\u30a8\u30d3\u30c7\u30f3\u30b9\u306e\u30ec\u30d9\u30eb(level)\u3001\u30a8\u30d3\u30c7\u30f3\u30b9\u306e\u968e\u5c64\u69cb\u9020(hierarchy)\u3001\u30a8\u30d3\u30c7\u30f3\u30b9\u306e\u8cea(quality)\u3001\u306a\u3069\u306eEBM\u7528\u8a9e\u304c\u73fe\u5728\u3082\u591a\u7528\u3055\u308c\u3066\u3044\u307e\u3059\u304c\u3001
\n\uff08GRADE\u30b7\u30b9\u30c6\u30e0\u304c\u767b\u5834\u3059\u308b\u524d\u306f\uff09\u30a8\u30d3\u30c7\u30f3\u30b9\u306e\u8cea\u8a55\u4fa1\u306f\u7814\u7a76\u30c7\u30b6\u30a4\u30f3\u306b\u4f9d\u5b58\u3057\u305f\u3082\u306e\u3067\u3057\u305f\u3002
\n
\n\u305d\u3057\u3066\u3001Oxford Centre for Evidence-based Medicine (OCEBM) – Levels of Evidence\u306e2011\u5e74new version\uff08\u90e8\u5206\u7684\u306bGRADE\u30b7\u30b9\u30c6\u30e0\u3092\u5229\u7528\uff09\u306e\u3088\u3046\u306b\u3001GRADE\u30b7\u30b9\u30c6\u30e0\u304c\u5831\u544a\u3055\u308c\u305f\u5f8c\u3067\u3082\u3001\u591a\u304f\u306e\u30b0\u30eb\u30fc\u30d7\u306b\u304a\u3044\u3066\u30a8\u30d3\u30c7\u30f3\u30b9\u306e\u8cea\u306e\u8a55\u4fa1\u65b9\u6cd5\u306f\u5909\u308f\u3063\u3066\u3044\u307e\u305b\u3093\u3002
\nOCEBM\u3092\u53c2\u8003\u306b\u3057\u3066\u3044\u308bMinds2007\u3082\u540c\u3058\u8a55\u4fa1\u30a2\u30d7\u30ed\u30fc\u30c1\u3067\u3059\u3002<\/p>\n
<\/p>\n
\n\u3044\u3063\u305f\u3044\u3001\u3044\u3064\u304b\u3089\u7814\u7a76\u30c7\u30b6\u30a4\u30f3\u306b\u3088\u308b\u30a8\u30d3\u30c7\u30f3\u30b9\u30fb\u30ec\u30d9\u30eb\u306e\u8a55\u4fa1\u304c\u884c\u308f\u308c\u308b\u3088\u3046\u306b\u306a\u3063\u305f\u306e\u3060\u308d\u3046\u304b\uff1f
\n\u30fb\u30fb\u30fb\u30fb\u30fb\u30fb\u30fb
\n\u305d\u306e\u6700\u521d\u306e\u5831\u544a\u8ad6\u6587\u306f\u30011979\u5e74\u306eCanadian Task Force on the Periodic Health Examination\u3067\u3001David Sackett\u3082\u540d\u3092\u9023\u306d\u3066\u3044\u307e\u3059\u3002<\/p>\n
<\/p>\n
\n periodic health examination. Canadian Task Force on the Periodic Health Examination CMAJ November 3, 1979 121:1193-1254<\/b>
\n\u25a0Quality of the evidence\u306f4\u6bb5\u968e\uff1a<\/b>
\nI: Evidence obtained from at least one properly randomized controlled trial.
\nII-1: Evidence obtained from well designed cohort or case-control analytic studies, preferably from
\nmore than one centre or research group.
\nII-2: Evidence obtained from comparisons between times or places with or without the intervention.
\nDramatic results in uncontrolled experiments (such as the results of the introduction of penicillin
\nin the 1 940s) could also be regarded as this type of evidence.
\nIII: Opinions of respected authorities, based on clinical experience, descriptive studies or reports
\nof expert committees.\n<\/p>\n
<\/p>\n
\u25a0Classification of recommendations\u306f5\u6bb5\u968e\uff1a<\/b>
\nA: There is good evidence to support the recommendation that the condition be specifically considered
\nin a periodic health examination.
\nB: There is fair evidence to support the recommendation that the condition be specifically considered
\nin a periodic health examination.
\nC: There is poor evidence regarding the inclusion of the condition in a periodic health examination,
\nand recommendations may be made on other grounds.
\nD: There is fair evidence to support the recommendation that the condition be excluded from consideration in a periodic health examination.
\nE: There is good evidence to support the recommendation that the condition be excluded from consideration in a periodic health examination.\n<\/p>\n
<\/p>\n
\nthe final recommendation for each condition relied heavily on our assessment of the evidence for effectiveness of treatment. Thus, a class A recommendation was rarely made in the absence of grade I evidence regarding effectiveness of treatment or prevention. However, an exception to this rule occurred when a clinical intervention was shown, in grade II terms, to save the lives of victims of a previously universally fatal condition. For example, if malignant hypertension is left untreated, all affected patients will die; if treated, most will survive. Thus, grade II evidence is sufficient for a class A recommendation. Such examples are rare, however, and grade I evidence was required for the highest recommendation for most of the conditions.\n<\/p>\n
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\n\u8ad6\u6587\u306b\u306f\u3001C recommendation\u306e\u8003\u3048\u65b9\u3068\u304b\u3001risk benefit\u30d0\u30e9\u30f3\u30b9\u3001sensitivity, secificity and predictive value; and the safety, simplicity, cost and acceptability to the patient.\u3001\u306a\u3069\u73fe\u5728\u306eGRADE\u306b\u3064\u306a\u304c\u308b\u57fa\u672c\u7406\u5ff5\u304c\u8a18\u8f09\u3055\u308c\u3066\u3044\u307e\u3059\u3002<\/p>\n
<\/p>\n
\u6ce8\uff1a\u3000GRADE\u306b\u304a\u3044\u3066\u306f\u3001\u500b\u3005\u306e\u7814\u7a76\u306e\u30a8\u30d3\u30c7\u30f3\u30b9\u3092\u8a55\u4fa1\u3059\u308b\u306e\u3067\u306f\u306a\u304f\u3001\u8907\u6570\u306e\u7814\u7a76\u306e\u30b7\u30b9\u30c6\u30de\u30c6\u30a3\u30c3\u30af\u30fb\u30ec\u30d3\u30e5\u30fc\u3092\u4f7f\u3046\u3002\u3059\u306a\u308f\u3061\u3001\u30a2\u30a6\u30c8\u30ab\u30e0\u3092\u4e3b\u4f53\u3068\u3057\u3066\u7814\u7a76\u6a2a\u65ad\u7684\u306b\u53ce\u96c6\u3057\u305f\u7dcf\u4f53\u30a8\u30d3\u30c7\u30f3\u30b9\uff08body of evidence\uff09\u306e\u8cea\u3092\u3001\u30a2\u30a6\u30c8\u30ab\u30e0\u3054\u3068\u306b\u8a55\u4fa1\u3059\u308b<\/p>\n
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![\"qoe\"](\"http:\/\/aihara.la.coocan.jp\/item_24_qoe-thumb.jpg\")
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