The real voyage of discovery consists not in seeking new landscapes, but in having new eyes. Marcel Proust
iii 4 3 100 4 1 100 4
iv 2003 5 31 6 1
v iii 1 1 1.1... 1 1.2... 3 1.3... 6 1.4... 11 1.5... 12 1.6... 17 1... 18 2 19 2.1... 19 2.2... 23 2.3... 32 2.4... 34 2.5... 39 2.6 EBM... 41 2.7... 43 2.8... 44 2... 50 3 51 3.1... 51 3.2... 53 3.3 cure care... 56 3.4... 60 3.5... 64 3.6... 67 3.7... 70
vi 3.8... 73 3.9... 79 3.10... 81 3.11... 85 3.12... 87 3.13... 91 3.14... 94 3.15... 96 3.16... 98 3.17... 100 3.18... 105 4 107 4.1... 107 4.2... 116 4.3 BSE... 120 4.4... 144 4... 146 5 149 5.1... 149 5.2... 150 6 153 6.1... 153 6.2... 157 6.3... 160 6.4... 161 6.5... 163... 165 7 2004 169 7.1... 169 7.2... 175 8 183 8.1... 184 8.2... 186 8.3... 193 8.4... 195
vii 8.5... 197 9 199 9.1... 199 9.2... 203 9.3... 229 9.4... 276 9.5... 289 9.6... 298 305
1 1 1.1 1 A 1 A A A 3 3 1 =
2 1 = = (1) (2) (3) 3 (1) 100 1 A (2) (3)
1.2 3 1.2 1970 1980 A 5 6 A A A 1 A A 2 4
4 1 A 4 10 (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) A 1.1
1.2 5 1.1: 100 m 50m 20m
6 1 1.2: = = = 1.3 1
1.3 7 A 1 1.3
8 1 2 1.3: 2
1.3 9 4 C 2 0 6 1 3 10 4 1 1 5 24 24 1 2 3 4 5
10 1 1 1 10 kg 2 3 NOVA 1 2 3 1 7 1 3 6 S C C 6
1.4 11 1.4 100 1 X X X Y X Y X Y X Y
12 1 1.4 1.5 1
1.5 13 1.4: = = 50 B
14 1 B B B B B 40 1 1 B B B B
1.5 15 7 B B B 1980 B B 8 7 8 1
16 1 B B B B B B B
1.6 17 1.6 Yahoo! JAPAN TBS TBS 13 20 2003 4 13 1993 A B C
18 1 1 [1] 107 2003 [2] http://www.mental.ne.jp/ [3] http://www.so-net.ne.jp/vivre/kokoro/ [4] http://www.utu-net.com/ [5] http://www02.so-net.ne.jp/ bunretu/
19 2 EBM Evidence Based Medicine 2.1 IC IC [1] IC IC IC 400
20 2 1000 14 16 IC 1914 assault IC 2 1945 1946 1947 IC 1964 IC 1975 1983 2000 3 1960 1973 IC
2.1 21 1981 1982 IC IC IC 19 2 IC 1980 1984 1987 IC 1990 IC IC 1992 1995 IC IC (1) (2) IC IC 2.1 IC IC IC IC
22 2 IC (1) (2) IC IC 3 3 IC IC IC Quality of Life QOL IC IC IC 7 2.4 IC IC
2.2 23 IC IC IC 2.2 2 3 second opinion 2 2 2 1 2 3 CT 4 2
24 2 5 2 6 2 1 2 1 2 3 2
2.2 25 2
26 2 1 % 87 52 55 48 2 1 4 5
2.2 27 40 50 10 20 1 1 2.1 2.1: 1999 % 0 14 41.6 % 33.3 % 40 50
28 2 3 1 2.2 2.2 2.2
2.2 29 2.2: 1 2 3 2 1 2
30 2 1 1 1 2 1 1 3 2
2.2 31 2.2 1
32 2 2.3 truth telling
2.3 33 [9] 1 1988 100 % 1
34 2 2.4 1960 1970 3 2.3 1992 3 3 3 20.2 % 54.7 % 35.5 % 43.8 % 3 3 8 16.1 %
2.4 35 A: B: C: D: A E: F: G: A: B: C: D: A E: F: G: A: B: C: D: A E: F: G: 2.3: 2 2.1
36 2 2.1: (%) (%) 43.7 39.9 69.1 21.5 42.9 43.9 33.6 48.8 44.5 20.1 67.8 14.8 34.2 30.1 27.3 48.9 29.6 17.8 63.0 16.4 19.4 39.0 15.8 43.2 7 5
2.4 37 2002 4 56 % 77 % 81 % 74 % 8 74 % 65 % 20 9 70 45 % 27 % 27 % 27 % 47 % 23 % 2.4 2 9 2 4 5
38 2 2.4: I Can Cope Program I Can Cope Cope
2.5 39 2.5 5 1980 1999 3 2001 2004 2 1 2006 400 6 6 3 1 3
40 2 1 1950 1990 EBM
2.6 EBM 41 2.6 EBM EBM evidence DNA EBM DNA EBM EBM EBM evidence EBM evidence evidence EBM EBM 1970 1980 1988 4 1989 EBM 4 7
42 2 1991 McMaster Guyatt Evidence Based Medicine EBM Guyatt EBM Working Group JAMA User s Guide 1994 6 Workshop Guyatt EBM Sackett McMaster Oxford EBM 1997 EBM 1996 EBM EBM EBM EBM 1 EBM EBM 2 Evidence MEDLINE 3 4 EBM EBM EBM EBM EBM
2.7 43 2.7 DNA = DNA DNA A T C G 4 2 DNA 99.9 % 0.1 % DNA DNA X DNA Y SNP SNP SNP DNA 1998 HER2 HER2 HER2 HER2 HER2
44 2 SNP EBM EBM EBM A B2 A B EBM A A A B EBM EBM SNP SNP SNP 2.8 2 1983 2000 4 2003 6 1
2.8 45 4 1 3 4 1 2 3 3 1 2
46 2 5 2 3 5 advance directive 1) 2) 1) vol 7, No 1, 1997. 9
2.8 47 HMO
48 2 2 6 7 8 9 1960 3000 6 7 1986 2001 8 9 2.1
2.8 49 10 20 1970 1990 1 38000 20 CT MRI 10 right duty 50 1980 1990 10 http://www.med.or.jp/wma/helsinki02_j.html http://www.med.or.jp/wma/ 2.8
50 2 1960 1970 2 2003 5 2 2 [1] 1994 [2] Vol. 13 No. 3 2003 [3] informed consent: IC http://www2.freenet.jp/mizemi/kaiji.htm [4] http://www.nichibenren.or.jp/ [5] http://www.pp.iij4u.or.jp/ tokiyasu/ronbun/tokiyasu_02.html [6] http://www.yokkaichi-u.ac.jp/ ushijima/be_info/thema/ [7] http://www.umin.ac.jp/inf-consent.htm [8] 1989 [9] vol. 4 No. 1 1992 [10] 1994 [11] BP 1992 10 1997 7 [12] 1989 [13] 1989 [14] 1993 [15] 1997 [16] 1994 [17] 1994 [18] http://www.igaku-shoin.co.jp/nwsppr/nwsppr_index.html
51 3 2003 1 21 50 21 30 30 30 30 3.1 17 30 30 Web 1970 1 0467 2001 1 2729 2005 2035 1 1360 1 2003 4 7
52 3 140000 120000 100000 80000 60000 40000 1925 1950 1975 2000 2025 2050 3.1: 50 40 65 % 30 20 10 0 1925 1950 1975 2000 2025 2050 3.2: 65 300 1 250 200 150 100 50 0 1950 1960 1970 1980 1990 2000 3.3: 1
3.2 53 3.1 65 30 7.1 % 2001 18 % 2035 30.9 % 3.2 1970 24962 2000 30 3583 1 1970 2 4100 2000 23 9200 12 3.3 1970 4.09 % 2000 7.98 % 2 3.2 1958 3 2001 15 2 1949 6 12 1974 9 1983 7 1987 12 Visiting Assistant Professor Department of Physiology & Biophysics 1995 4 1999 10 1998 4 1999 5 2001 4 2003 3 2003 4 30 2 2 1998 6
54 3 1910 3 4 30 65 % 5 30 6 30 50 7 3 4 5 6 intervention 1981 http://www.bsjkk.co.jp/html/whatint/ 7 DNA
3.2 55 8 9 SNP 10 CT MRI 11 8 9 10 single nucleotide polymorphism DNA 1 11
56 3 195 3.3 cure care 1969 1973 1996 30 30 1972 1948 1973
3.3 cure care 57 1984 30 1 12 13 3 IBS 14 TEG 15 30 30 30 12 13 1901 1972 14 15
58 3 16 EMA Ecologically Momentary Asessment EMA EMA cure care cure care 1 cure care cure care care cure 16 10 1
3.3 cure care 59 1 4000 K 1000 1 750 250 9 1 1 1 1 1 1
60 3 care cure care cure care cure care cure care 3.4 20 2 30 30 3 2 4
3.4 61 17 SLE 18 19 20 γ 21 1970 22 23 1980 30 SLE 5 50 % 1990 24 17 18 19 20 21 22 23 24
62 3 1800 50 T T 3 21 21 HLA 25 50 % SNP 26 SNP 25 26 1
3.4 63 1 2 30 SLE 10 3
64 3 3.5 1 27 1998 1947 6 1 1973 1980 1982 NIH 30 30 30 4 28 27 28
3.5 65 30 29 17 8 29
66 3 gynecology gyne 50 30 HIV 30 2001
3.6 67 3.6 105 3.18 30 1971 1 30 30 CT 100 % 1 100 % 30 15 4 1
68 3 150 1 30 31 30 40 % 50 % 90 % QOL 32 1000 g 31 5 90 % 32 quality of life
3.6 69 30 4
70 3 3.7 30 30 molecular biology 10 DNA 30 CT 30 33 CT MRI 34 DC 35 33 34 neuroblastoma 35
3.7 71 36 37 molecular biology 20 1 200 300 bp 500 bp 2 3 6 cdna 3000 bp 1 1000 3.2 38 36 37 38 2002
72 3 12 2 4 24 field 8 1 / 10 1 2 1 / 3 1 / 4 4 39 11 4 40 41 42 30 39 40 2 41 2 3 1 42
3.8 73 30 β- 2000 30 30 3.8 3 1949 1973 3 1985 1995
74 3 2000 1957 1989 2002 3 2000 4 4 2000 21 17.2 % 6 1 2187 65 30 1973 9 65 7% 1970 1973 7.5 % 2000 65 1769 13.4 % 2000 30 52 3.2 2
3.8 75 1997 2000 3 3 1997 3.4 3.4: 2000 60 % 65 70 27.6 % 14.6 % 11.7 % 7.5 % 33.5 % 11.7 % 9.1 %
76 3 6 3.5 30 25 20 15 1995 1996 1997 1998 1999 2000 2001 3.5: 1997 2000 21.8 2000 4 30 2033 2000 2030 3 1 65 75
3.8 77 ADL
78 3 21 20 30 1 1 1 1 1 1 1 2000 4 2002
3.9 79 3.9 30 2 2 3 43 Standard liver volume 44 US guided PTC 45 PTGBD 46 US guided PTC PTGBD 43 44 = 706.2 + 2.4 ) Standard liver volume ) 45 46
80 3 1970 47 1964 Thomas Stazl 1960 1980 1983 Bismuth Pichlmayr 1 2 Rogier 1998 2 2 HPD 48 1990 1 30 10 49 NIH 50 47 48 49 DNA DNA 50 National Institutes of Health
3.10 81 20 3.10 30 30 30 30 1973 30 30 1973 30 20 1 2 40 5 51 5 5% 1973 51
82 3 30 mortality 20 30 % 2 3% 2 3% 52 53 2 2 54 5 30 30 30 30 30 55 56 30 30 30 52 53 54 55 56
3.10 83 30 10 20 57 58 30 30 30 30 30 30 59 SARS 57 58 59
84 3 10 30 30 60 70 80 90 30 30 30 30 30 30 30 50 100
3.11 85 3.11 2001 1946 7 26 1972 1978 WHO 2000 21 2001 60 60 1963 1970 1984 1998 2001
86 3 61 30 stem cell 62 30 61 disuse syndrome 62
3.12 87 1990 3.12 1984 2 1986 1989 30 30 2 1978 3 1984 2 2 3 1980 1977 PC
88 3 1980 PC PC PC AI 63 5 ICOT 1990 CT 1994 PC 2 1 63 artificial intelligence
3.12 89 PC 1 30 30 SNP 64 clinical bioinformatics PC 10 AI 20 80 X 64 55
90 3 2033 5 31 39.2 C 2012 99 % 1% 0.001 % OK
3.13 91 3.13 30 30 1984 30 20 1960 1970 BST 65 65
92 3 1980 BST 66 67 68 69 30 66 67 68 69 9
3.13 93 30 2 3 30 QOL 70 QOL QOL 70 quality of life QOL
94 3 30 QOL QOL 3.14 1972 1979 1983 1986 1996 1998 2001 4 2003 3 30 30 71 30 30 71
3.14 95 20 21 30 1 1 30 1 1 1 1 =
96 3 PTSD 30 22 193 3.15 2001 20
3.15 97 2 PET 72 fmri 73 SQUID 74 10 3 1 2 3 30 72 73 MRI PET MRI 74
98 3 3.16 30 1973 10 8 1999 75 76 4000 1961 3 75 76
3.16 99 77 78 2 3 30 30 30 3 25 30 30 in silico human in silico human 77 2003 4 78
100 3 E-Cell 30 in silico human 30 3.17 1946 3 16 1969 1973 1982 1986 1987 1991 2000 2001
3.17 101 BP RNA 30 WHO 1980 1 2 79 NHK X 80 WHO 1988 81 2 79 116 4.2 80 2002 4 2 http://www.nhk.or.jp/projectx/82/ 81 20 30 1 RNA RNA RNA DNA
102 3 2 2000 1% 3.6 82 3.6: WHO WHO 99 % 82 http://www.who.int/vaccines-polio/all/news/files/pdf/polio_news_eng17.pdf
3.17 103 OPV 83 500 1 IPV 84 10 IPV OPV IPV OPV IPV 2 RNA 83 oral poliovaccine 84 inactivated poliovaccine
104 3
3.18 105 3.18 1895 X 1895 X 1928 1947 1950 1951 1952 DNA RNA 1953 2 DNA 1955 1955 1957 21 1959 1961 DNA 3 1 1963 1963 1964 intermentional radiology 1965 1966 1967 1967 1967 1968 1968 1969 1960 1972 X CT 1973 30
106 3 1975 CT DNA 1975 NMR 1975 PET 1976 1977 PTCA 1 1978 1980 2 WHO 1980 MRI 1981 2 AIDS 1983 1983 CCD 1985 PCR 1986 1987 1988 1988 1989 60 1989 1990 1993 1994 1996 O157 1997 1999 PTCA 2000 2001 2003 3 2003 SARS
107 4 4.1 1 Y=48,000 Y=218,000
108 4 Y=15,000 H 2 O
4.1 109 1 2 2 1930 1960 2000 3 H 2 O H 3 O + H 3 O + (H 2 O) n NH + 4 NH + 4 (H 2 O) n O 2 (CO 3 ) (NO 3 ) (OH ) NO 3 (HNO 3 ) m (H 2 O) n HNO 3 3 /cm 3 1 1930
110 4 DNA 1 2 1930 1 1 1
4.1 111 95 % 1992 100 30 1996 95 % 3 98 % + ADP + H + + ATP ATP ADP ATP 1 ADP ATP ATP ADP ATP ATP ATP 30 % 1
112 4 1990 327 2 120 mg 52 1 100 2002 11 25 5 ppm 0.005 % 1 0.6 µg 20 12 8 6 3200 1 48000 µg 8
4.1 113 http://www.kokusen.go.jp 2 1. 2. 3. 35 145
114 4 2001 3 27 A 3 A placebo I shall please QOL
4.1 115 CM 3
116 4 4.2 2 SARS MMR 1 2 2
4.2 117 1910 1940 3 1950 100 1 1 1 MMR 3 1996 1999 4 444 3 1 47
118 4 1796 1858 1885 1921 BCG 1948 1951 1943 1958 1954 1964 1968 DTP 1970 1975 DTP 1976 1977 1978 1979 1980 WHO 1981 DTP 1987 1989 MMR 1990 1993 MMR 1994 1995 1998 1999 DPT 2003 9 30 A B Weil BCG [ ] [ ] DPT [ ] 1981
4.2 119 [ ] 10 % [ ] 300 400 1 15 37 26 1 2 1 [ ] [ ] 7 12 20 % 1 2 100 1 [ ] 1 6% 2000 3000 1 7 9% 2 4 2000 1 10 1 6 8 [ ] 100 6 1 2 [ ] [ ] [ ] 1 [ ] 2 37.5 100 1 ADM [ ] 30 50 % [ ] 2 3 100 2 3 2 4 1 [ ] 2 20 1 300 1 65 % 2 10 % [ ] 14 30 [ ] 3 50 250 500 4 [ ]
120 4 [ ] DPT B [ ] [ ] 3 4 4.3 BSE BSE BSE BSE BSE 2001 9 BSE BSE bovine spongiform encephalopathy BSE BSE 1986 2 6
4.3 BSE 121 BSE 1 BSE 2 3% BSE prion proteinaceous infectious particle proin o i S 1997 1 2 DNA RNA BSE 1732 4.1: scraping
122 4 Creutzfeldt Jakob disease CJD 1920 CJD CJD 3 CJD 9 100 1 65 CJD 10 % CJD CJD CJD CJD CJD 3 CJD BSE 1996 CJD variant CJD vcjd CJD vcjd 29 vcjd 1 CJD 4.2 4.2: CJD vcjd vcjd CJD CJD BSE 1996
4.3 BSE 123 BSE BSE BSE BSE 1 vcjd CJD CJD BSE vcjd BSE CJD vcjd BSE 2 vcjd CJD BSE vcjd BSE CJD vcjd BSE 100 % 4.3: BSE BSE vcjd BSE vcjd 1 vcjd BSE BSE vcjd BSE BSE 500
124 4 vcjd vcjd vcjd vcjd vcjd CJD vcjd BSE 1986 BSE BSE 1988 EU EU BSE BSE BSE BSE BSE 5 BSE 1989 1990 5
4.3 BSE 125 BSE BSE BSE BSE 1990 BSE BSE 1991 WHO BSE BSE BSE CJD BSE 1996 BSE CJD BSE BSE BSE EU 4 3 EU EU 1990 BSE EU 1990 EU 1990 BSE 6 1994 1996 BSE EU BSE
126 4 2000 BSE BSE BSE BSE 40 BSE EU EU EU EU BSE 1990 1994 BSE 1991 BSE 1990 1997 1996 BSE BSE EU BSE vcjd BSE vcjd BSE BSE BSE 1238 781 BSE OIE 2003 5 8 28 1 / 100 1 / 1000 BSE 100
4.3 BSE 127 vcjd 2003 5 8 vcjd 134 BSE 2 vcjd vcjd 2000 BSE 75 BSE 1 vcjd 2000 750000 0.0027 BSE 100 vcjd vcjd 100 0.0027 0.27 2002 26000 17 BSE BSE MRM vcjd 1980 1990 vcjd BSE 1 BSE 2001 10 18 BSE 1 BSE 1 2 3
128 4 1 BSE BSE 2 BSE 0% 1 2 BSE 1 vcjd 0.0027 MRM vcjd BSE BSE 15 2001 9 10 BSE BSE vcjd 2001 9 10 BSE 2 BSE BSE EU BSE 1996 BSE WHO BSE
4.3 BSE 129 1.4 % BSE EU 2001 EU BSE 3 BSE BSE BSE EU 2001 4 300 BSE BSE BSE 2001 8 6 BSE BSE BSE 9 10 BSE 12 9 22 BSE BSE BSE EU 1. 2. BSE 3. 1 EU 30 1 4. BSE
130 4 BSE O157 BSE 4.4 4.4: vcjd BSE BSE 2001 10 4 BSE BSE 22 vcjd BSE
4.3 BSE 131 BSE vcjd vcjd EZTV 2001 10 7 vcjd 1000 1 1 2001 10 18 BSE 2 3 BSE
132 4 BSE mad cow disease BSE 2001 10 25 vcjd = 2001 10 18 2003 4 26 187 0630 1 104 0.006 % BSE 6 1 5.8 % 1 BSE 1 BSE 9 10 BSE BSE
4.3 BSE 133 6 9 9 1684 2002 6 6 BSE 400 8 http://square.umin.ac.jp/massie-tmd/ BSE BSE 2 3 BSE 2001 9 10 BSE BSE vcjd BSE BSE
134 4 100 BSE BSE BSE BSE BSE vcjd 10 18 vcjd 150
4.3 BSE 135 5 BSE 3 1. 2. 3.
136 4 vcjd BSE BSE BSE 1964 1 2002 10 DNA
4.3 BSE 137 DNA biological 1 2 1980 1990 1996 vcjd ELISA BSE BSE
138 4 vcjd 1996 2 2001 10 10 1 1 2 ELISA ELISA 10 BSE BSE BSE BSE
4.3 BSE 139 BSE BSE CJD BSE BSE vcjd 500 30 24 BSE BSE
140 4 BSE NHK BSE BSE BSE 18 BSE vcjd 130 SARS SARS BSE BSE 5 6 BSE vcjd 100 % 100 % 100 %
4.3 BSE 141 BSE BSE BSE 1997 1998 BSE
142 4 Priority BSE 1 1982 90 92 2002 http://square.umin.ac.jp/massie-tmd/ BSE: Bovine Spongiform Encephalopathy BSE vcjd: variant Creutzfeldt-Jakob disease BSE BSE vcjd BSE 80 90 vcjd 2001 9 BSE BSE HIV CJD BSE 2001 13 1 BSE Web BSE 5 31
4.3 BSE 143 BSE BSE 4.3 BSE
144 4 4.4 BSE BSE vcjd
4.4 145 media literacy media literacy media literacy media literacy entertainment education entertainment education media literacy media literacy media literacy media literacy
146 4 media literacy 4 [1] 2002 [2] 2002 [3] 2000 [4] 2001 [5] 2001 [6] 2003 [7] 9 2002 [8] WHO, http://www.who.org/ [9] CDC, http://www.cdc.gov/ncidod/ncid.htm [10] http://www.ne.jp/asahi/vaccin/kyo/ [11] http://www.med.or.jp/ [12] http://www.ims.u-tokyo.ac.jp/imswww/index-j.html [13] http://www.nih.go.jp/niid/ [14] http://idsc.nih.go.jp/index-j.html [15] 2002 [16] NHK 2002 [17] 1998 [18] 2001 [19] BSE [20] 1998 [21] http://www.mhlw.go.jp/houdou/0110/h1018-6.html [22] http://vetweb.agri.kagoshima-u.ac.jp/vetpub/dr_okamoto/ DrYosikawa/DrYoshi2003/ [23] http://niah.naro.affrc.go.jp/disease/bse/bse-s.html [24] 2002 [25] 2002
4.4 147 [26] http://news.kyodo.co.jp/kyodonews/2001/ushi/ [27] 2002 [28] http://square.umin.ac.jp/massie-tmd/ [29] Center for Disease Control and Prevention, http://www.cdc.gov/ [30] Hollywood Health & Society, http://www.learcenter.org/html/projects/?cm=hhs [31] Arbind Singhal and Everett M. Rogers. Entertainment-Education; A communication Strategy for Social Change [32] 1988 7 2 [33] e-learning site: http://iiionline.iii.u-tokyo.ac.jp/ index.php
149 5 5.1
150 5 5.2
5.2 151 1 10 1000 4 1 2 PL 1 DRG/PPS 1970 1983
152 5
153 6 Z 6.1 10 2000
154 6 2 100 2 3 2.38% 1973 400 700 1973 500 1973 2003 30 500 30% 500
6.1 155 1 Z 10 Z Z 40 A 9 201 165 14 16 7% 167 6.1
156 6 9 A 50 B B 40 1 2 3 3 3 1 2003 5 16
6.2 157 1231 1891 10 6.2 165 167 Q1. Q2. Q3. Q4. 1 Q5. Q6. Q7. Q8. MR Q9. MR Q10. Q11. Q12. Q13. Q14. Q1 16 Q2 Q7 16
158 6 16 Q8 Q9 MR Medical Representative MR MR MR Q8 MR MR Q9 MR MR Q2 Q7 MR Z MR MR MR MR Q10 Q11 15
6.2 159 20 1000 1 MR Q10 Q11 Q12 Q12 2003 4
160 6 Q13 Q13 Q14 6.3
6.4 161 Drug Information 2002 5 10 BP 20 1 DI 6.4 Q15. Q16. 1 2002 7 24
162 6 Q17. Q18. Q19. Q20. Q19 Q21. Q15 16 12 75% Q16 Q17 Q16 Q18 Q17 Q17 Q16 Q17 Q18 Q20 2 6
6.5 163 Q21 6.5 10
164 6 5 5 100 14
6.5 165 201 2003 3 4 14 16 7% Q1. Q2. 1. 2. Q3. 0 Q4. 1 Q5. 1. 2. Q6. 1. 2. Q7. 1. 2. Q8. MR 1. 2. 3. 4. 5. Q9. MR 1. 2. 3. 4. 5. Q10. 1. 2. 3. 4. 5. Q11. 1. 2. 3. 4. 5. Q12. 1. 2. 3. 4. 5. Q13. 1. 2. 3. 4. 5. Q14. 1. 2. 3. 4. 5. Q15. 1. 2. Q16. 1. 2. 3. 4. 5. Q17. 1. 2. 3. 4. 5. Q18.
166 6 1. 2. 3. 4. 5. Q19. 1. 2. 3. 4. 5. Q20. 1. 2. 3. 4. 5. Q21. 1. 2. 3. 4. 5. Q22. 1. 2. 3. 4. Q23.
6.5 167 5 4 3 2 1 Q8 Q9 Q10 Q11 Q12 Q13 Q14 Q16 Q17 Q18 Q19 Q20 Q21 6.1: 5 Q8 Q14 Q16 Q21 5: 4: 3: 2: 1: Q8. MR Q9. MR Q10. Q11. Q12. Q13. Q14. Q16. Q17. Q18. Q19. Q20. Q19 Q21.
169 7 2004 7.1 2004 2000 11 4 3 2
170 7 2004 10 / 190764 9/59 98532 46/75 209817 59/68 274046 128/142 282413 61/63 296009 126/167 80 % 9 2002 11 30 8
7.1 171 12 1 2 2 8
172 7 2004 1. 2. 3. 4. 5. 6. 7. 8. 2 2 1 175 34 ( ) 17 18 18 88
7.1 173 7.1 7.1: 8
174 7 2004 6 6 7 8 9 10 10 1 100 / 1 2 1000 100 1 50 1 100 7 1 5 2
7.2 175 7.2 2000 2004 2002 12 2003 4 25 EBM 1 2
176 7 2004 87 % 1 2 2 2 2 2 95 % 2 34 1 87 % 1999 1 2 15000 13 %
7.2 177 17 172 2 7 1997 6
178 7 2004 specific 2 2 3 3 4 intensive
7.2 179 1 1 2 1 2 1952
180 7 2004 50 50 2 3 7 3 3 10 4 1 7
7.2 181 effort time 40 10 3 1 1 8
182 7 2004
183 8 1 1 26 2
184 8 8.1 1973 1979 1994 1998 10 20
8.1 185 PSA PSA PSA watchfull waiting 12 1 18 500
186 8 ED DHEA 23 23 3 1 8.2 1967 1975 1992 2002 15
8.2 187 10 20 30 4 2
188 8 5000 5 25000 5000 5 5000 10 PET 8 PET PET PET PET PET PET PET PET PET
8.2 189 QOL 600 800 500 5000 30 GDP 7 14
190 8 1 10 A B A 80 50 300 1 600 200 600
8.2 191 PET 30 200 30 4 600 GDP
192 8 1
8.3 193 30 30 30 30 1 8.3 3 22 94 22 1. QOL Quality Of Life EBM Evidence Based Medicine 2. IT 3. 4. IT 5.
194 8 6. 22 1 1 3000 1 2 ID
8.4 195 8.4 53 22 22 22 10 10 22 GDP 18 20 GDP 3.5 1 6 1 7 1 3 1 4 1
196 8 1000 500 60 1 15 1000 650 ICU CCU 14 50 MRI 5 1 22 22
8.5 197 1 1000 0.5 1.0 1000 0.5 0.3 1000 0.2 1000 5 3 4 1000 2 2 5 5 2 5 7 SNP 600 22 8.5 4 4 5
198 8 10 3 3 10 2
199 9 9.1 Blu
200 9 2 26 Rosso
9.1 201
202 9 9.1 1. 709 415 2. 211 5 50 3.
9.2 203 9.2 HIV X Y Communication H4.3.16 786-221 X 1 A X 2 A,Y A B A C B 58 6 A 42 Y B A B C A A X B A H2.10.9 750-221 B A B Y
204 9 B C B A C A B C B C S53.7.11 719-71 364-163 X A Y A B C B D A 7 A B C A A A X Y A 12 A 1 5 A D A A B,C B Y 1. B 2. B D
9.2 205 X D X B D H7.4.25 49 4-1163 X A Y A B Y B 58 3 2 A A Y B A A B A A 3 22 B A 3 18 A B A B 6 12 22 X B A Y 1. B A A 2. A B B 3
206 9 Communication Communication ADR Alternative Dispute Resolution S61.5.21 1221-39 615-79 X,Y,Z,A,B, X 44 2 1 7 Y 45 Y A 6 X A Z B 9 9 B X Y X B 709 Y Z 715 X
9.2 207 1. 2. A X B B X 3. 1% 4. 5. B X H7.6.9 49 6-1499 X,Y X 49 12 11 Y X X 3 3 X 0.06 X
208 9 100 % S54.9.20 949-111 X:A,E,F,B, Y:H 1971 H A B 2 E F H F A B E F A B E 6 1977 A F H A E F B H
9.2 209 2 300 4 200 1. 2. : 3. : 4. : 6 2 300 4 200 4 1. 2. 3. 4. 4 1. S58.9.16 1091-9 507-221 2. S49.4.2 738-24 307-122 1. X:,Y: 2. X:
210 9 4,Y: 1. 1974 25 4 2 19 2. 1965 28 3 1. 2. 10 2 S62.6.10 644-234 X: 16,Y: 1986 3 7 16
9.2 211 3 4 7 7 Y 1 2 3 5760 6 1. 2. S52.2.28 9 1.2-82 858-115 Y:, P:, A: P A Y Y 1. 2. 3. 1 3 5 4 1 2
212 9 100 % S28.12.22 7 13 2608 X,Y, Z,W,V X 8 1 6500cc 3% 100cc 9 30 Y X Y Y Z Z
9.2 213 W V 2 2 W X Y W X Y 1. 2. 3. W W X Y S28.12.22 7 13 2608
214 9 X,Y, Z,W,V X 8 1 6500cc 3% 100cc 9 30 Y X Y Y Z Z W V 2 2 W X Y W X Y 1. 2.
9.2 215 3. W W X Y S61.8.28 1208-85 X 58 3 6 X 1 1 2 1. 13 134 2. (a) (b) 1.2. 1.
216 9 2. (a) (b) (a) 645 (b) 2 1. 2. 2. 1.
9.2 217 S57.4.1 36 4-519 X, Y X 26 6 X X X 6 2 X 1. 2. 10 H4.1.30 1428-114
218 9 H7.3.28 1530-28 877-148 Y Y 1991 4 1 4 11 4 11 Y 4 13 4 13 11 Y Y a Y b Y 8 35 KCL 8 46 c (c) 199 (a)(b) c c a b c 1. 2. 3. 4. 4 1.
9.2 219 2. 4. 3. 4. 3 (a) (b) (c) 2 2 202
220 9 H4.6.30 1458-127 802-196 X,S,Y,T,N X 8 10 8 12 200 S S Y X S 8 34 T 11 8 39 K 8 48 N 9 13 1 5 X 6 50 T T X T 150 1. T X 2. T T T 3. T K X T
9.2 221 H4.3.26 794-142 Y, A,B A,B X 56 A Y Y X A B X X A,B X Y 58 X A B X A,B 1. Y 2. Y A 3. Y A,B X 4. 5. Y Y A,B 1 Y 2 X Y A,B X X X Y 3
222 9 A,B X Y Y X 4 5 X Y X Y 1. 2. 1. 2. 3.
9.2 223 S60.12.2 1180-113 570-30 Y, Y X 59 Y Y Y Y Y Y X Y Y Y Y Y X Y Y Y Y X X Y Y Y X X Y Y
224 9 X Y Y X Y Y Y Y Y Y X Y Y
9.2 225 2 H1.11.29 1346-103 1 1 2 3 60 11 18 19 30 H4.9.25 1490-125 MARU2 58 4 28 1 8 40 30
226 9 1 1 ( ) 1988 23 45 1 2 1 2 1 H3.4.19 45 4 367 1 43 6 1 3 709
9.2 227 5 45 16 50 29 3 H4.12.18 1445-3 807-78 2 51 62 36 124 160 47 3 29 3 1 2 45 51 6
228 9 H7.3.20 142 62 3 6 58 11 HA 51 16 2 6 6 12 1 26 13 2 S39.11.24 18 9 1927 4 27 6 5 6 19
9.3 229 H1.8,18 1361-109 733-206 5 53 59 4 27 TIG TIG 10 59 1 3 6 13 4 5 5 9.3 1 1
230 9 5 442 347 1352 6 505 392 1465 7 484 426 1523 8 572 500 1595 9 593 527 1661 10 622 584 1699 11 663 569 1793 12 775 690 1878 13 805 715 1968 1 2 5 13 45.1% 8.4% 2 5 143511 137934 113768 6 146392 144693 115467 7 144479 146654 113295 8 142959 145858 110396 9 146588 147373 109611 10 152678 150683 105605 11 150952 154395 102163 12 156850 158781 100232 13 155541 157451 98322 1 2 3 3
9.3 231 5 36955 17 347 42.6 6 38640 16.6 392 42 7 40604 16.6 426 39.1 8 42017 16.4 500 37.5 9 42979 15.7 527 36.7 10 46913 14 584 35.3 11 47270 14.4 569 34.6 12 - - 690 35.5 13 - - 715 32.7 1 2 63 9 19.5% 25.3% 2002 211 1 5 50 1.
232 9 2. 5 3. 4. 20 1. 2. 3. 4. 4 3
9.3 233 co-medical 8 3 4 10
234 9 1993 132 173 20 22 1994 178 174 21 19 1995 172 198 29 27 1996 176 259 29 36 1997 193 278 27 29 1998 234 285 29 36 1999 231 267 37 34 2000 304 317 39 30 2001 331 315 31 35 1951 2266 262 268 41% 48% 6% 6% 3 4 3 3 4 2 3
9.3 235 1 1 1998 1
236 9 2001 3 4 1230 85% 20 49 77% 54% 60% 70% 68% 20 29 73% 60 69 52% 53% 18% 20 49
9.3 237 GDP 1999 GDP % 3998 13.6 2701 10.5 7089 10.3 2291 9.3 1884 9.3 2071 8.6 2085 8.6 984 8.5 2196 8.5 1695 8.4 1881 8.3 2104 8.2 2629 8.2 2832 8.1 1312 7.6 802 7.6 2467 6 7.4 17 36 185 53 37 56 36
238 9 WHO 1 12 6 11 7 9 14 15 1 3 1
9.3 239 13 13 44.7 30.4 9.1 39.3 102 11.9 8.2 35.2 69.7 10.6 4.1 45.3 131 9.8 3.6 76.9 228 7 1 1 1 1
240 9 1.8 7.4 2.6 8.1 1.6 4.3 3.4 9 2.9 5.9 5.5 5.5 2.1 8.9 3.1 10.2
9.3 241 (%)(1993) 29.5 11.33 19.9 17.1 16.4 29.5% 2.66 2.65 1.39 1.14 1.7 29.5% 52.7% 43.6% OECD29 32.5% 1993 1994 1995 1996 1997 1998 1999 2000 0.295 27.20% 28.00% 25.90% 24.90% 24.00% 20.80% 20.10% 2001 2002 GDP 470 5 10 850 5 1250 5 10 1680
242 9 2 2500 13000 1 3 100 2000 100 1000
9.3 243
244 9
9.3 245 1 1 4 1. 2000 2600 2. 67 3. 120 4. 1 3 10 15% 1 3 1. 2. 3. 3 1000 1 2 3 4 4 1 16 11 A
246 9 1 1 1 1 100 100 500 400 100 100 100 2 1 2 1 6 100 100 3
9.3 247 4 1000 1000 100 1000 2 3 2 3
248 9 1998 8 16 6 388 30 54 126 38
9.3 249 1999 1 2 15000 87% 4 3 4 1 15000 13% 2000 3 11 20 75% 0 10 74% 98% 62% 2001 190764 98532 209817 274046 282143 296009 4 80% 65% 80% 90% 9
250 9 9 9 3 6 ACGME Accreditation Council for Graduate Medical Education: ACGME ACGME 2003 7 80 24 JAMA 2002 288 9 1112-1114
9.3 251 2 5 4 6 1 2 40 40 3 10 2 5
252 9 0 40 50 40%
9.3 253 9.1: 10 20 30 40 50 60 70 80 90 4 49 49 25 56 57 39 6 1 8 294 0 11 12 12 25 34 15 4 0 0 113 4 38 37 13 31 21 22 2 1 2 171 0 0 0 0 0 2 2 0 0 6 10 3 1 2000 12 200 10 300 294 9.1 12 282 282 161 9.1 113 62 169 99 1. 2. 3. 4.
254 9 9.1: 9.2 9.2: 9.3 40 9.3:
9.3 255 9.2: % * 20 12.4 12 7.5 6 3.7 116 72 8 5 161 9.3: % 25 21.6 17 14.7 18 15.5 43 37.1 6 5.2 20 17.2 116 1. 2. 3. 4. 5. 9.2 9.3 1. 2. 3. 4. 9.4
256 9 9.4: % 68 24.1 135 47.9 36 12.8 11 3.9 32 11.3 9.5: % 8 11 43.8 49.9 37.3 35.2 5.2 5.9 13.7 9.0 49.3 57.0 35.3 28.9 7.5 9.0 7.9 5.1 8 11 8 11 9.5 9.13 Charles Vincent 1994 The Lancet Why Do People Sue Doctors?: A Study of Patients and Relatives Taking Legal Action Vol.343,1609-1613 1992 5 solicitor 446 227 1 8 9.6: % 40.7 43 2.1 14.3 36.4 48.1 5.6 9.8 8 2 11 35.4 43.2 5.9 0.5 15 34.1 42.3 9.1 1.7 12.8 11
9.3 257 9.7: % 8 11 16.0 23.3 63.8 60.9 20.2 15.8 24.8 38.2 58.6 47.7 16.6 14.1 8 11 9.8: % 31.2 50.3 7.6 0.7 10.2 54.5 40 3.3 0.3 2 26 49.5 12.3 2.4 9.7 49.1 40.9 6.8 0.9 2.2 11 1 9.9: 28.7 22.4 35.2 3.8 1.2 1.7 45.7 20.2 24.2 1.4 0.7 1.8 18 26.9 42.9 4.2 1.1 1.2 9.8 13.8 45.6 14.2 4.5 2.4 11.3 12.9 31.5 12.4 14.7 5.7 18.1 15.8 42.2 8 3.9 3.6 11 2 36.1 20.7 28 3.7 1.8 2.3 7.4 53.7 18.3 17.7 1.5 1.3 0.9 6.7 26.9 25.7 34.2 4.2 1.5 1.9 5.7 19.6 16.1 39.2 9.7 4 4.2 7.2 25.5 11.4 30.4 6.9 11.2 6.6 8.1 25.8 14.9 33.8 6.6 6.1 5.1 7.6 11
258 9 1 8 9.10: % 71.4 56.7 16.5 3.1 21.2 10.2 78.6 63.1 34.3 7.1 19.6 7.5 8 2 11 75.3 58.4 21.5 34.5 39.3 16.1 5.6 5.7 83.3 70.2 45.4 45.3 32.9 19.6 5.7 4.8 11 9.11: % 30.2 41.9 27.4 55.3 23.6 23.2 4.6 4.3 33.8 40.4 30.7 61 23.1 20.2 6 4.8 11 9.12: % 32.4 31.3 16.4 5.9 2.5 0 14 40.6 34.7 13.6 2.7 1.9 15 39 44.1 29.7 16.1 3.1 2 40 64 34.8 33.8 15.9 4.4 2 65 74 27.1 31.5 17 6.5 2.3 75 22.2 26.7 17.7 11.2 4.2 32.4 29.5 14.8 5.4 2.2 29.5 24.9 17.3 12 6.7 0 14 45.5 27.9 14.4 3.1 3.7 15 39 47.8 24.2 17.4 3.7 3.1 40 64 36.3 28.2 15.7 8.6 4.2 65 74 28.9 26.8 16.2 11.5 5.7 75 19.4 21.6 19.2 17.4 10.2 31.1 25.2 15.4 9.3 6.3 11
9.3 259 9.13: % 14.4 48.3 8.7 21 2.8 1 0 14 19.8 49.3 7.1 17 3.4 0.8 15 39 27.5 39.6 8.9 18.6 3 0.7 40 64 12.1 48.9 9.2 22.8 2.9 0.9 65 74 9.5 52.8 8.2 20.7 2.5 1.1 75 8.9 49.6 9.2 21.7 2.7 1.2 13.3 50.4 8.3 19 3 0.9 14 44.4 7.3 25.1 3.4 1.5 0 14 17.2 52.4 4.1 19.8 3.5 1 15 39 30.5 39.1 6.8 18.3 2.9 1 40 64 12.8 43.8 8 27.2 3.8 1.3 65 74 9.9 47.5 7 24.9 3.3 1.4 75 10.8 43.6 7.5 26.9 3.2 2 14.5 44.2 8.2 22.3 3.3 1.3 11 13 I wanted an explanation. I wanted the doctors to realize what they had done. To get back at the doctor involved. Robyn S. Shapiro 1989 Archives of Internal Medicine A Survey of Sued and Nonsued Physicians and Suing Patients Vol.149,2190-2196 642 83% 22% 1 2 3 4
260 9
9.3 261
262 9 FAX 3
9.3 263 2003.4.15. 2001.4 2001.10 NPO COCODES ADR
264 9 1. 2. 3. 3 3 1. 2. 3. 5 1.
9.3 265 2. 3. 4. 5. 5 2000 1. 2. 3. 4.
266 9 5. 119 99% 119 119 12 10 418 25
9.3 267 8 3373394 2.8 9 3476504 3.1 10 3702075 6.5 11 3930999 6.2 12 4184121 6.4 11,428 7.6 42770 234171 885382 1026617 1605 2190545 4970 39762 140832 575559 591 761714 3644 42223 136202 302717 422 485208 7950 148560 273520 128556 1889 560475 59334 464716 1435936 2033449 4507 3997942 51% 8 1 1 1.
268 9 2. 76% 3. 4. 190 2 1 1 53 % 2 40 % 3 26 % 4 7% 5 4% 98 %
9.3 269 3 1. 2. 3. 30 50
270 9 1. 2. 2 1. 2001 7 5000 2. 1. 2. 3.
9.3 271 4. 5. 6. 3 1. 2. 3. 3
272 9 1. 2. 3. 1. 2.
9.3 273 4 1. 2. 3. 4. 4 N 76 37 24 O A 120ml
274 9 50 2580 2
9.3 275 1. 2. 1
276 9 2 9.4 e-mail AERA 2,3
9.4 277 1997 (1) (2)
278 9
9.4 279 44000 90000 10000
280 9 1,2 ADR Alternative Dispute Resolution ADR mediation ADR ADR mediation)
9.4 281 NPO 9 NPO ADR 2 700
282 9 ) (1) (2) (3) (4) (5)
9.4 283 1 2 9 (1) (2) (3) (4)
284 9
9.4 285 2
286 9 3 1 Professional
9.4 287 Freedom (1) (2) (3) 1970 3000 HMO 1978 (Peer Review Organization) JCAHO(Joint Commission for Accreditation of Healthcare Organization)
288 9 JCAHO Exemption Clause Complaint manager & Ombudsman a. 1 1 3 b. 41 c. d. e. 3 / 4 d. f.
9.5 289 1 9.5 2003 5 12 7 5/16
290 9
9.5 291 30
292 9
9.5 293
294 9
9.5 295 3000 30
296 9
9.5 297 6 1 9 1
298 9 9.6
9.6 299 30
301 A Z ADL 77 AI 88 BSE 120 BST 91 CJD 122 DNA 43 EBM 41 EMA 58 fmri 97 gynecology 66 HIV 66 HLA 62 IC (informed consent) 19 MMR 116 MR Medical Representative 158 PET 97 PTSD 96 QOL 93 SARS 116 SNP 43, 55, 62 SQUID 97 truth telling 32 T 62 vcjd 122 153 126 91 160 51 5 20 160 95 85 60 98 70 56 152 43 111 62 80 158 113 153 98 21 74 53 160 54 19, 23, 40, 151 66, 101 127 120 6, 95, 179 116 66 114 61 64 85 22 127 73 87 182 43 118 96 74 95 67 154 95 161 39 39 32, 53, 61, 70, 91 164 61, 101, 116 MRI 97 15 120 54 121 154 56 40, 151 40 111 121 40 103 91 116 15 62 113 21 85 176 92 61 92 153 21 128, 153, 176 116 66 53 103 32 1 66
302 150 66 68 91 55, 69, 80, 83, 96 57 61 64 62 64 21, 28, 30 61 61 31 180 88 17 116 57 99 86 92 62 123 53 70 67, 70 71 67 64 64 153 21, 28, 30 95 94 21, 66 37 81 82 88 53 57 54 81 151 56 177 121 55 175 2, 57 86 13, 94 94 1 11 79 20 23, 151, 160 126 21 59 161 159 61 60 92 7 7 7 177 65 128 159 75 81 81 96 64 122 97 153 96 41, 43, 62 51 51, 67 39, 54 101 11, 124, 179 99 75 113 113 182 160 95 149 53 73 116 161 124 22 96 21, 154 21 153 65 71 20 20 64 125 1, 97 53 128 100 101 66 92 67 20 70 3, 58, 95 86 91 43 19 91 3, 95 103, 116 41, 175 157 26 66 40 175 55 121 121 80 92 11, 95 76 61 20 57 122 54 95 92 64 114 101 91 107 79 149 68 14 179 160 71 157 116 62 60
303 163 61 155 153 151, 154 160 60 87 160 78 101, 116 118 60 21 10 85, 97 159 156 57 116 20 160 82 101, 116
305 2
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