成人の糖尿病性腎臓病の患者における低たんぱく質食 何が問題なのか？ 透析を必要としない糖尿病性腎臓病（DKD）の患者には、慢性腎臓病の進行を遅らせるために、食事中のたんぱく質の量を制限することが推奨される場合がある。しかし、たんぱく質の摂取量については依然として不明な点がある。 何を行ったのか？ 透析を受けていない成人のDKD患者において、低たんぱく質食が腎臓病の進行に及ぼす影響に関するエビデンスについて検索を行った。検索したエビデンスは2022年11月17日までのものである。低たんぱく質食（0.6～0.8g/kg/日）と通常食、または非制限食（1.0g以上/kg/日）について12か月以上比較を行った研究を検索し、すべての研究の結果を統合した。 何が見つかったのか？ 異なる病期の慢性腎臓病を持つ計486人のDKD患者を対象とした8件の研究が見つかった。研究には、1型糖尿病と2型糖尿病が含まれていた。その結果、低たんぱく質食の糸球体濾過率の減少を遅らせる効果については不確実であった。通常食、または非制限食と比較した場合、低たんぱく質食は死亡、または透析が必要な腎不全への進行に対し、ほとんど影響を及ぼさない可能性が示唆された。ほとんどの研究で栄養状態が報告されており、低たんぱく質食群において栄養不良の可能性を示した研究は1件のみであった。健康に関連した生活の質（QOL）にはほとんど、...

Location: Flexible location (remote working) – contract type dependent on location.
Specifications: Permanent position. Employment contract if successful applicant based in UK, Germany or Denmark. Consultancy contract in other locations.
Hours: Full-time (37.5 hours per week) or part-time (please specify desired working hours)
Salary: £30,000 per annum, prorata
Application Closing Date: Tuesday 17 January 2023 (Midnight GMT).

This role is an exciting opportunity to use your communication and problem-solving skills to make a difference in the field of healthcare research and publishing. 

Cochrane implemented Editorial Manager in 2021 as the editorial and production system for Cochrane Reviews. This role has a significant focus on supporting authors, editors and peer reviewers in using Editorial Manager for submission and peer review; and our linked system Convey for managing Declarations of Interest. Applications are particularly welcomed from candidates with experience of using these or similar systems.

The Cochrane Support team provides technical and user support to Cochrane editorial teams and review authors; and handle enquiries from members of the public about Cochrane’s work. We pride ourselves on our timely and coordinated support service, covering a broad range of areas, with a focus on Cochrane review-writing software and editorial processing and publication.

The team works closely with Cochrane’s Central Editorial Service and other related departments, to ensure accurate, consistent responses to queries on Cochrane technology, policies and methods.

Cochrane is a global, independent network of health practitioners, researchers, patient advocates and others, responding to the challenge of making vast amounts of research evidence useful for informing decisions about health. We do this by synthesizing research findings to produce the best available evidence on what can work, what might harm and where more research is needed. Our work is recognised as the international gold standard for high quality, trusted information.

Cochrane welcomes applications from a wide range of perspectives, experiences, locations, and backgrounds; diversity, equity and inclusion are key to their values.

How to apply: 

• For further information on the role and how to apply, please click here  
• The supporting statement should indicate why you are applying for the post, and how far you meet the requirements, using specific examples.
• If you are applying for part-time work, please specify the number of hours you are interested in working.
• Read our Recruitment Privacy Statement
• Deadline for applications: Tuesday 17 January 2023 (12 midnight GMT)

 

Thursday, December 22, 2022 Category: Jobs

Location: Remote, UK. 
Specifications: Permanent contract.
Hours: Full-time week (flexible working considered) – 37.5 hours.
Salary: £52,363 per annum.
Application Closing Date: 8 January (Midnight GMT Time)

We are a global, independent organization that strives to inform health-care decisions every day. We gather and summarize the best evidence from research to help doctors, nurses, patients, carers, researchers, funders, and policymakers. We do not accept commercial or conflicted funding, and work to minimize risk of bias, in order to generate authoritative and reliable information.

As our new IT Infrastructure Operations Manager, you will ensure the fitness-for-purpose, cost-effectiveness, availability, and security of Cochrane’s IT systems infrastructure and operations. Monitor and help manage the lifecycle of our in-house software. Set policy for, and advise on the provision of, IT for the Cochrane Central Executive team (ca. 100 people).

Cochrane welcomes applications from a wide range of perspectives, experiences, locations, and backgrounds; diversity, equity and inclusion are key to their values.

How to apply:

• For further information on the job description and how to apply, please click here. 
• The supporting statement should indicate why you are applying for the post, and how far you meet the requirements, using specific examples. 
• Note that we will assess applications as they are received, and therefore may fill the post before the deadline.
  
• Read our Recruitment Privacy Statement
• Deadline for applications: 8 January 2023 (Midnight GMT).
• Interviews to be held on: W/C 16 February 2023(times and exact dates to be confirmed).

Thursday, December 22, 2022 Category: Jobs

Specifications: Full Time (Permanent)
Salary: £51,489 per annum
Location: Ideally based in the UK, Germany or Denmark. Candidates from the rest of the world will be considered; however, Cochrane’s Central Executive Team is only able to offer consultancy contracts outside these countries (1-year fixed-term contracts)
Application Closing Date: 8th January 2023

Cochrane has established a centrally-resourced Editorial Service to support the efficient and timely publication of high-quality systematic reviews in the Cochrane Library. The reviews that are published through the Central Editorial Service address some of the research questions considered to be the most important to decision makers.

Working as part of a friendly and supportive international team, the Senior Managing Editor will be responsible for managing the efficient and timely editorial processing of a portfolio of approximately 150 publications per year.  The role holder will be expected to prioritise and delegate editorial tasks as appropriate. They will also need to be an advocate for the Editorial Service internally and externally to Cochrane and remain alert to immediate demands of delivering high-quality review content for publication in a timely fashion.      

Reporting to the Executive Editor and working with members of the Editorial Production and Methods Directorate, the role holder will need to have good awareness of Cochrane guidance for different types of standard and complex systematic reviews (intervention, qualitative, diagnostic test accuracy, prognosis, rapid and overview), plan how they will need to be handled in their team, and work to ensure that deadlines are met. The role holder will also be required to ensure that pilots aimed at innovating the editorial process can be supported as needed.  

The majority of Cochrane Central Executive staff are located in London, UK, however flexible locations are possible for the right candidate. Please note, however, that we are only able to offer consultancy contracts outside of the UK, Germany or Denmark.

We will consider extended notice periods if required for applicants who wish to honour existing contracts. We fully support remote and flexible working arrangements.  

How to apply

• For further information on the role and how to apply, please click here. 
• The deadline to receive your application is by 8th January 2023. 
• The supporting statement should indicate why you are applying for the post, and how far you meet the requirements, using specific examples.
• Note that we will assess applications as they are received, and therefore may fill the post before the deadline.
• Read our Recruitment Privacy Statement

Wednesday, December 21, 2022 Category: Jobs

Cochrane Crowd is a global community of volunteers who are helping to classify the research needed to support informed decision-making about health care. Recently Cochrane Mexico held an in-person screening challenge that helped introduce students to randomized control trials and evidence assessment while contributing to global research efforts. 

The job of the Cochrane Crowd community is to review descriptions of research studies to identify and classify randomized controlled trials (RCTs), a type of study that is considered the gold standard for clinical trials. Reports of RCTs are then fed into Cochrane’s Central Register of Controlled Trials, helping Cochrane authors and other systematic reviewers around the world quickly find the evidence they need to determine whether a treatment works, or whether a diagnostic test is accurate.

8,000 RCTs identified in 24-hour student event

The Cochrane Mexico Associated Centre at Sinaloa’s Pediatric Hospital and the Autonomous University of Sinaloa took on their second in-person Cochrane Crowd challenge. For 24 hours students from both logged into Cochrane Crowd, screened studies, and identified RCTs. In total, 579 students performed more than 250,000 classifications, which identified 8,712 RCTs. This 24-hour event topped the number of RCTs identified in Cochrane Mexico’s first Cochrane Crowd event in 2018, which lasted for 3 days.

Students who screened more than 1,000 records received their Cochrane membership . In addition, evidence-based medicine books were awarded to all those who exceeded 1,000 classifications, had a sensitivity greater than 95%, and an overall accuracy greater than 70% to identify clinical trials. 

Giordano Perez-Gaxiola, director of Cochrane Mexico and key challenge organizer, says: “Cochrane Crowd is a great introduction to systematic reviews and randomized control trials for students. Having students participate in a time-limited challenge is a fun way to engage students and was simple for us to set-up. The students exceeded all our expectations this year and we are so proud of them! Many of the students enjoyed it so much and could see results of their efforts for global health research that they are continuing to do screening on Cochrane Crowd!”

Anyone can join Cochrane Crowd and no previous experience is necessary

“Cochrane sends its thanks to all those involved in this citizen scientist challenge using Cochrane Crowd – what an amazing achievement in just 24 hours!” says Anna Noel-Storr, Head of Cochrane’s Evidence Pipeline. “We hope these students inspire everyone to give Cochrane Crowd a try. From medical students, to clinicians, to anyone with an interest in health research – being a part of Cochrane Crowd can help individuals develop skills in understanding health evidence while collectively contributing to global research efforts.” 

Has Cochrane Mexico inspired you to organise a Cochrane Crowd challenge at your workplace or university? If so, please get in contact and we will support you to get one up and running: crowd@cochrane.org.

• Join Cochrane Crowd - everyone is welcome! 
• If you teach evidence-based medicine, check out Cochrane Classmate, the platform we run challenges on.  

Thursday, January 12, 2023

Dear Cochrane Colleagues, Members and Supporters, 

Thank you to everyone across our community for your dedication and commitment to Cochrane during 2022. The last few years have at times felt tumultuous, both due to Covid and world events, but also because of the changes we are making to ensure that Cochrane is fit for a future that meets our vision of a world of better health for all people, where decisions about health and care are informed by high-quality evidence. 

We are well on our way to creating an evolved impact-driven organisation to support evidence-based health and social care. With your help we are building on your enormous achievements, over the past thirty years, to create new ways of producing the right evidence, in a timely manner, to support decision making.  

Our updated Future Cochrane micro-site demonstrates the scale of progress at Cochrane and the work under way to transition to our new model. The site is designed to be a one-stop shop for news and information on the change process.  

In November we announced Cochrane’s first seven new Thematic Groups. The first groups are: 

• Global Ageing 
• Health Equity 
• Nutrition and Physical Activity 
• Person-Centred Care, Public Health and Health Systems 
• Sexual and Reproductive Health 
• Vascular 
• Work and Health and Social Security 

Feature profiles of each Thematic Group will be published in the months ahead, with Person Centred Care, Health Systems and Public Health and Nutrition and Physical Activity kicking off the series this month. Keep an eye out for Health Equity when the series resumes in early February.  

Many of you are interested in the next steps of our transition. We will make further announcements about the process for establishing Evidence Synthesis Units next year. 

At the end of November Jimmy Volmink provided a superb Cochrane lecture focusing on equality and diversity. Many of the themes and challenges that he raised are already being threaded through our future plans.  

Open Access is of course key to that future, ensuring that more people have immediate access to our content.  Progress demonstrating our commitment was evident last month when Cochrane launched Cochrane Evidence Synthesis and Methods, our first open access journal, in which we will publish diverse types of evidence synthesis, methods research, and research on other areas vital to evidence synthesis. This new platform allows us to disseminate research beyond systematic reviews from across Cochrane groups and collaborators ­– who until now, have not been able to publish their research in a Cochrane journal.  

And of course, we have been delighted with the high-profile reviews that we’ve published in the Cochrane Library. 

• Efficacy and safety of COVID‐19 vaccines  
• Unintended consequences of measures implemented in the school setting to contain the COVID-19 pandemic: a scoping review 
• SARS-CoV-2-neutralizing monoclonal antibodies to prevent COVID-19 
• Janus kinase inhibitors for the treatment of COVID-19 
• Interleukin-1 blocking agents for the treatment of COVID-19 
• Interventions for preventing falls in Parkinson's disease 
• Interventions to increase COVID-19 vaccine uptake: a scoping review 
• Inhaled corticosteroids for the treatment of COVID-19 
• Immunity after COVID-19 vaccination in people with higher risk of compromised immune status: a scoping review 
• Replacing salt with low-sodium salt substitutes (LSSS) for cardiovascular and renal health in adults, children and pregnant women 
• Fluvoxamine for the treatment of COVID-19 
• Guaiac-based faecal occult blood tests versus faecal immunochemical tests for colorectal cancer screening in average-risk individuals 

As we ramp up our fundraising efforts across the organisation it’s great to see that we have already had success in the US, with  $5 million for Cochrane Eyes & Vision US Satellite,  $1 million to Cochrane US Network and in South Africa with partners, funding for The Global Evidence, Local Adaptation project.  

Other successes include: 

• 6,100+ plain language summaries were translated in 15 different languages in 2022 so far 
• Cochrane Rehab joins World Rehab Alliance 
• Impact factor increased 
• WHO postnatal guidelines 
• WHO labour recommendations  

Diversity and Inclusion progress: 

• Diversity and inclusion report 
• Launch of Evidence Essentials 5: consumer involvement in Cochrane  
• Signed a public involvement pledge 
• Updated Cochrane Engage volunteer hub 

And there’s also great news from our Evidence Pipeline Team. Cochrane has always been a leader in innovation, and now we have demonstrated further success by introducing the ability to browse the Cochrane Library by patient/population, intervention, comparison, and outcomes, which is universally shortened to PICO. It is now possible to browse Cochrane content using themed groups of included PICOs from the Cochrane Library homepage. Users can discover Cochrane content using themed groups of included PICOs curated and maintained by Cochrane PICO ontology experts. With one click, users can see all available search results for categories with included PICOs. In addition, there is clear contextual help for those new to PICOs, with clear guidance on using PICOs and links to the relevant section of the Cochrane Handbook.  

Additional successes include: 

• Over 5200 new contributors have joined Cochrane Crowd this year, bringing total Crowd community to 28,302 people from 178 countries! 
• 1.7 million records assessed by the Crowd this year 
• Launched new Crowd task PICO Extract in August 2022. Over 4000 RCTs have now been PICO annotated.  
• We launched the Central Study Identification Service – a service that helps to identify the studies for any Cochrane Review. We are in a pilot phase at the moment but the service has been used by 7 Cochrane Intervention Reviews so far and reduced author screening by an average of 70%.  
• Cochrane Crowd hosted a huge 24-hour screening challenge in October this year: organised by Cochrane Mexico using Cochrane Classmate, nearly 600 students screened over 250,000 records in just 24 hours. 

2022 has been a busy but productive year, thank you all for the incredible work you have done. 

2023 promises to be challenging as we continue our transformation. This includes the changes to UK Review Groups as a result of the loss of NIHR funding in the UK; their contribution to the Cochrane Library and Cochrane has been immense. It is difficult to find words which adequately describe how much they have given to Cochrane. 

As we look towards a new future at Cochrane I look forward to collaborating and working with you to use the best of the past to create more impact in more locations around the world. 

Best wishes for a wonderful festive season and a happy and healthy 2023, 

Catherine Spencer, CEO 

On behalf of the Executive Leadership Team 

Wednesday, December 21, 2022

Thursday, December 15, 2022

早産・低出生体重児の動脈管開存症（PDA）に対するパラセタモール（アセトアミノフェン）の効果と危険性は何か？ 背景 早産児や未熟児、低出生体重児によく見られる合併症に、動脈管開存症（PDA）がある。赤ちゃんが生まれる前は、肺がまだ機能していないため、肺への血液循環は必要ない。その代わり、胎盤が胎児の血液に酸素を供給している。PDAは、肺動脈（生まれた後には、心臓から肺に酸素が少ない血液を運ぶ血管）と大動脈（肺静脈を通って肺から心臓へと戻された、新鮮な酸素を多く含んだ血液を、心臓から全身へと送り出す血管）をつなぐ胎児の仮設の血管である。言い換えれば、PDAは肺を通る胎児の血液循環を「ショートカット」させるものである。子宮の中にいる時は生命を維持するために必要で、出まれた後は閉じるべき血管であるが、児の発達が未熟な場合に動脈管が開いたままになってしまうことがある。 早産児のPDAは、生命を脅かす合併症と関連している。PDAの治療には、プロスタグランジンの生成を抑制してPDAの閉鎖を促すインドメタシンやイブプロフェンという薬剤が一般的に使われてきた。プロスタグランジンは、特定の臓器に限らず全身で作られる化学物質で、特に軟部組織が損傷した場所で作られる。その合成は、治癒の過程において重要な役割を担っている。この物質は、動脈管が開いている状態を維持するのに重要な役割を果たすことが知られてお...

Cochrane is made up of 11,000 members and over 67,000 supporters come from more than 130 countries, worldwide. Our volunteers and contributors are researchers, health professionals, patients, carers, people passionate about improving health outcomes for everyone, everywhere.

Getting involved in Cochrane’s work means becoming part of a global community. The Cochrane International Mobility programme connects successful applicants with a placement in a host Cochrane Group, learning more about the production, use, and knowledge translation of Cochrane reviews. The prgramme offers opportunities for learning and training not only for participants but also for host staff.

In this series, we profile those that have participated in the Cochrane International Mobility Program and learn more about their experiences.

Name: Martina Albertella
Location: Italy
Cochrane International Mobility location: Cochrane Sweden

How did you first learn about Cochrane?
I first heard about Cochrane at my University (in Genoa, Italy): during lectures a lot of Professors used to mention Cochrane evidence and results, as it has such a high impact. I was interested in the paediatrics research field, so I looked for more information about the organization, I contacted Matteo at Cochrane Sweden and I started the Cochrane Interactive Learning modules before coming to Sweden. These modules were my first real learning opportunity about systematic reviews.

What was your experience with your Cochrane International Mobility?
I’ve always been interested in the research field and Cochrane is the perfect environment to learn everything about it. I also wanted to have an abroad experience so, thanks to Matteo’s help, I applied to start my Erasmus Traineeship at Cochrane Sweden for three months.

What are you doing now in relation to your Cochrane International Mobility experience?
My team and I submitted a few weeks ago our systematic review about the use of an enzyme to prevent a chronic disease in preterm infants. That was a great learning experience: Matteo and Martin have been always supportive. They explained to me very clearly how to do the work, step by step. Whenever we had a doubt, they were always there to help us! After that, I joined another team working on another systematic review, but still related to paediatrics: now I feel more confident and it’s great because I realize how much you can learn with this experience!

Do you have any words of advice to anyone considering a Cochrane International Mobility experience?
If you want to learn more about systematic reviews but also about how to read and understand a scientific text and its methodology, this is the perfect experience for you. It also gives you the opportunity to work and collaborate with people from all over the world and to improve your English skills. If you are a student like me, who didn’t have any experience in the research field before, my personal advice is: connect yourself to Cochrane! This is a chance to put into practice everything you are learning.

 

 

Wednesday, December 14, 2022

かぜ予防のためのワクチン レビューの論点 ワクチンはかぜの予防になるか？ 背景 かぜは、主に上気道のウイルス感染によって引き起こされる。かぜをひいた人は、体調が悪くなり、鼻水、鼻づまり、くしゃみ、のどの痛みの有無にかかわらず咳をし、体温が少し高くなる。しかし、通常、自己の免疫システムがウイルス感染による影響をコントロールすることで、回復する。かぜに対する治療は、症状を和らげることを目的としている。世界的に見ると、かぜは広く病気を引き起こし、大きな経済的損失をもたらしている。米国では、かぜによる経済的損失は年間400億ドルを上回ると推定され、これには数百万日もの欠勤日数や学校での欠席日数が含まれる。欧州では、1回の発症あたりの総費用は最大1,102ユーロとなる可能性がある。また、不適切な抗菌薬処方による支出も大きい。かぜの原因ウイルスは複数存在するため、予防のためのワクチンを製造することは困難であった。健康な人に対するかぜ予防のためのワクチンの効果はまだ不明である。 検索日 エビデンスは2022年4月26日現在のものである。 研究の特性 今回の更新では新規の試験は見つからなかった。このレビューには、過去に確認されている、1965年に実施されたランダム化比較試験（参加者を2つ以上の治療群のうちの1つに無作為に割り当てるタイプの試験）が含まれている。この研究は、米国海軍の訓練施設に所属...

Specifications: Full Time, 37.5 hours per week
Employment Type: Permanent employment contract if in the UK, Denmark or Germany, consultancy contract if outside these three areas
Salary: £60,000 per annum full-time salary
Location: Flexible location but must have a demonstrable understanding of UK regulations
Application Closing Date: Sunday 8th January 2023 at midnight

Cochrane is a charity and a global, independent network of health practitioners, researchers, patient advocates and others, responding to the challenge of making vast amounts of research evidence useful for informing decisions about health. They do this by synthesising research findings to produce the best available evidence on what works. Their work has been recognised as the international gold standard for high quality, trusted information.

The core purpose of this role is to lead Cochrane’s governance and to support the strategic aims and operational activities of the organisation. The role will provide oversight of policy development, implementation, monitoring, and reporting to the Governing Board to ensure that Cochrane is compliant and follows the best practice.

Part of your duties will include:

• Maintaining knowledge and being well-informed of best practice and developments within charity governance and policy, advising the Board, CEO and Executive Leadership Team.
• Ensuring the appropriate support structures and processes are in place to enable Cochrane’s Governing Board to meet its responsibilities and obligations; and lead and oversee high-quality support to the Board, its Committees, the Cochrane Council, and other governance bodies.
• Contributing to Cochrane’s budget planning processes and manage the governance budget effectively.
• Working with the Chief Executive Officer and Director of Finance & Corporate Services, develop a strategy to ensure an appropriate level of assurance for the charity and wider Community with implementation, monitoring and evaluation plans.
• Working with the CEO and the ELT to establish and review policies and procedures that ensure the organisation meets constitutional, legal, and regulatory requirements relating to company administration.

Cochrane welcomes applications from a wide range of perspectives, experiences, locations, and backgrounds; diversity, equity and inclusion are key to their values.

How to apply

• For further information on the role and how to apply, please click here
• The deadline to receive your application is by 8 January 2023
• The supporting statement should indicate why you are applying for the post, and how far you meet the requirements, using specific examples
• Note that we will assess applications as they are received, and therefore may fill the post before the deadline
• Read our Recruitment Privacy Statement

Tuesday, December 13, 2022 Category: Jobs

Cochrane’s Editor in Chief, Dr Karla Soares-Weiser, has today published an editorial to mark the end of 2022 and the beginning of Cochrane's 30th anniversary year in 2023. In Looking back, looking forward: Cochrane at 30 and beyond, Karla reflects on Cochrane’s many contributions to global health, recognizes past and future challenges, and shares her deep gratitude to the Cochrane community – who for three decades have delivered the trusted evidence our rapidly changing world needs.

"As the third year of the pandemic draws to a close" Karla writes, "it seems we have reached something of an inflection point where as individuals, as an organization, and as a global community we are looking back and assessing the consequences and costs of COVID-19, and to consider what lies ahead."

In doing so, Karla looks back at the major challenges faced and achievements realized by Cochrane before and during the pandemic and looks forward as we transition to a new, sustainable model of evidence production in especially tumultuous times for health, funding and geo-political stability. She underscores the critical issue of equity following years of deepening health and wealth disparities, and restates Cochrane’s commitment to fostering diversity, tacking inequity and making a tangible contribution to the United Nations Sustainable Development Goals. 

Karla says:

Cochrane's values, focus on collaboration, and commitment to rigour and innovation have been vital to cementing our reputation as one of the most trusted sources of evidence in health and care decisions over three decades. We draw on these strengths now more than ever, as the shifting health landscape demands that we increase the pace of high-quality evidence production, deliver on our commitment to equity, diversity and inclusion, and respond in a more focused way to the diverse needs of all our users.

The shape and output of our organization continues to adapt to the needs of the times, while together we continue to deliver the evidence the world needs at this critical juncture for humanity.

• Read Karla’s full editorial
• Find out more about the changes underway within Cochrane 

Wednesday, December 14, 2022

小児の急性呼吸器感染症の予防と治療における経口ホメオパシー薬の利点とリスクは何か？ 要点 ホメオパシーは、補完代替医療の一種である。これは、健康な人に病気や症状を引き起こす可能性のある物質が、ごく少量であれば、病気や症状を治療できるということ、そして、高度に希釈された物質の分子は、元の物質の記憶を保持しているという2つの主要な考え方に基づいている。明確なエビデンスが存在しないために、小児の急性呼吸器感染症（ARTI）の予防と治療に対する経口ホメオパシー薬の利点とリスクは、未だ不明である。研究デザインや報告の質が低い研究においては、しばしば経口ホメオパシー薬の有益性の可能性が示唆されているが、質の高い研究においては有益性を示す報告はない。 呼吸器感染症とは何か？ 風邪やインフルエンザに代表される呼吸器感染症は、一般的にウイルスの感染によって引き起こされるが、肺や耳においては細菌の感染によって引き起こされるものも存在する。これらの感染症は同時に発症することもあり、見分けるのが困難な場合がある。これらの感染症の多くは、治療を行わなくても改善するが、最初の感染が治まった後にも症状が続くことがある。そのため、治療は症状の緩和が目的となる。 なぜ小児における呼吸器感染症が重要なのか？ 小児は、年間で平均3回から6回の呼吸器感染症にかかる。ほとんどは軽症で、治療が可能だが、急性（症状が重く、急...

根管治療（歯の神経の治療）は、1回で完了すべきか、複数回に分けて行うべきか？ 要点 歯の中心部にある神経や血管を含む柔らかい組織（歯髄）が、生きているか死んでいるかに関わらず、単回治療でも、複数回による治療でも、歯内療法（根管治療）は同程度に効果的である。 また、どちらの治療法を用いたとしても、治療後の短期的な痛みを伴うことがある。 根管治療とは何か？ 根管治療とは、歯髄が回復不可能なほど損傷している場合に必要となる、歯科における一般的な処置（いわゆる「神経の処置」）である。根管治療は、治療後、痛みなどの症状がなく、レントゲン上で骨や歯の支持組織への損傷が見られず、また、歯肉の腫れや、ろう孔（膿の通路）の形成などの感染の兆候が見られない場合に「成功」とみなされる。 根管治療はどのように行われるのか？ 根管治療は、1回または複数回の治療で行われる。まず、治療する歯にゴム製のシート（ラバーダム）を装着し、唾液から隔離した後、ドリルで歯冠（歯の口の中に見える部分）を歯髄に到達するまで削り、歯髄を除去する。そして根管（歯髄の入っていた管）内を消毒した後、最後に詰め物（根管充塡材）を用いて根管内を密封する。 以前は、これらの処置は2回以上に分けて行われ、次回の治療との間に少量の薬剤（根管貼薬剤）を根管内に入れておくことで、残存した細菌の殺滅を図っていたが、現在は薬剤（根管貼薬剤）を使用せず...

成人における末梢静脈穿刺に超音波ガイドは有効か？ 末梢静脈穿刺とは？ 末梢静脈内への投与経路の留置は、医療において最も必要とされる処置の1つである。（カテーテルまたはカニューレと呼ばれる）細い柔軟な管を針を使って静脈に入れる方法である。この手技は「カニュレーション（穿刺）」と呼ばれる。末梢静脈路は輸液や薬物の投与、採血の際に必要となる。 通常、末梢静脈カニュレーションは手や腕の標的とする静脈を見たり触れたりして行われる。この手法を「ランドマーク法」と呼ぶ。末梢静脈路の留置が困難な場合があり、医療従事者が適切な静脈を見つけられない場合は何度も針を刺す必要がある。ランドマーク法で末梢静脈カニュレーションが失敗した場合、次の方法として頸部や胸部に中心静脈路を留置することが多い。しかし、中心静脈路の留置は感染症、血栓症（血の塊）、気胸（肺の虚脱）などの重大な合併症を引き起こす可能性がある。また、末梢静脈路に比べてより時間や費用がかかる。したがって、中心静脈路の挿入は最後の手段とされるべきである。 超音波ガイド（USG）はどのように役立つのか？ 超音波は目には見えない標的にする静脈を見つけることができる。また、超音波により医療従事者は管を挿入する際、針や傷つけてはならない重要な周囲の構造を見る事ができる。中心静脈カニュレーションには超音波ガイドがよく使われるが、末梢静脈カニュレーションへの...

COVID-19を予防するためのワクチンの効果とリスクは何か？ 要点 - ほとんどのワクチンは、COVID-19患者やCOVID-19の重症患者を減少させるか、減少させる可能性がある。 - 多くのワクチンにおいて、発熱や頭痛などの事象を経験する人の数が、プラセボ（薬の成分は入っていないが、見かけ上本物のワクチンと同様に見える偽のワクチン）と比較して増加する可能性がある。これは、主にワクチンに対する体の反応によるもので、予期される事象である。通常、軽度かつ短期間である。 - 多くのワクチンは、プラセボと比較して、重篤な有害事象の発生率にはほとんど、または全く差がみられなかった。 - 研究における死亡者数が少なかったため、死亡率に関してワクチンとプラセボの間に差があったかどうかを判断するためのエビデンスは不十分であった。 - ほとんどの研究では、ワクチンの短期間における効果が評価されており、懸念される変異株に対する効果は評価されていなかった。 SARS-CoV-2、およびCOVID-19とは何か？ SARS-CoV-2（重症急性呼吸器症候群コロナウイルス-2、新型コロナウイルス）は、COVID-19（新型コロナウイルス感染症）の原因となるウイルスである。SARS-CoV-2に感染したすべての人が、COVID-19の症状を発症するわけではない。症状は軽度なもの（発熱や頭痛など）から、生...

透析を必要とする慢性腎臓病患者に対するカルニチン補充療法の効果 レビューの論点 カルニチン欠乏症は、透析を必要とする慢性腎臓病（CKD）患者にみられる重要な問題である。透析に伴うカルニチン欠乏によって、透析中の症状（例：筋肉のけいれん（こむら返り）や筋力低下など筋肉症状や低血圧）および腎不全の慢性合併症（例：貧血）が悪化する可能性がある。しかし、カルニチンを補充すれば、透析に伴うカルニチン欠乏の症状を改善できるかどうかは不明である。 本レビューで実施したこと 透析を要するCKD患者に対するカルニチン補充に関して実施された全ランダム化比較試験について、医学文献を検索した。目的は、カルニチン補充が生活の質（QOL）およびカルニチン欠乏による症状を改善するかどうかを明らかにすることにあった。また、有害事象の観点から、カルニチン補充が安全かどうかも評価した。エビデンスの確実性は、GRADE（Grading of Recommendations, Assessment, Development, and Evaluations）を用いて評価した。 わかったこと 透析を受けているCKD患者計3,398人を対象とした研究52件が見つかった。L-カルニチンがQOLおよび透析に伴うカルニチン欠乏による症状に与える影響については、明らかにすることができなかった。一方、L-カルニチンによってこのような...

3剤併用吸入療法とは何か、どのような場合に使用され、喘息にどのような効果をもたらすのか。 喘息の管理に吸入はどのように使用されるのか。 喘息の管理には、重症度に応じて段階的な一連の治療が必要である。初期治療は、通常、必要に応じて短時間作用型吸入薬を使用し（ステップ1）、必要に応じて喘息のコントロールを改善するために低用量から中用量の吸入ステロイド薬を毎日追加する（ステップ2）。その後、必要に応じて吸入ステロイドに加え、気道の通路を拡張・弛緩させて呼吸の苦しさを軽減する長時間作用型β（ベータ） 2 刺激薬（LABA）と呼ばれる気管支拡張薬を使用するのが一般的である（ステップ3、4）。 吸入ステロイドとLABAの併用で喘息がコントロールできない場合、どのような選択肢があるか。 現在のガイドラインでは、中用量吸入ステロイドとLABAの2剤併用吸入療法で喘息がコントロールできない場合、高用量の吸入ステロイドを使用するか、または長時間作用型抗コリン薬（LAMA）という別の気管支拡張薬の追加（すなわち3剤併用吸入療法）を行うことが推奨されている（ステップ5）。 本レビューにおける疑問に、どのように答えたのか。 コントロールされていない喘息を抱えた青年と成人の計17,161人を含む17件の研究からデータを収集し、ネットワークメタ解析という特殊な方法を用いて、複数の吸入療法の群を同時に比較するこ...

妊娠37週以前の単胎児出産を防止するための膣頸部支持器具 早産とは？ 早産とは、妊娠37週未満での出産をいう。早産は新生児の主な死因である。多くの場合、早産は子宮頸管（子宮の下の細い部分）の弱さ（訳注：子宮口が閉鎖した状態を保つ力のことをいい、専門用語では頸管無力とされる）が原因である。 早産を防ぐために、子宮頸管の弱さはどのように治療すればよいのか。 子宮頸管の脆弱性を治療する方法としては、子宮頸管縫縮術（子宮頸管に糸を通して縫い縮めることで、子宮口が早期に開くのを防ぐ）、待機的管理（問題が生じるまで介入せずに経過観察）、女性ホルモンのプロゲステロンによる内科的治療（経膣投与） または子宮頸管ペッサリー（子宮頸管を閉じておくためのシリコンリング）の使用が挙げられる。子宮頸管ペッサリーは、妊娠12週から24週の間に膣の上部に挿入され、37週で取り外される。麻酔を必要としない簡便な低侵襲術で、子宮頸部縫縮術に取って代わる可能性がある。 知りたかったこと 1人の赤ちゃんを妊娠し（単胎妊娠）、子宮頸管が弱くなるリスクがある女性の早産予防において、子宮頸管ペッサリーが、他の治療または無治療よりも優れているかどうかを知りたかった。 本レビューで実施したこと 子宮頸管が弱くなるリスクのある単胎妊娠の女性を対象に、子宮頸管ペッサリーを他の治療法、または無治療と比較検討した研究を検索した。研究結...

心臓手術患者における血圧目標値について レビューの論点 心肺バイパス術（CPB）による心臓手術を受ける患者で、高い血圧目標値は、低い血圧目標値と比較してどのような効果をもたらすか？ 要点 高い血圧目標値は、低い目標値と比較して、腎障害、認知（学習し理解する能力）障害、および生存においてほとんど差がない結果かも知れない。 血圧目標値を高くした場合、入院期間がわずかに長くなる可能性がある。 心臓手術とは？ 心臓手術は、世界中でよく行われている手術である。ほとんどの術式の心臓手術は、CPBを使用して行われる。CPBは、心臓や肺の働きに代わり、血液を循環し、血液に酸素を取り込み、血液から二酸化炭素を排除する医療機器である。心臓手術を受ける患者は血圧が高い（高血圧症と呼ばれる）ことが多い。高血圧症の患者は、脳や腎臓などの重要な臓器への血流を維持するために、より高い血圧を必要とする。しかし、心臓手術時における最適な血圧目標値に関するエビデンスは乏しい。 何を調べたかったのか？ 血圧目標値をより高くした場合とより低くした場合における、腎臓、脳、生活の質（QOL）、および入院中に起こる合併症に及ぼす影響を評価したかった。 何を行ったのか？ CPBによる心臓手術において、高い対低い血圧目標値の比較を行った臨床研究を医学データベースで検索した。 何を見つけたか？ 心臓手術を受けた737人を対象とした...