\u4f9b\u3059\u308b\u3082\u306e\u3067\u3042\u308a\u3001\u9069\u5207\u306a\u5224\u65ad\u3092\u78ba\u5b9f\u306b\u884c\u3046\u52a9\u3051\u3068\u306a\u308b\u304c\u3001\u30e6\u30fc\u30b6\u30fc\u81ea\u8eab\u306e\u5224\u65ad\u306e\u5fc5\u8981\u305d\u306e\u3082\u306e\u3092\u306a\u304f\u3057\u3066\u3057\u307e\u3046\u3082\u306e\u3067\u306f\u306a\u3044\u3068\u3059\u308b\u7acb\u5834\u3092\u660e\u78ba\u306b\u3057\u8a55\u4fa1\u30b7\u30b9\u30c6\u30e0\u3092\u958b\u767a\u30fb\u63d0\u6848\u3057\u3066\u3044\u308b\u70b9\u3067\u3042\u308b\u3002
\n————————————————————————————————————<\/p>\n

\n\u76f8\u539f\u8a55\uff1a\u3000\u8457\u8005\u3089\u306fGRADE\u306e\u91cd\u8981\u306a\u70b9\u3092\u9069\u683c\u306b\u89e3\u8aac\u3057\u3066\u3044\u307e\u3059\u3002<\/p>\n

(*) \u3057\u304b\u3057\u3001\u3053\u306e\u8a18\u8f09\u306f\u8aa4\u308a\uff08BMJ\u8ad6\u6587\u306e\u6d25\u8c37\u7ffb\u8a33\u8ad6\u6587\u3067\u3082\u540c\u69d8\u306e\u30df\u30b9\u304c\u3042\u308b\uff09\u3067\u3042\u308a\u3001GRADE\u30a2\u30d7\u30ed\u30fc\u30c1\u306b\u304a\u3051\u308b\u300c\u304a\u52e7\u3081\u5ea6\u300d\u306f\u3001\u5f37\u3044(strong)<\/b><\/u> \u304b\u5f31\u3044(weak)<\/b><\/u> \u306e2\u7a2e\u985e\u306e\u3044\u305a\u304b\u3067\u3059\u3002\u63a8\u5968\u306e\u5f37\u3055\u3068\u65b9\u5411\u6027\u3092\u5408\u308f\u305b\u3066\u8003\u616e\u3059\u308b\u3068\u3001do it, probably do it, probably don’t it, don’t it\u306e\uff14\u3064\u306e\u3044\u305a\u308c\u304b\u3067\u3059\u3002<\/p>\n

<\/p>\n

\n\"bmj\"<\/a>\n<\/p>\n



<\/p>\n","protected":false},"excerpt":{"rendered":"

\u8a3a\u7642\u30ac\u30a4\u30c9\u30e9\u30a4\u30f3\u306e\u305f\u3081\u306eGRADE\u30b7\u30b9\u30c6\u30e0\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\u304d\u305f\u306e\u304b\u30fb\u30fb\u30fb\u3002 \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 […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[16],"tags":[146,439,324],"_links":{"self":[{"href":"http:\/\/aihara.la.coocan.jp\/index.php?rest_route=\/wp\/v2\/posts\/225"}],"collection":[{"href":"http:\/\/aihara.la.coocan.jp\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/aihara.la.coocan.jp\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/aihara.la.coocan.jp\/index.php?rest_route=\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"http:\/\/aihara.la.coocan.jp\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=225"}],"version-history":[{"count":1,"href":"http:\/\/aihara.la.coocan.jp\/index.php?rest_route=\/wp\/v2\/posts\/225\/revisions"}],"predecessor-version":[{"id":457,"href":"http:\/\/aihara.la.coocan.jp\/index.php?rest_route=\/wp\/v2\/posts\/225\/revisions\/457"}],"wp:attachment":[{"href":"http:\/\/aihara.la.coocan.jp\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=225"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/aihara.la.coocan.jp\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=225"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/aihara.la.coocan.jp\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=225"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}