{"id":1221,"date":"2022-05-26T10:16:45","date_gmt":"2022-05-26T01:16:45","guid":{"rendered":"https:\/\/info.zanet.biz\/?p=1221"},"modified":"2022-05-27T15:32:48","modified_gmt":"2022-05-27T06:32:48","slug":"%e8%87%a8%e5%ba%8a%e7%9a%84%e3%82%a8%e3%82%ad%e3%82%b9%e3%83%91%e3%83%86%e3%82%a3%e3%83%bc%e3%82%ba%e3%81%a8ebm","status":"publish","type":"post","link":"https:\/\/info.zanet.biz\/?p=1221","title":{"rendered":"\u81e8\u5e8a\u7684\u30a8\u30ad\u30b9\u30d1\u30c6\u30a3\u30fc\u30ba\u3068EBM"},"content":{"rendered":"\n

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Wieten S\u306f\u3001\u3055\u3089\u306b\u3001\u30a8\u30ad\u30b9\u30d1\u30c6\u30a3\u30fc\u30ba\u3068\u306f\u4f55\u304b\u306b\u3064\u3044\u3066\u3001\u54f2\u5b66\u7684\u8003\u5bdf\u3092\u884c\u3063\u3066\u304a\u308a\u3001\u300c\u8003\u3048\u306a\u304f\u3066\u3082\u3001\u9023\u7d9a\u3057\u3066\u719f\u7df4\u3057\u305f\u4f5c\u696d\u304c\u3067\u304d\u308b\u3053\u3068flow of skilled coping\u300d\uff08Hubert Dreyfus\uff09\u3001\u300c\u793e\u4f1a\u7684\u306b\u8a8d\u77e5\u3055\u308c\u305f\u653f\u6cbb\u7684\u30d1\u30ef\u30fc\u3092\u3082\u3064\u5c02\u9580\u7684\u80fd\u529b\u300d\uff08Stephan Turner\uff09\uff08GOBSAT Good Old Boys Sit Around A Table\u306e\u3088\u3046\u306a\u3082\u306e\uff09\u3001\u300c\u7d71\u8a08\u5b66\u7684\u4e88\u6e2c\u30eb\u30fc\u30eb\u306a\u3069\u3092\u7528\u3044\u306a\u3044\u3067\u76f4\u89b3\u529b\u306b\u3088\u308b\u5224\u65ad\u304c\u3067\u304d\u308b\u3053\u3068\u300dMichael Bishop & JD Trout)\u3001\u300c\u305d\u306e\u5206\u91ce\u3092\u719f\u77e5\u3057\u3066\u304a\u308a\u72ec\u81ea\u306e\u8ca2\u732e\u304c\u3067\u304d\u308b\u3053\u3068\uff08contributory expertise)\u307e\u305f\u306f\u72ec\u81ea\u306e\u8ca2\u732e\u306f\u3067\u304d\u306a\u3044\u304c\u305d\u306e\u5206\u91ce\u306e\u8a00\u8a9e\u3092\u30de\u30b9\u30bf\u30fc\u3057\u3066\u3044\u308b\u3053\u3068\uff08interactional expertise)\u300d\uff08Harry Collins \uff06 Robert Evans\uff09\u306b\u3064\u3044\u3066\u89e3\u8aac\u3057\u3066\u3044\u308b\u3002<\/p>\n\n\n\n

\u3055\u3066\u3001\u30e2\u30c7\u30eb\u2462\u306b\u3064\u3044\u3066\u81ea\u5206\u306e\u8ffd\u52a0\u7684\u8003\u5bdf\u3092\u8ff0\u3079\u3066\u304a\u304d\u307e\u3059\u3002\u7814\u7a76\u30a8\u30d3\u30c7\u30f3\u30b9\u3092\u6b63\u3057\u304f\u7406\u89e3\u3057\u3066\u3044\u3066\u3082\u3001\u81e8\u5e8a\u7684\u30b9\u30ad\u30eb\u304c\u7121\u3051\u308c\u3070\u3001\u4ecb\u5165\u3092\u5b9f\u884c\u3059\u308b\u3053\u3068\u306f\u3067\u304d\u306a\u3044\u3068\u3044\u3046\u3053\u3068\u306f\u660e\u767d\u3067\u3059\u3002\u3059\u3079\u3066\u306e\u533b\u7642\u306f\u305d\u306e\u533b\u7642\u8005\u306e\u30b3\u30f3\u30d4\u30c6\u30f3\u30b7\u30fc\uff1d\u81e8\u5e8a\u7684\u30a8\u30ad\u30b9\u30d1\u30c6\u30a3\u30fc\u30ba\uff0b\u03b1\u3092\u901a\u3058\u3066\u5b9f\u73fe\u3059\u308b\u3053\u3068\u306f\u5426\u5b9a\u306e\u3057\u3088\u3046\u304c\u3042\u308a\u307e\u305b\u3093\u3002\u4f8b\u3048\u3070\u3001\u5185\u8996\u93e1\u7684\u306b\u6cbb\u7642\u53ef\u80fd\u306a\u65e9\u671f\u80c3\u764c\u3067\u30015\u5e74\u751f\u5b58\u7387\u306f95%\u4ee5\u4e0a\u3060\u3068\u5206\u304b\u3063\u3066\u3044\u3066\u3082\u3001ESD Endoscopic Submucosal Dissection\u304c\u3067\u304d\u306a\u3051\u308c\u3070\u3001\u305d\u306e\u533b\u7642\u306f\u5b9f\u73fe\u3067\u304d\u307e\u305b\u3093\u3002\u307e\u305f\u3001\u59d4\u8a17\u53ef\u80fd\u306a\u30ec\u30d9\u30eb\u3067ESD\u304c\u51fa\u6765\u308b\u3088\u3046\u306b\u306a\u308b\u306b\u306f\u3069\u3046\u3057\u305f\u3089\u3044\u3044\u304b\u306f\u81e8\u5e8a\u7814\u4fee\u306e\u8ab2\u984c\u306b\u306a\u308a\u307e\u3059\u3002<\/p>\n\n\n\n

\u60a3\u8005\u306e\u597d\u307f\u3068\u884c\u52d5\u3001\u7814\u7a76\u30a8\u30d3\u30c7\u30f3\u30b9\u3001\u81e8\u5e8a\u72b6\u614b\u3068\u72b6\u6cc1\u306e3\u3064\u306e\u8981\u7d20\u304b\u3089\u3001\u5b9f\u969b\u306e\u533b\u7642\u3092\u5b9f\u73fe\u3067\u304d\u308b\u304b\u3069\u3046\u304b\u306f\u3001\u81e8\u5e8a\u7684\u30a8\u30ad\u30b9\u30d1\u30c6\u30a3\u30fc\u30ba\u306b\u3088\u3063\u3066\u6c7a\u307e\u3063\u3066\u304d\u307e\u3059\u3002\u305d\u3057\u3066\u3001EBM\u306e\u30b9\u30c6\u30c3\u30d7\uff12\uff0c\uff13\u306e\u30a8\u30d3\u30c7\u30f3\u30b9\u306e\u691c\u7d22\u3068\u6279\u5224\u7684\u541f\u5473\u306f\u81e8\u5e8a\u7684\u30a8\u30ad\u30b9\u30d1\u30c6\u30a3\u30fc\u30ba\u306e\u4e00\u90e8\u3067\u3057\u304b\u3042\u308a\u307e\u305b\u3093\u3057\uff08\u4ee5\u524d\u306e\u6295\u7a3f\u53c2\u7167<\/a>\uff09\u3001EBM\u306e\u30b9\u30c6\u30c3\u30d7\uff14\u306e\u60a3\u8005\u3078\u306e\u9069\u7528\u306b\u306f\u6df1\u3044\u7406\u89e3\u3068\u79d1\u5b66\u7684\u30fb\u8ad6\u7406\u7684\u6df1\u3044\u601d\u8003\u304c\u5fc5\u8981\u3067\u3059\u3002\u7279\u306b\u3001\u30a8\u30d3\u30c7\u30f3\u30b9\u306e\u691c\u7d22\u3068\u6279\u5224\u7684\u541f\u5473\u306f\u30b7\u30b9\u30c6\u30de\u30c6\u30a3\u30c3\u30af\u306b\u884c\u308f\u306a\u3044\u3068\u3001\u3072\u3068\u3064\u306e\u8ad6\u6587\u306e\u6279\u5224\u7684\u541f\u5473\u3060\u3051\u3067\u306f\u9593\u9055\u3063\u305f\u7d50\u8ad6\u306b\u5230\u9054\u3059\u308b\u30ea\u30b9\u30af\u304c\u3042\u308a\u307e\u3059\u3002Shared Decision Making\u5354\u50cd\u610f\u601d\u6c7a\u5b9a\u306e\u80fd\u529b\u3082\u81e8\u5e8a\u7684\u30a8\u30ad\u30b9\u30d1\u30c6\u30a3\u30fc\u30ba\u306b\u542b\u307e\u308c\u307e\u3059\u3002<\/p>\n\n\n\n

\u81e8\u5e8a\u6c7a\u65adClinical Decision Making\u3042\u308b\u3044\u306fMedical Decision Making\u3092\u79d1\u5b66\u7684\u30fb\u8ad6\u7406\u7684\u306b\u884c\u3046\u80fd\u529b\u306f\u81e8\u5e8a\u7684\u30a8\u30ad\u30b9\u30d1\u30c6\u30a3\u30fc\u30ba\u306b\u542b\u307e\u308c\u308b\u3053\u3068\u306f\u660e\u767d\u3067\u3059\u304c\u3001\u6c7a\u65ad\u306e\u79d1\u5b66Decision Science\u3001\u305f\u3068\u3048\u3070Multi-Criteria Decision Analysis \uff08MCDA\uff09\u306a\u3069\u306e\u77e5\u8b58\u30fb\u30b9\u30ad\u30eb\u304c\u5fc5\u8981\u306b\u306a\u308a\u3001\u3053\u308c\u3089\u306f\u5c11\u306a\u304f\u3068\u3082\u308f\u304c\u56fd\u3067\u306f\u901a\u5e38\u306eEBM\u306e\u6559\u80b2\u30b3\u30f3\u30c6\u30f3\u30c4\u304c\u5341\u5206\u30ab\u30d0\u30fc\u3057\u3066\u3044\u308b\u3068\u306f\u3044\u3044\u304c\u305f\u3044\u72b6\u6cc1\u3067\u3059\u3002EBM\u304c\u81e8\u5e8a\u7684\u30a8\u30ad\u30b9\u30d1\u30c6\u30a3\u30fc\u30ba\u3092\u5305\u542b\u3057\u3066\u3044\u308b\u3068\u3044\u3046\u3088\u308a\u3001\u81e8\u5e8a\u7684\u30a8\u30ad\u30b9\u30d1\u30c6\u30a3\u30fc\u30ba\u304cEBM\u306e\u30b3\u30f3\u30d4\u30c6\u30f3\u30b7\u30fc\u3092\u5305\u542b\u3057\u3066\u3044\u308b\u3068\u8003\u3048\u308b\u3079\u304d\u3067\u3059\u3057\u3001\u5b9f\u969b\u306e\u533b\u7642\u3082\u81e8\u5e8a\u7814\u4fee\u3082\u305d\u306e\u3088\u3046\u306a\u69cb\u9020\u3067\u884c\u308f\u308c\u3066\u3044\u307e\u3059\u3002<\/p>\n\n\n\n

EBM\u306f\u5b66\u554f\u306e\u4f53\u7cfb\u3067\u306f\u306a\u304f\u3001\u533b\u7642\u5b9f\u8df5\u306e\u4f53\u7cfb\u3067\u3001EBM\u306e\u30b3\u30f3\u30d4\u30c6\u30f3\u30b7\u30fc\u306f\u5b9f\u8df5\u306e\u305f\u3081\u306b\u500b\u4eba\u30ec\u30d9\u30eb\u3067\u5fc5\u8981\u306a\u77e5\u8b58\u3001\u30b9\u30ad\u30eb\uff08\u6280\u80fd\uff09\u3001\u614b\u5ea6\u3001\u4fa1\u5024\u89b3\u306e\u3053\u3068\u3067\u3059\u3002<\/p>\n\n\n\n

Wieten S\u306e\u8ad6\u6587\u3092\u719f\u8aad\u3057\u305f\u4e0a\u3067\u3001\u81ea\u5206\u3067\u3082\u719f\u8003\u3059\u308b\u3053\u3068\u3092\u304a\u52e7\u3081\u3057\u307e\u3059\u3002<\/p>\n\n\n\n

\u6587\u732e\uff1a<\/p>\n\n\n\n

Wieten S: Expertise in evidence-based medicine: a tale of three models. Philos Ethics Humanit Med 2018;13:2. doi: 10.1186\/s13010-018-0055-2 PMID: 29394938<\/a><\/p>\n\n\n\n

Haynes RB, Devereaux PJ, Guyatt GH: Physicians’ and patients’ choices in evidence based practice. BMJ 2002;324:1350. doi: 10.1136\/bmj.324.7350.1350 PMID: 12052789<\/a><\/p>\n\n\n\n

Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS: Evidence based medicine: what it is and what it isn’t. BMJ 1996;312:71-2. doi: 10.1136\/bmj.312.7023.71 PMID: 8555924<\/a><\/p>\n\n\n\n

Evidence-Based Medicine Working Group: Evidence-based medicine. A new approach to teaching the practice of medicine. JAMA 1992;268:2420-5. doi: 10.1001\/jama.1992.03490170092032 PMID: 1404801<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

Evidence-Based Medicine (EBM)\u306b\u304a\u3051\u308bClinical Expertise \u81e8\u5e8a\u7684\u5c02\u9580\u80fd\u529b\u3042\u308b\u3044\u306f\u81e8\u5e8a\u7684\u30a8\u30ad\u30b9\u30d1\u30c6\u30a3\u30fc\u30ba\u306b\u3064\u3044\u3066\u3001Haynes\u3089\u306e\u3053\u306e\u3088\u3046\u306a\u56f3\u3092\u898b\u305f\u3053\u3068\u304c\u3042\u308b\u4eba\u306f\u591a\u3044\u3068\u601d\u3044\u307e\u3059 … “\u81e8\u5e8a\u7684\u30a8\u30ad\u30b9\u30d1\u30c6\u30a3\u30fc\u30ba\u3068EBM” \u306e<\/span>\u7d9a\u304d\u3092\u8aad\u3080<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[27,8,3,6],"tags":[],"class_list":["post-1221","post","type-post","status-publish","format-standard","hentry","category-benefit-harm-assessment","category-essay","category-mdm","category-sdm"],"_links":{"self":[{"href":"https:\/\/info.zanet.biz\/index.php?rest_route=\/wp\/v2\/posts\/1221","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/info.zanet.biz\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/info.zanet.biz\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/info.zanet.biz\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/info.zanet.biz\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=1221"}],"version-history":[{"count":14,"href":"https:\/\/info.zanet.biz\/index.php?rest_route=\/wp\/v2\/posts\/1221\/revisions"}],"predecessor-version":[{"id":1243,"href":"https:\/\/info.zanet.biz\/index.php?rest_route=\/wp\/v2\/posts\/1221\/revisions\/1243"}],"wp:attachment":[{"href":"https:\/\/info.zanet.biz\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=1221"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/info.zanet.biz\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=1221"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/info.zanet.biz\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=1221"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}