{"id":140,"date":"2014-06-12T13:23:40","date_gmt":"2014-06-12T04:23:40","guid":{"rendered":"http:\/\/www.hcfm.jp\/journal\/?p=140"},"modified":"2015-08-06T13:24:05","modified_gmt":"2015-08-06T04:24:05","slug":"%e6%a4%9c%e6%9f%bb%e3%81%8c%e9%99%b0%e6%80%a7%e3%81%a7%e3%82%82%e6%82%a3%e8%80%85%e3%81%af%e5%ae%89%e5%bf%83%e3%81%97%e3%81%aa%e3%81%84","status":"publish","type":"post","link":"https:\/\/www.hcfm.jp\/journal\/?p=140","title":{"rendered":"\u691c\u67fb\u304c\u9670\u6027\u3067\u3082\u60a3\u8005\u306f\u5b89\u5fc3\u3057\u306a\u3044"},"content":{"rendered":"<p>\u2015\u6587\u732e\u540d\u2015\u2028Diagnostic testing does not reassure patients with low probability of serious disease. Systematic Review and Meta-analysis JAMA Intern Med. 2013;173(6):407-416<\/p>\n<p>\u2015\u3053\u306e\u6587\u732e\u3092\u9078\u3093\u3060\u80cc\u666f\u2015\u2028\u3000\u300c\u982d\u75db\u306a\u306e\u3067\u8133\u816b\u760d\u304c\u5fc3\u914d\u300d\u300c\u54b3\u304c\u51fa\u308b\u306e\u3067\u80ba\u764c\u304c\u5fc3\u914d\u300d\u306a\u3069\u306b\u4ee3\u8868\u3055\u308c\u308b\u3001\u81e8\u5e8a\u7684\u306b\u4e8b\u524d\u78ba\u7387\u304c\u4f4e\u3044\u72b6\u6cc1\u306b\u304a\u3051\u308b\u3001\u91cd\u7be4\u306a\u75be\u60a3\u3078\u306e\u61f8\u5ff5\u306f\u533b\u5e2b\u304c\u6700\u3082\u983b\u7e41\u306b\u7d4c\u9a13\u3059\u308billness\u306e\u3072\u3068\u3064\u3067\u3042\u308d\u3046\u3002\u7814\u4fee\u533b\u6642\u4ee3\u306f\u691c\u67fb\u3067\u9670\u6027\u3092\u78ba\u8a8d\u3057\u3066\u3082\u3001\u6642\u9593\u304c\u7d4c\u3064\u3068\u540c\u3058\u4e0d\u5b89\u3067\u53d7\u8a3a\u3059\u308b\u60a3\u8005\u306b\u9589\u53e3\u3057\u3066\u3044\u305f\u899a\u3048\u304c\u3042\u308b\u304c\u3001\u5bb6\u5ead\u533b\u3068\u3057\u3066\u7814\u947d\u3092\u7a4d\u3080\u306b\u3064\u308c\u3001\u60a3\u8005\u306eIllness\u3092\u6df1\u304f\u7406\u89e3\u3059\u308b\u8853\u3092\u77e5\u308b\u3053\u3068\u3067\u691c\u67fb\u3092\u884c\u3046\u4ee5\u5916\u306e\u30aa\u30d7\u30b7\u30e7\u30f3\u3067\u5b89\u5fc3\u3057\u3066\u9802\u3044\u305f\u308a\u3001\u5bfe\u5fdc\u3059\u308b\u5e45\u3082\u5e83\u304c\u3063\u3066\u3044\u308b\u304c\u3001\u305d\u306e\u4e00\u65b9\u3067\u691c\u67fb\u3092\u3059\u308c\u3070\u7c21\u5358\u306b\u89e3\u6c7a\u3059\u308b\u30b1\u30fc\u30b9\u3082\u3042\u308b\u306e\u3067\u306f\u306a\u3044\u304b\u3068\u3044\u3046\u7591\u554f\u304c\u3042\u3063\u305f\u3002\u4eca\u56de\u306f\u305d\u3046\u3057\u305f\u7591\u554f\u306b\u7b54\u3048\u308b\u30bf\u30a4\u30c8\u30eb\u306e\u30e1\u30bf\u30a2\u30ca\u30ea\u30b7\u30b9\u3092\u898b\u3064\u3051\u305f\u305f\u3081\u3001\u5171\u6709\u3057\u305f\u3044\u3002<\/p>\n<p>\u2015\u8981\u7d04\u2015\u2028\u3010\u80cc\u666f\u3068\u76ee\u7684\u3011\u2028\u81e8\u5e8a\u533b\u306f\u3001\u3068\u3042\u308b\u75be\u60a3\u306e\u4e8b\u524d\u78ba\u7387\u304c\u4f4e\u3044\u72b6\u6cc1\u3067\u3082\u3001\u3057\u3070\u3057\u3070\u305d\u306e\u75be\u60a3\u3092\u9664\u5916\u3057\u3066\u60a3\u8005\u3092\u5b89\u5fc3\u3055\u305b\u308b\u305f\u3081\u306b\u8a3a\u65ad\u7684\u691c\u67fb\u3092\u5b9f\u65bd\u3059\u308b\u3002\u2028\u305d\u3046\u3057\u305f\u8a3a\u65ad\u7684\u691c\u67fb\u304c\u3001\u91cd\u7be4\u306a\u75be\u60a3\u306e\u4e8b\u524d\u78ba\u7387\u304c\u4f4e\u3044\u72b6\u6cc1\u306b\u3042\u308b\u60a3\u8005\u306e\u75be\u60a3\u3078\u306e\u61f8\u5ff5\u3084\u3001\u4e0d\u5b89\u3001\u75c7\u72b6\u306e\u6301\u7d9a\u3001\u305d\u306e\u5f8c\u306e\u533b\u7642\u6a5f\u95a2\u30fb\u533b\u7642\u8cc7\u6e90\u306e\u5229\u7528\u306b\u3069\u306e\u3088\u3046\u306a\u5f71\u97ff\u3092\u4e0e\u3048\u308b\u306e\u304b\u3092\u8abf\u67fb\u3057\u305f\u3002<\/p>\n<p>\u3010\u30a8\u30d3\u30c7\u30f3\u30b9\u306e\u8abf\u67fb\u65b9\u6cd5\u3011\u2028\u30b7\u30b9\u30c6\u30de\u30c6\u30a3\u30c3\u30af\u30fb\u30ec\u30d3\u30e5\u30fc\u3068\u30e1\u30bf\u30a2\u30ca\u30ea\u30b7\u30b9\u3092\u884c\u3063\u305f\u3002\u76ee\u7684\u306b\u898b\u5408\u3063\u305f\u30e9\u30f3\u30c0\u30e0\u5316\u6bd4\u8f03\u8a66\u9a13\u3092\u63a2\u3059\u305f\u3081\u306b\u3001MEDLINE, the Cochrane Central Register of Controlled Trials, EMBASE, PsychINFO, CINAHL, and ProQuest Dissertations electronic databases\u30922011\u5e7412\u670831\u65e5\u5206\u307e\u3067\u8abf\u67fb\u3057\u305f\u3002\u6211\u3005\u306f\u5225\u3005\u306b\u3001\u7814\u7a76\u3092\u691c\u7d22\u3057\u3001\u30c7\u30fc\u30bf\u3092\u62bd\u51fa\u3057\u305f\u3002(\u7814\u7a76\u8005\u9593\u306e)\u4e0d\u4e00\u81f4\u304c\u3042\u3063\u305f\u5834\u5408\u306f\u3001\u8b70\u8ad6\u306b\u3088\u3063\u3066\u89e3\u6c7a\u3057\u305f\u3002Heterogeneity\u304c\u4f4e\u3044\u3042\u308b\u3044\u306f\u4e2d\u7b49\u5ea6\u306e\u5834\u5408(\u3064\u307e\u308a\u3001\u30ab\u30a4\u4e8c\u4e57\u691c\u5b9a\u304c50%\u4ee5\u4e0b)\u306f\u3001\u30e1\u30bf\u30a2\u30ca\u30ea\u30b7\u30b9\u3092\u884c\u3063\u305f\u3002<\/p>\n<p>\u3010\u7d50\u679c\u3011\u202814\u306eRCT\u304c\u898b\u3064\u304b\u308a\u30013828\u4eba\u306e\u60a3\u8005\u304c\u53c2\u5165\u57fa\u6e96\u306b\u5f53\u3066\u306f\u307e\u308a\u3001\u30a2\u30a6\u30c8\u30ab\u30e0\u3092\u5206\u6790\u3057\u305f\u3002\u30a2\u30a6\u30c8\u30ab\u30e0\u306f3\u30f6\u6708\u4ee5\u5185\u30683\u30f6\u6708\u4ee5\u4e0a\u306b\u5206\u3051\u3066\u5206\u6790\u3057\u305f\u30023\u3064\u306e\u7814\u7a76\u304b\u3089\u3001\u8a3a\u65ad\u7684\u691c\u67fb\u306f\u3001\u75be\u60a3\u3078\u306e\u61f8\u5ff5\u306b\u5f71\u97ff\u304c\u306a\u3044(\u6539\u5584\u3057\u306a\u3044)\u3053\u3068\u304c3\u3064\u306e\u7814\u7a76\u304b\u3089\u5206\u304b\u308a(OR 0.87 95%CI, 0.55-1.39))\u3001\u66f4\u306b\u975e\u7279\u7570\u7684\u306a\u4e0d\u5b89\u3078\u306e\u5f71\u97ff\u3082\u306a\u3044\u3053\u3068\u304c\u4e8c\u3064\u306e\u7814\u7a76\u304b\u3089\u793a\u3055\u308c\u305f(standardized mean difference, 0.06 [-0.16 to 0.28])\u300210\u306e\u7814\u7a76\u304b\u3089\u3001\u75c7\u72b6\u306e\u6301\u7d9a\u306b\u3082\u5f71\u97ff\u304c\u306a\u3044\u3053\u3068\u304c\u308f\u304b\u3063\u305f(odds ratio, 0.99 [95% CI, 0.85-1.15])\u300211\u306e\u7814\u7a76\u304c\u305d\u306e\u5f8c\u306e\u30d7\u30e9\u30a4\u30de\u30ea\u30b1\u30a2\u306e\u53d7\u8a3a\u3092\u8a55\u4fa1\u3057\u3066\u3044\u305f\u304c\u3001\u7814\u7a76\u9593\u306e\u7570\u8cea\u6027\u304c\u9ad8\u304b\u3063\u305f(I^2=80%)\u3002\u5916\u308c\u5024\u3067\u3042\u308b\u7814\u7a76\u3092\u53d6\u308a\u9664\u3044\u3066\u884c\u3063\u305f\u30e1\u30bf\u30a2\u30ca\u30ea\u30b7\u30b9\u304b\u3089\u306f\u3001\u308f\u305a\u304b\u306b\u53d7\u8a3a\u56de\u6570\u304c\u6e1b\u308b\u3053\u3068\u304c\u793a\u5506\u3055\u308c\u305f\u3002<\/p>\n<p>\u3010\u7d50\u8a9e\u3011\u2028\u91cd\u7be4\u306a\u75be\u60a3\u306e\u4e8b\u524d\u78ba\u7387\u304c\u4f4e\u3044\u72b6\u6cc1\u3067\u306e\u8a3a\u65ad\u7684\u691c\u67fb\u306f\u305d\u306e\u5f8c\u306e\u53d7\u8a3a\u3092\u6e1b\u3089\u3059\u53ef\u80fd\u6027\u306f\u3042\u308b\u304c\u3001\u6b86\u3069\u60a3\u8005\u3092\u5b89\u5fc3\u3055\u305b\u305a\u3001\u4e0d\u5b89\u3082\u89e3\u6d88\u305b\u305a\u3001\u5f7c\u3089\u306e\u75c7\u72b6\u3092\u6539\u5584\u3055\u305b\u306a\u3044\u3053\u3068\u304c\u308f\u304b\u3063\u305f\u3002\u533b\u5b66\u7684\u306b\u5fc5\u8981\u306a\u691c\u67fb\u3067\u5f97\u3089\u308c\u308b\u5b89\u5fc3\u3092\u6700\u5927\u9650\u306b\u3057\u3001\u691c\u67fb\u3067\u7570\u5e38\u304c\u3042\u308b\u53ef\u80fd\u6027\u304c\u4f4e\u3044\u6642\u306b\u3001\u691c\u67fb\u3092\u305b\u305a\u306b\u60a3\u8005\u3092\u30de\u30cd\u30b8\u30e1\u30f3\u30c8\u3059\u308b\u5b89\u5168\u306a\u6226\u7565\u3092\u958b\u767a\u3059\u308b\u305f\u3081\u306b\u306f\u3001\u66f4\u306a\u308b\u7814\u7a76\u304c\u5fc5\u8981\u3067\u3042\u308b\u3002<\/p>\n<p>\u2015\u8003\u5bdf\u3068\u30c7\u30a3\u30b9\u30ab\u30c3\u30b7\u30e7\u30f3\u2015\u2028\u300c\u5358\u7d14\u306b\u60a3\u8005\u306e\u5e0c\u671b\u3067\u691c\u67fb\u3092\u3057\u3066\u9670\u6027\u3092\u4f1d\u3048\u3066\u3082\u3001\u60a3\u8005\u306f\u7d50\u5c40\u5b89\u5fc3\u3057\u306a\u3044\u300d\u3068\u3044\u3046\u81ea\u5206\u306e\u7d4c\u9a13\u5247\u306b\u5408\u81f4\u3059\u308b\u7814\u7a76\u7d50\u679c\u3067\u3042\u3063\u305f\u304c\u3001\u305d\u308c\u4ee5\u4e0a\u306b\u8457\u8005\u306e\u8003\u5bdf\u306f\u8208\u5473\u3076\u304b\u304b\u3063\u305f\u3002<\/p>\n<p>(\u8003\u5bdf\u3088\u308a\u8981\u7d04\u3057\u3066\u5f15\u7528)\u2028\u3000\u5fc3\u7406\u5b66\u7684\u306b\u306f\u3001\u5b89\u5fc3\u306b\u306f\u2460\u611f\u60c5\u7684\u306a\u5b89\u5fc3\u3068\u2461\u8a8d\u77e5\u306e\u5909\u5316\u306b\u3088\u308b\u5b89\u5fc3\u304c\u3042\u308a\u3001\u524d\u8005\u306f\u77ed\u671f\u7684\u306a\u5b89\u5fc3\u3092\u4f5c\u308b\u304c\u3001\u9577\u304f\u306f\u3082\u305f\u306a\u3044\u305f\u3081\u3001\u9577\u671f\u7684\u306a\u5b89\u5fc3\u3092\u5f97\u308b\u305f\u3081\u306b\u306f\u2461\u304c\u5fc5\u8981\u3067\u3042\u308b\u3068\u8a00\u308f\u308c\u3066\u3044\u308b\u3002\u5358\u7d14\u306b\u691c\u67fb\u3092\u884c\u3044\u3001\u305d\u306e\u9670\u6027\u3092\u4f1d\u3048\u308b\u3060\u3051\u306e\u30a2\u30d7\u30ed\u30fc\u30c1\u306f\u611f\u60c5\u7684\u306a\u5b89\u5fc3\u3057\u304b\u4e0e\u3048\u3066\u3044\u306a\u3044\u3053\u3068\u306b\u306a\u308b\u3002\u5b9f\u969b\u306b\u3001\u691c\u67fb\u306e\u9670\u6027\u3092\u4f1d\u3048\u308b\u3060\u3051\u3067\u306f\u6570\u6642\u9593\u3067\u60a3\u8005\u306e\u4e0d\u5b89\u306f\u518d\u5ea6\u51fa\u73fe\u3059\u308b\u3068\u3044\u3046\u7d50\u679c\u3092\u793a\u3057\u305f\u7814\u7a76\u3082\u3042\u308b\u3002\u9577\u671f\u7684\u306a\u75c7\u72b6\u306b\u5bfe\u3059\u308b\u5b89\u5fc3\u3092\u60a3\u8005\u306b\u5f97\u3066\u3082\u3089\u3046\u305f\u3081\u306b\u306f\u3001\u75c7\u72b6\u306b\u5bfe\u3059\u308b\u60a3\u8005\u306e\u8a8d\u77e5\u306e\u67a0\u7d44\u307f\u305d\u306e\u3082\u306e\u3092\u5909\u3048\u3066\u3044\u304f\u5fc5\u8981\u304c\u3042\u308a\u3001\u5b9f\u969b\u306b\u691c\u67fb\u7d50\u679c\u304c\u9670\u6027\u3067\u3042\u308b\u3053\u3068\u306e\u610f\u5473\u4ed8\u3051\u3092\u60a3\u8005\u306b\u3088\u308a\u53d7\u3051\u5165\u308c\u3066\u3082\u3089\u3046\u305f\u3081\u306e\u5fc3\u7406\u7684\u4ecb\u5165\u3092\u8ffd\u52a0\u3059\u308b\u3053\u3068\u3067\u3001\u60a3\u8005\u306e\u5b89\u5fc3\u304c\u5897\u3057\u305f\u3068\u3044\u3046\u7814\u7a76\u3082\u8907\u6570\u5b58\u5728\u3059\u308b\u3068\u306e\u3053\u3068\u3067\u3042\u3063\u305f\u3002(\u3053\u3053\u307e\u3067)<\/p>\n<p>\u3000\u3064\u307e\u308a\u3001\u8457\u8005\u306f\u691c\u67fb\u3092\u884c\u3046\u304b\u3001\u884c\u308f\u306a\u3044\u304b\u3060\u3051\u3067\u306a\u304f\u3001\u884c\u3063\u305f\u6642\u306b\u3001\u9670\u6027\u306e\u7d50\u679c\u3092\u60a3\u8005\u306e\u4e2d\u3067\u9069\u5207\u306b\u610f\u5473\u4ed8\u3051\u3057\u3066\u3082\u3089\u3046\u3053\u3068\u304c\u91cd\u8981\u3060\u3068\u8ff0\u3079\u3066\u3044\u308b\u3002\u2028\u3000\u5bb6\u5ead\u533b\u304c\u65e5\u3005\u306e\u533b\u7642\u9762\u63a5\u3067\u7528\u3044\u3066\u3044\u308bPatient centered clinical method\u306f\u3001\u60a3\u8005\u306e\u75c7\u72b6\u3078\u306e\u8a8d\u77e5\u306e\u69cb\u9020\u3092illness\u3068\u3044\u3046\u5f62\u3067\u5f15\u304d\u51fa\u3057\u3001\u691c\u67fb\u304c\u6301\u3064\u610f\u5473\u3092\u60a3\u8005\u3068\u5171\u6709\u3059\u308b\u30a2\u30d7\u30ed\u30fc\u30c1\u3060\u304c\u3001\u3053\u308c\u306f\u8a00\u3044\u63db\u3048\u308c\u3070\u3001\u60a3\u8005\u306e\u75c7\u72b6\u306b\u5bfe\u3059\u308b\u8a8d\u77e5\u306e\u67a0\u7d44\u307f\u3092\u78ba\u8a8d\u3057\u3001\u691c\u67fb\u304c\u9670\u6027\u3060\u3063\u305f\u6642\u306b\u60a3\u8005\u306e\u8a8d\u77e5\u306e\u67a0\u7d44\u307f\u306e\u5909\u5316\u3092\u4fc3\u3059\u3053\u3068\u306b\u5f53\u3066\u306f\u307e\u308b\u3002\u307e\u3055\u306b\u3001\u4e0a\u8a18\u306e\u2461\u306b\u3042\u305f\u308b\u3001\u8a8d\u77e5\u306e\u5909\u5316\u306b\u57fa\u3065\u304f\u5b89\u5fc3\u3092\u4fc3\u3059\u305f\u3081\u306b\u6709\u7528\u306a\u624b\u6bb5\u306e\u4e00\u3064\u3067\u3042\u308b\u3068\u8003\u3048\u3089\u308c\u308b\u3002\u2028\u3000\u300c\u25cb\u25cf\u304c\u5fc3\u914d\u306a\u306e\u3067\u691c\u67fb\u3057\u3066\u307b\u3057\u3044\u300d\u3068\u3044\u3046\u60a3\u8005\u3001\u7686\u3055\u3093\u306f\u3069\u3046\u30a2\u30d7\u30ed\u30fc\u30c1\u3057\u3066\u3044\u308b\u3067\u3057\u3087\u3046\u304b\uff1f<\/p>\n<p>\u3010\u958b\u50ac\u65e5\u3011\u20282014\u5e746\u670811\u65e5(\u6c34)<\/p>\n","protected":false},"excerpt":{"rendered":"<p>\u2015\u6587\u732e\u540d\u2015\u2028Diagnostic testing does not reassure patients with low probability of serious disease. Systematic Review &hellip; <a href=\"https:\/\/www.hcfm.jp\/journal\/?p=140\" class=\"more-link\">\u7d9a\u304d\u3092\u8aad\u3080 <span class=\"screen-reader-text\">\u691c\u67fb\u304c\u9670\u6027\u3067\u3082\u60a3\u8005\u306f\u5b89\u5fc3\u3057\u306a\u3044<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2],"tags":[],"class_list":["post-140","post","type-post","status-publish","format-standard","hentry","category-2"],"_links":{"self":[{"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/posts\/140","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=140"}],"version-history":[{"count":1,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/posts\/140\/revisions"}],"predecessor-version":[{"id":141,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/posts\/140\/revisions\/141"}],"wp:attachment":[{"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=140"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=140"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=140"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}