{"id":718,"date":"2010-10-09T10:56:32","date_gmt":"2010-10-09T01:56:32","guid":{"rendered":"http:\/\/www.hcfm.jp\/journal\/?p=718"},"modified":"2015-08-07T10:56:59","modified_gmt":"2015-08-07T01:56:59","slug":"%ef%bd%9e%e3%83%97%e3%83%a9%e3%82%a4%e3%83%9e%e3%83%aa%e3%82%b1%e3%82%a2%e3%81%ab%e3%81%8a%e3%81%91%e3%82%8b%e8%aa%a4%e8%a8%ba%e3%83%bb%e8%a8%ba%e6%96%ad%e3%81%ae%e9%81%85%e3%82%8c%e3%81%ae%e4%ba%8b","status":"publish","type":"post","link":"https:\/\/www.hcfm.jp\/journal\/?p=718","title":{"rendered":"\uff5e\u30d7\u30e9\u30a4\u30de\u30ea\u30b1\u30a2\u306b\u304a\u3051\u308b\u8aa4\u8a3a\u30fb\u8a3a\u65ad\u306e\u9045\u308c\u306e\u4e8b\u4f8b\u306b\u306f\u3069\u3093\u306a\u7279\u5fb4\u304c\u3042\u308b\u304b\uff1f\uff5e"},"content":{"rendered":"

\u3010\u6587\u732e\u3011
\nDiagnostic difficulty and error in primary care -a systematic review- Family Practice 2008; 25: 400-413.<\/p>\n

\u3010\u8981\u7d04\u3011
\n<\u5c0e\u5165>
\n\u3053\u306eReview\u306f\u3001\u2460GP\u306e\u8a3a\u65ad\u30df\u30b9\u307e\u305f\u306f\u9045\u308c\u306e\u72b6\u6cc1\u3000\u2461\u3069\u3093\u306a\u7279\u5fb4\u304c\u3001\u8a3a\u65ad\u3092\u56f0\u96e3\u306b\u3057\u305f\u308a\u3001\u8aa4\u308a\u306e\u53ef\u80fd\u6027\u3092\u9ad8\u3081\u3066\u3044\u308b\u304b\u3000\u306e2\u70b9\u3092\u540c\u5b9a\u3059\u308b\u305f\u3081\u306b\u884c\u308f\u308c\u305f\u3002
\n< \u65b9\u6cd5>\u3053\u306e\u8ad6\u6587\u306e\u8457\u8005\u3089\u304c\u8a2d\u5b9a\u3057\u305f\u691c\u7d22\u30ef\u30fc\u30c9\u3067Pubmed\u3092\u691c\u7d22\u3057\u3001\u30bf\u30a4\u30c8\u30eb\u3084\u5185\u5bb9\u304b\u3089\u3055\u3089\u306b\u7d5e\u308a\u8fbc\u3093\u306021\u306eGP\u306e\u8a3a\u65ad\u30df\u30b9\u306b\u95a2\u3059\u308b\u6587\u732e\u3092\u30ec \u30d3\u30e5\u30fc\u3057\u305f\u3002\u5177\u4f53\u7684\u306b\u306f\u3001GRADE\u30b7\u30b9\u30c6\u30e0(\u7570\u306a\u308bMethodology\u306e\u6587\u732e\u3092\u304a\u4e92\u3044\u306b\u8a55\u4fa1\u51fa\u6765\u308b\u65b9\u6cd5\u3089\u3057\u3044\u3067\u3059)\u3067Study\u306e\u8cea\u3092\u30c1\u30a7\u30c3\u30af\u3057\u3001 \u304b\u3064\u8a3a\u65ad\u30df\u30b9\u304c\u8d77\u3053\u308b\u4e8b\u4f8b\u304c\u6301\u3064\u7279\u5fb4\u3092\u5272\u308a\u51fa\u3057\u305f\u3002
\n<\u7d50\u679c>
\n\u25cf\u4e0a\u8a18\u306e\u3054\u3068\u304f21\u306e\u6587\u732e\u304c\u8a72\u5f53\u3057\u305f\u3002\u305d\u306e\u3046\u3061\u30012\u3064\u306e\u524d\u5411\u304d\u7814\u7a76\u4ee5\u5916\u306f\u3001\u5168\u3066\u5f8c\u5411\u304d\u7814\u7a76\u3060\u3063\u305f\u3002
\n\u25cfError\u306e\u5b9a\u7fa9\u306f\u6587\u732e\u306b\u3088\u3063\u3066\u7570\u306a\u3063\u3066\u3044\u305f\u3002
\n\u3000\u30fb\u907f\u3051\u3089\u308c\u308b\u3079\u304d\u8a3a\u65ad\u306e\u9045\u308c\u3001\u884c\u3046\u3079\u304d\u7d39\u4ecb\u304c\u521d\u56de\u3067\u884c\u308f\u308c\u306a\u304b\u3063\u305f\u4e8b\u4f8b
\n\u3000\u30fb\u521d\u8a3a\u304b\u3089\u8a3a\u65ad\u307e\u3067\u306e\u6642\u9593\u304c\u9069\u5207\u304b\u3069\u3046\u304b(\u9069\u5207\u306e\u57fa\u6e96\u306f\u305d\u308c\u305e\u308c\u306e\u6587\u732e\u3054\u3068)
\n\u3000\u30fb\u8a3a\u65ad\u3067\u306f\u306a\u304f\u3001\u30de\u30cd\u30fc\u30b8\u5168\u4f53\u306e\u9069\u5207\u3055\u3092\u6271\u3063\u3066\u3044\u308b\u3082\u306e\u3082\u3042\u3063\u305f
\n\u25cf\u8a3a\u65ad\u30df\u30b9\u3084\u9045\u308c\u304c\u8d77\u3053\u308a\u3084\u3059\u3044\u4e8b\u4f8b\u306e\u7279\u5fb4
\n\u3000\u30fb7\u3064\u306e\u6587\u732e\u306f\u539f\u8457\u3067\u8a00\u53ca\u304c\u3042\u3063\u305f\u3002
\n\u3000\u30fb\u7b46\u8005\u3089\u306f\u3001\u8a3a\u65ad\u306e\u56f0\u96e3\u3055\u3068\u7d50\u3073\u4ed8\u304f5\u3064\u306e\u7279\u5fb4\u3092\u898b\u51fa\u3057\u305f\u3002\u3059\u306a\u308f\u3061\u30011\u975e\u5178\u578b\u7684\u306a\u81e8\u5e8a\u50cf\u30002\u7279\u7570\u7684\u3067\u306a\u3044\u81e8\u5e8a\u50cf\u30003\u975e\u5e38\u306b\u6709\u75c5\u7387\u304c\u4f4e\u3044\u75be\u60a3\u30004\u4f75\u5b58\u75be\u60a3\u306e\u5b58\u5728\u30005\u8a8d\u8b58\u3067\u304d\u308b\u7279\u5fb4\u304c\u898b\u9003\u3055\u308c\u308b\uff08\u898b\u9003\u3055\u308c\u3084\u3059\u3044\uff09\u3082\u306e\u3001\u3067\u3042\u3063\u305f\u3002\u3053\u306e\u7279\u5fb4\u3092\u8907\u6570\u6301\u3063\u3066\u3044\u308b\u3082\u306e\u3082\u591a\u304b\u3063\u305f\u3002
\n1\u975e\u5178\u578b\u7684\u306a\u81e8\u5e8a\u50cf
\n\u3044\u308f\u3086\u308b\u300cPrototypical features\u300d\u304c\u7121\u3044\u3053\u3068\u3092\u6307\u3059\u3002Prototypical\u3068\u306f\u3001\u6700\u3082\u591a\u304f\u306e\u60a3\u8005\u304c\u6301\u3064\u7279\u5fb4\u3001\u9032\u884c\u3057\u305f\u75be\u60a3\u3067\u307f\u3089\u308c\u308b\u7279\u5fb4\u3001\u533b\u5b66\u66f8\u306b\u5358\u7d14\u306b\u3088\u304f\u63cf\u304b\u308c\u3066\u3044\u308b\u7279\u5fb4\u3092\u6307\u3059\u3002
\n\u3000\u3000\u4e88\u60f3\u3057\u306a\u3044\u75c7\u72b6\u306e\u7279\u5fb4\u3092\u6307\u3059\u3053\u3068\u3082\u3042\u308b\u3002(\u53f3\u8155\u306b\u653e\u6563\u3059\u308b\u80f8\u75db\u3068\u304b\u3002)
\n\u3000\u30ec\u30d3\u30e5\u30fc\u3057\u305f\u6587\u732e\u306e\u4e2d\u3067\u306f\u3001\u4f8b\u3048\u3070\u300cBreast Lump\u300d\u304c\u7121\u3044\u4e73\u304c\u3093\u3001\u5fc3\u7b4b\u6897\u585e\u306b\u304a\u3051\u308b\u975e\u5178\u578b\u7684\u306a\u75c7\u72b6(\u3081\u307e\u3044\u3001\u80c3\u306e\u75db\u307f\u3001\u523a\u3059\u3088\u3046\u306a\u75db\u307f\u3001\u306a\u3069)\u3084\u5178\u578b\u7684\u306a\u75c7\u72b6\u304c\u7121\u3044\u72b6\u6cc1\u304c\u3042\u3063\u305f\u3002\u307e\u305f\u3001\u5973\u6027\u306e\u5fc3\u7b4b\u6897\u585e\u3082\u3088\u308a\u642c\u9001\u304c\u9045\u308c\u308b\u50be\u5411\u306b\u3042\u308b\u3068\u3044\u3046\u5206\u6790\u3082\u3042\u3063\u305f\u3002
\n2\u975e\u7279\u7570\u7684\u81e8\u5e8a\u50cf
\n\u8a3a\u65ad\u4fa1\u5024\u304c\u4f4e\u3044\u7279\u5fb4\u3084\u3001\u9451\u5225\u8a3a\u65ad\u3092\u3088\u308a\u308f\u3051\u3089\u308c\u306a\u3044\u7279\u5fb4\u3092\u6307\u3059\u3002\u4ee5\u4e0b\u306bStudy\u3092\u5217\u6319\u3059\u308b\u3002
\n\u3000\u30fb\u5598\u606f\u306b\u304a\u3044\u3066\u54b3\u81ea\u4f53\u304c\u3001\u4e0a\u6c17\u9053\u708e\u306a\u3069\u3068\u540c\u3058\u3088\u3046\u306b\u975e\u7279\u7570\u7684\u306a\u3082\u306e\u3067\u3042\u308b\u3002
\n\u3000\u30fb\u5c0f\u5150\u306e\u9aa8\u306e\u60aa\u6027\u816b\u760d\u306b\u304a\u3044\u3066\u306f\u56db\u80a2\u3088\u308a\u4f53\u5e79\u306e\u65b9\u304c\u898b\u9003\u3055\u308c\u3084\u3059\u3044(\u5185\u81d3\u75db\u3084\u6a5f\u80fd\u6027\u75be\u60a3\u306e\u975e\u7279\u7570\u7684\u306a\u75c7\u72b6\u3068\u6349\u3048\u3089\u308c\u3066\u3057\u307e\u3046)
\n\u3000 \u30fb\u80c3\u764c\u306e\u521d\u671f\u75c7\u72b6\u3067\u3042\u308bDyspepsia\u3084\u5fc3\u7aa9\u90e8\u75db(\u4e00\u822c\u4eba\u53e3\u306e40\uff05\u304c1\u5e74\u306e\u3046\u3061\u306b\u7d4c\u9a13\u3059\u308b\u75c7\u72b6)\u306a\u3069\u304c\u4f8b\u306b\u6319\u3052\u3089\u308c\u308b\u3002\u80c3\u764c\u306b\u3064\u3044\u3066\u306e\u524d\u5411\u304d\u7814\u7a76\u3067 \u306f\u3001\u4f53\u91cd\u6e1b\u5c11\u3084\u56a5\u4e0b\u969c\u5bb3\u3001\u9ec4\u75b8\u3001\u8ca7\u8840\u3068\u3044\u3063\u305f\u3001\u8d64\u65d7\u5fb4\u5019\u306e\u4eba\u306e\u65b9\u304c\u3088\u308aGP\u306f\u7d39\u4ecb\u3057\u3066\u3044\u305f(48\uff05vs32\uff05)\u3057\u304b\u3057\u3001\u5b9f\u969b\u306ePPV\u306f\uff13\uff05\u3067\u3057\u304b\u306a\u304f\u3001\u3057 \u304b\u3082\u80c3\u764c\u306e\u534a\u5206\u306fAlarm sympotom\u306a\u3057\u3067\u8a3a\u65ad\u3055\u308c\u3066\u3044\u305f\u3002
\n3\u975e\u5e38\u306b\u307e\u308c\u306a\u75be\u60a3
\n\u307e\u308c\u306a\u75be\u60a3\u306f\u3001\u8003\u616e\u3055\u308c\u308b\u983b\u5ea6\u304c\u5c11\u306a\u3044\u3053\u3068\u3001\u75c7\u72b6\u304c\u7279\u7570\u7684\u3067\u3042\u3063\u3066\u3082\u4e8b\u524d\u78ba\u7387\u304c\u4f4e\u3044\u305f\u3081\u3001PPV\u304c\u975e\u5e38\u306b\u4f4e\u3044\u3053\u3068\u306a\u3069\u304c\u95a2\u4e0e\u3057\u3066\u3044\u308b\u3068\u601d\u308f\u308c\u308b\u3002
\n\u3000\u30fb\u820c\u764c\u30fb\u7db2\u819c\u82bd\u7d30\u80de\u816b\u304c\u4f8b\u3068\u3057\u3066\u6319\u3052\u3089\u308c\u3066\u3044\u305f\u3002
\n\uff14\u5408\u4f75\u75be\u60a3\u304c\u3042\u308b\u5834\u5408
\n\u3000\u30fb\u4e00\u3064\u306e\u75be\u60a3\u304c\u4ed6\u306e\u75be\u60a3\u306e\u81e8\u5e8a\u50cf\u3092\u5909\u3048\u305f\u308a\u3001\u4e00\u3064\u306e\u75be\u60a3\u3067\u3001\u75c7\u72b6\u3092\u8aac\u660e\u3067\u304d\u3066\u3057\u307e\u3046\u5834\u5408\u3092\u6307\u3059
\n\u3000\u30fb\u4f8b\u3048\u3070\u3001\u8a8d\u77e5\u75c7\u306f\u3046\u3064\u75c5\u304c\u5408\u4f75\u3057\u3066\u3044\u308b\u3068\u3001\u8a3a\u65ad\u304c\u9045\u308c\u308b\u50be\u5411\u306b\u3042\u3063\u305f\u3002
\n5Perceptual features
\n\u75be\u60a3\u306b\u7279\u5fb4\u3060\u304c\u3001\u305d\u306e\u75be\u60a3\u304c\u9451\u5225\u306b\u60f3\u8d77\u3055\u308c\u3066\u3044\u306a\u3044\u3068\u307f\u3066\u3082\u6c17\u3065\u304b\u308c\u306a\u3044\u3082\u306e\u3092\u6307\u3059\u3002(SLE\u306b\u304a\u3051\u308b\u8776\u5f62\u7d05\u6591\u3084Mumps\u306b\u304a\u3051\u308b\u8033\u4e0b\u817a\u816b\u8139\u306a\u3069)
\n\u3000\u30fbHIV\u306b\u304a\u3051\u308b\u3001Kaposi\u8089\u816b\u3084Hairy Leukoplakia\u3001\u5168\u8eab\u6027\u306e\u30ea\u30f3\u30d1\u7bc0\u816b\u8139\u306b\u3064\u3044\u3066\u306e\u6587\u732e\u304c\u3042\u3063\u305f\u3002<\/p>\n

\u3010\u958b\u50ac\u65e5\u3011
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