JP3853754B2 - Checklist - Google Patents

Description

[0001]
BACKGROUND OF THE INVENTION
The present invention relates to a checklist that can easily express symptoms of illness and the like instead of filling in an inquiry sheet.
[0002]
[Prior art]
For example, when you go to a hospital, you will be given a medical questionnaire at the window and fill it out to let the doctor know the outline of the symptoms in advance. In such an inquiry table, there are methods such as answering a plurality of questions in a descriptive manner, or marking a selection type answer column.
[0003]
Also, if you feel a physical or mental abnormality, compare the typical symptoms described in the home medical book with your own symptoms or the symptoms of your family and determine whether you need to go to the hospital. In some cases.
[0004]
FIG. 5 is a view showing a conventional inquiry table 100. The questionnaire 100 is for checking when a family suspects dementia. Here, each of 19 questions is selected from 3 types of answers. The three types of answers are 104, unchanged 106, very bad 108, and given 2 points, 1 point, and 0 points, respectively. Compared with family members.
[0005]
If you think your family has changed (becomes worse) compared to a year ago in response to the question “Do you know the day of the week and month?” In question 1, circle the numbers in column 110 And so on. Similarly, when the answer is completed up to the last question, all the marked numbers are added up. In the case of the questionnaire 100, if the total score is 24 or less, it is determined that there is a suspicion of dementia.
[0006]
[Problems to be solved by the invention]
However, in a conventional questionnaire that is given at the hospital's window and filled in on the spot, it is necessary to fill in with writing instruments even if it is an alternative answer format, and both the responding person and the receiving hospital have symptoms There was a problem that it was difficult to read the tendency.
[0007]
In addition, the score summation questionnaire as shown in the Questionnaire 100 is easy to understand if the scores are definitely tabulated, but it is easy to avoid especially for the elderly, and the possibility of mistakes is also denied. There was a problem that I could not.
[0008]
The present invention has been made in view of such problems, and the object of the present invention is to provide a checklist that can be answered to any person in a short time, and that the tendency of symptoms can be expressed and communicated without error. It is.
[0009]
[Means for Solving the Problems]
In order to achieve the above-mentioned object, the present invention has a question and a selection answer field for the question on the surface, and a plurality of bent portions that can be bent when it corresponds to the answer to the question in the two-line selection answer field, There is a comparison table on the back side, and the comparison table displays the area where the number of bent parts in the two-line selection answer field is taken along the vertical axis and the horizontal axis, and is folded by the respondent in the two-line selection answer field. It is the check list comprised so that the position on an area | region may be pinpointed by the number of the bending parts made.
[0010]
According to the above configuration, it is possible to easily answer in a short time without requiring a writing tool or the like to answer, and the person who answered the checklist and the person who judges it can easily understand the tendency of symptoms.
[0012]
Further, the two columns of selection answer columns may be colored in different colors.
According to the above configuration, it is possible to judge by counting the number of answers by color and confirming them in the comparison table, so there is no hassle of summing up the scores, and the risk of mistakes in the summation affecting the diagnosis is also reduced. be able to.
[0013]
DETAILED DESCRIPTION OF THE INVENTION
Hereinafter, embodiments of the present invention will be described in detail with reference to the drawings. FIG. 1 is a diagram showing a check sheet 1 according to the first embodiment of the present invention. As shown in FIG. 1, the title 3 is written on the upper part of the check sheet 1 as to what is to be checked first. Since the check sheet 1 can infer the type of headache from the symptoms, it is described as “headache check sheet”.
[0014]
Next, as question 5, there is a question “Where does it hurt?”, And three types of selection answer columns 7, 9, 11 are provided on the side. These selection answer fields are provided for each of the six questions described in the check sheet 1 including the question 5 in three types. In addition, each selection answer field is formed with bowl-shaped cuts, and the answer is made by bending the corresponding part toward the back. Here, “bend” means to fold the selection answer fields 7, 9, and 11 with fingers as in the bingo game paper.
[0015]
In the lower part of the selection answer column, three types of headaches such as tension type headache are described as headache type 13 corresponding to the three types of answers. Below that, there are explanations of typical symptoms of each headache, such as explanation 15. In this case, the symptom seen in each case of tension type headache, migraine and cluster headache is described in the selection answer column for each question. An asterisk 17 attached to the left side of the selection answer column indicates a symptom particularly characteristic of each headache.
[0016]
Next, a procedure for making an answer using the check sheet 1 will be described. Here, it is assumed that a patient who has received the check sheet 1 answers for a preliminary examination in which the doctor is informed of the symptoms in advance at the hospital window. The patient reads each question and answers by folding the selection answer column in which the corresponding symptom is described to the back. When the selection answer column has been folded for all the questions, the check sheet 1 is submitted to the hospital side, and the symptom diagnosis is completed.
[0017]
As described above, according to the check sheet 1, it is possible to easily reply in a short time without requiring a writing tool or the like to reply. Moreover, when all the questions are answered in the check sheet 1, the selection answer column of the applicable part is folded, and the number of answers corresponding to each type of headache can be determined at a glance.
[0018]
For example, if the number of responses is different for each type of headache, it is considered that there is a high possibility of the type of headache with the largest number of responses, and if there is no difference in the number of responses, headaches with many stars Can be considered. The doctor who diagnoses can check the tendency of the symptoms at a glance with the check sheet 1, so that the efficiency of the diagnosis can be improved. Furthermore, it can be distributed to participants at a disease awareness seminar for consumers held in the media, local governments, pharmaceutical companies, medical institutions, etc., and used when the doctor as the performer explains the content.
[0019]
Next, a check sheet according to the second embodiment of the present invention will be described. FIG. 2 is a view showing a check sheet table (front) 20 according to the second embodiment, and FIG. 3 is a view showing a check sheet back 40 according to the second embodiment.
[0020]
As shown in FIGS. 2 and 3, the check sheet according to the second embodiment checks the possibility when a family suspects dementia. In the check sheet table (Omote) 20, the title 22 is “Checklist for suspected dementia for the family” on the left, and each question is answered by comparing the current state of the person with that of one year ago. It is supposed to be.
[0021]
In response to the question 24 “Do you know the day of the week and the month?”, The three types of selection answer fields 26, 28, and 30 are described as “not changed”, “somewhat worse”, “very worse”. Similarly, the above three types of selection answer fields 26, 28, and 30 are provided for one question. As a measure for determining whether or not the patient is demented, a score is associated with each answer, and the total score is used. In other words, 2 points are given for "not changed", 1 point is given for "somewhat worse", 0 is given for "very worse", and if the total score is 24 points or less, it is judged that there is a suspicion of dementia Is done.
[0022]
The selection reply fields 28 and 30 are formed with cuts in the same manner as the selection reply field according to the embodiment of the check sheet 1, and a reply is made by bending the corresponding part toward the back. Further, the selection response fields 28 and 30 are colored in different colors different from the color of the check sheet back 40. Here, the selection response column 28 is colored yellow, and the selection response column 30 is colored pink.
[0023]
On the left side of the check sheet 40, there are bent portions of selection answer fields 28 and 30 on the left side. When the selection answer fields 28 and 30 are selected as the answer, the bent portion is folded back so that the colored surface can be seen. As a result, the number of selection answer fields 28 and 30 selected can be easily counted.
[0024]
An explanatory diagram 42 and a comparison table 48 are written in the portions other than the bent portions of the selection response fields 28 and 30. FIG. 42 illustrates a method of determining whether or not there is a suspicion of dementia using the control table 48 after all the responses to the check sheet table (Omote) 20 have been completed.
[0025]
The number of selected answer fields 30 selected as responses is written on the vertical axis of the explanatory diagram 42, and the number of selected answer fields 28 selected on the horizontal axis. Whether or not there is a suspicion of dementia at the intersection of each number is written. Although it is judged, the area A44 where no dementia is suspected and the area B46 suspected of dementia are displayed separately. Area A44 is an area where the total number of selected answers is 25 points or more, and area B46 is an area where 24 points or less.
[0026]
As an example, the case where the number of yellow (selection answer column 28) is 10 places and the number of pink (selection answer box 30) is 1 is described, and the intersection is indicated by a black circle in the explanatory diagram 42. Since it corresponds to the area A44, there is no suspicion of dementia.
[0027]
In the comparison table 48, as in the explanatory diagram 42, the vertical axis indicates the number of selected answer fields 30 selected as responses, and the horizontal axis indicates the number of selected answer fields 28 selected, indicating the presence or absence of dementia. A44 and area B46 are shown respectively.
[0028]
Next, a method for using the check sheet according to the second embodiment will be described. First, the respondent looks at the check sheet table (Omote) 20 and answers each question. The answer is about a change compared to the state of the person one year ago, and when the answer seems to correspond to the selection answer field 28 or the selection answer field 30, the answer is made by bending the corresponding field to the back side. If the selected answer field 26 is applicable, the process proceeds to the next question.
[0029]
Similarly, when all the questions have been answered sequentially, the back 40 of the check sheet is viewed. The number of each answer selected at the left bent portion is counted, and the intersection of each number is obtained from the comparison table 48 to determine whether there is a suspicion of dementia. When the intersection is in the region A44, it is determined that there is no suspicion of dementia, and when it is in the region B46, it is determined that there is a suspicion of dementia.
[0030]
In the case of such a determination method, as described above, the writer has conventionally totaled the points. However, according to the check sheet according to the second embodiment, the check sheet back 40 has different colors. Since it is only necessary to count the number of selection answer fields and confirm in which area the position of the intersection is in the comparison table, this can be done in a short time and errors can be reduced.
[0031]
Next, a check sheet 51 according to the third embodiment will be described.
FIG. 4 shows a check sheet 51, and a title 53 is written on the check sheet 51.
The check sheet 51 is described as “allergic nasal inflammation check card”.
[0032]
Further, on the left side of the check sheet 51, there is a column indicating the severity 55, and on the right side there are a column 57 indicating "nose clogging", a column 59 indicating "crushing", and a column 61 indicating "blowing nose". There is a column to show.
[0033]
In addition, selection answer columns 63-1, 63-2, ..., 63-5 are provided below the column 57 indicating "nose clogging", and a selection answer column 63-1, 63-2, ..., 63-5 is provided below the column 59 indicating "crushing". Answer columns 65-1, 65-2,..., 65-5 are provided, and selection answer columns 67-1, 67-2,. Is provided.
[0034]
The respondent extracts a predetermined selection answer field 63 below the nasal congestion. For example, if it is completely clogged all day, the selection answer column 63-1 is extracted.
[0035]
In addition, for the crushing, a predetermined selection answer column 65 below the crushing 59 is extracted. For example, when the number of crushing times is 10 to 6, the selection answer column 65-3 is extracted. For the nose 61, a predetermined selection answer column 67 below is extracted. For example, when the number of times of sniffing is 5 to 1 on average per day, the selection answer column 67-4 is extracted.
[0036]
The selection response fields 63, 65, and 67, which are extraction parts, are notched, and a response is made by extracting the corresponding part toward the back. 1 is different from the check sheet 1 shown in FIG. 1 in that the selected answer field is completely removed from the check sheet 51 by the respondent.
[0037]
Then, the severity 55 on the left side of the extracted selected answer column is the severity of the respondent.
For example, when the selection answer columns 63-2, 65-2, and 67-3 are extracted, it is understood that the severity is “severe” or “moderate”.
[0038]
The preferred embodiments of the checklist according to the present invention have been described above with reference to the accompanying drawings, but the present invention is not limited to such examples. It is obvious for those skilled in the art that various modifications or modifications can be conceived within the scope of the technical idea described in the claims, and these are naturally within the technical scope of the present invention. It is understood that it belongs.
[0039]
For example, in the above embodiment, a sheet-like check sheet has been described as an example of the check list. However, the present invention is not limited to this, and other shapes such as a cylindrical one may be used. Moreover, although the checklist for making a judgment regarding illnesses has been described, the present invention is not limited to this, and the checklist can also be used, for example, when a problem such as a car or an electrical appliance occurs. Further, the layout of the check list, the number of types of selection answer fields, the method of writing the comparison table, etc. are not limited to those described above, and the scope of the present invention is as long as it has similar functions.
[0040]
【The invention's effect】
As described above in detail, according to the present invention, the bent portion is provided in the check list, and it is possible to answer the question by folding it, so that it is possible to easily answer the question in a short time. In particular, when it is necessary to calculate the score according to the answer, the answer column is color-coded to make it easier to count, and a comparison table is provided so that the total score need not be calculated. The risk of doing this can be reduced.
[Brief description of the drawings]
FIG. 1 is a view showing a check sheet 1 according to a first embodiment of the present invention. FIG. 2 is a view showing a check sheet table (front) 20 according to a second embodiment. FIG. 4 is a view showing a check sheet back 40 according to the second embodiment. FIG. 4 is a view showing a check sheet 51 according to the third embodiment. FIG. 5 is a view showing a conventional interview table 100.
1 Check sheet 3 Title 5 Question 7, 9, 11 Choice answer column 13 Headache type 15 Explanation of headache

Claims (2)

On the surface, there are a question, a selection answer field for the question, and a plurality of bent portions that are folded when corresponding to the answer to the question in two rows of selection answer fields,
Has a comparison table on the back,
  In the comparison table, the vertical axis and the horizontal axis indicate the number of bent portions to be bent in the two columns of selection answer fields,
  The check list characterized in that the position on the region is specified by the number of bent parts bent by the respondent in the two columns of selected answer fields. The check list according to claim 1, wherein the two columns of selection answer fields are colored in different colors.

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