頭蓋照射を受けた成人における認知障害の予防および改善に関する介入 背景 原発性または続発性（転移性）脳腫瘍に対して、あるいは体の他の場所から脳への腫瘍の転移を防ぐために、脳への放射線照射を受けた人に、精神／認知能力／スキルの問題（認知の副作用）がよくみられる。脳への放射線照射によるこの毒性の副作用は、急性（治療中）または治療後早期（1～6か月）に発生し、可逆的である場合もある。しかし、晩期の毒性は何か月も何年も経ってから発生することがあり、発生した場合は一般的に不可逆的で、多くの場合ゆっくりと進行する。記憶障害、作業計画の問題、行動の変化などの後期認知障害は、生活の質(QOL)や通常活動を行う能力に深刻な影響を与える可能性がある。これらの晩期放射線障害の予防や治療を支援する介入は、患者の幸福を向上させる可能性がある。ここでは、脳への放射線照射に伴う認知機能の副作用を予防または治療することを目的とした薬理学的（医療用医薬品）および非薬理学的（心理学的）介入に関するすべての研究をレビューする。 研究の特性 2014年8月に発表されたオリジナルレビューでは、査読付き雑誌などの定期刊行物の論文を特定するために使用される4種類の文献データベースを検索した。介入群または比較群（対照群）に無作為に割り付けられた6件のランダム化比較試験を組み入れることができた。各試験はそれぞれ異なる介入策を評価...

腸管熱（腸チフス）治療用のセファロスポリン系抗菌薬 要点 - セフトリアキソン（セファロスポリンの一種）は、成人および小児の腸チフスに対するアジスロマイシン、フルオロキノロン、クロラムフェニコール（他の抗菌薬）と比較して、性能に差がない可能性がある。 - セフィキシム（別の種類のセファロスポリン）も成人および小児の腸管熱の治療に使用できるが、フルオロキノロン系抗菌薬ほど有効でない場合がある。 - 政策立案者と臨床医は、腸熱の治療法を検討する際に、地域の薬剤耐性パターンを考慮する必要がある。 腸管熱とは？ 腸管熱とは、腸チフスとパラチフスと呼ばれる2つの類似した病気の総称である。これらの病気は、 Salmonella typhi (腸チフスの原因微生物の名称)や Salmonella paratyphi A 、B、C(パラチフスの原因微生物の名称)と呼ばれる細菌によって引き起こされ、水や衛生環境が十分でない低・中所得国で最もよく見られる病気である。腸管熱は通常、発熱や頭痛に加え、下痢や便秘、腹痛、吐き気、嘔吐、食欲不振などを引き起こす。放置しておくと、人によっては重篤な合併症を引き起こし、死に至ることもある。 セファロスポリンとはどのようなもので、どのように作用する可能性があるのか？ セファロスポリン系抗菌薬は、様々な感染症の治療によく使われる大きな抗菌薬のグループである。セファロ...

単一遺伝子疾患に対する着床前遺伝子検査での5日目と3日目における胚生検の比較 背景 嚢胞性線維症などの単一遺伝子疾患の既往歴や家族歴を持つ夫婦は、同じ遺伝子疾患を持った子どもを出産する確率を減らすために生殖補助医療（ART）を受けられるようになった。これは、単一遺伝子疾患の着床前遺伝子検査（PGT-M）と呼ばれるものである。PGT-Mでは、受精卵から細胞を採取し（生検）、遺伝子疾患について分析が行われた後、疾患を持たない受精卵が女性の子宮に戻される。生検は、胚発生後の3日目または5日目に行うことができ、現在は5日目における生検が最も広く用いられている。胚の生検を3日目に行うか、5日目に行うかによって、胚の発生の進展や着床、ならびに妊娠および周産期の結果に異なる影響を及ぼす可能性がある。 主な結果 ARTを受けている合計20人の女性を対象として、PGT-Mのために行われた5日目と3日目における胚生検を比較した1件のランダム化比較試験が見つかった。この研究からは、生児出生または流産の確率に違いがあるかどうかを示すのに十分なエビデンスが得られず、結果については非常に不確実であった。 エビデンスによると、3日目に胚生検を行った場合の生児出生率を40％と仮定した場合、5日目に行った場合の生児出生率は15％から85％の間であることが示唆されていた。 その他の妊娠および周産期の結果に関するエビ...

統合失調症がある人に対する抗精神病薬の減量 要点 抗精神病薬の投与量を減らすと、より多くの試験参加者が再発し、早期に試験から離脱する可能性がある。 生活の質（QOL）、機能、副作用に関する情報はほとんどなかった。 レビューテーマの紹介 統合失調症は、薬物治療（抗精神病薬）が必要な重い病気である。抗精神病薬の使用は副作用と関係があり、その副作用は投与量が多いほど悪化するようである。一方、症状に対する効果を発揮するためには、十分な量を投与する必要がある。 知りたかったこと 以下に示す項目の改善のために、抗精神病薬の量を減らすことが、同じ量を維持するよりも良いのかどうかを知りたかった。 – 生活の質（QOL）； - 再入院した参加者の数； - 副作用のため早期に試験を終了した参加者の数； - 機能； - 再発； - 何らかの理由で研究を早期に終了した参加者の数； - 少なくとも1つの副作用があった参加者の数。 実施したこと 統合失調症患者において、抗精神病薬の量を減らすことと、同じ量の抗精神病薬を維持することを比較検討した研究を検索した。 研究結果を比較してまとめ、研究方法や規模などの要素に基づいて、エビデンスに対する信頼性を評価した。 わかったこと 合計2,721人の統合失調症患者を対象とした25件の研究が見つかった。22件の研究（2,635人）のデータを解析のために使用した。研究期...

急性腎障害に対する腎代替療法（透析）の開始時期について レビューの論点 急性腎障害（AKI）は集中治療室（ICU）に入室した患者に非常に多く、腎機能が急速に低下することが特徴であり、死亡率が高い。AKI患者では、血清尿毒症毒素（クレアチニンや尿素）、血清カリウム値、代謝酸の値が上昇し、体液が蓄積され、ほとんどの場合、尿量の減少が認められる。この患者集団では、このような化学物質と体液過多が死亡率の上昇に関係する。理論的には、血液中の毒素や過剰な水分を早期に除去することで患者の予後（死亡率や腎機能の回復など）を改善できる可能性がある。 腎代替療法（KRT）は透析とも呼ばれ、過剰な水分や毒素を除去できる血液浄化技術である。腎代替療法は、カテーテル（静脈内に留置する中空で柔軟な管）を介して患者から脱血し、過剰な水分や毒素を除去する濾過システムに通し、浄化された血液をカテーテルから返血する。腎代替療法の早期開始は毒素や過剰な水分の除去を改善する。 本レビューの目的は、AKIの重症患者に対する腎代替療法の開始時期の違い（早期または標準）が、死亡、腎機能の回復、有害事象に及ぼす影響を詳しく調べることにあった。 本レビューで実施したこと 2022年8月4日までの文献を検索し、AKIを発症した重症患者4,880人を登録した研究12件を対象として評価を行った。 わかったこと 腎代替療法の早期開始は、...

Tuesday, November 22, 2022

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: Themistoklis Paraskevas
Location: Greece
Cochrane International Mobility location: Cochrane Sweden

How did you first learn about Cochrane?
I first learned about Cochrane during my postgraduate studies, but I got to know the organization better when I participated in an entry-level seminar co-hosted by Cochrane Sweden and Cochrane South Africa in Spring of 2022.

What was your experience with your Cochrane International Mobility?
I consider this experience to have been crucial for my future career in Medicine and Research Synthesis. Since I first contacted Matteo and Martin, they have been nothing but helpful both in academic matters as well as smaller problems during the mobility period.

What are you doing now in relation to your Cochrane International Mobility experience?
Right now, we have just finished two Cochrane projects, a  Systematic Review of Interventions and an Overview. Additionally, I am collaborating with an amazing international team in a challenging methods review.

Do you have any words of advice to anyone considering a Cochrane International Mobility experience?
Do not hesitate to contact Cochrane teams, as they can provide a suitable environment to enter the field of Systematic Reviews and Methodology. Also, take advantage of the plethora of available Cochrane modules online and especially the Cochrane Handbook.

 

 

Monday, November 21, 2022

心臓手術に伴う出血治療におけるプロトロンビン複合体濃縮製剤 このレビューの目的は、プロトロンビン複合体濃縮製剤を心臓手術に伴う出血を予防するため安全に使用できるか最近のエビデンスについて評価を行うことであった。また、他の治療法と比較した場合、死亡および他の重篤な合併症を減少させることができるかについても評価を行った。 背景 複雑な心臓手術に伴う出血は、管理することに挑戦し続けることができる。血液凝固経路は複雑で、心臓バイパス装置を使用されていると、血液中の特定の成分の減少が起きる。バイパス時間に依存して凝固因子が著しく減少することがある。新鮮凍結血漿とプロトロンビン複合体濃縮製剤が、これらの凝固因子を代替えする唯一の認識された方法である。新鮮凍結血漿は250から300mLがバッグに入っており、使用することで総血液量を増やすことができるが、心臓に余分な負担をかける可能性がある。プロトロンビン複合体濃縮製剤は粉末製剤であり、より少ない容量で溶解し投与する。希釈された新鮮凍結血漿はゆっくりと注入されるのに対し、この製剤は凝固因子が濃縮され迅速に投与されて速かに作用する。遺伝子組換え血液凝固第Ⅶa因子（rFⅦa）は、ヒトから得られたものではなく、人工的に作製されたもう一つの血液凝固因子である。出血が血液製剤で止めることができない程酷い時に用いられる。プロトロンビン複合体濃縮製剤がrFⅦa...

生殖補助医療における採卵時の卵胞フラッシュ レビューの論点 不妊治療のうち生殖補助医療（ART）を受けている女性において、採卵の一環として行われる卵胞フラッシュの安全性と有効性を評価しようとした。 背景 自然に妊娠するのが困難なカップルは、妊娠するための介入（治療）を受けることを選択するかもしれない。これらの介入は、生殖補助医療（ART）と呼ばれる。ARTのひとつに体外受精（IVF）がある。体外受精では、ホルモン剤を用いて卵巣を刺激し、それぞれの卵巣にある卵胞の中で卵を複数発育させる。この卵巣刺激に続き、これらの卵を採取するために、超音波ガイド下で卵胞内に針を挿入する。卵胞内を吸うだけでその内容物を回収する吸引法の代わりに、吸引後に卵胞内をフラッシュすることで、卵の回収率があがり、その結果、妊娠・出産の可能性が高くなるのではないかという提案がなされてきた。この方法は、卵胞フラッシュと呼ばれる。 研究の特性 合計1,643人の女性が、卵胞吸引単独群または卵胞吸引後フラッシュ群に無作為に割り付けられた15件の研究を対象とした。この2 つの手法に差があるかを見るため、主要な結果として出生率 (女性1000人あたり生まれた赤ちゃんの数)および流産率 ( 女性1000人あたりの流産数) について調査した。この分野で2021年7月に利用可能なすべての関連した研究を同定するため、包括的な検索を...

A comprehensive review of all the evidence available from randomised controlled trials of COVID 19 vaccines up to November 2021 has concluded that most protect against infection and severe or critical illness caused by the virus.

The review, a collaboration of independent, international experts, also found there was little or no difference between the number of people experiencing serious side effects after vaccination compared to those who were unvaccinated.

The researchers, led by Isabelle Boutron, Professor of Epidemiology at Université Paris Cité and Director of Cochrane France, analysed published data from 41 randomised controlled trials of 12 different COVID-19 vaccines, involving 433,838 people in various countries around the world. They assessed the certainty of the evidence and the risk of bias in the different studies.

The trials compared COVID-19 vaccines with placebo, no vaccine, or each other, and were published before 5 November 2021. The vaccines investigated were: Pfizer/BioNTech, Moderna, Oxford-AstraZeneca, Bharat (Covaxin), Janssen, Sinopharm-Beijing (WIBP-CorV and BBIBP-CorV), Novavax, Coronavac-Sinovac, Soberana 2 (Finlay-FR-2), Sputnik V (Gam-COVID-Vac) and Cure Vac AG (CVnCoV). Most trials were no longer than two months in length.

The review found that the following vaccines reduced or probably reduced the risk of COVID-19 infection compared to placebo: Pfizer/BioNTech, Moderna, CureVac COVID-19, Oxford-AstraZeneca, Janssen, Sputnik V (Gam-COVID-Vac), Sinopharm (WIBP CorV and BBIBP-CorV), Bharat (Covaxin), Novavax and Soberana 2 (Finlay-FR-2). The following reduced or probably reduced the risk of severe or critical disease: Pfizer/BioNTech, Moderna, Janssen, Sputnik V, Bharat and Novavax. In addition, the Janssen and Soberana 2 vaccines probably decreased the risk of death from any cause. There were very few deaths recorded in all the trials and so evidence on mortality for the other vaccines is uncertain.

For most of the vaccines investigated, more people who had been vaccinated reported localised or temporary side effects compared to those who had no treatment or placebo. These included tiredness, headache, muscle pains, chills, fever and nausea. With respect to the very rare side effects associated with some vaccines such as thrombosis, the team found that the reporting of these events was inconsistent, and the number of events reported in the trials was very low.

Given the evidence of efficacy of these vaccines, the researchers question whether further placebo-controlled trials are ethical. They suggest that further research compares new vaccines with those already in use.

The current review analysed data available up to November 2021. Since then, analyses have been updated and will continue to be made publicly available every two weeks by the COVID-NMA Initiative, which provides live mapping of COVID-19 trials. A living, systematic review of clinical trials is available to researchers and policy-makers alike on the COVID-NMA platform. This enables the team to provide the most up-to-date evidence on which to base further research and decisions about prevention and treatment for COVID-19.

Prof. Boutron said:

“The evidence on COVID-19 vaccines is constantly changing and updating. Everything moves so quickly that by the time the next Cochrane review is published, or other papers are published, the data are likely to be out of date. There are more than 600 randomised trials of vaccines registered at present, and about 200 of them are recruiting. COVID-NMA is the only initiative that continues to monitor the developing evidence from trials and provides a platform for researchers to conduct their own analyses via the metaCOVID tool on the website.

Researchers, clinicians and policy-makers have to take very rapid decisions about what to do to prevent and treat COVID-19. I hope that this initiative will help them to have access to the most up-to-date evidence on which to base their decisions.”

• Read the plain language summary and full review 
• Read this news item in Malay
• How to talk about vaccines when you’re not an expert: a Lifeology and Cochrane collaboration
• Evidently Cochrane Blog : Are COVID-19 vaccines effective and safe? New Cochrane evidence

Full citation: Graña C, Ghosn L, Evrenoglou T, Jarde A, Minozzi S, Bergman H, Buckley BS, Probyn K, Villanueva G, Henschke N, Bonnet H, Assi R, Menon S, Marti M, Devane D, Mallon P, Lelievre J-D, Askie LM, Kredo T, Ferrand G, Davidson M, Riveros C, Tovey D, Meerpohl JJ, Grasselli G, Rada G, Hróbjartsson A, Ravaud P, Chaimani A, Boutron I. Efficacy and safety of COVID-19 vaccines. Cochrane Database of Systematic Reviews TBD, Issue TBD. Art. No.: CD015477. DOI: 10.1002/14651858.CD015477.

About Cochrane
Cochrane is a global independent network of researchers, professionals, patients, carers, and people interested in health. Cochrane produces reviews which study all of the best available evidence generated through research and make it easier to inform decisions about health. These are called systematic reviews. Cochrane is a not-for profit organization with collaborators from more than 130 countries working together to produce credible, accessible health information that is free from commercial sponsorship and other conflicts of interest. Our work is recognized as representing an international gold standard for high quality, trusted information. https://www.cochrane.org/

If you are a journalist or member of the press and wish to receive news alerts before their online publication or if you wish to arrange an interview with an author, please contact the Cochrane press office -pressoffice@cochrane.org

Wednesday, December 7, 2022

慢性非特異的腰痛に対するヨガ 主要な結果 原因不明の腰痛（慢性非特異的腰痛）が長期間持続する人において、3カ月間ヨガをした場合としなかった場合では、疼痛と腰や背中の機能改善において、改善は小さいものの、ヨガは運動をしないよりもおそらく良いと考えられる。 腰や背中の機能改善について、ヨガと腰や背中に重点を置いた他の運動との間におそらくほとんどまたは全く差はないが、疼痛の改善についてはヨガと他の運動との間の差は明らかにされていない。 腰や背中の痛みは、ヨガの試験で最もよく報告された有害性であった。有害性のリスク（危険）は、ヨガをしない場合と比べてヨガによって高くなったが、ヨガと他の運動では同程度であった。ヨガが重篤な有害性のリスクと関連しているという示唆はなかった。 慢性非特異的腰痛とは何か？ 腰痛はよく起こる健康問題である。多くの場合、痛みの原因は不明で、「非特異的」腰や背中の痛みと呼ばれる。人によっては、痛みが3カ月以上持続することもあり、この時点で「慢性」と呼ばれる。 非特異的な腰痛は通常、市販の鎮痛薬と運動で治療され、手術などの侵襲的な処置は必要としない。ヨガは腰痛の治療や管理に使われることがある。 わかったこと ヨガが腰痛に関連する機能（例えば、歩行、家の周りの仕事、着替えなど）、疼痛、生活の質（Quality of Life：QOL）を改善するかどうかを検証したいと考えた...

On International Volunteer Day, 5 December, we would like to take the opportunity to say thank you to our incredible global community. Thank you to thousands of Cochrane Supporters and Members who volunteer in so many ways to help bring trusted health evidence to the people who need it, all over the world.

In 2023, nearly 4,000 people earnt Cochrane membership through volunteering have translated over 3 million words into different languages, screened over a million records in Cochrane Crowd and contributed in countless other ways.

Cochrane couldn’t have such a big impact without our volunteers. Volunteering is good for us – and good for our volunteers too! They can learn new skills and feel part of a global community working together to achieve better health for all. We value our volunteers and we are pleased to announce on International Volunteer Day our updated guidance on how you can look after the volunteers you work with.

Cochrane's Chief Executive, Catherine Spencer,  has expressed her heartfelt gratitude to our volunteers around the world: "On behalf of the Cochrane Collaboration, I would like to thank you. Your contribution is profoundly important and we couldn’t do this without you. I hope that you continue to volunteer with us, generously giving your time to help improve health evidence for everyone."

The ways in which people volunteer at Cochrane is vast. Our citizen science volunteers in Cochrane Crowd help to classify evidence. People with lived experience from our Consumer Network peer review our evidence and provide feedback. We have translation projects around the world that work with dedicated volunteers to translate our evidence into 15 languages. Our volunteer hub, Cochrane Engage, is the first stop for anyone who wishes to support our work by volunteering in any capacity.

There are many other volunteer roles in Cochrane and we are grateful to volunteers who make up our Board and Council, and anyone who helps promote Cochrane evidence  - whether they’re doing  by sharing on social media, blogging in Students4BestEvidence, updating Wikipedia articles, or creating Cochrane evidence podcasts.

Thank you again to our many Cochrane volunteers!  

 
Find out more about volunteering opportunities at Cochrane

Visit our volunteer platform, Cochrane Engage

Learn more about how Cochrane works with patients and carers


Watch this video in French

Learn more about the Cochrane Wiki project

Get social with Cochrane

Learn more about translating Cochrane evidence

Visit the Cochrane China website

Visit the Cochrane France website

Visit the Cochrane Japan website

Visit the Cochrane Malaysia website

Video also available in Portuguese

Watch this video in Russian

Video also available in Taiwanese Mandarin 

Video also available in Thai

 

Tuesday, December 5, 2023

Cochrane is pleased to announce the launch of Cochrane Engage, Cochrane’s one-stop-shop for those who want to get involved and volunteer in Cochrane.

Formerly Cochrane TaskExchange, the platform had outgrown its name and look, and it is now being used for much more than review tasks. The new name was chosen through conversations with members of the Cochrane Community.

Cochrane Engage is a place where anyone working in evidence-based health research can come to find volunteers to support their work – we welcome tasks posted by Cochrane Groups and any other organisations or individuals in the wider health research community. People can also browse our network of volunteers to find people with the skills they are looking for.

Those who are getting started in health research can build their skills and experience by applying to volunteer on evidence-based health care tasks, such as translating studies and providing consumer peer review. They will also find opportunities to engage with Cochrane Groups and other organisations. Recently we’ve had opportunities such as mentoring programmes, virtual internships, and requests for people to join author teams.

As well as a new name and new look, we have made other improvements suggested by users. Opportunities are now listed with the most recent tasks at the top of the page so you can easily see what’s new. People who post tasks can filter their tasks to find what they need more quickly. We have plans to continue improving the platform; let us know your suggestions.

Catherine Spencer, Cochrane’s CEO, says of the launch, “Cochrane Engage represents what is best about Cochrane; working collaboratively to improve health evidence for all. We thank everyone who has volunteered with us so far. Patients, carers, early career professionals, translators, and researchers – there are a wide range of volunteers and a wide range of tasks for all. I invite you to check out the newly launch Cochrane Engage and join us in improving health decisions globally.”

Could you use a volunteer? Want to get involved in producing health evidence? It’s easy to use Cochrane Engage to engage with a global health evidence community!

• Visit the Cochrane Engage website

Monday, November 28, 2022

A Cochrane review has found the strongest evidence yet that e-cigarettes, also known as ‘vapes’, help people to quit smoking better than traditional nicotine replacement therapies, such as patches and chewing gums.

New evidence published today in the Cochrane Library finds high certainty evidence that people are more likely to stop smoking for at least six months using nicotine e-cigarettes, or ‘vapes’, than using nicotine replacement therapies, such as patches and gums. Evidence also suggested that nicotine e-cigarettes led to higher quit rates than e-cigarettes without nicotine, or no stop smoking intervention, but less data contributed to these analyses. The updated Cochrane review includes 78 studies in over 22,000 participants – an addition of 22 studies since the last update in 2021.

Smoking is a significant global health problem. According to the World Health Organisation (WHO), in 2020, 22.3% of the global population used tobacco, despite it killing up to half of its users. Stopping smoking reduces the risk of lung cancer, heart attacks and many other diseases. Though most people who smoke want to quit, many find it difficult to do so permanently. Nicotine patches and gum are safe, effective and widely used methods to help individuals quit.

E-cigarettes heat liquids with nicotine and flavourings, allowing users to ‘vape’ nicotine instead of smoking. Data from the review showed that if six in 100 people quit by using nicotine replacement therapy, eight to twelve would quit by using electronic cigarettes containing nicotine. This means an additional two to six people in 100 could potentially quit smoking with nicotine containing electronic cigarettes.

Dr Jamie Hartmann-Boyce, Associate Professor at the University of Oxford, Editor of the Cochrane Tobacco Addiction Group, and an author of the new publication, said:

“Electronic cigarettes have generated a lot of misunderstanding in both the public health community and the popular press since their introduction over a decade ago. These misunderstandings discourage some people from using e-cigarettes as a stop smoking tool. Fortunately, more and more evidence is emerging and provides further clarity. With support from Cancer Research UK, we search for new evidence every month as part of a living systematic review. We identify and combine the strongest evidence from the most reliable scientific studies currently available.

For the first time, this has given us high-certainty evidence that e-cigarettes are even more effective at helping people to quit smoking than traditional nicotine replacement therapies, like patches or gums.”

In studies comparing nicotine e-cigarettes to nicotine replacement treatment, significant side effects were rare. In the short-to-medium term (up to two years), nicotine e-cigarettes most typically caused throat or mouth irritation, headache, cough, and feeling nauseous. However, these effects appeared to diminish over time.

Dr Nicola Lindson, University Research Lecturer at the University of Oxford, Cochrane Tobacco Addiction Group’s Managing Editor, and author of the publication said:

“E-cigarettes do not burn tobacco; and as such they do not expose users to the same complex mix of chemicals that cause diseases in people smoking conventional cigarettes. E-cigarettes are not risk free, and shouldn’t be used by people who don’t smoke or aren’t at risk of smoking. However, evidence shows that nicotine e-cigarettes carry only a small fraction of the risk of smoking. In our review, we did not find evidence of substantial harms caused by nicotine containing electronic cigarettes when used to quit smoking. However, due to the small number of studies and lack of data on long-term nicotine-containing electronic cigarette usage – usage over more than two years – questions remain about long-term effects.”

The researchers conclude that more evidence, particularly about the effects of newer e-cigarettes with better nicotine delivery than earlier ones, is needed to assist more people quit smoking. Longer-term data is also needed.

Michelle Mitchell, chief executive at Cancer Research UK, said:

“We welcome this report which adds to a growing body of evidence showing that e-cigarettes are an effective smoking cessation tool. We strongly discourage those who have never smoked from using e-cigarettes, especially young people. This is because they are a relatively new product and we don’t yet know the long term health effects.

While the long term effects of vaping are still unknown, the harmful effects of smoking are indisputable – smoking causes around 55,000 cancer deaths in the UK every year. Cancer Research UK supports balanced evidence-based regulation on e-cigarettes from UK governments which maximises their potential to help people stop smoking, whilst minimising the risk of uptake among others.”

• Read the full Cochrane review and plain language summary 
• Learn more about Cochrane Tobacco Addition Group
• Science Media Centre: Expert reaction to cochrane review on electronic cigarettes for smoking cessation

 

 Hartmann-Boyce J, Lindson N, Butler AR, McRobbie H, Bullen C, Begh R, Theodoulou A, Notley C, Rigotti NA, Turner T, Fanshawe TR, Hajek P. Electronic cigarettes for smoking cessation. Cochrane Database of Systematic Reviews 2022, Issue 11. Art. No.: CD010216. DOI: 10.1002/14651858.CD010216.pub7

This work was supported by Cancer Research UK [A ref. A29845]

To speak to a team member about this project please contact Dr. Hartmann-Boyce, jamie.hartmann-boyce@phc.ox.ac.uk or Dr. Lindson, nicola.lindson@phc.ox.ac.uk.

Thursday, November 17, 2022

脳卒中後の感情的傾向に対する薬物療法 レビューの論点 脳卒中後の情緒不安定な人に対する薬の利益と害を評価すること。 背景 脳卒中後は、情動不安定になることがよくある。情動不安定とは、感情的行動をコントロールすることが難しい状態を意味する。脳卒中後の患者は突然泣き出したり、稀ではあるが明らかな理由もなく笑ったりすることがある。この傾向は特定の人々や介護者を困らせる。うつ病がある人に効果がある抗うつ薬は脳卒中後の情動不安定に対する効果的な治療薬かもしれない。しかしながら、この分野でのランダム化比較試験（RCT）はほとんどなかった。（*RCTは、参加者を2つ以上の治療集団群に無作為に割り当てる研究デザインである。これは、参加者のグループが類似しており、調査員と参加者が誰がどのグループに入っているかを知らないようにするための最良の方法である。） 検索日 2022年5月26日に実施した検索により、研究を特定した。 研究の特性 情動不安定性を持つ239人が参加した7件のランダム化比較試験をレビューに含め、感情的傾向の治療に対する抗うつ薬の使用について報告した。研究対象者の人数は10人から92人であった。研究対象者の平均年齢/中央値は57.8歳から73歳であった。試験はヨーロッパ（イギリス:1件, デンマーク:1件, スコットランド:1件, スウェーデン:1件）; アジア（韓国:1件, 日本:...

A new Cochrane Library Editorial has been published about the role of Cochrane reviews in directing researchers away from potentially biased primary studies. 

The editorial discusses new evidence that risk of bias ratings disseminated in Cochrane reviews can influence the citations received by the appraised studies. Specifically, after a review is published, papers at ‘high risk of bias’ due to selective reporting attract fewer citations than a comparable group of ‘low risk of bias’ papers. Whilst the effect is modest, it is notable that systematic reviews can redirect researchers away from wayward science. 

The editorial calls for more research on how to turn the weak signal provided by risk of bias ratings into a stronger one, to increase the efficacy of systematic reviews in shaping follow-on science and to complement more traditional signals such as retractions, citations, and journal-level metrics.

Karla Soares-Weiser, Editor in Chief of Cochrane, says, "Cochrane is a strong advocate for transparency and integrity in research. These issues go to our core: without access to relevant, unconflicted and accurate data, our reviews will not be of the quality we want. This editorial highlights the potential for Cochrane reviews, and the rigorous assessments carried out as part of the review process, to further contribute to improving the overall quality of health research."

• Read the Cochrane Library Editorial : 'The power of weak signals: how systematic reviews direct researchers away from potentially biased primary studies'

Thursday, November 24, 2022

耳鳴りに対するイチョウ葉のハーブサプリメント 耳鳴りとは何か？ 耳鳴りは、外部からの音がないのに音が聞こえるという症状である。リンギング（訳注：振動によるノイズ音で、ジージー等の振動音）、ヒスノイズ（訳注：テープの再生時に鳴るシューとか、サーといった、高音域の音）や、ブンブン、ヒューヒューといった音で表現されることが多い。一般人口の5％から43％が罹患するといわれ、年齢とともに有病率は増加する。耳鳴りが続くと、睡眠障害（不眠症）、集中力の低下、コミュニケーションや人付き合いの難しさ、不安や抑うつを引き起こす人もいる。管理には、教育やアドバイス、リラクゼーション療法、耳鳴り再訓練療法（TRT）、認知行動療法（CBT）、音響発生器や補聴器、薬物療法が含まれる。また、ハーブのサプリメントであるイチョウ葉も使用されている。 知りたかったこと イチョウ葉が耳鳴りの程度を軽減するかどうか、また、好ましくない作用や有害な作用があるかどうかを調べたいと考えた。 実施したこと 大人と子どもの耳鳴りを対象に、イチョウ葉をプラセボ（「ダミー」治療）、無治療、教育・情報提供のみと比較した研究を探した。研究結果について比較、要約し、研究の進め方や参加人数などの要因に基づいて、エビデンスに対する信頼性を評価した。 わかったこと 合計1,915人を対象とした12件の研究が見つかった。11件の研究では、イチョウ...

介護施設における肺炎予防のための口腔ケア 介護施設関連肺炎（NHAP）とは何か？ 介護施設関連肺炎（NHAP）とは、長期療養施設や介護施設の入居者に発生する肺の細菌感染症を指す。 NHAPを防ぐ対策として、どのようなものがあるか？ 口腔内（口の中）の衛生状態が悪いと、感染症にかかりやすくなる可能性がある。専門的な口腔ケアとは、歯と歯ぐきのブラッシング、義歯の清掃、洗口液の使用、そして歯科医師による訪問診療などを組み合わせたものである。これに対して日常的な口腔ケアは、自分で行うケア、または口腔衛生に関する特別な教育を受けていない介護施設の職員が行うケアである。 何を調べたかったのか？ 口腔ケアによってNHAPが減少するかどうかを明らかにしたいと考えた。また、介護施設やその他の長期療養施設の入居者の死亡数（肺炎やその他の原因によるもの）が口腔ケアによって減少するかどうかについても調査を行った。 何を行ったのか？ 介護施設入居者の口腔ケアに関するランダム化比較試験（RCT）について、科学文献データベースおよび登録されている研究の検索を行った。ランダム化比較試験（RCT）は、参加者が各治療群に無作為に割り振られるため、最も信頼できる科学的エビデンスが得られると考えられている。研究結果を比較してまとめ、研究方法や規模などの要素に基づいて、エビデンスに対する信頼性を評価した。 何が見つかった...

An updated Cochrane Review, published in the Cochrane Library, suggests that yoga may lead to a small reduction in pain in people with chronic non-specific lower back pain over the short term, and that improvements in back function may be similar to those seen with other types of back-focused exercise. However, researchers advise that more studies are needed to provide information on long-term effects.

What is non-specific low back pain?

Low back pain is a common health problem. In many cases, there is no known cause for the pain and it is termed 'non-specific' back pain. For some people, the pain may last for three months or more and at this point it is termed 'chronic.' Non-specific low back pain is usually treated with over-the-counter pain medicines and exercise and does not require surgery or other invasive procedures. Yoga is sometimes used to help treat or manage low back pain.

What did we want to find out?

We wanted to find out if yoga improves function (for example, ability to walk, do jobs around the house, getting dressed), pain and quality of life associated with low back pain.

What did we do?

We searched medical databases for clinical trials comparing yoga practices using physical postures (often called 'hatha yoga') to any other treatment, sham (pretend) yoga, or to no treatment in adults (aged 18 years or older). We also included trials comparing yoga added to other treatments, versus those other treatments alone. 

What did we find?

We included 21 trials with 2223 participants. Ten trials were carried out in the USA, five in India, two in the UK, and one each in Croatia, Germany, Sweden, and Turkey. Most participants were women in their 40s or 50s.

Key results

• For people with long-lasting low back pain without a known cause (chronic non-specific low back pain), after three months of doing yoga or not doing yoga, yoga is probably better than not doing exercise for improving pain and back-related function, although the improvements are small.
• There is probably little or no difference between yoga and other types of back-focused exercise in improving back-related function, but we are uncertain about differences between yoga and other exercise for improving pain.
• Back pain was the most common harm reported in yoga trials. Risk of harms was higher with yoga than with no yoga, but similar for yoga and other exercise. There was no suggestion that yoga was associated with a risk of serious harms.

What are the limitations of the evidence?

Because we did not find any trials comparing yoga to sham yoga, we cannot say how yoga would affect low back pain if people did not know they were doing yoga. Participants in all the trials were aware of whether they were practicing yoga or not, and this may have influenced their interpretation of whether their back pain had changed. In addition, some trials were very small, there were few trials in some comparisons, and the trials in some comparisons had inconsistent results. Therefore, we downgraded the quality of the evidence to moderate, low, or very low.

Lead Cochrane author Susan Wieland from Cochrane Complementary Medicine at the Center for Integrative Medicine, University of Maryland School of Medicine, Maryland, commented,

“Our findings suggest that yoga exercise may lead to improving back-related function and reducing back pain by a small amount. Our findings also suggest that there may be little or no difference between yoga and other back-focused exercise when looking at improvements in back-related function at three and six months. At the moment we have very limited information on comparisons between yoga and other back-focused exercise with respect to improving back pain and for longer term effects beyond six months. Readers should remember that in each of the studies we reviewed, the yoga exercises were developed to treat low back pain and the yoga classes were led by experienced practitioners. The findings of this Cochrane Review will help people make more informed choices about their future treatment options.”

• Read the plain language summary and full review
• Read the Evidently Cochrane blog 'Is yoga good for back pain? Here's the evidence'

Full citation: Wieland LS, Skoetz N, Pilkington K, Harbin S, Vempati R, Berman BM. Yoga for chronic non‐specific low back pain. Cochrane Database of Systematic Reviews 2022, Issue 11. Art. No.: CD010671. DOI: 10.1002/14651858.CD010671.pub3. 

About Cochrane
Cochrane is a global independent network of researchers, professionals, patients, carers, and people interested in health. Cochrane produces reviews which study all of the best available evidence generated through research and make it easier to inform decisions about health. These are called systematic reviews. Cochrane is a not-for profit organization with collaborators from more than 130 countries working together to produce credible, accessible health information that is free from commercial sponsorship and other conflicts of interest. Our work is recognized as representing an international gold standard for high quality, trusted information. https://www.cochrane.org/

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If you are a journalist or member of the press and wish to receive news alerts before their online publication or if you wish to arrange an interview with an author, please contact the Cochrane press office: pressoffice@cochrane.org

Friday, November 18, 2022

Specifications:  Fixed Term Contract Fulltime (Part time will be considered at minimum 0.6FTE)
Salary: £47,000 per annum
Location: UK
Application Closing Date:  27 November 2022

The Evidence Production and Methods Directorate in Cochrane is made up of three departments that are responsible for the efficient and timely production of high-quality Cochrane Reviews addressing research questions that are most important to decision makers.

The Commissioning Editor will be responsible for ensuring that work on high-quality, relevant  reviews is initiated, and for monitoring progress. Overall, this role will contribute to producing trusted evidence by:

1. Working closely with the Head of Methods and Evidence Synthesis Development to identify priority Cochrane Reviews
2. Working with Cochrane Review Groups and Thematic Groups/Evidence Synthesis Units to coordinate support for reviews in process
3. Working with Cochrane’s Development Directorate in exploring funding opportunities for suites of related reviews and for individual reviews as necessary
4. Overseeing initiation and completion of new and updated Cochrane Reviews against agreed priority areas that meet Cochrane’s mission

Cochrane is a global independent network of health practitioners, researchers, patient advocates and others, responding to the challenge of making the vast amounts of evidence generated through research useful for informing decisions about health. We do this by identifying, appraising and synthesizing individual research findings to produce the best available evidence on what can work, what might harm and where more research is needed.

How to apply

• For further information on the role and how to apply, please click here. 
• The deadline to receive your application is by 27 November 2022. 
• The supporting statement should indicate why you are applying for the post, and how far you meet the requirements, using specific examples.
• Please indicate the FTE you would like to be considered for in your application. Note that we will assess applications as they are received.
• Read our Recruitment Privacy Statement

Tuesday, November 15, 2022 Category: Jobs