{"id":425,"date":"2012-06-04T07:58:39","date_gmt":"2012-06-03T22:58:39","guid":{"rendered":"http:\/\/www.hcfm.jp\/journal\/?p=425"},"modified":"2015-08-06T14:59:07","modified_gmt":"2015-08-06T05:59:07","slug":"%e9%ab%98%e9%bd%a2%e8%80%85%e6%95%91%e6%80%a5%e5%85%a5%e9%99%a2%e3%81%ab%e5%af%be%e3%81%99%e3%82%8bcga%e3%81%af%e6%ad%bb%e4%ba%a1%e7%8e%87%e3%81%a8%e5%9c%a8%e5%ae%85%e5%be%a9%e5%b8%b0%e7%8e%87","status":"publish","type":"post","link":"https:\/\/www.hcfm.jp\/journal\/?p=425","title":{"rendered":"\u9ad8\u9f62\u8005\u6551\u6025\u5165\u9662\u306b\u5bfe\u3059\u308bCGA\u306f\u6b7b\u4ea1\u7387\u3068\u5728\u5b85\u5fa9\u5e30\u7387\u3092\u6539\u5584\u3059\u308b"},"content":{"rendered":"

\u3010\u6587\u732e\u540d\u3011
\n\u8457\u8005\u540d\uff1aGraham Ellis et al
\n\u6587\u732e\u30bf\u30a4\u30c8\u30eb\uff1aComprehensive geriatric assessment for older adults admitted to hospital: meta-analysis of randomized controlled trials.\u00a0
\n\u96d1\u8a8c\u540d\u30fb\u66f8\u7c4d\u540d\uff1aBMJ 2011;343:d6553 doi: 10.1136\/bmj.d6553
\n\u767a\u884c\u5e74\uff1a2011<\/p>\n

\u3010\u8981\u7d04\u3011
\n\uff1cOBJECTIVE\uff1e
\n\u9ad8\u9f62\u8005\u6551\u6025\u5165\u9662\u306b\u304a\u3051\u308bCGA\u306e\u52b9\u679c\u3092\u8a55\u4fa1\u3059\u308b<\/p>\n

\uff1cPECO of Meta-analysis\uff1e
\nP\uff1d\u9ad8\u9f62\u8005\u3067\u6551\u6025\u5165\u9662\u3057\u305f\u8005
\n\u30fb\u9ad8\u9f62\u8005\u3068\u306f65\u6b73\u4ee5\u4e0a\u3001\u6551\u6025\u5165\u9662\u3068\u306f\u8a08\u753b\u3084\u4e88\u7d04\u304c\u306a\u3044\u6025\u6027\u306e\u72b6\u614b\u306b\u3088\u308b\u5165\u9662
\nE\uff1dCGA(Selection criteria\u53c2\u7167)\u3000
\nC=\u901a\u5e38\u30b1\u30a2\uff1d\u4e00\u822c\u5185\u79d1\u3078\u306e\u5165\u9662\u3067\u3001Geriatric specialist\u3067\u306f\u306a\u3044\u533b\u5e2b\u306b\u3088\u308b\u30b1\u30a2
\nO\uff1b1\u6b21\u30a2\u30a6\u30c8\u30ab\u30e0\u306f\u5728\u5b85\u751f\u6d3b
\n2\u6b21\u30a2\u30a6\u30c8\u30ab\u30e0\u306f\u6b7b\u4ea1\u7387\u3001\u65bd\u8a2d\u5165\u6240\u3001\u4f9d\u5b58\u72b6\u614b\u3001\u72b6\u614b\u306e\u60aa\u5316(\u6a5f\u80fd\u306e)\u3001\u6b7b\u4ea1or\u4f9d\u5b58\u72b6\u614b\u3001\u6b7b\u4ea1or\u72b6\u614b\u306e\u60aa\u5316\u3001ADL\u3001\u8a8d\u77e5\u8133\u3001\u518d\u5165\u9662\u3001\u5165\u9662\u671f\u9593\u3001\u8cc7\u6e90\u306e\u5229\u7528\u91cf\u3001\u3068\u3057\u305f\u3002
\nSearch strategy \u7814\u7a76\u8005\u304cEPOC Register, Cochrane’s Controlled Trials Register, the Database of Abstracts of Reviews of Effects (DARE), Medline, Embase, CINAHL, AARP Ageline, and handsearched high yield journals\u3092\u691c\u7d22\u3057\u305f\u3002\u66f4\u306b\u3001\u63b2\u8f09\u53ef\u80fd\u6027\u304c\u9ad8\u3044\u96d1\u8a8c\u3001\u30ab\u30f3\u30d5\u30a1\u30ec\u30f3\u30b9\u30d7\u30ed\u30b7\u30fc\u30c7\u30a3\u30f3\u30b0\u3001\u95a2\u9023\u3057\u305f\u30ec\u30d3\u30e5\u30fc\u306e\u53c2\u8003\u6587\u732e\u30ea\u30b9\u30c8\u3092\u76f4\u63a5\u8abf\u67fb\u3057\u305f\u3002<\/p>\n

\uff1cSelection criteria\uff1e\u00a0
\nCGA\u306e\u52b9\u679c\u3068\u901a\u5e38\u306e\u30b1\u30a2\u3092\u6bd4\u8f03\u3057\u305fRCT\u3067\u3042\u308b\u3053\u3068(\u75c5\u68df(Ward\u203b1)\u56fa\u5b9a\u306e\u7814\u7a76\u304b\u3001\u305d\u308c\u3068\u3082\u9662\u5185\u3067\u79fb\u52d5\u53ef\u80fd\u306a\u30c1\u30fc\u30e0(Team\u203b1)\u304b\u306f\u554f\u308f\u306a\u3044)\u3002CGA\u3068\u306f\u3001\u591a\u8077\u7a2e\u306b\u3088\u308b\u591a\u9762\u7684\u306a\u8a55\u4fa1\u30d7\u30ed\u30bb\u30b9\u3067\u3001\u533b\u5b66\u7684\u30fb\u5fc3\u7406\u5b66\u7684\u30fb\u6a5f\u80fd\u7684\u306a\u80fd\u529b\u3092\u865a\u5f31\u9ad8\u9f62\u8005\u306b\u304a\u3044\u3066\u8a55\u4fa1\u3057\u3001\u5354\u50cd\u7684\u3067\u3001\u7d71\u5408\u3055\u308c\u305f\u8a08\u753b\u3092\u6cbb\u7642\u3068\u9577\u671f\u30d5\u30a9\u30ed\u30fc\u30a2\u30c3\u30d7\u306b\u3064\u3044\u3066\u305f\u3066\u308b\u3082\u306e\u3067\u3042\u308b\u3002
\n\u9664\u5916\u57fa\u6e96\u3068\u3057\u3066\u3001\u3042\u308b\u7279\u5b9a\u306e\u75be\u60a3\u306b\u5bfe\u3059\u308b\u7d44\u7e54\u3060\u3063\u305f\u30b1\u30a2\u3092\u8a55\u4fa1\u3057\u305f\u7814\u7a76\u306f\u9664\u5916\u3057\u3001\u5165\u9662\u30bb\u30c3\u30c6\u30a3\u30f3\u30b0\u3067\u306a\u3044\u5834\u5408\u3082\u9664\u5916\u3057\u305f\u3002<\/p>\n

\uff1cData collection and analysis\uff1e
\n3\u4eba\u306e\u72ec\u7acb\u3057\u305f\u8a55\u4fa1\u8005\u304c\u3001\u500b\u3005\u306e\u7814\u7a76\u304c\u9069\u683c\u304b\u3069\u3046\u304b\u3068\u3001\u305d\u306e\u8cea\u3092\u8a55\u4fa1\u3057\u3001\u51fa\u7248\u3055\u308c\u305f\u30c7\u30fc\u30bf\u3092\u62bd\u51fa\u3057\u305f\u3002\u3055\u3089\u306b\u4e8c\u4eba\u306e\u8a55\u4fa1\u8005\u304c\u8abf\u6574\u3092\u884c\u3063\u305f\u3002<\/p>\n

\uff1cResults\uff1e6\u304b\u56fd\u306710315\u4eba\u3092\u8a55\u4fa1\u3057\u305f22\u306e\u7814\u7a76\u304c\u898b\u3064\u304b\u3063\u305f\u3002\u4e00\u6b21\u30a2\u30a6\u30c8\u30ab\u30e0\u3067\u3042\u308b\u5728\u5b85\u3067\u306e\u751f\u6d3b\u306b\u3064\u3044\u3066\u306f\u3001\u30d5\u30a9\u30ed\u30fc\u30a2\u30c3\u30d7\u671f\u9593\u306e\u6700\u5f8c\u306e\u6642\u70b9\u306b\u304a\u3044\u3066\u3001\u901a\u5e38\u306e\u30b1\u30a2\u3092\u53d7\u3051\u305f\u60a3\u8005\u3088\u308a\u3001CGA\u3092\u53d7\u3051\u305f\u60a3\u8005\u306e\u65b9\u304c\u3088\u308a\u81ea\u5b85\u3067\u751f\u6d3b\u3057\u3066\u3044\u305f\u3002(\u30d5\u30a9\u30ed\u30fc\u4e2d\u592e\u5024\u304c12\u304b\u6708\u306e\u5834\u5408\u306fOR 1.16 (95%CI 1.05 to 1.28; P=0.003; NNT 33)\u3001\u4e2d\u592e\u5024\u304c6\u304b\u6708\u306e\u5834\u5408\u306f1.25 (1.11 to 1.42; P<0.001; NNT 17)\u00a0\n\u66f4\u306b\u3001CGA\u3092\u53d7\u3051\u305f\u60a3\u8005\u306b\u304a\u3044\u3066\u306f\u5165\u6240\u306b\u306a\u3063\u305f\u8005\u304c\u3088\u308a\u5c11\u306a\u304b\u3063\u305f\u3002(0.78, 0.69 to 0.88; P<0.001).\u00a0\n\u30b5\u30d6\u30b0\u30eb\u30fc\u30d7\u89e3\u6790\u306b\u304a\u3044\u3066\u306f\u3001\u300cWard\u300d\u3068\u300cTeam\u300d\u3067\u884c\u3063\u305f\u5834\u5408\u306b\u3001\u524d\u8005\u306e\u65b9\u304c\u7d50\u679c\u304c\u826f\u597d\u3067\u3042\u3063\u305f(\u203b2)\u3002\u307e\u305f\u3001CGA\u3092\u53d7\u3051\u305f\u60a3\u8005\u306e\u65b9\u304c\u3001\u6b7b\u4ea1\u3068\u6a5f\u80fd\u4f4e\u4e0b\u306e\u5408\u8a08\u306e\u767a\u751f\u306f\u3088\u308a\u5c11\u306a\u304f(0.76, 0.64 to 0.90; P=0.001)\u3001\u8a8d\u77e5\u6a5f\u80fd\u306e\u6539\u5584\u306f\u3088\u308a\u591a\u304b\u3063\u305f(standardised mean difference 0.08, 0.01 to 0.15; P=0.02)\n\n\uff1cConclusions\uff1e\nCGA\u306f\u6551\u6025\u5165\u9662\u3057\u305f\u60a3\u8005\u306b\u304a\u3044\u3066\u3001\u81ea\u5b85\u3067\u306e\u751f\u5b58\u7387\u3092\u6539\u5584\u3057\u305f\u3002\u7279\u306b\u3053\u308c\u306f\u75c5\u68df\u5168\u4f53\u304cCGA\u3092\u884c\u3048\u308b\u3088\u3046\u306b\u7d44\u7e54\u3055\u308c\u305f\u5834\u5408\u306b\u5b9f\u73fe\u3059\u308b\u3068\u601d\u308f\u308c\u3001\u305d\u3057\u3066\u901a\u5e38\u306e\u533b\u5b66\u7684\u30b1\u30a2\u3068\u6bd4\u3079\u3066\u30b3\u30b9\u30c8\u524a\u6e1b\u3068\u3082\u95a2\u9023\u304c\u3042\u308b\u3068\u601d\u308f\u308c\u305f\u3002\n\n\n\u3010\u8003\u5bdf\u3068\u30c7\u30a3\u30b9\u30ab\u30c3\u30b7\u30e7\u30f3\u3011\n\u3000\u4eca\u307e\u3067CGA\u306b\u3064\u3044\u3066\u306f\u7279\u5b9a\u306e\u72b6\u6cc1\u3067\u306e\u30a8\u30d3\u30c7\u30f3\u30b9\u304c\u3042\u308b\u3053\u3068\u306f\u77e5\u3063\u3066\u3044\u305f\u304c\u3001\u3053\u306e\u3088\u3046\u306b\u4e00\u822c\u5316\u3057\u3066\u6551\u6025\u5165\u9662\u306e\u5f62\u3067\u52b9\u679c\u304c\u793a\u3055\u308c\u305f\u3053\u3068\u306f\u5927\u304d\u3044\u3002\u30a2\u30a6\u30c8\u30ab\u30e0\u306e\u8a2d\u5b9a\u306e\u4ed5\u65b9\u3082\u300c\u5728\u5b85\u751f\u5b58\u300d\u3067\u3042\u308a\u3001\u305f\u3060\u306e\u300c\u751f\u5b58\u300d\u3068\u3057\u3066\u3044\u306a\u3044\u3053\u3068\u3082\u6ce8\u76ee\u306b\u5024\u3059\u308b\u3002(\u901a\u5e38\u306e\u751f\u5b58\u306b\u3064\u3044\u3066\u306f\u6709\u610f\u5dee\u306a\u3057\u3002)\n\u3000\u65e5\u672c\u3067\u306f\u8001\u5e74\u533b\u5b66\u306e\u5c02\u9580\u5bb6\u306f\u975e\u5e38\u306b\u7a00\u6709\u3067\u3001CGA\u3092\u4e2d\u5fc3\u3068\u3057\u305f\u9ad8\u9f62\u8005\u30a2\u30d7\u30ed\u30fc\u30c1\u306e\u6559\u80b2\u306e\u4e3b\u8ef8\u306f\u5bb6\u5ead\u533b\u3084\u75c5\u68df\u7dcf\u5408\u533b\u304c\u62c5\u3063\u3066\u3044\u308b\u3068\u3044\u3063\u3066\u3082\u3088\u3044\u72b6\u6cc1\u3067\u3042\u308b\u3002\u305d\u3046\u3057\u305f\u4e2d\u3067\u3001\u6211\u3005\u5bb6\u5ead\u533b\u304c\u62c5\u3046\u3079\u304d\u5f79\u5272\u3068\u3057\u3066\u3001\n\n\u3000\u2460\u90e1\u90e8\u30b5\u30a4\u30c8\u30fb\u50fb\u5730\u3067\u5165\u9662\u65bd\u8a2d\u304c\u3042\u308b\u5834\u5408\u306f\u73fe\u5834\u3067\u306e\u5b9f\u8df5\n\n\u304c\u6319\u3052\u3089\u308c\u308b\u3057\u3001\u5165\u9662\u3092\u3082\u305f\u306a\u3044\u90fd\u5e02\u90e8\u30b5\u30a4\u30c8\u3067\u3042\u3063\u3066\u3082\n\n\u3000\u2461\u5bb6\u5ead\u533b\u8a3a\u7642\u6240\u306b\u898b\u5b66\u306b\u6765\u305f\u7814\u4fee\u533b\u3084\u75c5\u68df\u52e4\u52d9\u533b\u306b\u5bfe\u3059\u308b\u6559\u80b2\n\u3000\u2462\u533b\u5b66\u751f\u306b\u5bfe\u3059\u308b\u6559\u80b2\n\u3000\u2463\u30b3\u30e1\u30c7\u30a3\u30ab\u30eb\u306b\u5bfe\u3059\u308b\u6559\u80b2\n\u3000\u2464\u958b\u653e\u75c5\u5e8a\u3078\u306e\u30a2\u30d7\u30ed\u30fc\u30c1\u30fb\u9023\u643a\n\n\u304c\u6319\u3052\u3089\u308c\u308b\u3068\u8003\u3048\u3089\u308c\u305f\u3002\u5c06\u6765\u7684\u306b\u306f\u6211\u3005\u30d7\u30e9\u30a4\u30de\u30ea\u30b1\u30a2\u533b\u3068\u75c5\u68df\u52e4\u52d9\u533b\u306e\u9023\u643a\u306b\u3088\u308b\u30a2\u30d7\u30ed\u30fc\u30c1(\u6587\u732e\u4e2d\u306eTeam\u30a2\u30d7\u30ed\u30fc\u30c1\u306b\u8fd1\u3044\u3082\u306e\u306b\u306a\u308b\u3067\u3042\u308d\u3046)\u304c\u53ef\u80fd\u306a\u4ed5\u7d44\u307f\u3092\u63d0\u6848\u3057\u305f\u308a\u3001CGA\u3092\u5b9f\u8df5\u3067\u304d\u308b\u75c5\u68df\u52e4\u52d9\u533b\u3092\u591a\u304f\u80b2\u3066\u308b\u3053\u3068\u3067\u9ad8\u9f62\u8005\u30b1\u30a2\u306e\u8cea\u306e\u6539\u5584\u306b\u8ca2\u732e\u3067\u304d\u308b\u3068\u601d\u308f\u308c\u305f\u3002\n\n\n\u3010\u53c2\u8003\u3011\n\u203b1\u3053\u306e\u6587\u732e\u306b\u304a\u3051\u308bWard\u3068Team\n'Ward'CGA\u3092\u75c5\u68df\u3067\u30b1\u30a2\u3059\u308b\u969b\u306b\u306f\u4e8c\u3064\u306e\u4e3b\u6d41\u306a\u65b9\u6cd5\u304c\u3042\u308a\u3001\u75c5\u68df\u5168\u4f53\u3092CGA\u75c5\u68df\u3068\u3057\u3066\u904b\u55b6\u3059\u308b\u65b9\u6cd5\u3068\u3001\u79fb\u52d5\u53ef\u80fd\u306a\u30c1\u30fc\u30e0\u3092\u75c5\u9662\u5185\u3067\u5f62\u6210\u3057\u3001\u5fc5\u8981\u306a\u60a3\u8005\u3092\u8a2a\u308c\u3066\u62c5\u5f53\u306e\u533b\u5e2b\u3084\u30b9\u30bf\u30c3\u30d5\u306b\u6307\u793a\u3059\u308b\u65b9\u6cd5\u304c\u3042\u308b\u3002\u524d\u8005\u3092'Wards'\u3001\u5f8c\u8005\u3092'Mobile team'\u3068\u3053\u306eStudy\u3067\u306f\u547c\u3093\u3067\u3044\u308b\u3002\u524d\u8005\u306b\u306facute care for elders (ACE units), geriatric evaluation and management units (GEMU), or rehabilitation 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