![\"\"](\"https:\/\/info.zanet.biz\/wp\/wp-content\/uploads\/2022\/06\/ebm-5-steps.png\")
\u201dStep 1\uff1a \u5fc5\u8981\u306a\u60c5\u5831\u3092\u56de\u7b54\u53ef\u80fd\u306a\u8cea\u554f\u306b\u5909\u63db\u3059\u308b\u201d\u306fPICO\u5f62\u5f0f\u306e\u30af\u30ea\u30cb\u30ab\u30eb\u30af\u30a8\u30b9\u30c1\u30e7\u30f3\u3092\u4f5c\u6210\u3059\u308b\u3053\u3068\u3001\u3064\u307e\u308a\u3001Population\u5bfe\u8c61\u3001Intervention\u4ecb\u5165\u3001Comparator\u5bfe\u7167\u3001Outcome\u30a2\u30a6\u30c8\u30ab\u30e0\u306e4\u3064\u306e\u9805\u76ee\u3092\u8a2d\u5b9a\u3059\u308b\u3068\u8003\u3048\u3089\u308c\u3066\u3044\u308b\u3067\u3057\u3087\u3046\u3002\u3057\u304b\u3057\u3001\u30a2\u30a6\u30c8\u30ab\u30e0\u306f\u91cd\u8981\u306a\u30a2\u30a6\u30c8\u30ab\u30e0\u3092\u3072\u3068\u3064\u8a2d\u5b9a\u3059\u308c\u3070\u3044\u3044\u306e\u3067\u3057\u3087\u3046\u304b\uff1f\u81e8\u5e8a\u6c7a\u65ad\u306e\u305f\u3081\u306b\u306f\u3001\u8907\u6570\u306e\u76ca\u3068\u5bb3\u306e\u30a2\u30a6\u30c8\u30ab\u30e0\u306b\u5bfe\u3059\u308b\u4ecb\u5165\u306e\u52b9\u679c\u306e\u5927\u304d\u3055\u3068\u78ba\u5b9f\u6027\u3092\u5206\u6790\u3059\u308b\u5fc5\u8981\u304c\u3042\u308a\u307e\u3059\u3002\u76ca\u306e\u30a2\u30a6\u30c8\u30ab\u30e0\u3042\u308b\u3044\u306f\u81ea\u5206\u304c\u7591\u554f\u306b\u601d\u3046\u3001\u3042\u308b\u3044\u306f\u81ea\u5206\u306e\u8208\u5473\u3042\u308b\u30a2\u30a6\u30c8\u30ab\u30e0\u306b\u5bfe\u3059\u308b\u52b9\u679c\u3060\u3051\u3092\u8abf\u3079\u308b\u3060\u3051\u3067\u306f\u3001\u81e8\u5e8a\u6c7a\u65ad\u306b\u5fc5\u8981\u306a\u60c5\u5831\u306f\u5f97\u3089\u308c\u306a\u3044\u304b\u3082\u3057\u308c\u306a\u3044\u3068\u3044\u3046\u3053\u3068\u306b\u306a\u308a\u307e\u3059\u3002<\/p>\n\n\n\n
\u3053\u306e\u30c6\u30ad\u30b9\u30c8\u30d6\u30c3\u30af\u3067\u306f\u30014\u7ae0\u304b\u30896\u7ae0\u307e\u3067\u4ee5\u4e0b\u306e\u4e3b\u984c\u306b\u95a2\u3059\u308b\u7814\u7a76\u8ad6\u6587\u3092\u8a55\u4fa1\u3059\u308b\u969b\u306b\u3001\u3064\u307e\u308a\u201d\u6279\u5224\u7684\u541f\u5473\u201d\u3092\u884c\u3046\u969b\u306b\u3001\u2460\u59a5\u5f53\u304b\uff1f\u2461\u91cd\u8981\u304b\uff1f\u2462\u9069\u7528\u53ef\u80fd\u304b\uff1f\u306e\u9806\u306b\u6cbf\u3063\u305f\u67a0\u7d44\u307f\u3067\u3001\u8a55\u4fa1\u3059\u308b\u3053\u3068\u304c\u8ff0\u3079\u3089\u308c\u3066\u3044\u307e\u3059\u3002\u7b2c4\u7ae0\u3067\u306f\u3001\u81e8\u5e8a\u6c7a\u65ad\u5206\u6790\u306e\u7814\u7a76\u8ad6\u6587\u3084\u8a3a\u7642\u30ac\u30a4\u30c9\u30e9\u30a4\u30f3\u306e\u6279\u5224\u7684\u541f\u5473\u306b\u3064\u3044\u3066\u3082\u8ff0\u3079\u3089\u308c\u3066\u3044\u307e\u3059\u3002<\/p>\n\n\n\n
4 Therapy: \u30e9\u30f3\u30c0\u30e0\u5316\u6bd4\u8f03\u8a66\u9a13\u3001\u30b7\u30b9\u30c6\u30de\u30c6\u30a3\u30c3\u30af\u30ec\u30d3\u30e5\u30fc\u3001\u81e8\u5e8a\u6c7a\u65ad\u5206\u6790\u3001\u533b\u7642\u7d4c\u6e08\u5206\u6790\u3001\u8a3a\u7642\u30ac\u30a4\u30c9\u30e9\u30a4\u30f3\u3001n-of-1\u81e8\u5e8a\u8a66\u9a13<\/p>\n\n\n\n
5 Diagnosis: \u8a3a\u65ad\u691c\u67fb\u6cd5\u3001\u4e8b\u524d\u78ba\u7387\u3001\u8907\u6570\u306e\u8a3a\u65ad\u691c\u67fb\u6cd5\u3001\u30b9\u30af\u30ea\u30fc\u30cb\u30f3\u30b0<\/p>\n\n\n\n
6 Prognosis: \u4e88\u5f8c<\/p>\n\n\n\n
7 Harm: \u5bb3<\/p>\n\n\n\n
\u3053\u306e\u30b9\u30c6\u30c3\u30d7\u306f\u6cbb\u7642\u3001\u8a3a\u65ad\u3001\u4e88\u5f8c\u3001\u5bb3\u306e\u3044\u305a\u308c\u306e\u5834\u5408\u3082\u5171\u901a\u3067\u3059\uff08\u56f32\uff09\u3002<\/p>\n\n\n\n \u500b\u5225\u306e\u30e9\u30f3\u30c0\u30e0\u5316\u6bd4\u8f03\u8a66\u9a13\u306b\u3064\u3044\u3066\u306e\u8a18\u8ff0\u3067\u306f\u30013\u3064\u306e\u30b9\u30c6\u30c3\u30d7\u306e\u305d\u308c\u305e\u308c\u306b\u304a\u3051\u308b\u8a55\u4fa1\u9805\u76ee\u304c\u8a2d\u5b9a\u3055\u308c\u3066\u3044\u307e\u3059\uff08\u56f33\uff09\u3002\u305d\u306e\u9069\u7528\u53ef\u80fd\u6027\u306e\u8a55\u4fa1\u9805\u76ee\u3092\u307f\u308b\u3068\u3001\u201d\u308f\u308c\u308f\u308c\u306e\u60a3\u8005\u304c\u305d\u306e\u6cbb\u7642\u306b\u3088\u308a\u5f97\u3089\u308c\u308b\u53ef\u80fd\u6027\u306e\u3042\u308b\u76ca\u3068\u5bb3\u306f\uff1f\u201d\u3068\u3044\u3046\u9805\u76ee\u304c\u3042\u308a\u307e\u3059\u3002<\/p>\n\n\n\n \u6279\u5224\u7684\u541f\u5473\u306e\u5bfe\u8c61\u306e\u7814\u7a76\u8ad6\u6587\u306b\u201d\u76ca\u3068\u5bb3\u306f\u4f55\u304b\uff1f\u201d\u3001\u3042\u308b\u3044\u306f\u3001\u76ca\u3068\u5bb3\u306e\u5927\u304d\u3055\u304c\u76f4\u63a5\u8a18\u8ff0\u3055\u308c\u3066\u3044\u308b\u308f\u3051\u3067\u306f\u3042\u308a\u307e\u305b\u3093\u3002\u76ca\u306e\u30a2\u30a6\u30c8\u30ab\u30e0\u3001\u5bb3\u306e\u30a2\u30a6\u30c8\u30ab\u30e0\u306b\u5bfe\u3059\u308b\u4ecb\u5165\u306e\u52b9\u679c\u306f\u8a18\u8ff0\u3055\u308c\u3066\u3044\u3066\u3001\u305d\u308c\u3089\u3092\u77e5\u308b\u3053\u3068\u306f\u3067\u304d\u308b\u3067\u3057\u3087\u3046\u3001\u3057\u304b\u3057\u3001\u305d\u308c\u304c\u305d\u306e\u307e\u307e\u76ca\u3068\u5bb3\u306e\u5927\u304d\u3055\u3092\u8868\u3059\u308f\u3051\u3067\u306f\u3042\u308a\u307e\u305b\u3093\uff08Aler BS 2018, 2019\uff09\u3002\u307e\u305f\u3001\u4e00\u3064\u306e\u30e9\u30f3\u30c0\u30e0\u5316\u6bd4\u8f03\u8a66\u9a13\u306e\u7814\u7a76\u8ad6\u6587\u3067\u306f\u3001\u3059\u3079\u3066\u306e\u91cd\u8981\u30a2\u30a6\u30c8\u30ab\u30e0\u306b\u5bfe\u3059\u308b\u52b9\u679c\u3092\u77e5\u308b\u3053\u3068\u304c\u3067\u304d\u306a\u3044\u5834\u5408\u3082\u3042\u308a\u307e\u3059\u3002\uff08\u6bd4\u8f03\u52b9\u679c\u7814\u7a76Comprative Effectiveness Research, CER\u3067\u3042\u308c\u3070\u3001\u76f4\u63a5\u76ca\u3068\u5bb3\u306e\u5927\u304d\u3055\u306e\u63a8\u5b9a\u306b\u3064\u3044\u3066\u3001\u8a18\u8ff0\u3055\u308c\u3066\u3044\u308b\u304b\u3082\u3057\u308c\u307e\u305b\u3093\u3002\u4ee5\u524d\u306e\u6295\u7a3f\uff1e<\/a> \uff1e<\/a>\u304a\u3088\u3073\uff1e<\/a>\u3002\uff09<\/p>\n\n\n\n \u3053\u3053\u3067\u306f\u3001\u201d\u308f\u308c\u308f\u308c\u306e\u60a3\u8005\u304c\u3002\u3002\u3002\u201d\u3067\u3059\u304b\u3089\u3001\u76ee\u306e\u524d\u306e\u60a3\u8005\u304c\u305d\u306e\u4ecb\u5165\u3092\u5b9f\u65bd\u3057\u305f\u5834\u5408\u3001\u3069\u306e\u3088\u3046\u306a\u76ca\u3068\u5bb3\u3092\u53d7\u3051\u308b\u306e\u304b\uff1f\u3092\u305d\u306e\u62c5\u5f53\u533b\u304c\u5224\u65ad\u3059\u308b\u3053\u3068\u3092\u6c42\u3081\u3066\u3044\u308b\u3068\u8003\u3048\u3089\u308c\u307e\u3059\u3002Population-perspective\u306e\u7814\u7a76\u7d50\u679c\u304b\u3089\u3001Individual-perspective\u306e\u610f\u601d\u6c7a\u5b9a\u3092\u884c\u3046\u3068\u3044\u3046\u3053\u3068\u306b\u306a\u308a\u307e\u3059\u3002\u3057\u304b\u3057\u3001\u305d\u306e\u5224\u65ad\u3092\u3069\u3046\u3084\u3063\u305f\u3089\u3044\u3044\u306e\u3067\u3057\u3087\u3046\u304b\uff1f\u3057\u304b\u3082\u3001Shared Decision Making\uff08\u4ee5\u524d\u306e\u6295\u7a3f\uff1e<\/a> \uff1e<\/a> \uff1e<\/a> \uff1e<\/a>\u3092\u53c2\u7167\uff09\u306e\u30b9\u30c6\u30c3\u30d7\u3092\u8e0f\u3093\u3067\u3001\u60a3\u8005\u306e\u4fa1\u5024\u89b3\u3092\u8074\u3044\u305f\u4e0a\u3067\u3001\u533b\u7642\u306e\u30bb\u30c3\u30c6\u30a3\u30f3\u30b0\u3092\u8003\u616e\u3057\u305f\u4e0a\u3067\u3001\u6c7a\u65adDecision Making \u3059\u308b\u3068\u3044\u3046\u3053\u3068\u306f\u3069\u306e\u3088\u3046\u306a\u3053\u3068\u306a\u306e\u3067\u3057\u3087\u3046\u304b\uff1f<\/p>\n\n\n\n \u672c\u66f8\u306e\u7b2c4\u7ae0\u306b\u306f\u3001\u81e8\u5e8a\u6c7a\u65ad\u5206\u6790\u306b\u95a2\u3059\u308b\u90e8\u5206\u304c\u3042\u308a\u307e\u3059\u304c\u3001\u305d\u3053\u306f\u81e8\u5e8a\u6c7a\u65ad\u5206\u6790\u306e\u7814\u7a76\u8ad6\u6587\u306e\u6279\u5224\u7684\u541f\u5473\u306e\u624b\u9806\u306b\u3064\u3044\u3066\u306e\u8a18\u8ff0\u3067\u3042\u308a\u3001\u81e8\u5e8a\u6c7a\u65ad\u306f\u3069\u306e\u3088\u3046\u306b\u3057\u305f\u3089\u3044\u3044\u306e\u304b\uff1f\u306b\u3064\u3044\u3066\u66f8\u304b\u308c\u3066\u3044\u308b\u308f\u3051\u3067\u306f\u3042\u308a\u307e\u305b\u3093\u306e\u3067\u3001\u305d\u3053\u3092\u8aad\u3093\u3067\u3082\u81e8\u5e8a\u6c7a\u65ad\u306e\u79d1\u5b66\u7684\u306a\u65b9\u6cd5\u3084\u3001\u9650\u754c\u306b\u3064\u3044\u3066\u308f\u304b\u308b\u3088\u3046\u306b\u306a\u308b\u308f\u3051\u3067\u306f\u3042\u308a\u307e\u305b\u3093\u3002<\/p>\n\n\n\n \u3072\u3068\u308a\u3072\u3068\u308a\u306e\u60a3\u8005\u3055\u3093\u306f\u5c5e\u6027\u3001\u4fa1\u5024\u89b3\u304c\u7570\u306a\u308a\u3001\u540c\u3058\u6761\u4ef6\u306e\u4eba\u306f\u307e\u305a\u3044\u307e\u305b\u3093\u3002\u305d\u306e\u305f\u3081\u3001\u3053\u306e\u3088\u3046\u306a\u30c6\u30ad\u30b9\u30c8\u30d6\u30c3\u30af\u3067\u306f\u81e8\u5e8a\u6c7a\u65ad\u3092\u4e00\u822c\u7684\u306a\u65b9\u6cd5\u8ad6\u3068\u3057\u3066\u6271\u3046\u3053\u3068\u306f\u3067\u304d\u305a\u3001\u533b\u5e2b\u306e\u88c1\u91cf\u6a29\u306e\u4e2d\u3067\u3001\u500b\u5225\u306b\u5224\u65ad\u3059\u3079\u304d\u3068\u3044\u3046\u8003\u3048\u306a\u306e\u304b\u3082\u3057\u308c\u307e\u305b\u3093\u3002\u3057\u304b\u3057\u3001\u500b\u5225\u306e\u81e8\u5e8a\u6c7a\u65ad\u3092\u8ad6\u7406\u7684\u3001\u79d1\u5b66\u7684\u306b\u884c\u3046\u306b\u306f\u3069\u3046\u3057\u305f\u3089\u3044\u3044\u304b\uff1f\u306f\u6975\u3081\u3066\u91cd\u8981\u306a\u30c6\u30fc\u30de\u3067\u3059\u3002<\/p>\n\n\n\n \u307e\u305f\u3001\u8a3a\u7642\u30ac\u30a4\u30c9\u30e9\u30a4\u30f3\u3067\u306f\u63a8\u5968\u3092\u4f5c\u6210\u3059\u308b\u5fc5\u8981\u304c\u3042\u308b\u305f\u3081\u3001\u672c\u6765\u3001\u6c7a\u65ad\u5206\u6790\u304c\u5fc5\u8981\u306b\u306a\u308b\u306f\u305a\u3067\u3059\u3002\u533b\u7642\u7d4c\u6e08\u8a55\u4fa1\u3067\u3082\u305d\u3046\u3067\u3059\u3057\u3001\u533b\u7642\u653f\u7b56\u3082\u305d\u3046\u3067\u3059\u3002Elstein AS\u306f2004\u5e74\u306e\u6642\u70b9\u3067\u3001\u3053\u308c\u3089\u306e\u3053\u3068\u3092\u6307\u6458\u3057\u3066\u304a\u308a\u3001\u307e\u305f\u3001\u6c7a\u65ad\u5206\u6790\u306f\u533b\u7642\u754c\u306b\u5e83\u304f\u53d7\u3051\u5165\u308c\u3089\u308c\u3066\u3044\u306a\u3044\u3053\u3068\u3092\u3059\u3067\u306b\u6307\u6458\u3057\u3066\u3044\u307e\u3059\uff08Elstein AS 2004\uff09\u3002\u73fe\u5728\u3082\u3042\u307e\u308a\u5909\u308f\u3063\u3066\u3044\u306a\u3044\u3088\u3046\u306b\u601d\u3048\u307e\u3059\u3002<\/p>\n\n\n\n \u8a3a\u7642\u30ac\u30a4\u30c9\u30e9\u30a4\u30f3\u3067\u306f\u3001\u30a8\u30d3\u30c7\u30f3\u30b9\u306e\u78ba\u5b9f\u6027\u3060\u3051\u3067\u306a\u304f\u3001\u76ca\u3068\u5bb3\u306e\u30d0\u30e9\u30f3\u30b9\uff08\u6b63\u5473\u306e\u76ca\uff09\u3001Population-perspective\u3068Individual-perspective\u3001\u5f37\u3044\u63a8\u5968\u3068\u5f31\u3044\u63a8\u5968\u3001\u30c7\u30b7\u30b8\u30e7\u30f3\u30a8\u30a4\u30c9\u3001\u306a\u3069\u306b\u3064\u3044\u3066\u5341\u5206\u306a\u7406\u89e3\u304c\u5fc5\u8981\u3067\u3059\u3002\u8a3a\u7642\u30ac\u30a4\u30c9\u30e9\u30a4\u30f3\u4f5c\u6210\u306b\u306f\u3001EBM\u306e\u67a0\u7d44\u307f\u3092\u8d85\u3048\u305f\u77e5\u8b58\u3001\u30b9\u30ad\u30eb\u304c\u5fc5\u8981\u3067\u3059\u3002<\/p>\n\n\n\n \u5b9f\u81e8\u5e8a\u306b\u304a\u3051\u308b\u81e8\u5e8a\u6c7a\u65adMedical Decision Making\u3001\u5354\u50cd\u610f\u601d\u6c7a\u5b9aShared Decision Making \u3001\u305d\u3057\u3066\u8a3a\u7642\u30ac\u30a4\u30c9\u30e9\u30a4\u30f3\u4f5c\u6210Development of Clinical 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Working Group: Defining certainty of net benefit: a GRADE concept paper. 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Alper BS, Ehrlich A, Oettgen P: 6 putting it all together: from net effect estimate to the certainty of net benefit. BMJ Evidence-Based Medicine 2018;23(Supplement 1):
http:\/\/dx.doi.org\/10.1136\/bmjebm-2018-111024.6<\/a><\/p>\n\n\n\n
Elstein AS: On the origins and development of evidence-based medicine and medical decision making. Inflamm Res 2004;53 Suppl 2:S184-9. doi: 10.1007\/s00011-004-0357-2 PMID: 15338074<\/a>
Gail MH, Costantino JP, Bryant J, Croyle R, Freedman L, Helzlsouer K, Vogel V: Weighing the risks and benefits of tamoxifen treatment for preventing breast cancer. J Natl Cancer Inst 1999;91:1829-46. PMID: 10547390<\/a><\/p>\n\n\n\n
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